Maternal changes in pregnancy

Question 1

What are the causative factor which cause a major change in multiple systems?

Answer 1

• High levels of steroids
• Mechanical displacement
• Fetal requirements

Question 2

What do we have to do in order to diagnose an abnormality during pregnancy?

Answer 2

In order to diagnose an abnormality in pregnancy, we need to detect changes in the changes

Question 3

What could pregnancy do to maternal conditions?

Answer 3

• Exacerbate a pre existing condition

- Uncover a hidden or mild condition

Question 4

What are the changes designed to cope with several main events?

Answer 4

• Increase in size of the uterus
• Increased metabolic requirements of the uterus
• Structural and metabolic requirements of fetus
• Removal of fetus waste products
• Provision of amniotic fluid

Question 5

What are the hormones causing the most of the changes?

Answer 5

• Placental peptides
  
  • hCG, hPL, GH
• Maternal steroids
• Placental and fetal steroids
  
  • Progesterone,oestradiol, oestriol
• Maternal and fetal pituitary hormones
  
  • GH, thyroid hormones, prolactin, CRF

Question 6

What do placental steroids have an effect on?

Answer 6

• Renin angiotensin system
• Respiratory centre
• GI tract
• Blood vessels
• Uterine myometrial contractility

Question 7

Weight during pregnancy

Answer 7

Weight gain happens during pregnancy

Question 8

Why is there a need to increase energy output?

Answer 8

To cope with increased respiration and cardiac output

Question 9

Why is there a need for increased storage?

Answer 9

• For fetus

- For labour and puerperium

Question 10

How much fat and protein need to be gained and how?

Answer 10

Need to gain fat and protein stores by 4-5kg

-Increased consumption and reduced use

Question 11

Where is the fat and protein store mainly laid in the pregnant mother?

Answer 11

Store mainly laid down in anterior abdominal wall

Question 12

When is a increased availability for glucose required?

Answer 12

Increased availability needed in 2nd timester

Question 13

How is the glucose transported to the fetus?

Answer 13

Transported across placenta as facilitated diffusion as fetal energy source

Question 14

Where does the fetus store some of the glucose?

Answer 14

Fetus stores some glucose in the liver

Question 15

What happens in the 1st trimester to the maternal glucose reserves?

Answer 15

• beta cells increase in number
• Plasma insulin increases
• Fasting serum glucose decreases

Question 16

What happens in the 2nd trimester to fetal glucose reserves?

Answer 16

• hPL causes insulin resistance
• There’s less glucose in storage and therefore increased availability in serum glucose
  
  • However this can cause diabetes

Question 17

What do oestrogen and progesterone act on to increase water gain during pregnancy?

Answer 17

Act on renin angiotensin system causing an increase in plasma volume

Question 18

How many litres do mothers gain during pregnancy and what contributes to this?

Answer 18

Gain about 8-9 litres
Contributed by:
-Fetus
-Placenta
-Amniotic fluid
-Oedema
-Uterine muscle
-Mammary gland
-Plasma volume

Question 19

What happens to oxygen consumption during pregnancy ?

Answer 19

Oxygen consumption increased

Question 20

How does oestrogen and progesterone cause an increase in respiration?

Answer 20

• Increases respiratory centre sensitivity to CO2

- Thoracic anatomy changes, ribcage is displaced upwards and ribs flare outwards

Question 21

By what percentage does minute volume increase during pregnancy?

Answer 21

-Minute volume increases by 40%

Question 22

What happens to arterial pO2 and pCO2 during pregnancy?

Answer 22

Arterial pO2 increases and arterial pCO2 decreases

Question 23

Therefore what does high oxygen facilitate with?

Answer 23

High oxygen will facilitate gas transfer between the mother and the baby

Question 24

What happens to maternal plasma volume during pregnancy?

Answer 24

Increase in maternal plasma volume

Question 25

During pregnancy what is there an increased efficiency of in the maternal blood?

