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Pregnancy Physiology Flashcards

1
Q

Why are pregnant women more prone to back pain?

A

Centre of gravity no longer falls over feet

Woman needs to lean backwards and curves of the spine change along its whole length

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2
Q

What causes increased pliability and extensibility of connective tissue during pregnancy?

A

Relaxin: a hormone produced during pregnancy
Increased levels of eostrogen and progesterone
(Ligamentous joints become less stable)

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3
Q

What does the normal pubic symphyseal gap increase by during pregnancy?

A

3mm

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4
Q

Describe the change in metabolism during pregnancy.

A

Basal metabolic rate increases.
Changes to ensure adequate nutrition for fetal growth
Human placental lactogen produced by the placenta acts aganist maternal insulin.
Increased storage of lipids

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5
Q

What is normal weight gain during pregnancy?

A

10-14kg

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6
Q

When is fatigue most prevelant in pregnancy?

A

First trimester
Often returns towards the end of pregnancy: likely due to increased workload of advanced pregnancy, discomfort and difficulty sleeping

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7
Q

Why does reflux often occurr in pregnancy?

A

Food moves more slowly into the stomach and there is delayed gastric emptying
Hormones casue relaxation of the lower oesophageal shpihncter meaning contents are more likely to reflux.
Enlarging uterus makes this worse

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8
Q

Why is general anaesthetic more risky in pregnancy?

A

Tendancy for reflux means a higher risk of aspiration

Regional anaesthetics should be used instead if possible

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9
Q

What percentage of pregnant women will experience oedema?

A

80%

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10
Q

Why is there decreased venous return in pregnancy?

A

Compression of the IVC from the gravid uterus

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11
Q

What casues oedema in pregnancy?

A

Physiological sodium and water retention and a decreased ability to excrete a sodium and water load.
The increased blood volume of pregnancy and decreased venous return due to compression of the IVC from gravid uterus also contributes to peripheral oedema

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12
Q

What can oedema be an important sign of?

A

Pre-eclampsia

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13
Q

Describe breast changes in pregnancy

A

The breasts increase in size and vascularity and become warm, tense and tender. There is increased pigmentation of the areola and nipple and a secondary areola appears. Montgomery tubercles appear on the areola. Colostrum like fluid can be expressed from the end of the 3rd month.

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14
Q

Why is pregnancy associated with an iodine deficiency?

A

Maternal iodine requirements increase because iodine is actively trasnported to the fetoplacental unit and urinary iodine excretion is doubled because of an increased glomerular filtration rate and decreased renal tubular reabsorption.
The thyroid gland therefore works harder to increase its iodine uptake and may hyperthrophy to ensure adequate levels of iodine trapped.

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15
Q

What is hyperemesis gravidarum?

A

severe nausea and vomiting during pregnancy. The symptoms can be severely uncomfortable.

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16
Q

How does thyrotoxicosis occur in pregnancy?

A

Most often due to grave’s disease: autoimmune disorder. The antibodies that casues graves disease (anti-TSH receptor antibodies) can cross placenta and casue fetal and/or neonatal hyperthyroidism

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17
Q

When does fetal thyroid function begin?

A

Around 12 weeks gestation

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18
Q

Why is maternal susceptibility to infection increased in pregnancy?

A

Immunosupresision in pregnancy

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19
Q

Why does the heart have to work harder during pregnancy?

A

The heart has to work much harder during pregnancy because of the growing fetus, the weight gain associated with pregnancy and the increased oxygen requirements of the uterus and breasts. The heart also has to pump blood through the utero placental circulation.

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20
Q

What is the leading cause of maternal death in the UK?

A

Cardiac disease

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21
Q

What does the circulating blood volume increase by in pregnant women compared to non-pregnant?

A

50-70%

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22
Q

What causes a physiological anaemia in pregnancy?

A

Red cell mass increases by 40% causing a relative haemodilution

23
Q

For what groups of people can an increased blood volume be an issue?

A

Those with dilated cardiomyopathy, lesions such as mitral stenosis or pulmonary hypertension

24
Q

Why does systemic vascular resistance fall during pregnancy?

A

Due to increased circulating vasodilators and the diversion of blood into the low pressure uteroplacental unit

25
Q

What does blood flow to the kidneys increase by in pregnancy?

A

60-80%

26
Q

Why is there an increased risk of nose bleeds in pregnancy?

