Pregnancy Physiology

Question 1

How long can a pregnant woman go without not eating until she produces ketones?

Answer 1

12 hours (so need to watch out for Type 1 diabetics)

Question 2

What are the maternal risks of using general anaesthetic on a pregnant woman?

Answer 2

Become hypoxic quicker
More soft tissue round neck
Breasts bigger so compress chest
More acid reflux that can aspirate into lungs
Drug physiology different so adverse affects to anaesthetic more likely if pregnancy unknown

Question 3

What effect does pregnancy have on the maternal thyroid?

Answer 3

TSH is reduced and T3 and T4 stay the same

Thyroid can enlarge if there is an iodine deficiency in the diet as it will work harder

Question 4

What is colostrum and at what stage of pregnancy is it first produced?

Answer 4

Colostrum is the first breast milk produced that is high in calories and maternal antibodies
Produced at the end of the third month
Can harvest colostrum for babies with cleft palate (cant suck) and premature babies

Question 5

How does pregnancy affect the CVS?

Answer 5

Increased CO
Increased total blood volume
Increased heart rate
Systemic vascular resistance falls
In the supine position the CO reduces by 25% (never examine lying down, if need to resuscitate move to L lateral position)
CO increases by 10% during delivery and 80% for one hour post natal
Atria and ventricles will appear bigger on ECHO
Hg will be reduced but BC should be normal
Reduced blood pressure

Question 6

How does pregnancy affect the respiratory system?

Answer 6

Increased oxygen demand but decrease in PCO2
Increased respiratory rate
Increase in minute ventilation
Increased tidal volume
Reduced FRC

Question 7

How does pregnancy affect the renal system?

Answer 7

Increased urea, protein and creatinine excretion
Increasing urate with increasing gestation
Glycosuria common (doesn’t mean diabetic)
Microscopic haematuria common
Dilatation of renal system especially on R (hydronephrosis and hydroureter)
Increased GFR

Question 8

What haematological changes are seen during pregnancy?

Answer 8

Plasma volume increases (affected by birth weight)
WCC increases
Hypercoagulable
Reduced HG, RCC and Haematocrit
Need for folate and iron increases

Question 9

Why does Alkaline phosphatase increase during pregnancy?

Answer 9

The placenta produces it

Question 10

How does gestational diabetes develop?

Answer 10

Placenta produces human placental lactogen which is insulin resistant, the bigger the baby is the bigger the placenta is so more will be produced meaning the women is more likely to develop gestational diabetes
Increased chance of stillbirth

Question 11

How can diabetes be checked in pregnancy?

Answer 11

Can use HBA1C early in pregnancy
Use Glucose tolerant test (fasting-5.1, 2 hour-8.1)
Screening test at 28 weeks

Question 12

What is the definition of menorrhagia?

Answer 12

A menstrual flow of over 80ml

Question 13

What are three types of prolapse?

Answer 13

Procidentia-uterus and cervix come all out
Bladder into vagina (cystocoele)
Rectum into vagina

Question 14

What should be looked for in a VE?

Answer 14

Size of uterus (describe with gestation or fruits)
Uterus position
Mobility of uterus
Adnexal masses
Cervical excitation (can be an ectopic pregnancy with blood in pelvis) or tenderness
Wont feel ovarian masses without doing abdomen exam

Question 15

What is parity?

Answer 15

Any birth no matter the outcome that is after 24 weeks

+ 1 for any other birth under 24 weeks

Question 16

What should be looked for in an obstetric abdominal exam?

Answer 16

Inspect for scars, linea nigra, eyeball baby position
“the abdomen is distended compatible with pregnancy”
Palpate
Palpate for the fundus then measure the length from the pubic symphysis to the fundus
Feel for lie of baby (transverse, longitudinal or oblique)
Feel for presentation (cephalic or breach)
Check engagement using Pollox test (thumb and fingers and wiggle head, measure in 5ths)
Listen to foetal heartbeat over anterior shoulder