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40 Cards in this Set
- Front
- Back
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Anatomic kidney changes occurring during pregnancy
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Increase in size and weight due to increase in renal vascular and interstitial volume.
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Anatomic urinary tract changes occurring during pregnancy
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dilation of renal calyces/pelvis late 1st trimester.
dilation greater on right side than left due to cushioning of L ureter by sigmoid colon. |
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2 factors leading to dilatation of urinary tract
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1) Hormonal: progesterone plays role in ureteral smooth muscle relaxation
2) Mechanical - likely major cause. Compression of ureters |
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Clinical consequences of urinary tract changes
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Increase in ascending UTI due to urinary stasis
Difficulty interpreting radiologic exams of urinary tract Interference with eval of glomerular and tubular function (these require high urine flow rates) |
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What is the change in renal plasma flow in pregnancy?
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Increases 25-80%!
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What is the change in GFR in pregnancy?
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Increases 50%
Secondary to vasodilation of pre- and post- glomerular arterioles. |
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Consequences of increase in GFR in pregnancy?
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Decreased serum creatinine and urea!
Increase Creatinine clearance |
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What is the cause of sodium retention in pregnancy?
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Increase in renal tubular reabsorption and icnreased levels of aldo, estrogen, corticosterone
Renin levels increase in pregnancy. |
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Change in glucose excretion
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A little glucose spilling into urine is normal because the reabsorption mechanism if impaired.
Don't use to monitor pregnant women with DM |
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What is normal body weight change in pregnancy?
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30-35 lbs on average
2/3 increased weight is water |
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T/F Kidney stones increased in pregnancy
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F
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Why are stones passed more easily in pregnancy?
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presumably due to urinary tract dilation
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Nephrotic syndrome: proteinuria of ______g/day
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3-4 (contrast with severe pre-eclampsia which is 5)
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With concurrent severe renal deficiency in pregnancy, what additional factor prognosticates a poor outcome?
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moderate to severe hypertension
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Anatomic changes to pulmonary system in pregnancy
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Diaphragm rises
Subcostal angle widens Increased diaphragmatic excursion |
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Changes in PFTs during pregnancy/functional lung tests
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Most due to elevation of diaphragm
FRC decreases Tidal volume INCREASES Vital capacity unchanged |
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Changes in tidal volume during pregnancy
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Increased
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Changes in Vital Capacity during pregnancy
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Unchanged
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Changes in alveolar ventilation during pregancy
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increased
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Changes in minute ventilation during pregnancy
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increased
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Clinical significance for increase in minute ventilation during pregnancy
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Increases oxygen available to fetus
Pregnant woman is in slight respiratory alkalosis |
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Clinical significance for decrease in residual volume during pregnancy
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improves gas transfer from alveoli to blood
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What is the cause of increase in minute ventilation during pregnancy?
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The respiratory rate stays same, but increase in tidal volume.
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What is the cause of increase in minute ventilation during pregnancy?
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The respiratory rate stays same, but increase in tidal volume.
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Minute ventilation =
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Respiratory rate * Tidal volume
Respiratory rate is unchanged Tidal volume increases |
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T/F FEV1 increases in pregnancy
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F. This depends on lung compliance and resistance and is UNAFFECTED
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T/F Dyspnea is common in pregnancy
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T
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Effects of cystic fibrosis during pregnancy
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25% are premature
High perinatal mortality rate Prognosis worse in presence of cor pulmonale, hypoxemia, pulmonary htn |
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Most common viral pneumonias in pregnancy
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influenza
varicella |
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Varicella pneumonia in pregnancy: maternal effects
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worse with up to 35% mortality rate
CANNOT give vaccine in pregnancy |
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T/F Can give varicella vaccine in pregnancy
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F. It's a live attenuated. Don't give these in pregnancy
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Varicella pneumonia in pregnancy: fetal effects
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If infant is born after maternal viremia but prior to maternal Ig response, infant is at high risk for developing neonatal varicella infection. Infants are treated with varicella Ig if mother develops clinical varicella between 5 days prior and 2 days after delivery
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Infants are treated with varicella Ig if mother develops clinical varicella between _ days prior and _ days after delivery
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5;2
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How is a positive tuberculin skin test managed during pregnancy?
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Obtain shielded CXR to r/o active tb
If young <35 and recent converter, give prophylactic therapy Begin therapy after the first trimester of pregnancy Check LFTs every month |
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How is active TB managed during pregnancy?
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Pregnancy doesn't alter course of disease
Check LFTs every month |
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Complications are common in patients with significant renal disease, especially if ______ and _____ are present
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proteinuria; htn
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How is pregnant asthmatic treated?
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Generally handlse it well, but acute attacks must be managed aggressively due to decreased reserve
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What is change in blood volume during pregnancy?
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Expandsto 45% greater volume, appears to protect against effects of peripartum blood loss
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Despite the expansion in blood volume and RBC mass, there is a decrease in osmolality, why?
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The expansion in blood volume is more than the expansion in RBC mass. This permits retention of water
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What is the change in defn of anemia during pregnancy?
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hemoglobin under 10-11 grams at term is abnormal, and usually due to Fe deficiency
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