WEEK 4 Flashcards

Question

How does metablosim change during pregnancy?

Answer 1

Changes in carbohydrate and lipid metabolism occur during pregnancy to ensure a continuous supply of nutrients to the growing fetus despite intermittent maternal food intake

Answer 2

▪ Early pregnancy - Low BSL’s – Normal glucose production, but exaggerated insulin response post meals – Changes to lipid metabolism to enhance maternal fat stores

Answer 3

▪ Late pregnancy - High BSL’s – High glucose production to meet increasing needs of placenta & fetus – Insulin doubled, but insulin resistance high due to increased levels of oestrogen, progesterone & HPL – Lipid metabolism changes due to HPL to promote fat burning as alternate energy source for mother – All serve to increase availability of glucose for fetal use

Answer 4

▪ Oestrogen – Levels rise exponentially after 24/40 – Increase insulin production & enhances peripheral glucose usage = lowers BSL – Increases plasma cortisol second trimester = increases BSL

Answer 5

``` ▪ Progesterone – Levels rise exponentially after 32/40 – Increase insulin resistance – Exaggerated insulin release after meals – Net result is increased BSL ```

Answer 6

▪ Cortisol – Depletes hepatic glycogen stores & increases hepatic glucose production = increased BSL

Answer 7

▪ Human Placental Lactogen (aka hCS) – Correlates with fetal & placental weight so highest levels as pregnancy progresses but drops off from 37/40 – Big placenta (large baby/twins) = more HPL produced – Increases insulin resistance (antagonist), decreases insulin production = increased BSL’s • Glucose sparing mechanism • More glucose enabled for placenta – Increases synthesis & availability of lipids (instead of CHO) • Used as alternate maternal fuel (keeps glucose for baby)

Answer 8

▪ Rotates up and to the left ≈ 1-1.5cm as uterus enlarges and causes diaphragm to elevate ▪ Apex located at the 4th not the 5th I/C space ▪ Left axis shift on ECG ▪ ECG changes in lead 3 – – Q wave & – inverted T wave

Answer 9

▪ Resting heart rate may increase by 10-15 bpm ▪ Systolic murmurs may be heard – gentle, soft & usually heard best in the pulmonic area and apex ▪ Plasma volume ↑ 50% ▪ RBC volume ↑ 18-20% by 30-34 weeks gestation

Answer 10

▪ ↑ 35-50% in CO plateaus @ 24/40 ▪ Heart volume increases from 70ml → 80ml ▪ Due to ↑ stroke volume & ↑heart rate ▪ Blood flow to: – kidneys, brain & coronary arteries no change – Uterus ↑’s 3%-17% from 1st to 3rd trimester – Breast 1%-2% - early pregnancy to term

Answer 11

▪ Blood Volume increases 30%-50% – Protects mum & baby; – meets foetal needs – Assists perfusion & demands of other organs – Safeguards against blood loss @ delivery ▪ Red cell mass increases 18-20% ▪ Produces haemodilution – Leads to Physiological aneamia • Decreased plasma proteins –Decreased oncotic pressure

Answer 12

``` ▪ Arterial BP decreases due to: – decreased Peripheral & Pulmonary Vascular resistance • Lowest in 2nd trimester –nearly normal by term • Progesterone peaks by 32-34/40 ▪ Diastolic ↓’s in 1st trimester – ↓’s 10-15mmHg by 24/40 ▪ Systolic generally unchanged – ↓’s maximum of 5-10mmHg ▪ Pre-pregnant values return in 3rd trimester ```

Answer 13

– Preeclampsia • Eclampsia • HELLP syndrome – Non- proteinuric pregnancy induced hypertension (Gestational HTN) – Chronic hypertension

Answer 14

Chronic Hypertension ▪Hypertension prior to pregnancy or ▪↑ BP >140/90 Hg < 20 weeks & ▪Persists up to 6 weeks post natal

Answer 15

``` oRenal disease oDiabetes oObesity oAge >40 oHTN on the OCP ```

Answer 16

Gestational Hypertension ▪ Hypertension >140/90 on > 2 occasions ▪ No other signs of pre-eclampsia ▪ Occurs >20 weeks

Answer 17

