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Reproductive Medicine Exam 3 > Pregnancy (Pathophysiology) > Flashcards

Pregnancy (Pathophysiology) Flashcards

1
Q

Pregnant women are _____ (more/less) susceptible to some diseases.

A

More Susceptible

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2
Q

How do you determine the expected date of delivery?

A

Take the date of the last menstrual period, add seven days to that date, count back 3 months (add one year)

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3
Q

What is this woman’s due date….

The 1st day of her last period was Dec. 12, 2017?

A

9/19/18

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4
Q

What is the name of the organ that is the first part of a pregnancy, is specialized in nutrient and oxygen deliver, and is the barrier between the mother and the fetus?

A

The Placenta

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5
Q

The endometrium’s blood supply comes from ______ (basal/spiral) arteries

A

Basal Arteries

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6
Q

During the luteal phase…..

New _____ (basal/spiral) arteries are made

A

Spiral Arteries

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7
Q

With each period, ______ (basal/spiral) arteries are lost and the basalis makes new ones for the next cycle.

A

Spiral Arteries

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8
Q

When a pregnancy implants only the _____ (basal/spiral) arteries remain

A

Spiral Arteries

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9
Q

The placental barrier allows for the passage of certain material through ____ (active/passive) transport

A

Passive Transport

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10
Q

Most large proteins can not pass through the placental barrier, however there is one exception……

What is that exception?

A

IgG crosses the placenta which allows for maternal immunity

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11
Q

By the third trimester…..

What percent of cardiac output does the placenta/fetus receive?

A

20-25%

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12
Q

T/F: The placenta uses as much O2 as the fetus

A

True

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13
Q

What does the placental hormone progesterone do?

A

Maintains uterine lining and inhibits uterine contraction

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14
Q

What does the placental hormone lactogen do?

A

Stimulates mammary glands and supplies energy to the fetus

Also mimics GH and promotes maternal insulin resistance elevating glucose levels

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15
Q

What does the placental hormone relaxin do?

A

Softens cervix and weaken the pubic symphysis

This results in pelvic pain

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16
Q

What does the placental hormone Corticotropin Releasing Hormone (CRH do?

A

Increases HR, BP, Glucose, and stimulates parturition

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17
Q

Which of the following placental hormones is most responsible for pigmentation changes associated with pregnancy?

A) Progesterone
B) CRH
C) Estrogen
D) Relaxin

A

B) CRH

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18
Q

What are TWO examples of pigmentation changes associated with pregnancy?

A

Linea Nigra

Melasma

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19
Q

SVR in pregnancy decreases by 20% due to what?

A

The low resistance of the placenta

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20
Q

What major vein is at risk of compression during pregnancy?

A

Vena Cava

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21
Q

How much does blood volume increase by during pregnancy?

A

50-100^%

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22
Q

Changes in cardiac function are underway by __ weeks of gestation

A

8 weeks

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23
Q

Cardiac axis during pregnancy is displaced ______ (caudially/cephalad) and to the _____ (right/left)

A

Cephalad

Left

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24
Q

T/F: Murmurs are found in about 96% of pregnant women

If true, why?

A

True

Due to this increase in blood volume ‘whooshing’ around corners

25
Q

Can cardiomyopathy happen in pregnancy?

A

Yes, dont assume its just a physiological change

26
Q

BP actually _____ (increases/decreases) in the second trimester of pregnancy and returns to the original level by the end of pregnancy

27
Q

When do hypertensive disorders of pregnancy typically onset?

A

Towards the end of the pregnancy

28
Q

Cardiac output during pregnancy _______ (increases/decreases) by 43% during pregnancy

29
Q

PVR during pregnancy _______ (increases/decreases) by 34% during pregnancy

30
Q

SVR increases ___% during contraction

31
Q

By what gestational week is the uterus at the pelvic brim?

Umbilicus?

A

Pelvic Brim: 12 Weeks

Umbilicus: 20 Weeks

32
Q

Renin production is increased during pregnancy due to progesterone and production by the placenta…..

