Obs-Gyn-Lecs Flashcards by Jonah Little

Physiological changes during pregnancy

Increase in energy requirement in pregnancy? %

14%`

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Physiological changes during pregnancy

Metabolic increase in pregnancy? %

20%

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Physiological changes during pregnancy

Mean weight increase?

12.5kg increase

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Physiological changes during pregnancy

What happens with regards to insulin in early pregnancy? What happens in mid-pregnancy?

-Initial sensitivity to insulin→↑glycogen synthesis, ↑fat deposition and ↑amino acid transfer into cells

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Physiological changes during pregnancy

-After mid-pregnancy resistance of insulin develops:

→↑plasma glucose concentrations (maintained between 4.5-5.5mmol/L)

→↑serum lipids (can be used by the mother as an alternative fuel source)

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Physiological changes during pregnancy

Basal metabolic rate increases in pregnancy, true or false?

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Physiological changes during pregnancy

How much more protein/calories/folic acid per day does the pregnant woman need?

30g/300kcal/200ug

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Physiological changes during pregnancy

What is Dextro-rotation?

Uterus is tilted and twisted to the right in 80% of cases

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Physiological changes during pregnancy

What does left uterine displacement aid? 30* tilt

LUD helps venous return. C/S as part of resuscitation
LUD decreases chance of DVT
LUD increases O2 delivery to fetus:
Increases uterine artery pressure and decreases uterine venous pressure

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Physiological changes during pregnancy

What happens to the pelvic ligaments?

relaxation of the ligaments
relaxation of the pelvic joints
the pelvis become more mobile and ↑ in capacity

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Physiological changes during pregnancy

What changes occur to the breast?

Increased size and vascularity
Warm, tense and tender

↑ pigmentation of the nipple and areola

Secondary areola appear
(light pigmentation around the 1ry areola)

Montgomery tubercules appear on the areola (dilated sebaceous glands)

Colostrum like fluid is expressed at the end of the 3rd month

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Physiological changes during pregnancy

What are striae gravidarum?

stretch of the abdominal wall, rupture of the subcutaneous elastic fibers

Pink lines in flanks
- become white after labour

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Physiological changes during pregnancy

What are Striae distensae?

atrophic purplish bands on the medial aspect of the thigh

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Physiological changes during pregnancy

What is linea nigra?

pigmentation of the Linea Alba,

More marked below the umbilicus

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Physiological changes during pregnancy

What is Chloasma Gravidarum?

Butterfly pigmentation of the face (mask of pregnancy)

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Physiological changes during pregnancy

What changes occur with the kidney?

Kidneys
Increase in size
Hydronephrosis
Effective renal plasma flow is increased

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Physiological changes during pregnancy

What changes occur with the ureters?

Dilatation of the ureters
Atony of the ureteric muscle
Hydro-ureter
Caused by progesterone and relaxin

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Physiological changes during pregnancy

Is glycosuria normal in pregnancy?

↑GFR →more sugar reaching the tubules than can be reabsorbed

Glycosuria of a mild degree occurs in 35-50% of all pregnancies

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Physiological changes during pregnancy

Bowel changes in pregnancy?

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Decreased lower oesophageal sphincter pressure

Decreased gastric peristalsis

Delayed gastric emptying

Increased small and large bowel transit times

Decreased gastric acidity

Constipation

Physiological changes during pregnancy

What is Emesis gravidarum?

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Morning sickness
Occurs in 50%
Hyper-emesis gravidarum = Woman becomes ketotic due to dec intake fluids

Physiological changes during pregnancy

Why are preg women at increased risk of aspiration under general anaesthetic?

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Gastric emptying is delayed, increasing the risk of aspiration during anaesthesia.

Physiological changes during pregnancy
How much does cardiac output increase by, by the 3rd trimester?
What about HR?

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Cardiac output increases by up to 50% by the third trimester.
Heart rate increases by 15 – 25% as a result.

Physiological changes during pregnancy

What may you see on an ECG of a pregnant woman?

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Left ventricular hypertrophy and dilatation facilitate this change in cardiac output but contractility remains unchanged.

Together with the upward displacement of the diaphragm, the apex is moved anterior and to the left.

These changes may result in ECG findings of left axis deviation, depressed ST segments and inversion or flattening of the T-wave in lead III

Physiological changes during pregnancy

What normal change can be auscultated on a pregnant woman?

