Maternal fetal physiology-Table 1

Question 1

What are the derm changes that happen in pregnancy?

Answer 1

—Spider angiomata & palmar erythema (estrogen)
—Acne: ↑ sebum production
—Hyperpigmentation d/t ↑ melanocyte SH/estrogen driven (striae & linea nigra); pigmented nevi
—Scalp hair growth changes
—Vaginal condyloma, varicosities

Question 2

What changes are happening to the breast in the first 8 wks?

Answer 2

• Nipple/areola enlarge & prominent Montgomery tubercles

- Ductal growth & inc’d blood flow

Question 3

What are common breast complaints in pregnancy?

Answer 3

Breast can grow 2 cup sizes
Soreness
Stretch marks
Pruritus
Leaking
Change in size
See veins under skin
Concern about the “bumps”

Question 4

What are eye changes in pregnancy?

Answer 4

Blurred vision from thickened cornea, decreased intraocular pressure, and increased fluid retention

Question 5

What changes happen in the thyroid during pregnancy?

Answer 5

Gland increases in size

Question 6

Does TSH cross the placenta ?

Answer 6

No, doesn’t impact fetus

Question 7

What happens to thyroid hormones in pregnant?

Answer 7

—↑ thyroxine binding globulin (TBG) d/t estrogen
Inc’d TBG production = increase total T3 & T4 - hCG increases in first 12 wks, doubles every 24-48 hrs then levels out
- once this is even you can get accurate read on TSH

Question 8

What happens to ACTH and aldosterone in pregnancy?

Answer 8

Increase from increased cortisol from estrogen

Question 9

What is ptyalism?

Answer 9

Women feel like that have excessive salivation for first trimester

Question 10

What hormone plays a role on changes in the GI tract?

Answer 10

Progesterone

Question 11

What are the GI changes?

Answer 11

Increased incidence of gastric reflex, delayed gastric emptying, and prolonged transit time from stomach to cecum

Question 12

Why do women in the later 2-3rd trimester feel their abdomen is itchy?

Answer 12

Histamine rxn from the motility slow down

Question 13

What are pregnant women at increased risk for?

Answer 13

Cholecytitis and gallstones

Question 14

What is happen to insulin response in pregnancy?

Answer 14

Reduced tissue response/insulin d/t HPL effect on tissues plus inhibition liver gluconeogenesis
Pancreas/ beta cell hypertrophy

Question 15

What does HPL do?

Answer 15

increases resistance of peripheral tissues & liver to insulin effects
secretion increases with increased mass of the placenta

Question 16

Why should women not sleep on their backs in the later stages?

Answer 16

Femoral venous pressure increases d/t uterine compression inferior vena cava & fetal pressure on iliac veins = supine hypotension

Question 17

What happens to cardiac output in pregnancy?

Answer 17

Increases by 30-50%, uterus receives 2-20% of total output

Question 18

What happens to the heart in pregnancy?

Answer 18

Heart shifts left and up and the apex shifts laterally

Question 19

What are the EKG changes in pregnancy?

Answer 19

L axis shift due to diaphragm elevation

QRS up in lead I & AVF (vector is based on wave ventricular depolarization toward + skin electrode)

Question 20

What happens in hyperdynamic state?

Answer 20

S2 split from increased flow across A-V valves

Question 21

What happens to the blood during pregnancy? What does this put mom at risk for?

Answer 21

Hyper-coag state

DVT and PE

Question 22

What factors are increased in the hypercoag state in pregnancy?

Answer 22

Increased factors I, VII, VIII, IX, and X

Question 23

What increases on the CBC in mom?

Answer 23

Plasma and RBC volume = dilution effect

TIBC

Question 24

What decreased in blood labs?

Answer 24

Serum iron

Question 25

Does lung volume expand in pregnancy?

Answer 25

No, lungs are not bigger, just more efficient

Question 26

What happens to tidal volume?

Answer 26

Increases d/t inspirational capacity

Question 27

What happens to total lung capacity?

Answer 27

Decreases d/t elevated diaphragm and residual volume reduced

Question 28

Are moms alkolotic or acidoctic for most of pregnancy?

Answer 28

Progesterone driven state of respiratory alkalosis to protect the fetus from excess CO2

Question 29

What happens in maternal resp alkalosis?

Answer 29

Dyspnea, hyperventilation and decreased exercise tolerance

Question 30

What are renal changes?

Answer 30

Enlarged kidneys Increased residual volume d/t decreased bladder tone Decreased bladder capacity Dec BUN Cr and uric acid

Question 31

What is glucosuria?

Answer 31

Increased urinary glucose excretion common d/t higher GFR

Question 32

What happens in the MSK during pregnancy?