A

Increased blood flow to nasal mucosa

27
Q

Why is the cardiac output increaed during pregnancy?

A

Because stroke volume is increased
Increases by 30-50% by the end of the second trimester
Those who cannot increase their cardiac output (aortic stenosis) are at risk

28
Q

By term, what has HR usually increased by?

A

10-20 beats

29
Q

What conditions can cause tachycardia?

A

Hypovolaemia
Pulmonary embolus
Sepsis

30
Q

What does oxygen consumption increase by during pregnancy?

A

20-30%

31
Q

What might pregnancy trigger in those with coronary artery disease?

A

Ischaemic heart disease

MI

32
Q

What is important to remember in a maternal collapse/ cardia arrest?

A

In the event of a maternal collapse/cardiac arrest a pregnant patient MUST be resuscitated on a left lateral tilt or with the uterus manually displaced. YOU WILL NOT BE ABLE TO RESUSCITATE ANY PERSON WITH A GRAVID UTERUS WHO IS LYING FLAT BECAUSE OF THE REDUCTION IN CARDIAC OUTPUT THIS CAUSES.

33
Q

What does cardiac output increase by during labour?

A

Further 10% and immediately after delivery can increase to 80% above the already increased CO of pregnancy both because of lack of uteroplacental unit to be supplied but also because of the immediate relief of inferior vena caval compression.

34
Q

When do cardiovascular changes return to normal postpartum?

A

3 months post delivery

35
Q

Describe changes in BP levels after birth

A

The blood pressure (BP) initially falls then increases again by 3-7 days after birth. The BP returns to prepregnancy levels by 6 weeks

36
Q

How is oxygen avaliability increased in pregnancy?

A

Physiological adaptations during pregnancy increase the volume of air and gas exchange of each breath increasing oxygen availability and carbon dioxide removal in the mother and fetus.

37
Q

What does minute ventilation increase by during pregnancy ?

A

40-50%

38
Q

Describe PCO2 levels in pregnancy?

A

pregnant healthy person is in a state of compensated respiratory alkalosis.

39
Q

Why may asthma improve in some pregnancies?

A

Due to he bronchodilator effect of progesterone

40
Q

What does circulating blood volume increase by?

A

50-70%

41
Q

What is a normal Hb at 28 weeks gestation?

A

105 g/L (non pregnant reference range 120-160g/L)

42
Q

Why is there a 2-3 fold increase in iron requirments?

A

mainly for use by the fetus as well as the need for the increasing red cell mass

43
Q

What is the most common anaemia in pregnancy?

A

Fe deficiency

44
Q

What contributes to iron deficiency postnatally?

A

PPH

45
Q

What is Fe deficiency associated with in pregnancy?

A

Intrauterine growth restriction

46
Q

What is the second most common cause of anaemia in pregnancy?

A

Folate deficiency: 10-20 fold increase in folate requirements
Serum levels of folate are lower than in pregnancy however liver levels of folate are maintained.

47
Q

What WCC is normal in pregnancy?

A

a WCC of up to 16x109/L is normal in pregnancy

48
Q

Describe the changes in clotting factors in pregnancy.

A

Pregnancy is a hypercoagulable state. The factors which promote clotting increase, factors which reduce clotting decrease.
Clotting factors VII, IX and X increase as does fibrinogen. Protein S and C and anti thrombin 3 levels decrease.

49
Q

What causes an increased risk of DVT in pregnancy?

A

Due to venodilation and reduced venous return increasing venous stasis in the lower limbs

50
Q

Describe the increased risk of thromboembolism in pregnancy

A

Pregnancy increases the risk of thromboembolism by 6x.

51
Q

Why does dilatation occur in the urinary collecting system during pregnancy?

A

relaxation of the smooth muscle of the ureter caused by progesterone as well as the mechanical compression by the growing uterus.

52
Q

Describe the increase in renal plasma flow due to increased blood volume and decreased systemic vascular resistance

A

increase in renal plasma flow by up to 60-80% in the second trimester settling to a 50% increase through the third trimester.

53
Q

Describe GFR and creatinine in pregnancy

A

Glomerular filtration rate and creatinine clearance increase by about 50% meaning that normal levels of urea and creatinine are much lower during pregnancy.

54
Q

What substrate is responsible, for a lower blood pressure in pregnancy?

A

Progesterone due to smooth muscle relaxation

Reproduction (13 decks)

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