Flashcards in Maternal fetal physiology-Table 1 Deck (69)
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
What changes are happening to the breast in the first 8 wks?
-Nipple/areola enlarge & prominent Montgomery tubercles
-Ductal growth & inc’d blood flow
What are common breast complaints in pregnancy?
Breast can grow 2 cup sizes
Change in size
See veins under skin
Concern about the “bumps”
What are eye changes in pregnancy?
Blurred vision from thickened cornea, decreased intraocular pressure, and increased fluid retention
What changes happen in the thyroid during pregnancy?
Gland increases in size
Does TSH cross the placenta ?
No, doesn’t impact fetus
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
What happens to ACTH and aldosterone in pregnancy?
Increase from increased cortisol from estrogen
What is ptyalism?
Women feel like that have excessive salivation for first trimester
What hormone plays a role on changes in the GI tract?
What are the GI changes?
Increased incidence of gastric reflex, delayed gastric emptying, and prolonged transit time from stomach to cecum
Why do women in the later 2-3rd trimester feel their abdomen is itchy?
Histamine rxn from the motility slow down
What are pregnant women at increased risk for?
Cholecytitis and gallstones
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
What does HPL do?
increases resistance of peripheral tissues & liver to insulin effects
secretion increases with increased mass of the placenta
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
What happens to cardiac output in pregnancy?
Increases by 30-50%, uterus receives 2-20% of total output
What happens to the heart in pregnancy?
Heart shifts left and up and the apex shifts laterally
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)
What happens in hyperdynamic state?
S2 split from increased flow across A-V valves
What happens to the blood during pregnancy? What does this put mom at risk for?
DVT and PE
What factors are increased in the hypercoag state in pregnancy?
Increased factors I, VII, VIII, IX, and X
What increases on the CBC in mom?
Plasma and RBC volume = dilution effect
What decreased in blood labs?
Does lung volume expand in pregnancy?
No, lungs are not bigger, just more efficient
What happens to tidal volume?
Increases d/t inspirational capacity
What happens to total lung capacity?
Decreases d/t elevated diaphragm and residual volume reduced
Are moms alkolotic or acidoctic for most of pregnancy?
Progesterone driven state of respiratory alkalosis to protect the fetus from excess CO2
What happens in maternal resp alkalosis?
Dyspnea, hyperventilation and decreased exercise tolerance