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pregnancy physiology Flashcards

1
Q

mechanical adaptations to pregnancy

A

centre of gravity is no longer over feet

pregnant person needs to lean backwards and the curves of the spine change along the whole length

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2
Q

consequences of shift in centre of gravity for pregnanc women

A

more prone to back pain during and after pregnancy

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3
Q

what is relaxin

A

hormone produced during pregnancy

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4
Q

effects of relaxin, increased levels of oestrogen and progesterone

A

increased pliability and extensibility of connective tissue
ligamentous joints become less stable
symphysis pubis and sacroiliac joints are particularly affected

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5
Q

how much does the pubic symphyseal gap increase by

A

normally 4-5mm

increases on avg 3mm

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6
Q

what is symphysis pubis dysfunction

A

group of symptoms that cause discomfort in the pelvic region

usually occurs during pregnancy, when your pelvic joints become stiff or move unevenly.

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7
Q

when does joint loosening occur during pregnancy

A

as early as 10wks

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8
Q

when does joint loosening return to normal

A

4-12wks post partum

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9
Q

how much does the load on the hips increase during pregnancy

A

at term there is an increased load on the hip joints 2.8x the normal value when standing

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10
Q

how does the basal metabolic rate change during pregnancy

A

increases

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11
Q

why is metabolism altered during pregnancy

A

to ensure adequate nutrition for foetal growth

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12
Q

insulin and pregnancy

A

relative insulin insensitivity

human placental lactogen (from placenta) acts against maternal insulin

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13
Q

storage of lipids in pregnancy

A

increased storage of lipids in maternal tissues

FAs are vital for development of foetal organs

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14
Q

normal weight gain during pregnancy

A

10-14kg gain throughout pregnancy

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15
Q

what is gestational diabetes

A

high blood sugar (glucose) that develops during pregnancy and usually disappears after giving birth

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16
Q

fatigue during pregnancy

A

can be overwhelming during the 1st trimester
tends to get better in the 2nd trimester
often returns towards the end of the pregnancy - increased work load, discomfort and difficulty sleeping

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17
Q

why does fatigue occur during pregnancy

A

hormonal changes

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18
Q

why does heartburn and reflex occur during pregnancy

A

food moves more slowly into the stomach
delayed gastric emptying
relaxation of lower oesophageal sphincter
mechanical pressure from enlarged uterus

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19
Q

why is GA risk higher during pregancy

A

increased risk of gastric reflux

higher risk of aspiration and increases with advancing pregnancy

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20
Q

what % of pregnant people develop oedema

A

80% develop some oedema

particularly towards term

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21
Q

why does oedema develop during pregnancy

A

physiological sodium and water retention
decreased ability to excrete a sodium and water load
increased blood vol and decreased venous returin (IVC compression)

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22
Q

what can oedema be a sign of

A

pre-eclampsia

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23
Q

what is pre-eclampsia

A

a condition in pregnancy characterised by high BP sometimes with fluid retention and proteinuria