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3rd HS
Systolic ejection murmer from hyperkinetic flow
Usually resolve 2 weeks post-partum

Physiological changes during pregnancy | Normal physiological cardiac symptoms in the pregnant woman?

``` Fatigue Orthopnoea Palpitations Syncope Dyspnoea - 75% woman @ week 34 ```

Physiological changes during pregnancy | What CxR changes can be seen in pregnancy?

Straightening of left upper cardiac border Horizontal positioning of heart Increased lung markings Small pleural effusions early post partum

Physiological changes during pregnancy | Mitral/aortic regurg are well tolerated in pregnancy, wheras mitral/aortic stenosis are not, T/F?

Physiological changes during pregnancy | What changes in respiratory are seen in pregnancy?

Tidal volume rises by 30% in early pregnancy 40-50% by term -> driven by progesterone Fall in expiratory reserve and residual volume decrease the threshold increase the sensitivity of medulla oblongata to CO2 Elevation of the diaphragm in late pregnancy = Dyspnea RR doesnt change

Physiological changes during pregnancy | How does the fetus maintain oxygenation, despite a lower RV in the pregnant woman?

Rightward shift of the maternal oxyhaemoglobin dissociation curve (due to an increase in 2,3-DPG in erythrocytes) oxygen unloading to the fetus which has: - lower PCO2 (25-30 mmHg, 3.3-4 KPa) - marked leftward shift of the oxyhaemoglobin dissociation curve, (due to lower sensitivity of fetal haemoglobin to 2,3-DPG)

Physiological changes during pregnancy | What changes are seen to the ABG in a pregnant woman at term?

NORMAL RESP ALKALOSIS | Dec Bicarb as a result, inc pH

Physiological changes during pregnancy Erythropoietin rises especially if iron supplement not taken Human placental lactogen may stimulate haematopoiesis ↓ in packed cell volume from 36% in early pregnancy to 32% in the 3rd trimester ( normal plasma volume expansion) WBC count ↑ ( increase in polymorphonuclear leucocytes) Neutrophil number rises with oestrogen peak at 33 weeks stabilizing after that until labour and the puerperium, when they rise sharply True or false?

True

Physiological changes during pregnancy Circulating red cell mass ↑ by 20-30% (↑more in multiple pregnancies and iron supplement) Serum iron concentration ↓ absorption from gut + iron-binding capacity ↑ Plasma folate concentration halves by term (↑renal clearance) T/F?

Physiological changes during pregnancy | Why are Preg W more susceptible to viral infections?

T and B lymphocyte counts do not change but their function is suppressed (women become more susceptible to viral infections, malaria and leprosy)

Physiological changes during pregnancy | What is Virchows triad?

Increased Coag Venous stasis Vascular Injury

Physiological changes during pregnancy Describe the effects of pregnancy on, clotting factors, fibrinogen, fibrinolytic activity, antithrombin/PS, and the LEFT ILIAC VEIN

↑ Concentration of factors VIII, IX, X ↑ Fibrinogen levels by up to 50% ↓ Fibrinolytic activity ↓ Antithrombin and protein S levels Left iliac vein is compressed by the left iliac artery and ovarian artery.

Physiological changes during pregnancy The anterior pituitary increases by up to 10% during pregnancy with marked hyperplasia of prolactin-secreting cells? T/F?

False | Increases by up to 70%

Physiological changes during pregnancy | Describe fold changes to prolactin in pregnancy?

Prolactin levels ↑ (x10) and ↓ to pre-pregnancy levels approx. 2 weeks postpartum

Physiological changes during pregnancy | Luteinising hormone and follicle-stimulating hormone are usually undetectable, why?

Luteinising hormone and follicle-stimulating hormone are usually undetectable because of negative feedback from prolactin and high levels of sex hormones.

Physiological changes during pregnancy | Describe changes to PT gland?

Parathyroid | ↑ in size and activity to regulate calcium metabolism

Physiological changes during pregnancy | Adrenal changes in pregnancy? cort/aldo

↑ in size and activity Total cortisol is↑ (free cortisol unchanged)-25mg/day Leads to ↑Blood sugar Modifies antibody activity Aldosterone- ↑ levels with ↑retention of sodium and water

Physiological changes during pregnancy | Effects of progesterone in pregnancy?

``` Dec colon activity/bladder and ureteric tone. Dec diastolic pressure Nausea, constipation Inc temp Venous dilation ```

Physiological changes during pregnancy | Where is oestriol produced?

Oestriol produced by the placenta and fetal adrenals

Physiological changes during pregnancy | What are the effects of oestrogens?

1- Induce growth of uterus and control its function 2- Responsible for the development of breasts ( with progesterone) 3- Alter chemical constitution of connective tissue, become more pliable 4- Cause water retention 5- Reduce sodium excretion

Physiological changes during pregnancy What produces HCG? When does it peak (week)?

Produced by the trophoblast and peak at 16 weeks gestation (thereafter fairly constant) Early maintenance of the Corpus Luteum

Physiological changes during pregnancy | Why should you be aware of a rising pulse in the pregnant woman?

The significant increase in blood volume during pregnancy means that a pregnant woman has to lose 30% of her circulatory volume before signs of hypovolaemia are apparent Beware of a rising pulse!

Obs-Gyn-Lecs Flashcards

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