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1

What are the derm changes that happen in pregnancy?

—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

2

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

-Nipple/areola enlarge & prominent Montgomery tubercles
-Ductal growth & inc’d blood flow

3

What are common breast complaints in pregnancy?

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

4

What are eye changes in pregnancy?

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

5

What changes happen in the thyroid during pregnancy?

Gland increases in size

6

Does TSH cross the placenta ?

No, doesn’t impact fetus

7

What happens to thyroid hormones in pregnant?

—↑ 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

8

What happens to ACTH and aldosterone in pregnancy?

Increase from increased cortisol from estrogen

9

What is ptyalism?

Women feel like that have excessive salivation for first trimester

10

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

Progesterone

11

What are the GI changes?

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

12

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

Histamine rxn from the motility slow down

13

What are pregnant women at increased risk for?

Cholecytitis and gallstones

14

What is happen to insulin response in pregnancy?

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

15

What does HPL do?

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

16

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

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

17

What happens to cardiac output in pregnancy?

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

18

What happens to the heart in pregnancy?

Heart shifts left and up and the apex shifts laterally

19

What are the EKG changes in pregnancy?

L axis shift due to diaphragm elevation
QRS up in lead I & AVF (vector is based on wave ventricular depolarization toward + skin electrode)

20

What happens in hyperdynamic state?

S2 split from increased flow across A-V valves

21

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

Hyper-coag state
DVT and PE

22

What factors are increased in the hypercoag state in pregnancy?

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

23

What increases on the CBC in mom?

Plasma and RBC volume = dilution effect
TIBC

24

What decreased in blood labs?

Serum iron

25

Does lung volume expand in pregnancy?

No, lungs are not bigger, just more efficient

26

What happens to tidal volume?

Increases d/t inspirational capacity

27

What happens to total lung capacity?

Decreases d/t elevated diaphragm and residual volume reduced

28

Are moms alkolotic or acidoctic for most of pregnancy?

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

29

What happens in maternal resp alkalosis?

Dyspnea, hyperventilation and decreased exercise tolerance

30

What are renal changes?

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