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Obstetrics and Gynecology > Maternal Physiology > Flashcards

Maternal Physiology Flashcards

(60 cards)

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1
Q

Uterus from 70g becomes

A

1100 g

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2
Q

Uterus from 10ml becomes

A

5 L

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3
Q

Changes in uterine muscle

A

Hypertrophy and hyperplasia (under influence of hormones estrogen and progesterone)

Stretching beyond 20 weeks (1.5 cm or less)

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4
Q

Arrangement of uteirne muscle fiber

A

Outer hood-like layer
Middle layer (figure of 8), forms uterine wall
Internal layer - sphincter-like fibers

Important postpartum minimizing hemorrhage

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5
Q

Uterus shape

A

spherical by 12 weeks

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6
Q

Uterus position in cavity

A

Displaces intestine laterally and superiorly

Ascends from pelvis then rotate to the right (dextrorotation) which is likely caused by rectosigmoid on left side

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7
Q

At term uteroplacental blood flow

A

450-650 ml

Ave 550ml/min

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8
Q

There is increased venous caliber and distensibility of uterine blood vessels due to

A

Remodelling from reduced elastin content and adreneglrgic nerve density

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9
Q

With advancing gestational age, uteroplacental blood flow is regulated by vasodilation by

A

estrogen

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10
Q

Softening and cyanosis of cervix due to increased vascularity and edema
hypertrophy and hyperplasia of cervical glands

A

Goodell’s sign

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11
Q

Red and velvety cervix due to marked proliferation of columnar endocervical glands

Bleeds with minor trauma

A

Eversion

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12
Q

Labor ensues once bloody show occurs in

A

1-2 days

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13
Q

Arborization of crystals

A

Ferning - amniotic fluid leak

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14
Q

Endocervical gland hyperplasia and hypersecretory appearance induced by estrogen

A

Arias-stella reaction

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15
Q

Discoloration violet of vagina due to hyperemia secondary to increased vascularity

A

Chadwick’s sign

Inc in vaginal discharge: thick and white

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16
Q

vaginal pH

A

3.5-6.0

inc in lactic acid production by Lactobacillus acidophilus (Nitrazine test)

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17
Q

Pregnancy mask
Extreme form of pigmentation around the cheek, forehead and around the eyes
May be patchy or diffuse and disappears spontaneously after delivery

OCPs cause similar pigmentation

A

Chloasma gravidarum

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18
Q

Skin changes

A 
Striae gravidarum
Linea nigra
Spider angioma
Palmar erythema
Diastasis recti
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19
Q

Increase in basal metabolic rate

A

10-20%

20-30% in twin gestation

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20
Q

Energy demand/trimester

A

1st - 85
2nd - 285
3rd - 475

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21
Q

Total weight gain

A

27.5 (12.5 kg)

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22
Q

At term, the fetus, placent and AF contains how much fluid

A 
3.5 L
3 L (maternal blood volume)

