pregnancy, placenta and the fetus

Question 1

what may cause a decrease CO in pregnancy that is not necessarily pathological ?

Answer 1

when supine due to IVC compression

Question 2

what are the changes associated with placental perfusion during pregnancy?

Answer 2

there is an increase in placental perfusion from 50ml/min to 1300ml/min

Question 3

how is the cardiac output distributed during pregnancy ?

Answer 3

by term there is an increase of CO to the uterus and breast
decreased Co to skeletal muscles and splanchnic bed
organs including the brain, kidney, skin and coronary arteries does not change

Question 4

how is the maternal nutrient supply calculated ?

Answer 4

uterine blood flow x substrate concentration

Question 5

what are the ventilatory changes during pregnancy ?

Answer 5

respiratory rate doesn’t change
tidal volume increases
effective alveolar ventilation exceeds requirements which leads to respiratory alkalosis

Question 6

what factor in pregnancy increases the happening of respiratory alkalosis ?

Answer 6

increase progesterone levels stimulates the respiratory drive

Question 7

what changes may be seen on the cervix during pregnancy ?

Answer 7

cervix may have a bluish tinge and the mucus plug may be noted

Question 8

what structural changes happen to the uterus during pregnancy ?

Answer 8

the isthmus will give rise to the lower uterine segment

Question 9

what are the breast changes observed during pregnancy ?

Answer 9

pigmentation of the areola (2ry areola)
secretion of colostrum
presence of montgomery tubercles

Question 10

what are the skinn changes observed during pregnancy ?

Answer 10

linea alba becomes linea nigra
chloasma gravidarum
striae gravidarum
loss of hair

Question 11

what causes urine stasis inn pregnancy ?

Answer 11

atony of the ureters

hypertrophy of the lower end due to the effect of oestrogen

Question 12

what are the gastrointestinal changes observed during pregnancy ?

Answer 12

emesis gravidarum
ptyalism
reduced gastric acidity which reduces iron absorption
reflux
constipation due to decreased gut motility

Question 13

what hormone is responsible for the reduced gut motility in pregnancy ?

Answer 13

progesterone

Question 14

why is there a tendency for stone formation in the gall bladder ?

Answer 14

gall bladder relaxation

Question 15

what are the factors that increase hemostasis inn pregnancy ?

Answer 15

hypercoagulable state 
increased clotting factors 
resistance to protein C
reduced levels of protein S
placental PAI-2

Question 16

what does PAI-2 ?

Answer 16

inhibits tissue plasminogen which would normally break down clots

Question 17

what are the endocrine changes observed inn pregnancy ?

Answer 17

insulin hypersensitivity then insulin resistance
moderate iodine deficiency and smooth goitre
decreased T4 levels
TSh unaffected

Question 18

what are the immunological changes that happen during pregnancy ?

Answer 18

placental barrier 
HLA-G and HLA-C suppress local maternal immunity 
shift from Th1 to Th2 immune response 
ESR rises 
CRP unchanged

Question 19

what is the structure of the placenta on the uterine side ?

Answer 19

formed of placental cotyledons

Question 20

why is there any affection of the thyroid during pregnancy ?

Answer 20

there is relative iodine deficiency and higher incidence of a smooth goitre due to the increased levels of HCG