Normal/Abnormal Maternal Physiology

Question 1

Some conditions where we should reduce or modify physical activity

Answer 1

Patients with increased risk of preterm birth
Placenta previa (pelvic rest)
Contact sports and center of gravity considerations
Severe HTN
Fetal growth restriction
Ruptured membranes (pelvic rest)
Supine hypotension in 3rd trimester

Question 2

Supine Hypotensive Syndrome

Answer 2

Compression of gravid uterus on IVC that decreases venous return/CO
10% of women cannot compensate
Maternal symptoms: faint, light-headed, SOB, dizzy
Fetal sx: drop in HR as decreased O2 supply
Encourage lateral lilt, uncross legs, compression stockings, pump calf muscles

Question 3

3 main hormones in pregnancy

Answer 3

Estrogen
Progesterone
Human chorionic gonadotropin

Question 4

Physiologic anemia of pregnancy

Answer 4

Plasma volume increases more than RBC mass increase
Its a dilutional anemia
If < 105g/dL consider pathologic anemia

Question 5

Cardiovascular physiology adaptations

Answer 5

Increased blood volume
Increased CO
Decreased SVR

Question 6

How does placenta decrease SVR?

Answer 6

Cytotrophoblast invasion and remodelling of spiral arteries of uterus to create a low resistance shunt

Question 7

HTN in pregnancy definition

Answer 7

SBP 140 or higher
DBP 90 or higher
Average 2+ measurements, taken at least 15 mins apart, using the same arm

Question 8

Pre-existing (chronic) HTN

Answer 8

HTN that develops pre-pregnancy or < 20 weeks gestation

These patients can also develop chronic HTN with super-imposed preeclampsia

Question 9

Gestational hypertension

Answer 9

HTN that develops for the first time at 20 weeks +

No target organ involvement

Question 10

Preeclampsia

Answer 10

Gestational HTN with target organ involvement
New proteinuria OR
One or more adverse conditions OR
One or more severe complications

Question 11

Eclampsia

Answer 11

Gestational HTN with seizures

Question 12

Pathophys of gestational HTN and preeclampsia

Answer 12

Primary issue is poor placentation which leads to uteroplacental mismatch where the fetoplacental demands exceed the maternal circulatory supply
Mismatch also causes ischemia-reperfusion injury in the intervillous space, apoptosis and release of endothelium-damaging substrates into the intervillous soup
Endothelial activation leads to vasospasm and development or maternal syndrome

Question 13

Adverse preeclampsia conditions on history

Answer 13

N/V
Headache
Visual disturbances
Chest pain or SOB
RUQ pain
Lack of fetal movements or growth
Vaginal bleeding

Question 14

Adverse preeclampsia conditions on physical

Answer 14

DBP > 110
Pulmonary edema
RUQ tenderness
Oligouria
Hyperreflexia and clonus
SFH and fetal movements

Question 15

Management for gestational HTN and preeclampsia

Answer 15

Delivery!
Antihypertensives
Prevent seizures with MgSO4 (eclampsia)
Serial surveillance (mom and fetus)