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Medicine year 3 > Pregnancy physiology > Flashcards

Pregnancy physiology Flashcards

1
Q

Effect of hormone relaxin?

A

Relaxes all of the joints in the body
* S curve of the spine increases
* Knees are hyperextended
* Flat feet
* Pubic symphysis widens

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2
Q

Why might women get heartburn/reflux

A
  • OS relaxes/loosens
  • increased pressure on stomach
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3
Q

In the 3rd trimester the body becomes catabolic

a. true
b. false

A

a. true

fat stores are broken down quickly

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4
Q

What happens to the blood volume during pregancy

A

increases by 50-70%

  • increased bloodflow
  • increased CO
  • increased SV
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5
Q

There is increased BMR (basal metabolic rate) during pregnancy

a. true
b. false

A

a. true

and therefore increased 02 consumption

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6
Q

What happens to CO when pregnant women is laying in a supine position

A

reduced by 25% (reduce venous return)

if need CPR - do not lay flat -> lateral tilt to move uterus up and across

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7
Q

does plasma volume increase or decrease

A

increase

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8
Q

does CO increase or decrease

A

increase

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9
Q

does SV increase or decrease

A

increase

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10
Q

does total peripheral vascular resistance increase or decrease

A

decreases

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11
Q

does DBP and SBP increase or decrease?

A

should decrease until end of pregnancy

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12
Q

how does CO change during labour?

A

Increases by 10%

extra1/2 litre of blood is pumped into the system with every contraction

stays elevated by 80% in the hour post labour

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13
Q

does RR increase or decrease

A

increases

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14
Q

does tidal volume increase or decrease

A

increases

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15
Q

does functional residual capacity increase or decrease

A

decrease - there is pressure on diaphragm - lifted upwards (less space)

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16
Q

does PC02 increase or decrease

A

decreases

02 increases

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17
Q

where does 02Hb curve move during pregnancy

A

to the right - maternal hb is giving up 02 to foetal hb

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18
Q

effect of pregnancy on renal blood flow

A

60-80% increase in renal plasma flow by the end of second trimester

(GFR increases and creatine clearance increases by 50%)

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19
Q

effect of pregnancy on protein excretion

A

more protein is excreted due to increased GFR

-> can lead to oedema (80% of women)

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20
Q

why might there be dilatation of the urinary collecting system during pregnancy

A

progesterone opens tubules, ureters stretch (usually more prononced on right side)

  • can present with microscopic haematuria
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21
Q

Effects of increased renal blood flow during pregancy

A
  • increased protein excretion - oedema
  • increased glucose excretion (dilatation)
  • increased urea and creatine excretion
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22
Q

why might women get a UTI during pregnancy

A

bladder is not emptying - stasis due to pressure

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23
Q

does urate increase or decrease during pregnancy

A

increase

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24
Q

What type of anaemia is the most common in pregnant women

A

iron deficient - there is a 2-3 fold increase in iron

  • iron stores go to the foetus
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25
Q

why does RBC and platelet count drop during pregnancy

A

diluted (increased plasma volume)

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26
Q

there is a 10-20 fold increase in folate requirements during pregnancy

a. true
b. false

A

a. true

check B12 is normal first

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27
Q

does WCC increase or decrease

A

increase

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28
Q

why is iron deficiency anaemia common in pregnancy

A

During pregnancy, the body’s blood volume increases, which means more iron is needed to make more blood to supply oxygen to the baby.

If there isn’t enough iron, iron deficiency anemia can develop.

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29
Q

does d-dimer increase or decrease in pregnancy

A

increases

*do not used as investigative tool

30
Q

does alk phos increase or decrease in pregnancy

A

increase

produced by placenta

31
Q

does albumin increase or decrease during pregnancy

A

decrease

total protein decreases

32
Q

why does iron decrease during pregnancy

A

The body needs more iron to make hemoglobin, a protein in red blood cells that carries oxygen to the body’s tissues

during pregnancy, the body’s blood volume increases

which means more iron is needed to make more red blood cells

The baby also needs iron for growth and development, which comes from the mother’s stores.

33
Q

there is increased blood flow to the kidneys

a. true
b. false

A

a. true

34
Q

What is the effect of pregnancy on water and salt reabsorption?

A

salt and water absorption increases due to elevated sex hormone levels

35
Q

why is glycosuria common

A

due to increased GFR - and reduced tubular absorption of glucose

36
Q

What is the effect of pregnancy on protein, glucose, sodium (Na+) and water, creatinine, urea, albumin in urine?

