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Maternal Changes In Pregnancy Flashcards

1
Q

What are the reasons for changes in pregnancy?

A

→ High levels of fetal steroids
→ Mechanical displacement

→ Fetal requirements

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2
Q

What kind of an event is pregnancy?

A

→ Physiological

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3
Q

What can pregnancy do physiologically to existing conditions?

A

→ Exacerbate an existing condition

→ uncover a hidden or mild condition

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4
Q

What are 6 changes that occur during pregnancy?

A

→ Increase in uterus size
→ Increase metabolic requirements of the fetus

→ Structural and metabolic requirements of the fetus
→ Removal of fetal waste products
→ Prevision of amniotic fluids
→ preparation for delivery and puerperium

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5
Q

In what systems do pregnancy changes occur?

A

→ Respiratory system
→ Cardiovascular system

→ GI
→ Urinary
→ Endocrine

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6
Q

What are the three placental peptides?

A

→ hCG, hPL, GH

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7
Q

What takes over progesterone production?

A

→ Corpus luteum

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8
Q

What is the corpus luteum kept alive by?

A

→ hCG

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9
Q

What are the placental and fetal steroids?

A

→ Progesterones
→ Estradiol

→ Estrogen

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10
Q

What 4 hormones induce insulin resistance?

A

→ Growth hormone
→ Corticotropin releasing hormone

→ Estrogen
→ Human placental lactogen

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11
Q

Why do you want the myometrium to be quiescent?

A

→ Contractions would cause miscarriage

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12
Q

What is the total weight gain during pregnancy?

A

→ 12.5 - 13kg

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13
Q

What is the breakdown of the weight gain during pregnancy?

A

→ Fetus + placenta - 5kg
→ Fat and protein - 4.5kg

→ Body water 1.5kg
→ Breasts - 1kg
→ Uterus 0.5-1kg

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14
Q

Where is fat mainly laid down?

A

→ Anterior abdominal wall

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15
Q

What does the basal metabolic rate rise by in mid and late gestation?

A

→ 350kcal/day - mid

→ 250kcal/day - late

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16
Q

How does glucose get to the fetus?

A

→ Facilitated diffusion across the placenta

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17
Q

Where does the fetus store glucose?

A

→ in the liver

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18
Q

Describe what happens to maternal glucose reserves in the first trimester

A

→ Pancreatic ß cells increase in number
→ plasma insulin increases

→ Fasting serum glucose decreases (laid down as stores and used by muscle)

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19
Q

Describe what happens to fetal glucose reserves in the second trimester

A

→ hPL causes insulin resistance
→ less glucose into stores

→ increases availability in serum glucose so more crosses the placenta

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20
Q

Describe how gestational diabetes occurs

A

→ Hormones antagonise the effects of insulin
→ Insulin increases

→ Beta cells become hypertrophied
→ Glucose is going into cells to be stored
→ insulin resistance gets higher due to hPL
→ The body makes more insulin to overcome the resistance
→ if you are already obese and insulin resistant you get gestational diabetes

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21
Q

Describe how water gain occurs in pregnancy

A

→ Estrogen and progesterone activate the RAAS system
→ Sodium is retained

→ Plasma volume increases by 40-50%
→ A litre of amniotic fluid is made

22
Q

Why do you breathe quicker and deeper during pregnancy?

A

→ Estrogen and progesterone increase respiratory sensitivity to CO2

23
Q

What does the minute volume increase by?

A

40%

24
Q

What is gas transfer like between mother and fetus

A

→ high O2 in mothers blood it favors transfer to the fetus

→ high CO2 in fetus it goes to the mother

25
Q

What does the plasma volume increase by?

A

→ 40-50%

26
Q

How does Hb concentration change in pregnant women?

A

→ it decreases

→ Red cell count goes up by 20% but the plasma goes up by 40% so the Hb is more diluted

27
Q

How is more iron absorbed?

A

→ Transferrin

28
Q

Why do you become hypercoagulable?

A

→ clotting factors increase

→increased fibrinogen for placental separation, but increased risk of thrombosis

29
Q

What does smoking do to fetal blood?

A

→ Increases maternal carboxy-Hb which reduces binding of O2

→ fetal hypoxia

30
Q

How is blood transferred from the mother to the fetus?

A

→ Fetal blood has increased Hb
→ Increased O2 binding

→ Oxygen is given up by maternal Hb

31
Q

How much does cardiac output increase by?

A

→ 40-50%

32
Q

What is preeclampsia?

A

→ High blood pressure

33
Q

What is blood pressure like during pregnancy and why?

A

→ Blood pressure = peripheral resistance x CO
→ if CO goes up by 40-50% the blood pressure must go down

→ peripheral resistance must decrease
→ HIGH VOLUME AND LOW PRESSURE

34
Q

Where does blood flow increase?

A

→ Uterus
→ Placenta

→ Muscle
→ Kidney and skin

35
Q

Why does neoangiogenesis occur?

A

→ Extra capillaries in skin to assist with heat loss

36
Q

How does acid reflux occur?

A

→ in the third trimester the LOS tends to relax

37
Q

What does progesterone do to the GI tract?

A

→ Increases appetite
→ Smooth muscle relaxation throughout the whole gut

→ a common side effect is constipation

38
Q

What does deficiency of folic acid lead to?

A

→ Spina bifida - neural tube defect

39
Q

How much folic acid should be taken?

A

→ 5mg/day upto week 12

40
Q

Why do pregnant women get UTIs?

A

→ If you ultrasound a pregnant woman’s kidneys they are dilated
→ You may not void everything and get static urine and get UTIs

41
Q

How much does the filtrate increase by and why?

A

→ 40-50% because all the cardiac output goes through the kidney as well

42
Q

Why is there increased frequency in urination during pregnancy?

A

→ Baby’s head is pressing on the bladder in very late pregnancy

43
Q

What does the uterus hypertrophy in response to?

A

→ Estrogen

44
Q

Where is the incision for a C section done?

A

→ Just above the symphysis

45
Q

When does the cervix tissue soften?

A

→ From 8 weeks

46
Q

What is the function of the cervix?

A

→ To retain the pregnancy

47
Q

What happens to the glands in the cervix?

A

→ Great increase in mucus production

→ Anti-infective

48
Q

What happens when the placenta is delivered?

A

→ Rapid fall in steroids

49
Q

What happens to the uterus after delivery?

A

→ Rapidly loses oedema but contracts slowly

→ Never returns to pre-pregnancy size

50
Q

What enables prolactin?

A

→ Removal of steroids

51
Q

What are the maternal and fetal pituitary hormones?

A

GH, thyroid hormones, prolactin, CRF

52
Q

What happens to uterine muscle after delivery?

A

→rapidly looses edema but contracts slowly: never returns to pre- pregnancy size

Reproduction (12 decks)

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