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Repro. Med 3 > Obstetric Physiology > Flashcards

Obstetric Physiology Flashcards

1
Q

Most of the physiology changes that occur in early pregnancy are (hormonal/physical)

A

hormonal

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2
Q

What hormones are involved in the hormonal changes that occur in early pregnancy?

A 
Progesterone
Estrogen
Renin / aldosterone
Cortisol
Insulin
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3
Q

Most physiologic and anatomic changes are designed to optimize conditions for fetus and prepare for delivery. Especially geared toward the delivery of ____ and _____

A

oxygen

nutrients

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4
Q

How do you calculate the Expected Date of Delivery (EDD)

A
  • take the date of the last menstrual period
  • add 7 days to that date
  • count back 3 months
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5
Q

___ is the first part of pregnancy to develop

A

placenta

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6
Q

The placenta weighs ~ ___ at birth

A

1 lb

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7
Q

The placenta is specialized for ____ and ____ ____ and keeps the fetus from being recognized as ____ by the maternal immune system

A

oxygen and nutrient delivery

“non-self”

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8
Q

The endometrium’s blood supply comes from the ______.

With each new luteal phase, new ____ are created, which supply blood to the endometrium.

A

Basal Arteries

Spiral Arteries

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9
Q

With each period, ____ are lost and the basalis makes new ones for the next cycle.

What happens to the spiral arteries when a pregnancy implants?

A

spiral arteries

the spiral arteries remain

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10
Q

___ % of each heartbeat goes to the placenta

A

20%

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11
Q

Once pregnancy is established, the spiral arterioles expand and become confluent, forming ____ for maternal blood flow to encounter the fetal umbilical capillaries.

A

pockets

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12
Q

The placental barrier allows for (Passive/Active) transport of certain materials.

A

Passive

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13
Q

___ cannot cross the placenta, but ___ can!

A

Large proteins

IgG (maternal immunity)

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14
Q

By the 3rd trimester, the placenta receives ___% of the cardiac output.

A

20-25% (750 ml/min)

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15
Q

T/F: The blood supply to the placenta is susceptible to vasoactive medications

A

F: they are refractory to vasoactive meds

***This is why a woman can bleed out so rapidly w/ placenta abruption

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16
Q

The placenta uses (More/As much/Less) O2 as the fetus because of its significant metabolic activity

A

As much

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17
Q

What hormones does the placenta make?

A 
HCG
progesterone
estrogen
placental lactogen
parathyroid hormone RP
Realxin 
corticotropin releasing hormone
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18
Q

What does progesterone do?

What are some “side effects” of progesterone?

A

Maintains uterine lining, inhibits uterine contraction

Slows things down (constipation)

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19
Q

What does estrogen do?

A

Maintain uterine lining

Stimulate mammary glands

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20
Q

What does placental lactogen do?

What are some “side effects”?

A

Stimulate mammary glands
Supplies energy to fetus

Mimics growth hormone; promotes maternal insulin resistance; elevates glucose levels

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21
Q

What does the parathyroid hormone RP do?

A

Increase Ca++

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22
Q

What does relaxin do?

What are some “side effect”?

A

soften cervix
weakens pubic symphysis

Pelvic discomfort and double-jointedness

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23
Q

What does corticotropin releasing hormones do?

What are some “side effects”?

A

Increase HR, BP, blood glucose
Stimulates partition

Acts like glucagon; increases POMC

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24
Q

Placenta produces CRH –> What pituitary hormone is this promoting?

A

ACTH

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25
Q

What is the result of the high levels or ACTH and cortisol levels?

A

Skin pigment changes

  • linea nigra
  • melasma
  • *can be permanent
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26
Q

During pregnancy, there is (increased/decreased) tone / vaso-relaxation.

___ decreases by 20% due to the low resistance of the placenta

What can the the result of this change?

A

Decreased
SVR

Positional effects from Vena cava compression (dizziness)

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27
Q

In pregnancy blood volume increases ____-____%
RBC mass increases ___-___%

What can these changes mimic?

A

50-100%
25-40%

Anemia
Relative anemia (physiologic, dilutional)
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28
Q

Changes in cardiac function occur are early as ____ weeks gestation, before many pts are even aware that they are pregnant

A

8 wks

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29
Q

What happens to the location of the cardiac axis during pregnancy?

A

Displaced cephalad

Left axis deviation

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30
Q

Murmurs are present in > __%, which is usually due to increased ____
**Virtually all valves can be involved, especially aortic and pulmonary

A

96%

blood volume

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31
Q

What happens to HR during pregnancy?

A

Increases

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32
Q

There is a ___% increase in ventricular distention

A

25%

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33
Q

What are some alarming EKG changes that can occur during pregnancy?

A

Non-specific ST and T changes

Dysrrhythmias (hypokalemia)

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34
Q

T/F: LVH and mild pericardial effusion are common during pregnancy

A

T

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35
Q

During what trimester does BP decrease?

