Reproduction L04_Maternal Adaptations To Pregnancy

Front 1

What proportion of blood increase during pregnancy plasma and RBC mass?

Back 1

Plasma 75% RBC mass 25%

Front 2

what is the cause of physiologic anemia during pregnancy?

Back 2

increased of blood, but only 25% of increae is RBC (thus hemoglobing is down)

Front 3

What explains increased CO and increase in Renal and uteroplacental blood flow?

Back 3

increase in blood volume with only 25% increase in plasma

Front 4

1.What is the normal effect of SVR during pregnancy? (what %)

2. Why?

Back 4

1. 50% decrease…

2. systemic vasodilation, placenta is like a large fistula (which has lowered resistance) to materna circulaton

Front 5

What is the effect to maternal BP during pregnancy?

Back 5

generally little change

Front 6

What is the effect to pulse pressure during pregnancy (Pulse pressure = change in BP with heart contractions)… What is the cause of this?

Back 6

Pulse pressure Widen (↓ 10-15 mmHg in systolic w/ greater drop in diastolic)… (2) drop in systolic and diastolic are a reflection of the drop in SVR

Front 7

What effect does Estrogen have on renin?

Back 7

increases renin

Front 8

What effect does progesterone have on the renin angiotensin system?

Back 8

↑ Progesterone (natriuretic effect) → Hyponatremia→ ↑ Renin-Ang II

Front 9

What does expanded blood volume and lowered BP suggest about what controls the vascular resistance changes? What is a possible explanation?

Back 9

Expanded Blood Volume + Lowered BP (in spite of RAA increased activity) suggests arterial control over vascular resistance changes during pregnancy… (2) decreased sensitivity to vasopressive Angitensin II, which is mediated by prostacyclin, PGE1/2 - produced in the placenta

Front 10

What happens to the maternal CO for the first 5 months of pregnancy, staring in T1?

Back 10

increased CO --> max at 5 months

Front 11

What accounts for the overall increase in LV performance during pregnancy?

Back 11

increased preload, increased HR, decreased Afterload

Front 12

what happens to uterine resistance during pregancy? What effect does that have on blood flow?

Back 12

10-fold decrease resistance --> increased blood flow to the uterus

Front 13

What other tissues have an increased blood flow, besides the uterus?

Back 13

kidneys, skin, breasts

Front 14

What happen during supine posture in late pregnancy?

Back 14

Uterus compresses the abdominal aorta, and IVC --> ↑Afterload + reduced Venous return→ ↓ CO

Front 15

What are the symptoms associated aortacaval compression in the setting supine posture during late gestation?

Back 15

supine hypotension --> nausea, diaphoresis, decreased uterine blood flow

Front 16

Why is increased ventilation seen during pregnancy?

Back 16

increased protesterone --> a) Direct stimulation of respiratory center, b) Change in sensitivity to CO2

Front 17

What is the effect of pregnancy on inspiratory reserve volume?

Back 17

IRV increase (The additional air that can be inhaled after a normal tidal breath in. The maximum volume of air that can be inspired in addition to the tidal volume)

Front 18

What is the effect of pregnancy on Tidal volume

Back 18

TV increases (greater volume inhaled per breath)

Front 19

what is the effect of pregnancy on Inspiratory reserve capacity?

Back 19

IRC (TV + IRV) increases

Front 20

what is the effect of pregnancy on expriatory reserve capacity?

Back 20

ERV decreases (The amount of additional air that can be breathed out after the end expiratory level of normal breathing. )

Front 21

What is the effect of pregnancy on residual volume?

Back 21

RV decreases (The amount of air left in the lungs after a maximal exhalation)

Front 22

What is the effect of pregnancy on Functional Residual Capacity?

Back 22

(RV +ERV) decreases (The amount of air left in the lungs after a tidal breath out. The amount of air that stays in the lungs during normal breathing.)

Front 23

What is the effect of pregnancy on total lung capacity?

Back 23

Unchanged lung capacity (The volume of gas contained in the lung at the end of maximal inspiration.)

Front 24

What is the effect of pregnancy on respiratory rate?

Back 24

unchanged respriatory rate

Front 25

What is the effect of pregnancy on global airway resistance during pregnancy? Why?

Back 25

Unchanged maybe slightly reduced… (2) decreased resistance in large airway BALANCED w/ increased resistance in small airway

Front 26

What causes the decrease in resistance seen in large airways?

Back 26

Progesterone & Δ in prostaglandins → ↓ Bronchial smooth muscle tone → ↓Resistance to AF in large airways

Front 27

What causes the increase in resistance seen in small airways?

Back 27

Bronchial vascular congestion → ↑Resistance in small airways

Front 28

What accounts for the 40% increase in respiratory minute volume?

Back 28

Respiratory rate unchanged + ↑ tidal volume → 40% ↑ in respiratory minute volume

Front 29

What acounts for the increased diffusing capacity (diffusion of O2 --> RBCs)during pregnancy? (Diffusing capacity - a measurement of the lung's ability to transfer gases)

Back 29

increased pulmonic blood flow → ↑ DIFFUSION CAPACITY early pregnancy (drop shortly after early pregnancy until 28th week )

Front 30

How is it that given respiratory changes during pregnancy result in a neutral pH?

Back 30

(1) ↑ Ventilation → ↓ PCO2→ Alkalosis (2) Renal Bicarbonate release (it does result in an increase in base deficit)

Front 31

During pregnancy what happens to the residual lung volume?

Back 31

decreased residual lung volume

Front 32

During pregnancy what happens to the respiratory center sensitivy to CO2?

Back 32

CO2 sensitivity to CO2 in respiratory center

Front 33

During pregnancy what happens to the minute ventiliation?

Back 33

increased minute ventilation

Front 34

During pregnancy what happens to the pO2?

Back 34

increases

Front 35

During pregnancy what happens to the pCO2? What happens as a result of this?

Back 35

decreased pCO2 --> compensated respiratory alkalosis

Front 36

During pregnancy what happens to the serum bicarbonate?

Back 36

decreases

Front 37

During pregnancy what happens to the kidneys, why?

Back 37

enlarged kidneys: Obstructive Anatomic & Hormonal Factors… →Dilation of collecting system (more on the right)

Front 38

During pregnancy what happens to GFR?

Back 38

GFR increases by 30-50%

Front 39

What happens to filtration fraction in the kidneys during pregnancy? T1, T2, T3

Back 39

T1-T2 decrease… T3 increases

Front 40

Why would you see a change in the handling of plasma solutes (e.g., glucosuria in the absence of hyperglycemia)

Back 40

a) ↑ GFR + ↓ capacity for the tubular reabsorption of glucose… (b) ↓ Plasma osmolality

Front 41

During pregnancy what happens to serum: creatinine as a result of increased GFR?

Back 41

During pregnancy serum creatinine decreases as a result of increased GFR?

Front 42

During pregnancy what happens to serum urea nitrogen as a result of increased GFR?

Back 42

During pregnancy serum urea nitrogen decreases as a result of increased GFR?

Front 43

During pregnancy what happens to serum uric acid as a result of increased GFR?

Back 43

During pregnancy serum uric acid decreases as a result of increased GFR?

Front 44

During pregnancy what happens to protein excretion as a result of increased GFR?

Back 44

During pregnancy protein excretion increases as a result of increased GFR?

Front 45

Give 4 reasons why there is increased risk to urininary infections during infection.

Back 45

↑ urinary dead space… ↑ urinary glucose… ↑ urinary amino acids… difficulty emptying bladder