Answer 32

Increased bone turn over Decreased total serum calcium and increased PTH Back pain Ligament laxity

Question 33

What are common symptoms in pregnancy?

Answer 33

``` —HA —Heartburn, constipation, hemorrhoids —LBP, round ligament pain ---Ankle edema  ---Fatigue  ---Varicose veins  ---Leucorrhea ```

Question 34

What will tension HA feel like?

Answer 34

Band like pressure around the head

Question 35

How are tension HA tx in pregnant women?

Answer 35

acetaminophen

Question 36

What happens to migraines in preggo?

Answer 36

Typically improve | Can give acetaminophen with or without codeine

Question 37

How can pregnant women try to avoid reflux?

Answer 37

—Avoid triggers & ETOH, acidic fruits, caffeine, carbonated drinks —Take OTC antacids if dietary changes not helpful —Avoid food 2-3 hours before lying down —Elevate head to sleep

Question 38

Constipation and hemorrhoids just happen. How can you minimize or prevent?

Answer 38

Increase fluid, fiber, and fitness

Question 39

How can you tx pedal edema?

Answer 39

Elevate, comfy shoes (jokes) and pregnant belt

Question 40

What hormone is causing fatigue in the 1st trimester?

Answer 40

Progesterone

Question 41

Whats the deal with all dat discharge?

Answer 41

Nice and white and mucousy and can be until delivery!

Question 42

What should you make sure to check for if a preggo woman comes in with discharge complaints?

Answer 42

Make sure it is not vaginitis, std, or amniotic fluid leakage

Question 43

What is umbilical blood flow?

Answer 43

combined output both fetal ventricles proportional to fetal growth so umbilical flow is stable

Question 44

What is the role of the placenta?

Answer 44

Nutritional and waste removal Hormone production Resp and metabolite exchange Blocks and masks maternal antibodies

Question 45

What are the hormones produced by the placenta?

Answer 45

Estrogen, progesterone, hCG, and HPL

Question 46

What does HPL do?

Answer 46

↓ maternal insulin sensitivity which raises maternal blood glucose levels d/t decreased maternal glucose utilization this allows for adequate fetal nutrition & up regulation of pancreas

Question 47

What are the resp and metabolite exchanges?

Answer 47

Gas- simple diffusion Metabolism- glucose with facilitated diffusion Active transport- amino acids

Question 48

When is the placenta fully formed?

Answer 48

10-12 weeks

Question 49

What is developed in the fetus by weeks 5-6?

Answer 49

 Formation limb buds, neural tube & umbilical cord

Question 50

What is developed in the fetus by weeks 7-8?

Answer 50

 Ext’l ears, eyes, eyelids & upper lip

Question 51

What is developed in the fetus by weeks 11-12?

Answer 51

 Bones harden, skin & nails grow, can measure crown-rump length (CRL)

Question 52

What is developed in the fetus by weeks 13-14?

Answer 52

 Hair growth begins, roof of mouth forms

Question 53

What is developed in the fetus by weeks 19-20?

Answer 53

 Lanugo covers body, vernix caseosa on skin

Question 54

What is developed in the fetus by weeks 21-22?

Answer 54

 Taste buds | Bone marrow begins production

Question 55

What is developed in the fetus by weeks 23-26?

Answer 55

 Eyebrows & eyelashes, wt gain

Question 56

What is developed in the fetus by weeks 27-28?

Answer 56

 Eyelids unfuse

Question 57

What is developed in the fetus by weeks 33-34?

Answer 57

 Pupillary responses w/light, lanugo almost gone

Question 58

When is the fetal thyroid gland developed?

Answer 58

By the end of the 1st trimester

Question 59

When can you detect FHT with Doppler?

Answer 59

12-14wks

Question 60

What is fetal blood flow measuring?

Answer 60

Indirect measure of fetal growth and well being

Question 61

When does the fetus have regular chest mvmts with inhalation and exhalation of amniotic fluid?

Answer 61

16wks

Question 62

When is surfactant produced? Why is this important?

Answer 62

Wk 26 begins better at 28, large quantities at 40 Better lung maturity for fxn and survival Blood test for surfactant and try to delay delivery

Question 63

When can fetus start to hiccup?

Answer 63

38 wks | from amniotic fluid in trachea

Question 64

When does meconium accumulation begin?

Answer 64

18 wks

Question 65

At what week is the intestinal meconium formed signaling preparedness for the 1st BM?

Answer 65

38 wks

Question 66

When is there amniotic fluid gonadal differentiation?

Answer 66

6-8 wks

Question 67

When is the uterus developed in females?

Answer 67

19-20wk

Question 68

When do the testes descend into the scrotum?

Answer 68

30-34 wks

Question 69

Are male and female differentiation gene triggered?

Answer 69

No appears that males need gene trigger but females do not