Pregnancy Physiology

Question 1

Why do pregnant people get more ascid reflux?

Answer 1

There is relaxation of their lower oesophageal sphincter

Question 2

What happens to metabolism in pregnancy?

Answer 2

Increases

->need to produce energy for a second person

Question 3

Summarise the changes to the CVS in pregnancy.

Answer 3

Increased circulating blood volume
Increased blood flow to all organs
Increased HR
Increased O2 consumption

->one of the most leading indirect causes of maternal mortality is cardiac disease

Question 4

What happens to the CVS when a pregnant person lies down?

Answer 4

They lose 25% of cardiac output or venous return

->if unconscious and trying to do PCR on a pregnant person, don’t while they are supine won’t work, supine uterine displacement is required to move the uterus up. Two people will need to be involved in this CPR.

Question 5

If a pregnant women has not been resuscitated after four minutes, what do you need to do?

Answer 5

Empty the uterus

->does not matter gestation, 25wks, 35wks etc.

Question 6

What happens to BP in the first and second trimester?

Answer 6

Drops

->rises again in third

Question 7

If a pregnant person’s BP doesn’t drop during the first two trimesters, what are they at a higher risk of?

Answer 7

Pre-eclampsia

Question 8

Why do people with cardiac problems struggle in delivery?

Answer 8

Heart is under huge amount of pressure, cardiac output increases by 10% in labour and 80% in 1st post delivery hour

Question 9

Summarise the respiratory changes which occur in pregnancy.

Answer 9

Significant increase in oxygen demand
Increased respiratory rate (just a little, not to pathological levels e.g. 24 breaths/min)
40-50% increase in minute ventilation
Decreased functional residual capacity

->just for interest, some women find pregnancy helps their asthma due to effect of progesterone but some notice no change

Question 10

What changes in the acid-base balance are observed in pregnancy?

Answer 10

Oxygen levels go up
Carbon dioxide levels go down
Bicarb drops
Compensated metabolic alkalosis

->these changes are to allow oxygen to move more quickly and efficiently across the placenta to the baby

Question 11

Summarise the changes to the renal system in pregnancy.

Answer 11

-Dramatic dilatation of the urinary collecting system
-Increased renal plasma flow
-GFR increases and creatinine clearance increases by up to 50%
-Increased protein excretion
-Microscopic haematuria may be present
-Oedema (80% of women get this)

Question 12

Which common renal condition is even more common in pregnancy?

Answer 12

UTI

Question 13

Summarise the haematological changes which occur in pregnancy.

Answer 13

-Plasma volume increases
-Greater iron and folate requirements
-WCC increases
-Hypercoagulable

Question 14

What is the most common haematological disorder in pregnancy?

Answer 14

Iron deficiency anaemia

Question 15

Why do pregnant people need to take folate supplements before getting pregnant and for the first 12wks of pregnancy?

Answer 15

To reduce risks of neural tube defects

Question 16

What deficiency must you check for before giving folate supplements?

Answer 16

Vitamin B12 deficiency

->remember B before F, B comes before F in the alphabet

Question 17

Key symptom of PE in pregnancy?

Answer 17

Shortness of breath
Increased HR

->these both increase physiologically in pregnancy but always important to have a PE in mind

Question 18

Okayyyy, let’s see if you have been paying attention with some lab values.

What happens to haemoglobin levels in pregnancy?

Answer 18

Decreases

->physiological anaemia

Question 19

Okayyyy, let’s see if you have been paying attention with some lab values.

What happens to WCC levels in pregnancy?

Answer 19

Increases

Question 20

Okayyyy, let’s see if you have been paying attention with some lab values.

What happens to platelet levels in pregnancy?

Answer 20

Decrease

Question 21

Okayyyy, let’s see if you have been paying attention with some lab values.

What happens to CRP levels in pregnancy?

Answer 21

Stays the same

Question 22

Okayyyy, let’s see if you have been paying attention with some lab values.

What happens to ESR levels in pregnancy?

Answer 22

Increases

->never do ESR in pregnancy

Question 23

Okayyyy, let’s see if you have been paying attention with some lab values.

What happens to urea levels in pregnancy?

Answer 23

Decreases

->GFR increases

Question 24

Okayyyy, let’s see if you have been paying attention with some lab values.

What happens to creatinine levels in pregnancy?

Answer 24

Decreases

Question 25

Okayyyy, let’s see if you have been paying attention with some lab values.

What happens to urate levels in pregnancy?

Answer 25

Increases

->increases as pregnancy progresses. Higher in multiple pregnancy or larger BMI

Question 26

Okayyyy, let’s see if you have been paying attention with some lab values.

What happens to 24hr protein levels in pregnancy?

Answer 26

Increases

->protein excretion increases

Question 27

Okayyyy, let’s see if you have been paying attention with some lab values.

What happens to total protein levels in pregnancy?

Answer 27

Decreases

Question 28

Okayyyy, let’s see if you have been paying attention with some lab values.

What happens to albumin levels in pregnancy?

Answer 28

Decreases

Question 29

Okayyyy, let’s see if you have been paying attention with some lab values.

What happens to LFT’s levels in pregnancy?

Answer 29

Mostly stay the same

Question 30

Okayyyy, let’s see if you have been paying attention with some lab values.

What happens to alkaline phosphate levels in pregnancy?

Answer 30

Increase, sometimes dramatically

Question 31

Okayyyy, let’s see if you have been paying attention with some lab values.

What happens to bile acid levels in pregnancy?

Answer 31

Stays the same

Question 32

Okayyyy, let’s see if you have been paying attention with some lab values.

What happens to D-dimer levels in pregnancy?

Answer 32

Increases