When can you expect it to original level?

A

2nd

End of pregnancy

36
Q

____ d/o are common in pregnancy. When does this usually begin?

A

hypertensive

end of pregnancy (pre-eclampsia)

37
Q 
***FYI***
S/S that are normal during pregnancy that mimic heart dz 
Clinically?
Sx?
Auscultation?
A

Clinical Signs: Peripheral edema, JVD

Sx: Reduced exercise tolerance, Dyspnea

Auscultation: S3 gallop, Systolic ejection murmur

**others noted in previous cards

38
Q 
During pregnancy, increase or decrease?
CO \_\_\_\_
MAP \_\_\_\_
SVR \_\_\_\_\_
PVR \_\_\_\_
HR \_\_\_\_\_\_
A 
CO +  (43%)
MAP -  (10%) 
SVR -   (21%) 
PVR -   (34%) 
HR +  (17%)
39
Q

There is a __-___% increase in SVR during labor

A

10-25%

40
Q

“____” is 300-500cc can occur during labor because of the decrease in vascular resistance

What do you worry about in pts w/ heart dz?

A

Autotransfusion
- from blood being squeezed into central circulation during contractions

cardiac overload

41
Q

What happens to CO as labor progresses?

A

It increases

42
Q

The uterine position extends to the ___ at 12 weeks

A

Pelvis

43
Q

The uterine position extends to the ____ at 20 weeks

A

Umbilicus

44
Q

What can the enlarging uterus cause in the:
Bladder ____
Ureter ____
SI joint and Pubic symphysis ____

A

Bladder– frequency
Ureter– hydroureter
SI joint, Pubic symphysis– pain

45
Q

Progesterone stimulates ____, which is also made by the placenta

A

Renin

46
Q

What is the result of increased renin production?

A

Increased absorption of Na+
Increased excretion of K+
Water retention: 6-8 liters

47
Q

What is the result of the increase of blood volume during pregnancy on renal workload? What happens to GFR? What can these changes lead to?

A

50-75% increase in renal workload

GFR: 50% increase

Dilution of plasma proteins like albumin = lower colloid oncotic pressure
- leads to peripheral edema

48
Q

What are the urinary tract changes that occur during pregnancy?

A

Ureteral dilation / hydroureter
Dilation of renal pelvices and calyces
Increased kidney size

49
Q

Ureteral dilation is caused by:

  1. _____ causes smooth muscle relaxation– including the peristaltic muscles of the ureter.
  2. Later, uterine obstruction exacerbates the slowdown- especially on the (right/left)
  3. Urinary stasis increases ____ and risk of ____ that can ascend more easily.
A
  1. Progesterone
  2. Right
  3. ureteral dilation; bladder infection
50
Q

Due to the ureteral changes, ____ is much more common in pregnancy

A

pyelonephritis

51
Q

T/F: In general, respiratory rate and IRV (inspiratory reserve volume) do not change during pregnancy.

A

T

52
Q

What are respiratory adaptations that occur during pregnancy?

A

1 . Thorax (2 cm diameter, 5-7 circumference increase)

  1. Tidal Volume increases 30-40%
  2. FRC is reduced by ~20% because of smaller lung size at the end of respiration
  • less inspiration reserve volume
  • larger tidal volume
  • smaller residual volume
53
Q

During pregnancy the _____ increases by 2cm, and the ____ increases by 5-7cm

A

transverse diameter

circumference

54
Q

What are the pH changes due to respiratory adaptations in pregnancy?

A
  • More CO2 is exhaled/minute
  • pH rises slightly (7.44+)
  • ↑PaO2; ↓PaCO2 (40 – 30)
55
Q

What are GI changes that occur during pregnancy?

A
  • Slowed GI motility
  • Relaxation of LES (GERD)
  • Nausea / vomiting
  • Liver / gallbladder (stasis, stones)
  • ↑ liver production of coagulations
    factors (clotting tendencies)
  • ↑ binding proteins
56
Q

N/V in pregnancy are often proportional to ___ levels.

When is Hyperemesis gravidarum (HEG) worst/most common? (in weeks, why?)

A

HCG

weeks 9-12 (when hCG is highest)

57
Q

Other than hCG, what else may contribute to N/V of pregnancy?

A

Estriol

Leptin

58
Q

____ can mimic TSH, which increases T3/T4 and can also contribute to N

A

HCG

59
Q

How can you tx Hyperemesis gravidarum (HEG)?

A 
1st: conservative tx
IV hydration 
Phenegran, zofran 
GI motility durgs (reglan) 
Unisom _ B6
60
Q

If a woman presents w/ Hyperemesis gravidarum (HEG), what may you want to check for?

A 
Multiple gestation (HCG can be higher) 
Thyroid assessment to r/o Graves
61
Q

What are some orthopedic adaptations that occur during pregnancy?

