Maternal Adaptations To Pregnancy

Front 1

outline physical changes to woman

Back 1

uterine enlargement
cervical plug
breast tissue
decidualisatin
bone content
muscle added to ventricular wall
weight gain

Front 2

describe uterine enlargement in pregnancy?

Back 2

20 x size
pear shaped to globular to ovoid

Front 3

what seals the cervix?

Back 3

mucus plug

Front 4

what happens to the heart, physically, in pregnancy?

Back 4

increased muscle mass on ventricular wall

Front 5

what is responsible for maternal weight gain?

Back 5

extra blood volume, uterus, baby

Front 6

what changes occur in maternal bones?

Back 6

changes in calcium concentration

Front 7

outline cardiovascular changes in mother?

Back 7

heart rate increase from 70 to 85
stroke volume incrase from 63 to 71
cardiac output increase from 4 - 6 then to 8 in labour

Front 8

what happens to venous return?

Back 8

uterus falls back on IVC
decreased venous return, decreases cardiac output in last trimester

Front 9

what happens to cardiac output in last trimestr

Back 9

decreases due to decreased venous return

Front 10

how much cardiac output does the placenta take?

Back 10

25%

Front 11

what happens to plasma volume in pregnancyy?

Back 11

increases by up to 50%
babies weight proportional to it?

Front 12

what happens to blood pressure during pregnancy

Back 12

falls at mid term rises to full term

Front 13

what happens to total peripheral resistance in pregancy and why?

Back 13

falls at mid term by 40% then rises again at full term
due to increased vascular bed / relaxation of vascular tone
possibly due to low grade inflammatory state

Front 14

what are the respiratory changes?

Back 14

total lung capacity falls
minute ventilation increases from 6 - 10
funcitonal residual capacity decreaases
tidal volume increases
hyperventilation

Front 15

what are the changes to blood oxygen carrying capacity?

Back 15

increaes by 20%

Front 16

what are the changes to oxygen consumption?

Back 16

increases by 15%

Front 17

what are the changes to haematocrti?

Back 17

falls

Front 18

what are the changes to total Hb content of blood?

Back 18

increases

Front 19

how much more iron does pregnant woman need?

Back 19

700-1400mg /day
childbirth = 250mg or iron

Front 20

what percentage of women have low ferritin stores in pregnancy?

Back 20

40%

Front 21

discuss iron absopritpn / use in pregnancy?

Back 21

increased iron absorption in GI tract
crosses placenta by transferrrin receptor

Front 22

what are B12 and B9 needed for?

Back 22

DNA and RNA syntheiss
synthesis of methionine synthase which recylcles methionine from homocysteine

Front 23

describe basic renal changes in pregnany?

Back 23

expansion of calyces, pelvis, ureters
RPF and GFR rate increase
natiuresis
glucose loss
increased creatinine clearance

Front 24

what happens to normal ranges in pregnancy?

Back 24

often change
eg creatinne clearance increaes so chnages from being 60 - 120 to less than 75

Front 25

why does GFR and RPF decrease in pregnancy

Back 25

decreased renal vascular resistance
possibly due to increased NO synthase

Front 26

why does natriuresis occur

Back 26

increased GFR - increased delivery
also increased progesterone - mild natruietic and vasodilator

Front 27

why does glucose excretion rise in pregnancy?

Back 27

TmG falls to a level below glucose delivery
glucose deliver increases due to increased GFR

Front 28

what does glucose excretion in pregnancy cause?

Back 28

low plasma glucose levels in first trimester

Front 29

what happens to amino acid excretion in pregnancy?

Back 29

increased GFR - increased amino acids filtere
increased excretion
can cause environemnt for UTIs
also sig. nutrient loss

Front 30

what happens to carbohydrate metabolism in 1st trimester?

Back 30

low glucose levels
switch to fatty acid metabolism
placental somatomammatropin encourages switch to fatty acid metabolism and decreased use of glucose by mother
storing of glucose

Front 31

what happens to the mothers response to glucose load in pregnancy?

Back 31

gets less effective
requires more insulin to achieve baseline / takes longer

Front 32

what happens to insulin in first trimester?

Back 32

insulin secretion increases
insuiln sensitivity increases

Front 33

at what week is there a change in carbohydrate metabolism?

Back 33

week 20

Front 34

what occurs at week 20?

Back 34

insulin resistance begins to take over
further change to fatty acid metabolism
hepatic gluconeogenesis and glycogen breakdown
increased glucose levels

Front 35

what hormones are involved in insulin secretion and action ?

Back 35

estrogen
progesterone
leptin
placental lactogen
cortisol
placental somatommammotrophin

Front 36

what does estrogen do to insulin?

Back 36

increases secretion
increases sensitivity

Front 37

why is the mucosa of the endometrium unique?

Back 37

must be immunocompetent butt not reject fetus

Front 38

what does leptin do?

Back 38

increases insulin resistance

Front 39

what does cortisol do?

Back 39

increaes insulin resistance

Front 40

discuss lympocyte trafficking from uterus

Back 40

does not occur

Front 41

what kind of MHCs does endometrium have?

Back 41

HLA G and C

Front 42

what is dilution of antigens?

Back 42

idea that antibodies do cross
but are diluted as many cells have antigens
does not occur in rhesus antibodies

Front 43

what is placental selectivity

Back 43

theory that placenta is selective for IgG but does not allow anti-fetal antibodies across
problem = rhesus

Front 44

describe fetal allograft hypothesis

Back 44

1) MHCs on EVTs switched to G and C
2) uterine killer cells interact, regulate invasion and immunity
3) lymphatic supply decreases
4) dendritic cell distribution occurs. may release cytokines Il10 which are antiinflammatory
5) T reg cells dampen immune response

Front 45

what is the chnaging maternal self hypothesis?

Back 45

syncytial knots released from placenta
phagocytosed
dendritic cells interact with T cells
cause T cell apoptosis or conversion to T reg cells

Front 46

describe changes to cervix in preparation for labour?

Back 46

softening and dilation
relaxin - dissociation of tough connective tissue

Front 47

what is the placental clock?

Back 47

CRH increases thorughout pregnancy
oestrogen increases

Front 48

how does the uterus prepare for brith?

Back 48

increased connexons due to high oestrogen levels
increased sensitivity (100x) to oxytocin

Front 49

what kind of contraction occurs in 3rd trimester?

Back 49

Braxton Hick's contractions
false labour

Front 50

what is labour?

Back 50

positive feedback cycle
involves oxytocin and prostaglandin

Front 51

describe involution of uterus?

Back 51

caused by oxytocin
stimulated by breastfeeding