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26 Cards in this Set
- Front
- Back
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What general changes occur in the uterus during pregnancy?
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Weight (15x)
Cavity Volume (500x) Uterine Blood flow (10-14x) 0.8-->7% total cardiac output! Dextro-rotates (to the right) |
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What general changes occur in the vagina during pregnancy?
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Thickened secretions
Acidic pH Fungal infections Vaginal dryness Inc'd vascularity, inc'd capillary pressure from uterus obstructing venous return (leads to hemorrhoids, varicosities, vulvar edema), bluish hue to mucosa |
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How long is a term pregnancy?
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37-42 weeks
or 280 days (40 weeks from last menstrual period) |
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When does the cervix become responsible for maintaining pregnancy?
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During second trimester. If incompetent internal os, then baby will slip out!
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What maternal CV changes occur during pregnancy?
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Diaphragm is displaced superiorly (along with GI contents)
Results in left axis deviation of heart (apex in 4th rather than 5th intercostal space) Increase in intravasc volume (increased EDV) Increase in cardiac work-->myocardial hypertrophy CARDIAC OUTPUT INCREASES 30-35% Systemic and pulm vasc resistance decrease Pulse increases by 15bpm |
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Why does cardiac output increase during pregnancy?
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1)Low resistance, high flow A-V fistula (shunt)
High flow through shunt Dec'd peripheral resistance Inc'd plasma volume Inc'd peripheral circulation 2)Heat gradient from mother to fetus 3)High PG concentrations Hyperpolarizes cell membrane; greater levels of stimuln reqd to produce depol and muscle contraction |
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What are the possible complications of a large uterus during pregnancy?
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IVC Compression (decreased venous return and supine hypotn, may lead to uterine hypoperfusion)
Venous pressure and lower extremity stasis (varicosities, hemorrhoids, edema; DVT/PULMONARY EMBOLUS!) |
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What is the effect of pregnancy on blood pressure? Why?
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Despite large increase in CO, there's a DECLINE in BP because of decrease in SVR due to PGs, NO, Progesterone
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Maternal CO is at its maximum during the _________.
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Postpartum period (10-30 minutes after delivery)
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Why do pregnant women exhibit mild dyspnea and orthopnea?
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Diaphragm is displaced superiorly!
Orthopnea = dyspnea while lying down (need to sleep on many pillows) |
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What EKG changes occur in pregnancy?
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Left axis deviation, altered QRS (depressed) and ST
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Why do 90% of pregnant women exhibit a third heart sound?
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Rapid diastolic filling
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What hematologic/clotting changes occur in pregnancy? How?
Explain anemia in pregnancy. |
RBC mass increases depending on Fe stores (need Fe supplements!)
Hg and Hct fall due to plasma volume increase (increases more than RBCs increase)--normal physiological anemia Why? 1)Estrogen effects on liver: Inc'd Fibrinogen, Factors VII, VIII, X Decreases: ATIII, Prot S/C 2)Inc'd erythropoietin |
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Why is pregnancy considered a hypercoaguable state?
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1) Estrogen stimulates hepatic clotting factor synthesis (fibrinogen, factors VII, VIII, X)
ATIII, Prot S/C decrease 2 ) Venous stasis! |
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What are the pulmonary effects of pregnancy?
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Decreased expiratory reserve volume
Decreased residual lung volume Decreased pulmonary diffusion capacity Despite these restrictive effects, increased ventilation is required, thus, oxygen requirements increase 15% But RR doesn't change! Tidal volume increases (amount you inhale)! Tracheobronchial resistance decreases |
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What is the effect of pregnancy on the pituitary? What are hormone levels like?
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Increased size and vascularity of pituitary
HGH, FSH, LH low because of E/PG inhibition TSH unchanged, responsive to TRH PL increases 10X by term |
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What is the effect of pregnancy on the thyroid? What are hormone levels like?
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Increased size, vascularity
TBG doubles, gets even higher by term Total T4 increases but free thyroxine unchanged |
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What is the effect of pregnancy on adrenal secretions?
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Serum cortisol increases 2-3x
Diurnal variation maintained Free cortisol increases only slightly Aldosterone increases (compensates for natriuretic effect of progesterone) |
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When does weight gain occur (significantly) during pregnancy?
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Third Trimester (due to fetus)
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What is the effect of pregnancy on metabolism?
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BMR increases; 2/3 of increase due to fetal/placental metabolic work
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What nutrients can cross the placenta?
Which does the fetus use almost exclusively? |
Fetus uses glucose almost exclusively as its metabolic fuel
AAs and ketones also diffuse freely across placenta |
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What is the effect of pregnancy on insulin levels? Why is this necessary?
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Increased insulin levels because higher [insulin] is required to dispose of glucose (facilitates glucose transport from maternal to fetal side)
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Why is insulin resistance necessary in pregnancy?
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Physiologic adaptation to direct glucose and AAs to fetus
Placental estrogens encourage platelet cell hyperplasia to keep up w/inc'd insulin demand Placental lactogen is prime anti-insulin hormone |
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How does gestational diabetes arise? Effect on fetus/neonate?
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Islet cells can't produce enough insulin to keep up with insulin
Leads to maternal hyperglycemia; causes high glucose levels in fetus. Causes fetal macrosomia (inc'd birth rate/pancreas) resulting in neonatal hypoglycemia (no more high sugar from mom after birth) |
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What is the effect of pregnancy on ureteral peristalsis? Effect?
Why are pregnant women more prone to developing kidney stones? Which side? Why? |
PG is a muscle relaxant-->slows ureteral peristalsis, results in hydro-ureters (dilation); this is normal
Enlarging uterus may also compress ureters; leads to stasis, risk of UTIs/stones More common on right than left, bc of uterine dextro-rotation Sigmoid colon shields left uretur |
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Why does pregnancy result in increased urinary frequency?
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Inc'd RBF/GFR during first trimester (inc'd bladder filling) + Enlarging uterus (inc'd bladder pressure)-->Inc'd urinary frequency + nocturia
24º urine protein excretion is unchanged |