A
  • protein is LOST - proteinuria
  • gluocse is LOST - glycosuria
  • Na+ is retained/gained
  • Water is retained/gained
  • Creatinine LOST
  • Urea LOST
  • Albumin LOST
37
Q

effect of pregnancy on SV, HR and CO

A
  • SV up by 30%
  • HR up by 15%
  • CO up by 40%
38
Q

effect of pregnancy on systolic BP and diastolic BP

A
  • Systolic BP is unaltered
  • Diastolic BP is reduced in the 1st/2nd trimester (normal by term)
39
Q

Effect of pregnancy on venous return

A

a large foetus can interfere with venous return

-> ankle oedema, supine hypotension, varicose veins

hypotension when lying down on back- uterus interupts venous return

40
Q

why does SV increase

A

increased plasma volume

41
Q

why does TV increase during pregnancy

A

500ml -> 700ml

due to progesterone - effect on respiratory centre

increased pulmonary ventilation by 40%

oxygen requirements are increased but there is still overbreathing

42
Q

why might people feel SOB during pregnancy

A

overbreathing - TV increases

fall in PC02

also - diaphragm elevated due to baby

43
Q

effect of pregnancy on BMR

A

increased!! due to thyroxine and adrenocortical hormones

find warm spaces uncomfortable

44
Q

why might Hb levels fall in pregnancy

A
  1. diluted by increased blood volume
  2. iron deficiency - affects Hb production
45
Q

effect of pregnancy on coagubility

A
  • hypercoaguble state - increased fibrinogen and facts 7,8,10
  • decreased fibronolytic activity -

increased ESR, cholesterol, fibrinogen

risk of thromboembolis

46
Q

WCC and ESR increased during pregnancy

a. true
b. false

A

a.true

47
Q

effect of pregnancy on calcium requirement

A

calcium requirements increase!! especially 3rd trimester (is actively transported across the placenta)

-> serum calcium and phosphate falls
-> ionised calcium stays the same

48
Q

what vitamin helps absorb calcium

A

1,25 hydroxy vitamin D

49
Q

effects of pregnancy on the liver

A

hepatic blood flow does not change

ALP raised 50%

albumin levels fall

50
Q

what are braxton hicks

A

non-painful practice contractions in late pregnancy

30+ weeks

51
Q

why might constipation occur?

A
  1. mass effect of the baby
  2. relaxation of smooth muscle (progesterone)
52
Q

effect of progesterone in pregnancy

A

relaxes smooth muscle
* reduced BP
* constipation
* ureteral dilation
* bladder dilation
* biliary stasis
* increased TV(lungs expand further)

53
Q

when does placenta start producing progesterone

A

starts 6 weeks and takes over from corpus luteum at 12 weeks

54
Q

progesterone inhibits uterine contractions

a. true
b. false

A

a. true

by increasing the production of prostaglandins

decreases sensitivity to oxytocin (stimulates development of lobules and alveoli)

55
Q

effect of estrogen in pregnancy

A

stimulates growth of myometrium

growth of ductal system in breasts

56
Q

which cells produce hCG

A

synchiotrophoblast

57
Q

when is hCG detected?

A

9 days after implantation

peaks at 9 weeks

58
Q

Relaxin - effects?

A
  • supresses myometrium contractions
  • relaxes pelvic ligaments
  • relaxes pubic symphysis
59
Q

How is polyspermy prevented

A
  1. when the sperm first contacts the egg - it triggers an influx of Na+ into the cells (depolarises the oocyte) - and creates a FAST BLOCK by preventing additional sperm binding - is temporary/not enough
  2. SLOW BLOCK - release of calcium ions within egg - creates a permanent blockade - stimulates cortical granules in egg periphery to release contents into the perivitelle space (modifys zona pellucida and makes it impenatrable to sperm
60
Q

what is the fast block

A

when the sperm first contacts the egg - it triggers an influx of Na+ into the cells (depolarises the oocyte) - and creates a FAST BLOCK by preventing additional sperm binding - is temporary/not enough

61
Q

what is the slow block

A

SLOW BLOCK - release of calcium ions within egg - creates a permanent blockade - stimulates cortical granules in egg periphery to release contents into the perivitelle space (modifys zona pellucida and makes it impenatrable to sperm

62
Q

What do sperm bind to on zona pellucida

A

ZP3 receptor - this triggers the acrosome reaction

Hydrolytic enzymes digest the zona and create pathway to the ovum plasma membrane

63
Q

when sperm fuses with ovum is forms a diploid zygote

a. true
b. false

A

a. true

64
Q

what is the slow block

A

sperm stimulate the release of calcium ions

in cortical granules of ovum which inactive ZP3 receptors to prevent polyspermy

65
Q

when does meiosis 1 begin in oogenesis

A

in utero - then halted in prophase 1 for years

until menstrual cycle (before ovulation) when primary oocytes re-enter the cell cycle and develop through meosis 1 to become secondary oocytes (begin meosis 2) , held in metaphase 2 of meosis 2 until fertilisation

66
Q

what phase of the cell cyle are ovum in before puberty

A

meosis 1 - prophase 1

67
Q

what phase of the cell cyle are ovum in before fertilisation occurs

A

meosis 2 - metaphase 2 (seconday oocyte)

68
Q

how is progesterone used to test for ovulation

A

day 21 progesterone is tested (luteal phase) - if regular 28-30 day cycle

Sign egg has been released

69
Q

what structure produces beta hcG

A

the placenta - signals to corpus luteum to produce more progesterone and estrogen

(synctriotrophoblast cells of placenta) -

hCG can cause nausea and vomiting

70
Q

safe pain relief for breast feeding mothers?

A
  1. paracetamol
  2. ibuprofen
  3. dilofenic (or topical)
  4. dihydrocodeine (short term)

Medicine year 3 (9 decks)

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