Answer 25

-Increased efficiency of Iron absorption from gut

Question 26

What is haemodilution?

Answer 26

Is the apparent anaemia as concentration of Hb falls as plasma volume increases

Question 27

What other changes happen in maternal blood during pregnancy?

Answer 27

Changes in white cells and clotting factors

Question 28

Why does blood become more hypercoagulable?

Answer 28

Due to increased fibrinogen for placental separation There's an increased risk of thrombosis

Question 29

What does increased Hb in fetal blood allow?

Answer 29

-Increased Hb allows increased O2 binding, therefore oxygen is given up by maternal Hb more easily

Question 30

What does smoking result in to the fetal blood?

Answer 30

Smoking increases maternal carboxy-Hb which is more permanent and reduces increased binding of oxygen leading to fetal hypoxia

Question 31

How does an expanding uterus effect the CVS?

Answer 31

- Pushes the heart round | - Changes ECG and heart sounds

Question 32

Why is there an increased cardiac output during pregnancy?

Answer 32

- Due to increased heart rate and stroke volume | - For maternal muscle and fetal supply

Question 33

What does an increased cardiac output and vasodilation by steroids result in?

Answer 33

Increased cardiac output and vasodilation by steroids result in reduced peripheral resistance

Question 34

What occurs to the CVS to assist in heat loss?

Answer 34

Neoangiogenesis occurs including extra capillaries in skin to assist in heat loss

Question 35

Effect of steroids on GI tract

Answer 35

steroids: - Increase appetite and thirst - Reduce GIT motility causing constipation - Relax LOS causing acid reflux

Question 36

Why do we need more folic acid during pregnancy?

Answer 36

Involved in DNA production, growth, blood cells for uterus placenta and fetus

Question 37

What is a deficiency in folic acid linked to?

Answer 37

Linked to spina bifida

Question 38

What does progesterone effect in the bladder?

Answer 38

Progesterone effects smooth muscle in bladder

Question 39

What happens to the urinary tract during pregnancy and what does this increase?

Answer 39

Urinary tract dilates and relaxes however there's increased UTI

Question 40

During pregnancy there's increased blood flow to kidneys, what does this therefore do and result in?

Answer 40

Increased blood flow to the kidneys cause an increased filtration rate. This results in an increased clearance of: - Creatinine - Urea - Uric acid

Question 41

In early pregnancy, why is there an increased frequency of urination?

Answer 41

In early pregnancy the uterus is enlarging but it is within the pelvis compressing the bladder increasing the frequency of urination

Question 42

In mid-pregnancy, what leads to micturition being normal?

Answer 42

Mid-pregnancy the uterus is lifted out of the pelvis leafing to micturition being normal

Question 43

At term, why is there an increased frequency of urination again?

Answer 43

At term the head of the fetus descends into the pelvis increasing frequency of urination again

Question 44

Why is there a change in uterine size during pregnancy?

Answer 44

- Due to huge increase in muscle mass | - Huge increase in blood flow

Question 45

What is the primary function of the cervix?

Answer 45

Primary function is to retain pregnancy

Question 46

What happens to the vascularity of the cervix during pregnancy?

Answer 46

There's an increase in vascularity

Question 47

When do the tissues in the cervix start softening and how?

Answer 47

Tissues soften from 8 weeks - Changes in connective tissue - Begins gradual preparation for expansion

Question 48

What happens to the glands in the cervix during a pregnancy and how?

Answer 48

Proliferation of glands: - Mucosal layer becomes half of mass - Great increase in mucus productions

Question 49

After delivery of the baby what returns to normal in the mother?

Answer 49

- Dramatic and rapid fall in steroids on delivery of the placenta - Most endocrine-driven changes return to normal rapidly - Uterine muscle rapidly lose oedema but contracts slowly - Removal of steroids permits action of raised prolactin on breast