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24
Q

breast changes in pregnancy

A 
increase in size and vascularity 
become warm, tense and tender
increased pigmentation of areola and nipple
2y areola appears
montgomery tubules appear on the areola
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25
when can colostrum like fluid be expressed
from the end of the 3rd month
26
changes in thryoid hormone levels during pregnancy
liver produces more thyroid binding globulin | total level of T4 and T3 also increase so free T3 and T4 stay the same
27
iodine and pregnancy
pregnancy is associated with a relative iodine deficiency | maternal iodine requirements increase
28
why are maternal iodine requirements increased
iodine is actively transported to the fetoplacental unit and urinary iodine excretion is doubled because of an increased glomerular filtration rate and decreased renal tubular reabsorption
29
why might the thyroid gland hypertrophy during pregnancy
gland works harder to increase its's iodine uptake | may hypertrophy to ensure adequate levels of iodine are trapped
30
why is hyperemesis gravidarum associated with biochemical hyperthyroidism
the beta sub unit of BHCG is very structurally similar to TSH betablockers can be used to control tachycardia caused by high T4 levels biochemical hyperthyroidism will resolve with hyperemesis
31
how common is thyrotoxicosis in pregnancy
1/500 pregnancies most often due to Graves (AI) TSH receptor antibodies can cross the placenta and cause foetal +/or neonatal hyperthyroidism
32
how common is hypothyroidism in pregnancy
1%
33
why is good thyroid replacement important in pregnancy for hypothyroidism
foetus is dependent on maternal thyroid function until foetal thyroid function begins ~12wks gestation
34
immunosuppression in pregnancy
general state of immunosuppression to allow for foetal tolerance this increases maternal susceptibility to infection explains why some AI conditions can improve during pregnancy
35
why does the maternal heart have to work harder during pregnancy
growing fetus weight gain associated with pregnancy increased oxygen requirements of uterus and breasts also has to pump blood through the utero placental circulation
36
why is cardiac disease important to consider during pregnancy
people with cardiac disease can suffer significant complications during pregnancy can result in maternal and fetal death previously undiagnosed cardiac disease may come to light
37
by how much does the circulating blood volume increase during pregnancy
by 50-70% of the non-pregnant
38
what causes the physiological anaemia during pregnancy
RBC mass increases but only by ~40% | causes a relative haemodilution
39
why is EDV increased during pregnancy
increase in circulating blood vol increased L ventricular and EDV can be seen as early as 10wks on ECHO
40
why can increased circulating blood vol be a problem during pregnancy
can cause issues for those w/ dilated cardiomyopathy or other lesions (e.g. mitral stenosis, pulmonary HT)
41
resistance of the the peripheral vasculature during pregancy
falls | at its lowest between 20-32wks
42
equation for systemic vascular resistance
SVR = (MAP-MVP)/CO
43
changes to SV during pregnancy
drops | due to increased circulating vasodilators and diversion of blood into the low pressure uteroplacental unit
44
how does blood flow to the organs change during pregancy | give an example
increased kidneys - increased by 60-80% above non-pregnant state warm, red hands and feet increased risk of nose bleeds, sensation of stuffiness/congestion due to increased blood flow to nasal mucosa
45
how does cardiac output change during pregnancy
increased as SV is increased CO = SV X HR CO increases by ~30-50% by the end of 2nd trimester people who cannot increase CO (e.g. aortic stenosis) are at risk
46
how does HR change during pregnancy
increases at term ~10-20 beats higher than non-pregnant value sinus tachycardia isn't uncommon other pathologies causing tachycardia (hypovolaemia, pulmonary embolus, sepsis) should be considered depending on clinical context
47
oxygen consumption during pregnancy
increases by 20-30% at term myocardium has to work harder therefore increased oxygen requirements pregnancy can trigger ischaemic heart disease and MI in those w/ coronary artery disease (older, diabetic, smoker)
48
why can you never lie a pregnant patient flat
they will lose 25% of their cardiac output and faint | due to vena caval compression by pregnant uterus
49
in what position must a pregnant patient be resucitated in the event of maternal collapse/cardiac arrest
on a left lateral tilt or with the uterus manually displaced you will not be able resucitate any person with a gravid uterus who is lying flat due to the reduction in CO
50
intrapartum CV changes
autotransfusion of contractions - with every contraction another (up to) 500ml is dumped into the circulation pain - increases circulating catecholamines and increases HR, BP and CO