Min amount of extra water: 6.5 L

Inc plasma osmolality by 10

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23
Q

Protein is regulated by

A

Placenta - protein synthesis, oxidation and transamination of NEAA

Higher nitrogen balance

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24
Q

Carbohydrates in pregnancy

A

Mild fasting hypoglycemia
Postprandial hyperglycemia
Hyperinsulinemia

Hyperplasia and hypertrophy of beta cells

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25
Switch in fuel from glucose to lipids
Accelerated starvation
26
GH-like hormone that increases lipolysis Inc in lipolysis -> inc FA -> inc tissue resistance to insulin Maternal hyperlipidemia - inc insulin resistance and estrogen stimulation Inc lipolytic activity and dec lipoprotein lipase activity in adipose tissue
Placental lactogen
27
Maternal blood volume inc to
45% near term Expands rapid during 2nd tri Inc in plasma and erythrocytes causing dilutionak anemia of pregnancy
28
Functions of pregnancy induced hypervolemia
Meet metabolic demands Abundance of nutrients and elements to support placenta and fetus Protect mother and fetus against deleterious effects of impaired venous return in supine and erect Safeguard mother against adverse effects of blood loss
29
Amount of iron needed in pregnancy
1000mg iron 300mg ferrous sulfate, twice if anemic
30
Blood cell changes
Leukocytosis Thrombocytopenia - below 25th percentile due to inc consumption and hemodilution Hypercoagulable, Thromboembolism Inc Fibrinogen (Factor 1) by 50% Inc F 8 Inc F 7,9,10 and 12 Shortened PT, PTT Dec FIBRINOLYTIC activity
31
Changes in CV system
Inc SV Inc HR by 10 bpm Inc CO Inc O2 consumption Dec SVR Dec SBP Dec DBP Dec MBP
32
Changes in ECG
Inc HR | 15 deg LAD
33
Changes in CXR
Heart larger Displaced, left, upward and rotated as a result apex is moved somewhat laterally from its usual position causing a larger silhouette
34
Cardiac sound
Exaggerated splitting of 1st heart sound with inc loudness Loud 3rd sound Soft and transiet murmurs 90% has systolic murmur during inspiration disappears shortly after delivery
35
Cardiac output
Inc due to dec in MAP dec in VR inc in BV and BMR CO is position dependent supine - diminished left lateral cubitus - inc by 20%
36
Dec in 10% CO in supine patients Significant arterial hypotension Uterine arterial pressure and blood flow is lower than brachial artery directly affecting fetal heart patterns Compression of inferior vena cava Dec venous return Dec CO output Lower BP
Supine hypotensive syndrome
37
No fall in blood pressure because of reflex vasoconstriction
Concealed caval compression In left lateral cubitus, fetal oxygenation is higher
38
Highest peak of CO | Inc plasma volume and heightened oxygen demand of fetus
28-32nd week
39
Periods of inc CO
28-32nd week Labor Immediately after delivery First week puerperum (6 weeks after childbirth)
40
Peripheral vascular resistance falls during pregnancy due to
Progesterone’s relaxing effect on smooth muscle Dec in PVR leads to fall in SBP during first 24 weeks
41
Venous blood pressure
Unchanges in UE Inc in LE especially supine sitting or standing returns to normal in lateral decubitus Occlusion of pelvic veins and IVC hence edema
42
PCWP | CVP
No change
43
Changes in respiratory tract
Diaphragm rises to 4cm Subcowtsl angle widens Transverse diameter of thoracic cage by 2cm Thoracic cirumference by 6cm
44
Pulmonary function
DEC FRC by 20-30% (Dec ERV by 15-20; Dec RV by 20) ``` Inc IC by 5-10 Inc/unchanged TLC by 5 RR unchanged Inc TV by 30-50 Inc RMV (inc respiratory drive from progesterone, low expiratory reserve volume and compensated respi alkalosis) ```
45
Maternal AV oxygen difference
Decreased amount of O2 delivered to lungs by inc TV exceeds O2 requirement Total oxygen carrying capacity increased due to inc total hemoglobin mass Inc CO
46
SOB is a complaint due to
Inc TV that lowers PCO2 Over breathing by progesterone acting centrally to lower threshold and inc senstivity of chemoreflex response to CO2 Shift to the left (Bohr) Offset by inc 2,3 DPG to the right (Haldane)
47
Urinary changes
Uterus rises above pelvis resting upon ureters laterally displacing and compressing them at pelvic brim Dilatation of collecting system because of progesterone and compression of ureter Physiologic hydroureter: R ureter is compressed more than left because Dextrorotation of uterus Sigmoid on left cushioning the ureter Greater kinking of ureter due to internal iliac within the pelvic brim Right ovarian complex passes obliquely over the ureter
48
Urinary physiologic changes
Inc renal plasma flow RPF Inc glomerular filtration rate by 50% expect glucosuria DEC serum creatinine and BUN Inc frequency of micturition
49
GI Tract
Pregnancy gingivitis - hyperemia and softened bleeding gums Appendix displaced laterally and upwards Dec tone and motility of GIT Pyrosis (heart burn), dec LES Hemorrhoids
50
Focal, highly vascular swelling of gums | Pyogenic granuloma that occasionally develops but regresses spontaenously after delivery
Epulis gravidarum
51
Impaired GB contraction High residual volume inhibition of CKK by
Progesterone Inc bile cholesterol saturation -> inc stones for multiparous
52
Pituitary gland inc in size by
135% GH - same as nonpregnant -at 17 weeks, placenta (synciotrophoblast)primary source differs by 13 AA
53
Major determinant of maternal insulin resistance in mid pregnancy
GH by synciotrophoblast
54
Inc by 10 fold (150) Estrogen stimulation TRH Serotonin
Prolactin
55
Ensures lactation of delivery by acting to initiate DNA synthesis and mitosis of glandular epithelial cells and presecretory alveolar cells of the breast Inc estrogen and prolactin receptors Promotes mammary gland galactopoiesis and production of casein, lipids and lactose
Prolactin
56
Prolactin is produced in amniotic fluid (10,000) at 20-26 weeks by Prevents fetal dehydration by impairing water transfer from fetus to maternal compartment
Uterine decidua
57
Thyroid gland changes
Euthyroid Enlarges by hyperplasia and vascularity Inc production of thyroid hormones 40-100% Does not cause thyromegaly
58
Early trimester thyroid changes
TBG inc and peaks to 20 weeks FT4 rise slightly and peak with HCG returns to normal Total serum T4 inc and peaks up to 18 weeks TRH does not inc but crosses placenta to stimulate pituitary to secrete TSH TSH and HCG similar alpha components Elevated HCG affects alpha of TSH manifested as thyroid storm in H moles
59
Musculoskeletal changes
Inc mobility of SI, SC, pubic joints Relaxation of pubic symphysis >1 cm Regresses and resolves 3-5 months postpartum
60
CNS Changes
Memory decline 3rd trimester (attention, concentration, memory) Sleep - difficulty 12 weeks to first 2 months

Obstetrics and Gynecology (18 decks)

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