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Year 3 - Reproduction > Pregnancy physiology > Flashcards

Pregnancy physiology Flashcards

1
Q

What happens the breasts throughout pregnancy?

A

> Increased size and vascularity – warm tense and tender
Increased pigmentation of the areola and nipple
Secondary areola appears
Montgomery tubercules appear on the areola
Colostrum like fluid can be expressed from the end of the 3rd month

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2
Q

What happens the CVS throughout pregnancy?

A

> Significant changes occur early in first trimester
Increased circulating blood volume -50-70% of non pregnant
Systemic vascular resistance falls – maximal at 20-32 wks
Increased blood flow
Increased cardiac output (40%), stroke volume increases (SVxHR= CO)
Increased heart rate
In supine position – 25%reduction in cardiac output
Increased O2 consumption

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3
Q

What happens the CVS at 20-32 wks pregnancy?

A

Systemic vascular resistance falls maximally between this point

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4
Q

What happens the circulating blood volume during pregnancy?

A

Increases 50-70%

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5
Q

What happens blood flow during pregnancy?

A

Increased blood flow

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6
Q

What happens the cardiac output during pregnancy?

A

Increased CO due to an increase in both stroke volume and hear rate

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7
Q

What happens the O2 consumption during pregnancy?

A

Increased O2 consumption

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8
Q

Intrapartum cardiovascular changes?

A

> Autotransfusion of contractions
Pain – increasing catecholamines
CO increases by 10% in labour and by 80% in 1st post delivery hour

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9
Q

Postpartum cardiovascular changes?

A

> Return to normal by 3 months (mostly)
Blood volume decreases by 10% 3 days post delivery
BP initially falls then increases again days 3-7(pre preg levels by 6 wks)
SVR increase over first 2 wks to 30% above delivery levels
HR returns to pre pregnancy over 2 weeks
CO increases by up to 80% 1st hr post delivery then continues to fall over the next 24 weeks

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10
Q

Postpartum cardiovascular changes - Blood volume?

A

Decrease by 10% 3 days post delivery

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11
Q

Postpartum cardiovascular changes - BP?

A

> BP initially falls then increases again days 3-7

> Pre pregnancy levels by 6 wks)

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12
Q

Postpartum cardiovascular changes - SVR?

A

SVR increase over first 2 wks to 30% above delivery levels

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13
Q

How long does it take for the HR to return to normal following delivery?

A

Returns to pre pregnancy rate over 2 weeks post delivery

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14
Q

Postpartum cardiovascular changes - CO?

A

CO increases by up to 80% 1st hr post delivery then continues to fall over the next 24 weeks

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15
Q

Respiratory changes during pregnancy?

A 
> Significant increase in oxygen demand (20%)
> 40-50% increase in minute ventilation
> Increased respiratory rate 
> Increased tidal volume
> Decreased functional residual capacity
> PEFR and FEV1 unchanged
> PCO2 ↓
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16
Q

Respiratory changes during pregnancy - Oxygen demand?

A

Significant increase in oxygen demand (20%)

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17
Q

Respiratory changes during pregnancy - minute ventilation?

A

40-50% increase

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18
Q

Respiratory changes during pregnancy - Respiratory rate?

A

Increased RR

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19
Q

Respiratory changes during pregnancy - functional residual capacity?

A

Decreased

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20
Q

Respiratory changes during pregnancy - PEFR and FEV1?

A

No change

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21
Q

Respiratory changes during pregnancy - PCO2?

A

PCO2 decreased

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22
Q

Renal system changes during pregnancy?

A

> Dramatic dilatation of the urinary collecting system – more pronounced on right
Increased renal plasma flow – 60-80% by end of second trimester
GFR ↑ and creatinine clearance increases by up to 50%
Protein excretion increased
Microscopic haematuria may be present
80% women develop oedema
Glycosuria common
Urate ↑ with increasing gestation
Urea ↓, creatinine ↓

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23
Q

Which side has a more pronounced dilation of the urinary collecting system during pregnancy?

A

The right side

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24
Q

By the end of the second trimester what has happened to the renal plasma flow?

A

Increase renal plasma flow rate - 60-80% by end of the second trimester

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25
Q

Renal system changes during pregnancy - Glomerular flow rate? What effect does the have on creatinine clearance?

A

GFR is increased and as a result creatinine clearance goes up by 50%

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26
Q

Renal system changes during pregnancy - protein excretion?

A

Increased

27
Q

Renal system changes during pregnancy - Haematuria, glycosuria?

