Week 8.1 - Maternal problems in Pregnancy Flashcards Preview

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Flashcards in Week 8.1 - Maternal problems in Pregnancy Deck (37)

Describe the cardiovascular changes which occur in pregnancy

-Blood Volume increases (upto 50%) therefore CO, SV and HR all increase


What happens to BP during pregnancy?

-Decreases in T1/T2 normal in T3 (systolic never increases)


What effects will pregnancy have on preload and afterload and why?

-Preload will increase as CO is increased, increased vol of blood returning to heart
-Afterload should decrease if BP decreases as TPR will decrease


Why is hypotension experiences in T1 and T2?

-Progesterone causes relaxation of smooth muscle in BVs therefore decreasin TPR


What could be a potentially dangerous cause of hypotension in T3?

-Aortocaval compression by enlarged uterus reducing venous return to the heart


Name one possible outcome of the bvs not vasodilating during pregnancy

-Pre-eclapsia -> uncontrolled hypertension with endothelial dysfunction


What changes occur in the urinary system during pregnancy?

-Glomerular filtration rate increases thus renal plasma flow increases and functional renal reserve decreases


What causes the increase in GFR during pregnancy?



What happens to creatinine clearance during pregnancy? Why?

-Because GFR has increased


What happens to urea excretion during pregnancy? Why?

-Because GFR increases


\Why is it important to know the normal for pregnancy range of creatinine and urea?

-May look like they are in the normal range when they are in fact high for pregnancy as more urea and creatinine should be excreted, therefore there may be a problem with the kidneys


What is the range of creatinine clearance during pregnancy?



What is the approximate value of urea during pregnancy?



Why is it significant that bicarbonate decreases during pregnancy?

-Reduced buffering capacity of the kidney


What is a potential problem which progesterone can place on the urinary system?

-Increasing GFR so much that hydroureter develops


Name a common cause of urianry stasis during pregnancy?

-Obstruction of ureter by gravid uterus


Why are UTIs concering during pregnancy?

-Possible to develop to pyelonephritis and cause pre-term labour


Name the anatomical changes which occur within the respiratory system during pregnancy

-Diaphragm displaced
-AP and transverse diameters of the thorax increase


Name the physiological changes which occur in the respiratory system during pregnancy

-Physiological hyperventilation due to increased CO2 production and increased respiratory drive effect of progesterone


How is physiological hyperventilation of pregnancy compensated for?

-Increased bicarb excretion to compensate for the respiratory alkalosis


What are the changes in the capacities of the lungs during pregnancy?

-Reduced functional residual capacity but total lung capacity remains unchanged
-Increased TV with RR unchanged


What happens to O2 consumption during pregnancy?

-Increases by 20%


Why is vital capacity unchanged during pregnancy?

although TV increases ERV volume decreases so VC remains unchanged


What happens to carboydrate metabolism during pregnancy?

-Increased peripheral resistance to insulin by hPL and the body switched to gluconeogenesis and alternative fuels to spare glucose for fetus
-Decreased fasting blood glucose
-Increased post-prandial blood glucose


List some risk factors for gestational diabetes

-advancing age


What is gestational diabetes?

-Increased blood glucose during T3 due to improper insulin response which doesnt persist post partrum


What is the outcome on the fetus of poor control of gestational diabeted?

-Macrosomic fetus, still birth, congenital defects


What happens to lipid metabolism during pregnancy?

-Increased lipolysis for T2
-Increased plasma free fatty acids on fasting to spare glucose for fetus


Why is pregnancy associated with a risk of ketoacidosis?

-If there is inappropriate lipolysis excess FA can get converted to ketones


What happens to thyroid metabolism in pregnancy?

-Thyroid binding globulin, T3 and T4 increase so free T4 in normal range
-Decreased TSH due to the effects of hCG


Describe the anatomical changes to the GI tract during pregnancy

-Alterations in the disposition of the viscera eg appendix moves to RUQ as uterus enlarges


Describe the physiological changes which occur in the GI tract during pregnancy

-Smooth muscle relaxation by progesterone -> delayed emptying -> constipation
-Biliary tract stasis
-Increased risk of pancreatitis


Describe the haematological changes which occur during pregnancy

-Prothrombotic state with increased fibrin deposition at implatation site and increased fibrinogen and clotting factors in blood.
-Reduced fibrinolysis and changes in vascular flow due to venodilation


Why cant you give warfarin in thromboembolic disease of pregnancy?

-Warfarin can cross the placenta and is teratogenic


What causes anaemia during pregnancy?

-Plasma volume increases more than red cell mass -> physiological anaemia
-Can also be due to Fe or folate deficiencies


Describe changes in the immune system during pregnancy

-Non-specific suppression of the local immune responses at the materno-fetal interface


Give 2 diseases which can occur due to transfer of antibodies across the placenta

-Haemolytic disease of the newborn
-Graves disease