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20 Cards in this Set
- Front
- Back
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cardiovascular
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Cardiac output goes up 50%
-stroke volume and heart rate go up, SVR goes down -BP should drop a bit to mid trimester then go back up -beocme resistant to endogenous vasopressers labor increases CO dramatically and then after delivery, venous return increases alot and this is when heart is most likely to decompensate |
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blood, plasma, red cells
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plasma volume up 50%, blood cells less, leading to an apparent anemia (normal)
iron - need 1 gram (half for new red cells, 200 for losses, 300 for fetus) |
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coagulation changes
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hypercoagulable state
-more of factors 7-11 -less of protein S |
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pulmonary changes
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up - oxygen reqs, tidal volume, vital capacity, minute volume
down - CO2 (breath more), bicarb (avoid alkalosis), residual volume, expiratory reserve volume, total lung capacity early on - progesterone causes dyspnea, later on it is the mass effects |
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renal changes
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GFR shoots up 50%, and mechanically, renal pelves and ureters are more dilated.
GFR rise lowers creatinine. glucosuria, protein < 100/24 hours is common. sodium drops, osmolarity drops, calcium doesn't change |
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skin changes
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nevi can grow
skin gets more pigmented stria gravidarum hirsutism palmer erythema hyperpigmentation spider angioamas ec |
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lipid changes
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triglycerides up
cholesteroal up ketones raise |
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substrate metabolism
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carbs - fasting hypoglycemia, post prandial hyperglycemia, post meal insulin 2-5X higher (human placental lactogen)
protein - alanie lower, amino acids less, more protein turnover fat - enhanced lipolysis, higher triglyeride, predisposed to ketogenesis |
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thyroid activity
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remains stable although levels could change
TSH levels could vary due to hCG mimic effect |
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dental changes
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gingival disease, and dental care hould be more
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GI changes
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4-16 weeks - morning sickness
dietary cravings, pica, ptyalism heartburn, constipation from progesterone |
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musculoskeletal
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lumbar lordosis (duhh)
common musculoskeletal complaints bone turnover up so need calcium |
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ophthalmic
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blurred vision; don't change lenses though as this corrects post pregnancy - due to fluid in the eye
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reproductive track changes
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utrus grows 100 fold.
hernias become prominent as the muscles get distended increased vulvar vaginal secretions |
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fetal circulation
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right to left shunts
low oxgen pressure overall |
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fetal kidney function
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fetal urine is primary source of amniotic fluid in 2nd half of pregnancy
forms 400-1200 ml of urine each day |
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fetal thyroid function
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fetal thyroid hormone begins production at 12 weeks of gestation. fetus basically makes and regulates its own thyroid function
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placental-related endocrine changes
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hcg
hpl - highest levels in 3rd trimester, stimulates breast development progesterone - made primarily by placenta after 8 weeks estrogens - made primarily by placenta after 6 weeks |
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nutrient transport across placenta
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glucose passive
active transport for most other things - amino acids, calcium, iron, folate, b12. |
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placental structure problems
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placenta previa - women with 2nd half heavy bleeding, assume this until proven otherwise
abruptio placenta, placental mosaicism |