``` o Primiparity/first child with new partner o Obesity o Diabetes o Previous severe pre-eclampsia o Pre-existing cardiovascular disease o Age >40 ```

Answer 18

WHat classifies gestational hypertension in pregnancy? - renal involvement - haematological involvement - liver involvement - neurological involvement

Answer 19

•Significant proteinuria – a spot urine protein/creatinine ratio ≥ 30mg/mmol •Serum or plasma creatinine > 90 μmol/L •Oliguria: <80mL/4 hour

Answer 20

▪Thrombocytopenia ▪Haemolysis ▪DIC

Answer 21

* Abnormal LFTs | * Severe epigastric / RUQ pain

Answer 22

* Convulsions (Eclampsia) * Hypereflexia * New headache * Visual distrubances * Stroke

Answer 23

hypertension of at least 140/90 recorded on at least 2 seperate occasions and at least 300mg of protein in a 24 hor collection of urine, arising after the 20th week of pregnancy in a previously normotensive woman and resolving completely by the 6th postpartum week.

Answer 24

DBP 90-99 | SBP 140-149

Answer 25

DBP 100-109 | SBP 150-159

Answer 26

DBP >110 | SBP >160

Answer 27

– H/T with endothelial cell damage affects capillary permeability – Plasma proteins leak → ↓ plasma colloid pressure → oedema – → hypo-volaemia & haemo-concentration

Answer 28

Coagulation system – Altered coagulation cascade – ↑ platelet consumption → thrombocytopenia • DIC → occludes kidneys; brain, liver & placenta

Answer 29

``` – H/T → vasospasm of afferent arterioles – ↓ blood flow • → hypoxia & oedema of glomerulus allows plasma proteins to filter into urine – Oliguria a late sign ```

Answer 30

– H/T with CVS endothelial damage → • ↑blood-brain permeability → oedema & micro-haemorrhaging – Headaches & convulsions

Answer 31

– Vasoconstriction → hypoxia & oedema – Epigastric pain & intracapsular haemorrhage – ↓Albumin & ↑ liver enzymes

Answer 32

– Vasoconstriction ↓ blood flow – Vascular lesions can occur → abruptio – Hypoxia → ↓ foetal growth

Answer 33

``` ▪ BP sharp rise >140/90 in – 2 nd half of pregnancy ▪ Proteinuria – Complains of ↓ output ▪ Oedema – Sudden severe • widespread – Non-dependent areas e.g. face ▪ Hyper-reflexia ```

Answer 34

``` ▪ Complaints of other symptoms – Frontal/occipital headache; blurred vision; epigastric pain; headache; Visual disturbances; Drowsiness/confusion; Nausea & vomiting; Epigastric pain ▪ May indicate disease is deteriorating ```

Answer 35

``` ▪ Eclampsia ▪ APH Placental abruption ▪ HELLP syndrome – Haemolysis, Elevated Liver enzymes, Low Platelets • Haemtological disturbances ▪ Blindness ▪ Intra uterine hypoxia – LBW infant; FDIU; Prem. Delivery ```

Answer 36

``` ▪ Considered a variant / complication of preeclampsia Stands for: ▪ Haemolysis ▪ Elevated ▪ Liver enzymes ▪ Low ▪ Platelets ```

Answer 37

* Known pre-eclampsia * Multiparity * Previous Hx of HELLP

Answer 38

New onset of convulsions in pregnancy | – May occur independent of pre-eclampsia

Answer 39

– Premonitory → Transient & quick • Roll eyes; muscles twitch – Tonic → 30secs. • Violent spasm; Resps. cease → cyanosis – Clonic → last up to 2 mins • Jerky muscular movements; frothy blood stained saliva; stertuous breathing – Comatose → lasts few minutes to hours • Deeply unconscious

Answer 40

``` ▪ Continue to assess for deterioration – Sharp rise in BP –  Proteinuria →  Urine Output – Frontal or occipital headache – Drowsiness or confusion – Visual disurbances – Nausea & vomiting; Epigastric pain – PV Bleeding → Abruption ```

Answer 41

``` ▪ Haemolysis ▪ Elevated ▪ Liver enzymes ▪ Low ▪ Platelets ```

WEEK 4 Flashcards

(67 cards)