Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
48 Cards in this Set
- Front
- Back
|
What are the effects of pregnancy on the following:
a) diaphragm height b) FEV1 c) Peak expiratory flow rate d) Airway resistance e) oxygen consumption f) PaO2 g) PaCO2 |
a) diaphragm rises ~4cm, subcostal angle rises b) no change c) no change d) no change e) 15-20% increase (due to presence of placenta and fetus) f) increased (slight, no biological relevance) g) decrease |
|
|
How does pregnancy affect the following lung volumes:
a) tidal volume b) expiratory reserve volume (ERV) c) residual volume d) respiratory rate e) minute ventilation |
a) 30-40% increase b) 20% decrease c) 20% decrease d) no change e) 30-40% increase (due to changes in respiratory center) |
|
|
What is the change in heart position in pregnancy? |
Heart shifted to the left, anterior, and rotated toward a transverse position |
|
|
What causes the change in heart position in pregnancy? |
Estrogen causes cardiac hypertrophy |
|
|
What are the changes in heart sounds heard in pregnancy? |
Wide splitting of S1, splitting of S2 in the third trimester
Systolic ejection murmor (up to grade 2/4 over the pulmonary and tricuspid areas) -increased circulatory volume → flow from valves changes from laminar to turbulent → normal to have a low murmur
Third heart sound present in most pregnant women (rapid phase of ventricular filling)
Fourth heart sound rarely heard |
|
|
When do the auscultory changes of the heart begin in pregnancy? |
Late first trimester |
|
|
What hormone is responsible for decreasing arterial tone in pregnancy? |
Progesterone
Decrease systemic vascular resistance (so even though CO increases, BP goes down) |
|
|
What are the changes in venous pressure in the following areas during pregnancy: a) upper extremities b) central venous c) lower extremities |
a) no change b) no change c) slight increase at 10 weeks, big increase at term: increase in intravascular and extravascular volume → increase in venous pressure → slow down blood flow → fluid will escape veins → peripheral edema (especially lower peripheral edema) |
|
|
What causes "physiological anemia" of pregnancy? |
Hemodilution is normal in pregnancy
Increase in plasma volume throughout pregnancy |
|
|
What are the hemodynamic changes induced by pregnancy? |
Increase in cardiac output
Sodium and water retention
Blood volume expansion
Reduction in systemic vascular resistance and systemic blood pressure
|
|
|
Describe the invasion of the endometrium by the embryo (very general) |
Invasion of endometrium and myometrium by fetal tissue that will ultimately end up as villi -one subtype ends up as anchoring villi -another coats the maternal blood vessels -invasion by fetal trophoblasts supports maternal blood vessels |
|
|
Where are most hormones made in the placenta? |
The endocrine tissue in the placenta is mostly in the syncytiotrophoblast, which covers the chorionic villi and arises from the fusion of the cytotrophoblasts
Decidua makes prolactin |
|
|
What is the role of endocrine function of the placenta? |
Establishment and maintenance of pregnancy |
|
|
What happens to maternal GnRH levels in pregnancy?
|
Increases |
|
|
What happens to maternal CRH levels in pregnancy? |
Rises exponentially near the end of pregnancy -binding protein for CRH decreases so the amount of free CRH is increased -higher and earlier rise in CRH in patients who deliver preterm -patients who deliver post term have a lower level and slower rise in CRH |
|
|
What happens to maternal GHRH/GH levels in pregnancy? |
Does not change
However, GH values are higher (probably due to placental GH) |
|
|
What happens to maternal FSH/LH levels in pregnancy? |
Decline in circulation throughout gestation |
|
|
What happens to maternal ACTH levels in pregnancy? |
Increases
Which increases serum, salivary, and urinary free cortisol -cortisol travels bound to protein so you see a lot of free cortisol in pregnancy
|
|
|
What happens to maternal prolactin levels in pregnancy? |
Increases throughout pregnancy |
|
|
What happens to maternal TSH levels in pregnancy? |
Modestly reduced in the first trimester in response to the thyrotropic effects of hCG in ~20% of normal pregnancies
|
|
|
What are the changes in renin, angiotensin II, aldosterone, and ADH in pregnancy? |
All increase
|
|
|
How does the vascular response to angiotensin II change in pregnancy? |
Decreased vascular responsiveness to angiotensin II -decreased plasma response → decreased vascular resistance
Desensitization of arteries to angiotensin in normal pregnancy |
|
|
What happens to TBG (thyroid binding globulin) concentration in pregnancy? |
Rises twofold
Total T4 and T3 increase but not free T4 and T3 Increase in binding capacity → decrease in free fraction → body reacts by stimulating the system (total levels in pregnancy are elevated) |