A

Altered center of gravity
Altered gait
Joint laxity

62
Q

What are some skin changes that can occur during pregnancy? (x6)

A
  • Spider angiomata and palmar erythema
  • Hair growth (abdomen and face)
  • Mucosal hyperemia
  • Striae gravidarum
  • Hyperpigmentation
  • Rashes and acne relatively common
63
Q

What endocrine changes occur in the pancreas?

A

Carbohydrate metabolism
Insulin resistance
Human placental lactogen, cortisol

64
Q

What endocrine changes occur due to thyroid function?

A

Increased TIBG (via liver)

Increased total T4 and T3

  • free levels unchanged
  • HCG suppresses TSH
65
Q

What endocrine changes occur due to adrenal function?

A

Free plasma cortisol is elevated

- CRH from placenta stimulates ACTH

66
Q

Maternal glucose can cross the placenta to the baby, but insulin cannot. So how does this baby metabolize the glucose?

A

They make their own insulin

67
Q

Where will the baby store glucose? In what form is the glucose stored?

A

Stored as glycogen in the:

  • trunk
  • shoulders
  • liver
68
Q

Diabetic mothers are at high risk of what complication during delivery?

A

Shoulder dystocia

***requires C-section

69
Q

Fetal wt = lbs
4000 g = ___ lbs
4500 g = ___ lbs
5000 g = ___ lbs

A

4000 g = roughly 9 lbs
4500 g = roughly 10 lbs
5000 g = roughly 11 lbs

70
Q

What are fetal complications that occur due to maternal diabetes?

A

Macrosomia
Hyperbilirubinemia
Birth injury from shoulder dystocia

71
Q

Who should be screened for Gestational DM?

When should this screen occur?

A

ALL pregnant pts

24-28 weeks

72
Q

Early gestational DM screening is required for who?

If early screen is normal, then when should it be repeated?

A

Pts w/ RF

  • prior GDM
  • impaired glucose metabolism
  • BMI > 30

Repeat at 24-28 weeks

73
Q

How is the GDM screening performed?

A

Check glucose after 50g sugar load

74
Q

If GDM screening is abnormal, what should you do?

A

Perform 3 hr GTT w/ a 100g sugar load
or
FBS and 2 hour glucose test

**if FBS is elevated, criteria for GDM is met

75
Q

What happens to the immune system during pregnancy?

A

It is turned DOWN

  • *autoimmune dzs are alleviated during the pregnancy :)
  • *make sure immunizations are UTD
76
Q

What are pregnant women more susceptible to?

A

CMV
HSV
Varicella
Malaria

77
Q

What is the TORCH titer?

A 
T = Toxoplasmosis, Hepatitis B, Syphilis, Varicella 
O = Other
R = Rubella, Rubeola
C = CMV
H = Herpes simplex
78
Q

What is the worry w/ TORCH infections? When are these infections the most detrimental?

A

birth defects
stillbirth
worse in 1st trimester

79
Q

____ is transmitted to the mother through raw meat or exposure to infected cat’s feces

A

Toxoplasmosis
rare; toxoplasma gondii [protozoal infection]
Severity > in 1st trimeter

80
Q

_____ is a member of herpesvirus, worse in 1st trimester, infant may have life-threatening dz

A

Varicella

81
Q

____ has a 50% rate of malformation in the 1st trimester such as: Hearing loss, Deafness, Blindness, Heart/Neuro defects, Mental Retardation

A

Rubella

82
Q

___ is part of herpesvirus family.
Fetal Defects: mental retardation, hydrocephaly , microcephaly, blindness, deafness.
If 1st trimester infection occurs, may consider AB.

A

Cytomeglovirus

83
Q

___ can cause blindness, MR, death if primary case happens during pregnancy

A

HSV 1 or 2 [genital ]

84
Q

Perinatal HSV can cause ____ if contracted in birth canal during delivery
**Check for lesions prior to delivery

A

HSV encephalopathy

85
Q 
WHAT IS THE RISK to the infant? 
Varicella \_\_\_\_
CMV\_\_\_\_
HIV \_\_\_\_
Parvovirus B 19 \_\_\_\_
Syphilis- risk \_\_\_\_
Group B strep \_\_\_\_
A

Varicella: risk = neonatal/ perinatal encephalopathy and/or maternal pneumonia
CMV: risk = retinitis
HIV: risk = perinatal transmission
Parvovirus B 19: risk = fetal hydrops
Syphilis: risk = PTL, PTD, IUGR, perinatal transmission, fetal hydrops/ HSM, and more
Group B strep: risk = GBS pneumonia, sepsis

86
Q

What can cross the placenta to the baby? To the mother?

A

To the baby: O2, water, electrolytes, nutrients, hormones, antibodies, drugs, viruses

To the mother: CO2, water and urea, waste products, hormones

Repro. Med 3 (14 decks)

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