UW physiologic changes of pregnancy 02-13 (1)

Question 1

cardiovascular 3 changes?

Answer 1

incr. blood volume (plasma>RBC)
decr. SVR
incr. HR and CO

Question 2

pulmonary 2?

Answer 2

incr. central respiratory drive (hyperventilation)
decr. PaCO2 (resp. alkalosis), incr. PaO2

Question 3

Renal 4?

Answer 3

incr. RBF and urine output
incr. GFR, decr. BUN and Cr
incr. HCO3 excretion (metabolic compensation)
decr. serum Na concentration (incr. ADH secretion)

Question 4

Hematologic, 2?

Answer 4

Incr. prothrombin coagulation factors
decr. Hb (dilutional anemia)

Question 5

Laboratory definitions for anemia vary by trimester: <11 g/dL in the first and third trimesters and <10.5 g/dL in the second trimester.

Answer 5

.

Question 6

Chronic hyperventilation is a normal physiologic change of pregnancy triggered by elevated progesterone, which stimulates respiratory drive (to meet metabolic demand) and creates the sensation of dyspnea.

Answer 6

.

Question 7

Hyperventilation of pregnancy mostly involves .. what changes and what normal?

Answer 7

increased tidal volume with a minimal increase in respiratory rate.

Question 8

Hormone-induced laxity of the intercostal muscles also enlarges the thoracic cavity, further contributing to the increase in tidal volume.

diaphragmatic excursion is not impaired, allowing for the increase in tidal volume.

Answer 8

.

Question 9

hyperventilation leads to slightly incr. PaO2

Answer 9

.

Question 10

Pregnant patients with isolated mild or moderate dyspnea, Mx?

Answer 10

reassurance

Question 11

if findings suggest cardiopulmonary disease, do what?

Answer 11

cardio - cardioecho
pulmonary - ventilation perfusion scan

Question 12

PE how differs from normal dyspnea in pregnancy?

Answer 12

hypoxemia rather than high PaO2!!!

Do ventilation perfusion (not CTA)

Question 13

for what perform kardioUG? what months?

Answer 13

for peripartum cardiomyopathy

which manifests during the last month of pregnancy or within 5 months postdelivery

Question 14

what symptoms in decompensated peripartum cardiomyopathy?

Answer 14

decompensated heart failure (eg, lung crackles) are expected

Question 15

systolic murmur if present -likely a flow murmur due to the physiologic expansion of blood volume

Answer 15

.

Question 16

why ankle edema?

Answer 16

ankle edema is explained by uterine compression of the inferior vena cava

Question 17

in what pregnancy pathology can be decr. urine Cl?

Answer 17

Metabolic alkalosis can be caused by severe vomiting (eg, hyperemesis gravidarum).

Question 18

what is anemia Hb in first trimester?

Answer 18

<11 g/dL in the first

Question 19

what is anemia Hb in 2nd trimester?

Answer 19

<10.5 g/dL in the second trimester.

Question 20

what is normal Hb in 3rd trimester?

Answer 20

<11 g/dL in the first and third trimesters

Question 21

Because the oxygen-carrying capacity of blood is not reduced, dilutional anemia is unlikely to cause dyspnea.

Answer 21

.

Question 22

Dyspnea is common during pregnancy and is most often explained by physiologic progesterone-induced hyperventilation that leads to primary respiratory alkalosis.

Answer 22

Patients without findings suggesting cardiopulmonary disease (eg, peripartum cardiomyopathy, pulmonary embolism) should be provided reassurance.