|
|
What happens to CBG (cortisol binding globulin) in pregnancy? |
Increases two to three fold -total cortisol is increased to a greater degree than the free cortisol (both are elevated) |
|
|
What happens to SHBG (sex hormone binding globulin) in pregnancy? |
Increases 6 fold
Total testosterone concentrations rise, free testosterone exceeds normal nonpregnant levels i the third trimester |
|
|
What happens to serum calcitriol levels in pregnancy? |
Increase |
|
|
What are the effects of placental hormones on metabolism? |
Affect glucose and lipid metabolism
Switch from carbohydrate to fat utilization facilitated by insulin resistance and increased plasma concentrations of lipolytic hormones
Triglyceride and cholesterol levels increase
Triglyceride rise due to: increased hepatic lipase activity and reduced lipoprotein lipase |
|
|
How does the response to plasma glucose change in pregnancy? |
State of insulin resistance in pregnancy Risk of gestational diabetes
Insulin levels are higher in both the fasting and postprandial states
Increased storage of tissue glycogen
Increased peripheral glucose utilization
Decreased hepatic glucose production
Glucose is fetal fuel! |
|
|
What hormone mediates renal anatomic changes in pregnancy and how? |
The smooth muscle relaxation effects of progesterone in pregnancy lead to dilation of the renal pelves, calyces, and ureters to the point that it can give the appearance of hydronephrosis |
|
|
What are some effects of the physiologic hydronephrosis and resulting urinary stasis of pregnancy? |
Predisposes pregnant women to lower UTI and pyelonephritis
Predisposes to the development of renal calculi |
|
|
Where else are the dilatory effects of progesterone seen in the pregnant woman besides the kidneys? |
Arteries (hypotension)
Veins (edema)
Large intestine (constipation) |
|
|
What are the functional changes in the kidney during pregnancy? |
Increased renin secretion (estrogen effect) |
|
|
What happens to the following kidney values during pregnancy?
a) GFR b) Creatinine clearance c) plasma bicarb d) plasma urate e) urinary protein excretion f) glycosuria g) aminoaciduria |
a) Increases by 50% b) increased c) decreased d) decreased e) increased f) common, can occur in the absence of diabetes in normal pregnancy g) common in normal pregnancy
|
|
|
What happens to the following hematologic components in pregnancy? a) WBC b) lymphocytes
|
a) increases
b) unchanged |
|
|
What happens to platelet count during pregnancy? |
Progressive decline in platelet count throughout pregnancy - in part due to hemodilution
Platelet count should remain in normal range
|
|
|
What happens with coagulability in pregnancy? |
Hypercoagulable state
- estrogen stimulates liver to produce clotting factors -increased clotting factors despite volume expansion
|
|
|
When is the highest risk of thromboembolism? |
Puerperium (right after delivery) |
|
|
Circulating levels of which coagulation factors increase the most in pregnancy? |
Fibrinogen (factor I) and factor VIII levels |
|
|
Circulating levels of which coagulation factors decrease in pregnancy? |
Factor XI decreases slightly toward the end of pregnancy
Factor XIII (fibrin stabilizing factor) is appreciably reduced at term |
|
|
What are is the effect of pregnancy on fibrinolytic activity? |
It is depressed |
|
|
How does progesterone mediated smooth muscle dilation affect GI function? |
Esophagus: decreased lower esophageal sphincter tone; "heartburn"
Stomach: decreased tone and mobility; "full stomach"
Large intestine: decreased motility - increased water absorption; "constipation" |
|
|
How is cardiac output affected by pregnancy? |
Increases 30-50% during pregnancy
Supine positioning and standing are both associated with a fall in CO
CO is maximum during labur and the immediate postpartum period |
|
|
How is PCWP affected by pregnancy? |
As a result of the marked fall in systemic vascular resistance and pulmonary vascular resistance, PCWP does not rise, despite an increase in BP |
|
|
What are the effects of pregnancy on PaO2 and PaCO2? |
Fall during pregnancy because of increased minute ventilation
This facilitates transfer of CO2 from the fetus to the mother and results in a mild respiratory alkalosis |
|
|
What happens to hematocrit during pregnancy? |
Normally decreases, but not below 30% |
|
|
What happens to RBC volume during pregnancy? |
Increases about 18-30% |
|
|
What are the effects of pregnancy on BUN and creatinine? |
BUN and creatinine normally decrease as a result of the increased GFR |
|
|
What are the effects of pregnancy on insulin sensitivity? |
Peripheral insulin resistance, primarily mediated by human placental lactogen
Insulin resistance increases as pregnancy advances; this results in hyperglycemia, hyperinsulemia, and hyperlipidemia in response to feeding, especially in the third trimester |
