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20 Cards in this Set
- Front
- Back
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What are some vascular changes in pregnancy?
Hematologic? |
\Tone & vasorelaxation --> \\SVR (20%)
+ positional effects ^^Blood Volume (50-100%) ^RBC 25-40% --> physiologic anemia |
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Do pregnant pts tend to be hypercoagulable or thinned? Why?
What do platelets do? WBC? |
hypercoag.
- Estrogen + vascular stasis ---> ^^Thromboembolic dz ----> ^^all coag factors except II, V, and XII.... decreased protein S and sensitivity to APC. decreased # of platelets ^^WBC |
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Ht changes:
- axis? - PMI? why? - murmurs? - rate? - distention? |
- axis cephalad and left
- PMI lateral and elevated; not just due to baby, due to altered thoracic dimensions - murmurs in >96% of pts, virtually all valves. - ^HR ~80bpm - ^ventricular distention (25%) |
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Are there any rhythm changes seen in EKG during pregnancy? Dysrhythmias? Why/whynot?
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Non-specific ST & T changes
Increase in dysrhythmias - Physiologic hypokalemia |
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Do you seen LVH and RVH in pregnancy? How about pericardial effusion?
CO? SV? HR? |
LVH & pericardial effusion
all three increase during pregnancy in a relatively steady fashion. |
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What do you see in BP during prenancy?
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Diastolic (low) is impacted more than systolic (also low)... often in the 50-60s even in the beginning of pregnancy. Toward the end of pregnancy, the diastolic (and sometimes systolic can climb)... can be hard to differentiate between something more normal and preeclampsia.
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CO, BP, SVR, HR... note the changes seen in normal pregnancy.
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^43%, \10%, \21%, ^17%
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What might be the problem with getting a mother to lay down on her back later in pregnancy?
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the fetus is gettin' big, puts pressure on the IVC... \\CO!
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What happens cardiovascularly during labor? (SVR, CO)
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^10-25% SVR w/ contraction
^^CO w/ dilation |
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What fraction of O2 relative to the fetus does the placenta use?
Is the placenta responsive to vasoactive meds? How much of CO does it recieve? |
as much O2 as the fetus!
no, it's refractory. ~25% |
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What are some signs and sx of normal pregnancy that can mimic ht dz?
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peripheral edema, JVD
Reduced exercise tolerance, Dyspnea S3 gallop, Systolic ejection murmur On X-ray: Change in ht position and size, increased vascular markings EKG: nonspecific ST-T wave changes, axis deviation, LVH |
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What happens re: renal changes in pregnancy?
- What does the placenta make that affects the renal system prominently? How about re: renal blood flow changes? albumin? |
progesterone --> stim renin
renin --> net abs of Na, excretion of K --> hypokalemia & water retention. ^^Renal blood flow (50-75%); 50% increase in GFR; decreased albumin --> lower colloid oncotic pressure. |
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What other changes with the urinary tract are seen w/ pregnancy?
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- Ureteral dilation / hydroureter
- Smooth muscle relaxation - Later exacerbation by uterine obstruction - Urinary stasis - Dilation of pelves and calyces - Increased kidney size |
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Is there a change in Respiratory rate in pregnancy? IRV (inspiratory reserve volume)?
Chest circumference? minute ventilation? FRC? Tidal Volume? |
No change in rate or IRV
- ^ thorax circumference 5-7cm - ^ minute ventilation - ^FRC 20% - ^TV 30-40% |
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In pregnancy, do you see acidosis/alkalosis? why?
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you see *metabolically compensated* respiratory alkalosis
- ph 7.4+ - ^PaO2, \PaCO2 (40-->30) Its like this so that it can drive gradient between mom and fetus. |
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GI changes in pregnancy:
- motility? - LES? - N&V is often proportional to what? - Bile and Cholesterol effects? - binding proteins (thyroid, steroid, VitD)? - coag factors? |
- slowed GI motility --> constipation, early satiety
- relaxation, GERD - yes, often proportional to B-HCG lvl - biliary stasis, cholesterol saturation, increased most coag factors, and increased binding proteins. |
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Other changes to just note:
Spider angiomata and palmar erythema Hair growth (abdomen and face) Mucosal hyperemia Striae gravidarum Hyperpigmentation (esp. linea nigra) Rashes and acne relatively common Altered center of gravity Altered gait Greater joint laxity Widening of symphysis pubis Affects other joints Thorax; widened costovertebral angle Fatigue / somnolence |
don't memorize these
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CARB metabolism changes?
Adrenal fx - cortisol? Why? |
insulin resistance
^^ free plasma cortisol - placental CRH stim ACTH. |
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How is the immune response altered in pregnancy?
What does this mean for CMV, HSV, varicella, and malaria susceptibility? Sx from autoimmune dz? |
must adapt to accept allograft
- \cell-mediated immunity b/c of progesterone - enhanced humoral/innate immunity increased susceptibility decreased sx from some autoimmune dz |
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Should you make sure pregnant women get their vz corrected?
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^^ Thickness of the cornea (3%) due to fluid retention
\\Intraocular pressure |
