Maternal Physio, Preconception Counseling

Question 1

during pregnancy, hemangioma can appear on genitals due to effect of…

Answer 1

estrogen

Question 2

pH of vagina during pregnancy

Answer 2

3.5-6 (acidic, may become moreso)

Question 3

changes to vascular tree during pregnancy

Answer 3

• uterine a. diameter doubles
• uterine BF inc
• vasodilatation (estradiol, progesterone)
• v. dilate, less competent
• lymph channels open

Question 4

breast changes during pregnancy

Answer 4

leakage at 12 wk

sebaceous gland hypertrophy at 5-15 wk

Question 5

linea nigra

Answer 5

black pigmented area in midline

Question 6

strie graviderum

Answer 6

stretch marks

Question 7

skin changes during pregnancy

Answer 7

• inc sweating, sebum

- hair loss

Question 8

blood during preg

Answer 8

• rbc mass inc
• disproportionate inc in plasma and rbc vol –> HEMODILUTION
• hypercoaguable state
• inc hepatic synthesis of proteins
• reduced total plasma proteins (albumin)

Question 9

chest changes during preg

Answer 9

• displaced diaphragm
• heart displaced up, left
• apex moves laterally
• straightening of L border of heart
• inc prominence of pulmonary conus

Question 10

respiratory changes during preg

Answer 10

• chest shape/circumference inc
• inc in O2 consumption
• mucosa of nasopharynx –> hyperemic and edematous
• HYPERVENTILATION –> inc tidal vol
• respiratory ALKALOSIS
• arterial O2 is unchanged

Question 11

progesterone effects on respiration

Answer 11

stimulant of respiration and respiratory drive

Question 12

cardiovascular changes during preg

Answer 12

• heart size inc
• murmurs
• ECG positional changes
• extrasystoles
• output rises
• HR rises
• progesterone dec SVR
• inc angio II –> water and sodium retention

Question 13

cardiac exam in pregnancy - which type of murmurs are common?

Answer 13

systolic

Question 14

cardiac exam in pregnancy - which type of murmurs are potentially pathologic?

Answer 14

diastolic

Question 15

ECG changes

Answer 15

left axis deviation

• sagging ST segments, inversion or flattening of T wave
• mammary souffle
• arrythmias

Question 16

best position to lay in while pregnant

Answer 16

lateral decubitus, avoids venocaval compression

Question 17

COP during preg

Answer 17

progesterone –> dec SVR –> low bp –> inc COP

Question 18

urinary changes during preg

Answer 18

• inc renal BF
• inc excretion and reduced blood urea, creatinine
• mild glycosuria (inc GFR)
• inc water retention –> dec plasma osmolality
• HYDRONEPHROSIS

Question 19

GI tract changes during preg

Answer 19

• progesterone –> relax LES –> reflux
• reduced GI motility (inc absorption, inc constipation)
• delayed emptying
• gallbladder may dilate
• CHL gallstomes
• spongy, friable gums

Question 20

ptyalism

Answer 20

xs saliva

acidic saliva contents

Question 21

pseudocyesis

Answer 21

-false pregnancy, unknown cause

Question 22

follicle development - 2 phases

Answer 22

1. gonadotropin independent phase

2. gonadotropin dependent phase

Question 23

meiosis of oocytes is arrested at

Answer 23

prophase I

Question 24

When is meiotic division of oocytes completed?

Answer 24

just prior to ovulation

Question 25

sperm binding protein on oocytes

Answer 25

ZP3

Question 26

endometrium stromal cells (fb-like)

Answer 26

get transformed by steroid hormones like progesterone into decidua

Question 27

implantation window

Answer 27

about 4d, 6-10d after LH peak

Question 28

decidua basalis

Answer 28

uterus at site of impact (interacts with trophoblast)

Question 29

immune protection of early implantation

Answer 29

- maternal immune cells removed - maternal/decidual/conceptus cells release CRH which blinds to receptors on surface of trophoblast --> expression of Fas --> immune cell death

Question 30

placenta accreta

Answer 30

Abnormal adherence of the placenta to the uterine wall (attaches to myometrium)

Question 31

placenta increta

Answer 31

Abnormal adherence of the placenta THROUGH the myometrium.

Question 32

placenta percreta

Answer 32

Abnormal adherence in which the placenta invades through the myometrium to the uterine serosa and even to adjacent organs (bladder, rectum)

Question 33

low-pregnancy weight consequences

Answer 33

gastroschisis

Question 34

type I pregestational diabetes

Answer 34

- AI, destroys beta - onset earlier in life - need insulin therapy

Question 35

type II pregrestational diabetes

Answer 35

- MORE COMMON - onset later - peripheral insulin resistance - relative insulin deficiency - obesity

Question 36

human placental lactogen

Answer 36

- anti-insulin, lipolytic effects - peripheral insulin sensitivity during 3rd trimester falls by 50% - higher basal hepatic glucose output

Question 37

specific genetic testing

Answer 37

- Canavan (neuro, infancy, white matter, aspartoacylase) - Tay-Sachs - cystic fibrosis

Question 38

Comm meds to avoid during preg

Answer 38

- acne - asthma - DM (stop oral, start insulin) - HTN ( NO ACEi or ARB) - hypERthyroidism (use propylthiouracil dur 1st trimester)

Question 39

Fick equation

Answer 39

k*A*(P2-P1)/D k=diffusion constant A=area for gas exchange P=diff in partial pressure D=diffusion distance