Week 4

Question 1

what are the seven system that affected in pregnancy

Answer 1

weight
Endocrine
Cardio
Resp
Urinary
GIT
Haem abd Biochem
Skin

Question 2

Physiological weight increase during pregnancy

Answer 2

Fetus	              3.5 kg  (7lbs)
Placenta	  0.5 kg  (1lb)
Amniotic fluid	 1.5 kg (2lbs)
Uterus	             1.0 kg  (2lbs)
Blood volume	 1.5 kg  (3lbs)
Breasts	             1.0 kg  (2lbs)

Total 9.0 kg (20lbs)

Question 3

Placental Hormones

Answer 3

Human chorionic gonadotrophin (hCG)
Oestrogen
Progesterone
human placental lactogen (hPL)

Question 4

hormones that are insulin antagonists and tend to increase the glucose level

Answer 4

Cortisol, progesterone, oestrogen & hPL

Question 5

HUMAN CHORIONIC GONADOTROPIN (ß-hCG)

Answer 5

Detectable:
in maternal serum approximately 10 days post fertilisation
in maternal urine approximately 14 days after fertilisation

Concentration doubles almost every 48 hours in a healthy pregnancy, peaking between 8 to 12 weeks and tapering off thereafter

Question 6

Serum progesterone:

Answer 6

increases throughout pregnancy

is thought to relax uterine muscle and prevent preterm labour

Question 7

CARDIOVASCULAR CHANGES

Answer 7

Venous dilatation: (Progesterone effect
Blood pressure falls 
volumes changes
Cardiac output / RBF and uterine flow
CARDIAC SYMPTOMS & SIGNS

Question 8

CARDIAC SYMPTOMS & SIGNS

Answer 8

Dyspnoea (occurs in up to 75% of women in the third trimester)

Oedema (Incidence around 80%)

Loud S1

Loud S3 in 90%

Systolic murmur in 95% (Results from increased cardiac output)

Cardiac apex moves to the left

Question 9

RESPIRATION symptoms

Answer 9

Respiratory rate increases
Tidal volume increases by 40%
Mild respiratory alkalosis pH = 7.44
Reduced pCO2

Question 10

URINARY TRACT in pregnancy

Answer 10

Renal blood flow & Glomerular filtration rate (30-50%)
Post prandial glycosuria (which is normal)
Dilated collecting systems (dilated ureters; Lead to urinary stasis)
Risk of urinary tract infection (might be asymptomatic)

Question 11

GASTROINTESTINAL SYSTEM in Preg

Answer 11

Dental carries/gum disease

Nausea / vomiting

Gastrointestinal reflux / ‘heartburn’ (Due to progesterone-induced relaxation of the smooth muscle of the gastro-oesophageal junction)

Constipation (Due to relaxation of the smooth muscle of the bowel)

Question 12

HAEMATOLOGY & BIOCHEMISTRY in Preg

Answer 12

Reduced Hb
Lower urea and creatinine - haemodilution & increased GFR
Raised alkaline phosphatase - generated by placenta
Lower albumin and oncotic proteins

Question 13

SKIN CHANGES

Answer 13

Chloasma, linea nigra: increased activity of melanocytes in pregnancy

Spider naevi, palmer erythema

Stretch marks

Increased pigmentation of areolae and Montgomery follicles

Question 14

Height of uterine fundus

Answer 14

Fundus first palpable per abdomen at 12 –14 weeks
Fundus at umbilicus at 20 weeks
Fundus at Xiphisternum at 36 weeks

Question 15

Ultrasound – can be used to accurately date pregnancy

Answer 15

The most commonly used parameters are:
1-Gestational sac volume at 4-7weeks;
2-Crown-rump length (CRL) at 6-12 weeks.
3-Biparietal diameter(BPD), femur length(FL) and abdominal circumference(AC) from 15-24weeks (less reliable+++)

After 24 weeks, gestational age cannot be accurately determined by ultrasound