What are THREE manifestations of this?

A

Increased Na+ absorption
Increase K+ secretion
Water Retention (6-8 Liters)

33
Q

Due to the increased renal blood flow during pregnancy…..

There is a 50% ______ (increase/decrease) in eGFR

Colloid oncotic pressures are ______ (higher/lower) do to dilution of albumin

A

Increase

Lower

34
Q

T/F: Progesterone causes smooth muscle relaxation

35
Q

Is ureteral obstruction more common on the left or right?

36
Q

The increased thoracic volume in pregnancy results in a(n) _______ (increased/decreased) minute ventilation and tidal volume

37
Q

Due to pH changes during pregnancy, there is a compensated _______ (respiratory/metabolic) _______ (acidosis/alkalosis)

What is the mechanism behind this?

A

Respiratory Alkalosis

More CO2 is leaving fetal circulation at the placenta and more O2 is entering fetal circulation

38
Q

GI motility is _____ (increased/decreased) during pregnancy

39
Q

T/F: Cholelithiasis is less common in pregnancy

A

False

More common

40
Q

T/F: Pregnancy places women in a hypercoaguable state

41
Q

What hormone produced during pregnancy is most closely associated with hyperemesis gravidarum?

42
Q

When is beta-HCG at its highest levels?

A

9-12 weeks gestation

43
Q

What are two ‘risk factors’ for hyperemesis gravidarum?

A

Twin Gestations

Multiple Pregnancies

44
Q

How does beta-HCG and the thyroid potentially cause nausea during pregnancy?

A

Beta-HCG mimics TSH which can increase T3/T4 levels contributing to nausea

**These levels should be re-check in the second trimester

45
Q

How is hyperemesis gravidarum managed?

A

IV Fluids

Antiemetics (Zofran, Phenergan)

46
Q

During pregnancy cortisol levels are _______ (elevated/decreased)

47
Q

T/F: Maternal glucose crosses the placenta via diffusion

48
Q

T/F: Maternal insulin crosses the placenta via diffusion

A

False

It does not as the baby makes it’s own

49
Q

The fetus will store glucose as glycogen….

Where is this stored?

A

Liver
Trunk
Shoulders

50
Q

What are fetal complications of diabetes?

A 
Macrosomia
Neonatal Hypoglycemia
Hyperbilirubinemia
Shoulder Dystocia
Birth Trauma
51
Q

T/F: All pregnant women should be screened for gestational diabetes

A

True, by 24-28 weeks

52
Q

When should pregnant women be screened EARLY for gestational diabetes?

A

Prior GDM
Impaired Glucose Tolerance
BMI > 30

53
Q

Where is weight distributed in macrosomia?

Why is this a problem?

A

Weight is primarily distributed in the shoulders and abdomen which makes delivery through the birth canal difficult

54
Q

How is the GDM screen done?

How is it confirmed or tested?

A

Screen: a 1 hour glucose check after a 50 gm sugar load (cut-off of normal is around 140, any thing less is fairly normal)

Confirmed: A three hour GTT (100 gm load), or a FBS and 2 hour glucose test, if FBS is elevated then it is confirmed -OR- you need two abnormal glucose values 1, 2, or 3 hours out

55
Q

What pathogens are pregnant women more susceptible to?

A

CMV
HSV
Varicella
Malaria

56
Q

When should a women receive her Tdap vaccination?

A

27-36 weeks gestation of EVERY pregnancy

57
Q

What is a “TORCH” titer?

When is this given?

A 
T - Toxoplasmosis
O - Other (Hepatitis B, Syphilis, Varicella) 
R - Rubella, Rubeola
C - Cytomegalovirus
H - Herpes Simplex

Given in the 1st Trimester

58
Q

Why is a “TORCH” titer given in pregnancy?

A

These are all common causes of birth defects or still births in fetuses.

Reproductive Medicine Exam 3 (10 decks)

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