A

Microscopic haematuria and glycosuria may be present

28
Q

Renal system changes during pregnancy - urate levels?

A

Urate increases with increasing gestation

29
Q

Renal system changes during pregnancy - Urea and creatinine?

A

Both urea and creatinine decrease

30
Q

Haematological changes during pregnancy?

A 
> Plasma volume increases cf birthweight
> ↓ hg, hcrit, rcc
> No change MCV nor MCHC
> ↓ platelet count
> 2-3 fold increase in requirement for iron
> 10 -20 fold increase in folate requirements
> WCC increases 
> Hypercoaguable
31
Q

Haematological changes during pregnancy - Plasma volume?

A

Increase

32
Q

Haematological changes during pregnancy - Haemoglobin, Haematocrit?

A

Decrease

33
Q

Haematological changes during pregnancy - platelet count?

A

Decrease

34
Q

Haematological changes during pregnancy - Iron requirement?

A

2-3 fold increase in requirement of iron

35
Q

Haematological changes during pregnancy - White cell count?

A

WCC increases

36
Q

Haematological changes during pregnancy - Coagulability?

A

Hyper-coagulable

37
Q

Lab value changes during pregnancy - Hg?

A

Decrease in Hg

38
Q

Lab value changes during pregnancy - WCC?

A

Increase in WCC

39
Q

Lab value changes during pregnancy - platelets?

A

Decrease or normal platelet

40
Q

Lab value changes during pregnancy - CRP?

A

Normal CRP

41
Q

Lab value changes during pregnancy - ESR?

A

Increase ESR

42
Q

Lab value changes during pregnancy - Urea?

A

Decrease Urea

43
Q

Lab value changes during pregnancy - Creatinine?

A

Decrease in creatinine

44
Q

Lab value changes during pregnancy - Urate?

A

Decrease but increases with gestation

45
Q

Lab value changes during pregnancy - 24hr protein?

A

Increases

46
Q

Lab value changes during pregnancy - Total protein?

A

Decreases

47
Q

Lab value changes during pregnancy - Albumin?

A

Decreases

48
Q

Lab value changes during pregnancy - AST/ALT/GGt?

A

Decreases or stays normal

49
Q

Lab value changes during pregnancy - Alk phosphate?

A

Increases a lot

50
Q

Lab value changes during pregnancy - Bile acids?

A

Normal

51
Q

Lab value changes during pregnancy - D dimer?

A

Increases

52
Q

In pregnancy what rescues the corpus luteum from regressing?

A

The production of human chorionic gonadrotropin (HCG), which is produced by the placenta

53
Q

What happens to oestrogen throughout pregnancy?

A

Increases

54
Q

What happens to progesterone throughout pregnancy?

A

Increases

55
Q

What is the role of the increasing oestrogen and progesterone in pregnancy?

A

1) Maintain endometrium
2) Inhibits FSH and LH release thus inhibiting follicular development
3) Stimulates breast development

56
Q

What produces the estradiol and progesterone during the first trimester? What stimulates this?

A

The corpus luteum is responsible for the production of estradiol and progesterone during the first trimester.

The placental HCG stimulates the corpus luteum

57
Q

When does HCG levels peak?

A

By week 9 and then begin to decrease

58
Q

During the second and third trimester what produces the progesterone?

A

The placenta

59
Q

During the second and third trimester what produces the oestrogen?

A

An interplay between:
1) The fetal adrenal cortex which produces DHEA-S, which is hydroxylated in the faetal liver

2) Placenta process this removing sulphate and aromatising to oestrogens

60
Q

What is the action of oestrogen on the anterior pituitary throughout pregnancy?

A

1) Negative feedback on the release of LH and FSH inhibiting ovarian follicular development
2) Progressively stimulating the release of prolactin

61
Q

Why does lactation not occur throughout pregnancy even though levels of prolactin steadily increase?

A

The high levels of oestrogen and progesterone block the action of prolactin on the breast

62
Q

Why does lactation rapidly occur following birth?

A

There is a dramatic decrease in the oestrogen and progesterone levels

63
Q

How is lactation maintained after birth?

A

Suckling, which stimulates both oxytocin and prolactin secretion

64
Q

Why does lactation inhibit another pregnancy?

A

Lactation inhibits ovulation because prolactin:

1) Inhibits the hypothalamic GnRH secretion
2) Inhibits the action of GnRH on the anterior pituitary, thus inhibiting LH and FSH secretion
3) Antagonizes the action of LH and FSH on the ovaries

As a result ovarian follicular development cannot occur

Year 3 - Reproduction (25 decks)

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