51
increase in CO during labour
can increase by a further 10% and immediately after delivery up to 80% above the already increased CO of pregnancy - due to lack of uteroplacental unit to be supplied and also immediate relief of IVC compression
52
post-partum CV changes
most return to normal by 3mths after delivery 3 days - blood volume decreased by 10% 3-7 days - BP initially falls then increases again 6wks - BP returns to pre-pregnancy levels systemic vascular resistance begins to increase again over first 2wks, HR falls to prepregnancy levels
53
respiratory changes during pregnancy
increased oxygen requirements increased volume of air and gas exchange with each breath - increases oxygen availability and CO2 removal in mother and foetus
54
changes to tidal volume during pregnancy
increases | 40-50% increase in minute ventilation
55
changes in resp rate during pregnancy
increases | can be percieved as SOB
56
hyperventilation in pregnancy
relative hyperventilation PCO2 levels are lower in pregnancy healthy pregnant person is in a state of compensated respiratory alkalosis
57
changes in the chest during pregnancy
enlarging uterus pushes the diaphragm up up to 4cm | increased diameter of lower thorax by 2cm - splaying of lower ribs
58
changes in functional residual capacity during pregnancy
decreases ~20-30% | further reduced by supine position
59
asthma and pregnancy
improves in some cases | due to the bronchodilator effect of progesterone
60
Hb at 28wks
at 28wks a Hb of 105g/L or above is considered normal non-pregnant range 120-160 this is the physiological anaemia of pregnancy
61
plasma volume and pregnancy
increases proportionate to birthweight | relative decrease in platelet count due to this - remains in normal limits for the non-pregnant patient
62
changes in iron levels during pregnancy
2-3x increase in requirements | mainly for use by foetus as well as increasing red cell mass
63
what is the most common haematological abnormality of pregnancy
iron deficiency anaemia more common in twin/multiple pregnancies also associated with intrauterine growth restriction
64
why are some women iron deficient going into pregnancy
menorrhagia inadequate diet previous recent pregnancies
65
what contributes to iron deficiency postnatally
post partum haemorrhage | 2-5% of deliveries
66
folate requirements during pregnancy
increase 10-20x during pregnancy 2nd most common cause of pregnancy anaemia serum levels of folate are lower in pregnancy but liver levels are maintained
67
changes in WCC during pregnancy
increase - overall WCC and neutrophil | WCC up to 16x109/L is normal
68
changes in coagulation during pregnancy
hypercoagulable state | factors which promote clotting increase, factors which prevent decrease
69
what clotting factors increase during pregnancy
VII, IX, X | fibrinogen
70
which anti-clotting factors decrease during pregnancy
protein S and C anti-thrombin 3 fibrinolytic activity decreases
71
DVT risk and pregnancy
increased risk | also increased by venodilation and reduced venous return - increased venous stasis in lower limbs
72
pulmonary embolus and pregnancy
one of the main causes of direct maternal mortality in UK 6-15 people killed p/a in pregnancy or puerperium pregnancy increases risk of thromboembolism by 6x
73
when do changes in coagulation occur
from very early in pregnancy can persist up to 6wks after delivery 1/2 of all clots associated with the antenatal period occur in first 15wks
74
why does the urinary system significantly dilate during pregnancy
relaxation of smooth muscle of ureter - caused by progesterone mechanical compression of the growing uterus
75
hydronephrosis and pregnancy
physiological hydronephrosis can be seen | usually more pronounced on the R side
76
changes in renal blood flow during pregnancy
increase in circulating blood vol and reduction in systemic vascular resistance increase in renal plasma flow by up to 60-80% in 2nd trimester settles to 50% increase through 3rd trimester
77
GFR and creatinine clearance during pregnancy
increase by ~50% | normal levels of urea and creatinine are much lower during pregnancy
78
changes in excretion and secretion in the kidneys during pregnancy
excrete more protein retain more sodium (and water) increased secretion of vit D, renin and erythropoetin
79
haematuria in pregnancy
microscopic haematuria is more common if there is no proteinuria, no infection and renal US and function is normal - likely due to bleeding from the small vessels in the dilated renal function glycosuria is also common
80
UTI in pregnancy
more common | should be treated w/ abx safe in pregnancy promptly
81
kidney disease and pregnancy
any underlying kidney disease is likely to worsen during pregnancy due to additional work being done by the renal system

Y3 repro (47 decks)

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