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Repro > Week 8.1 - Maternal problems in Pregnancy > Flashcards

Week 8.1 - Maternal problems in Pregnancy Flashcards

1
Q

Describe the cardiovascular changes which occur in pregnancy

A

-Blood Volume increases (upto 50%) therefore CO, SV and HR all increase

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2
Q

What happens to BP during pregnancy?

A

-Decreases in T1/T2 normal in T3 (systolic never increases)

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3
Q

What effects will pregnancy have on preload and afterload and why?

A
  • Preload will increase as CO is increased, increased vol of blood returning to heart
  • Afterload should decrease if BP decreases as TPR will decrease
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4
Q

Why is hypotension experiences in T1 and T2?

A

-Progesterone causes relaxation of smooth muscle in BVs therefore decreasin TPR

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5
Q

What could be a potentially dangerous cause of hypotension in T3?

A

-Aortocaval compression by enlarged uterus reducing venous return to the heart

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6
Q

Name one possible outcome of the bvs not vasodilating during pregnancy

A

-Pre-eclapsia -> uncontrolled hypertension with endothelial dysfunction

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7
Q

What changes occur in the urinary system during pregnancy?

A

-Glomerular filtration rate increases thus renal plasma flow increases and functional renal reserve decreases

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8
Q

What causes the increase in GFR during pregnancy?

A

-Progesterone

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9
Q

What happens to creatinine clearance during pregnancy? Why?

A
  • Increases

- Because GFR has increased

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10
Q

What happens to urea excretion during pregnancy? Why?

A
  • Increases

- Because GFR increases

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11
Q

\Why is it important to know the normal for pregnancy range of creatinine and urea?

A

-May look like they are in the normal range when they are in fact high for pregnancy as more urea and creatinine should be excreted, therefore there may be a problem with the kidneys

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12
Q

What is the range of creatinine clearance during pregnancy?

A

-40-50%

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13
Q

What is the approximate value of urea during pregnancy?

A

-~3.1mmol/L

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14
Q

Why is it significant that bicarbonate decreases during pregnancy?

A

-Reduced buffering capacity of the kidney

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15
Q

What is a potential problem which progesterone can place on the urinary system?

A

-Increasing GFR so much that hydroureter develops

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16
Q

Name a common cause of urianry stasis during pregnancy?

A

-Obstruction of ureter by gravid uterus

17
Q

Why are UTIs concering during pregnancy?

A

-Possible to develop to pyelonephritis and cause pre-term labour

18
Q

Name the anatomical changes which occur within the respiratory system during pregnancy

A
  • Diaphragm displaced

- AP and transverse diameters of the thorax increase

19
Q

Name the physiological changes which occur in the respiratory system during pregnancy

A

-Physiological hyperventilation due to increased CO2 production and increased respiratory drive effect of progesterone

20
Q

How is physiological hyperventilation of pregnancy compensated for?

A

-Increased bicarb excretion to compensate for the respiratory alkalosis

21
Q

What are the changes in the capacities of the lungs during pregnancy?

A
  • Reduced functional residual capacity but total lung capacity remains unchanged
  • Increased TV with RR unchanged
22
Q

What happens to O2 consumption during pregnancy?

A

-Increases by 20%

23
Q

Why is vital capacity unchanged during pregnancy?

A

-VC = TV+IRV+ERV

although TV increases ERV volume decreases so VC remains unchanged

24
Q

What happens to carboydrate metabolism during pregnancy?

A
  • Increased peripheral resistance to insulin by hPL and the body switched to gluconeogenesis and alternative fuels to spare glucose for fetus
  • Decreased fasting blood glucose
  • Increased post-prandial blood glucose
25
Q

List some risk factors for gestational diabetes

A
  • PCOS
  • advancing age
  • Ethnicity
26
Q

What is gestational diabetes?

A

-Increased blood glucose during T3 due to improper insulin response which doesnt persist post partrum

27
Q

What is the outcome on the fetus of poor control of gestational diabeted?

A

-Macrosomic fetus, still birth, congenital defects

28
Q

What happens to lipid metabolism during pregnancy?

A
  • Increased lipolysis for T2

- Increased plasma free fatty acids on fasting to spare glucose for fetus

29
Q

Why is pregnancy associated with a risk of ketoacidosis?

A

-If there is inappropriate lipolysis excess FA can get converted to ketones

30
Q

What happens to thyroid metabolism in pregnancy?

A
  • Thyroid binding globulin, T3 and T4 increase so free T4 in normal range
  • Decreased TSH due to the effects of hCG
31
Q

Describe the anatomical changes to the GI tract during pregnancy

A

-Alterations in the disposition of the viscera eg appendix moves to RUQ as uterus enlarges

32
Q

Describe the physiological changes which occur in the GI tract during pregnancy

A
  • Smooth muscle relaxation by progesterone -> delayed emptying -> constipation
  • Biliary tract stasis
  • Increased risk of pancreatitis
33
Q

Describe the haematological changes which occur during pregnancy

A
  • Prothrombotic state with increased fibrin deposition at implatation site and increased fibrinogen and clotting factors in blood.
  • Reduced fibrinolysis and changes in vascular flow due to venodilation
  • Anaemia
34
Q

Why cant you give warfarin in thromboembolic disease of pregnancy?

A

-Warfarin can cross the placenta and is teratogenic

35
Q

What causes anaemia during pregnancy?

A
  • Plasma volume increases more than red cell mass -> physiological anaemia
  • Can also be due to Fe or folate deficiencies
36
Q

Describe changes in the immune system during pregnancy

A

-Non-specific suppression of the local immune responses at the materno-fetal interface

37
Q

Give 2 diseases which can occur due to transfer of antibodies across the placenta

A
  • Haemolytic disease of the newborn

- Graves disease

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