Week 8.1 - Maternal problems in Pregnancy Flashcards Preview

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Flashcards in Week 8.1 - Maternal problems in Pregnancy Deck (37):
1

Describe the cardiovascular changes which occur in pregnancy

-Blood Volume increases (upto 50%) therefore CO, SV and HR all increase

2

What happens to BP during pregnancy?

-Decreases in T1/T2 normal in T3 (systolic never increases)

3

What effects will pregnancy have on preload and afterload and why?

-Preload will increase as CO is increased, increased vol of blood returning to heart
-Afterload should decrease if BP decreases as TPR will decrease

4

Why is hypotension experiences in T1 and T2?

-Progesterone causes relaxation of smooth muscle in BVs therefore decreasin TPR

5

What could be a potentially dangerous cause of hypotension in T3?

-Aortocaval compression by enlarged uterus reducing venous return to the heart

6

Name one possible outcome of the bvs not vasodilating during pregnancy

-Pre-eclapsia -> uncontrolled hypertension with endothelial dysfunction

7

What changes occur in the urinary system during pregnancy?

-Glomerular filtration rate increases thus renal plasma flow increases and functional renal reserve decreases

8

What causes the increase in GFR during pregnancy?

-Progesterone

9

What happens to creatinine clearance during pregnancy? Why?

-Increases
-Because GFR has increased

10

What happens to urea excretion during pregnancy? Why?

-Increases
-Because GFR increases

11

\Why is it important to know the normal for pregnancy range of creatinine and urea?

-May look like they are in the normal range when they are in fact high for pregnancy as more urea and creatinine should be excreted, therefore there may be a problem with the kidneys

12

What is the range of creatinine clearance during pregnancy?

-40-50%

13

What is the approximate value of urea during pregnancy?

-~3.1mmol/L

14

Why is it significant that bicarbonate decreases during pregnancy?

-Reduced buffering capacity of the kidney

15

What is a potential problem which progesterone can place on the urinary system?

-Increasing GFR so much that hydroureter develops

16

Name a common cause of urianry stasis during pregnancy?

-Obstruction of ureter by gravid uterus

17

Why are UTIs concering during pregnancy?

-Possible to develop to pyelonephritis and cause pre-term labour

18

Name the anatomical changes which occur within the respiratory system during pregnancy

-Diaphragm displaced
-AP and transverse diameters of the thorax increase

19

Name the physiological changes which occur in the respiratory system during pregnancy

-Physiological hyperventilation due to increased CO2 production and increased respiratory drive effect of progesterone

20

How is physiological hyperventilation of pregnancy compensated for?

-Increased bicarb excretion to compensate for the respiratory alkalosis

21

What are the changes in the capacities of the lungs during pregnancy?

-Reduced functional residual capacity but total lung capacity remains unchanged
-Increased TV with RR unchanged

22

What happens to O2 consumption during pregnancy?

-Increases by 20%

23

Why is vital capacity unchanged during pregnancy?

-VC = TV+IRV+ERV
although TV increases ERV volume decreases so VC remains unchanged

24

What happens to carboydrate metabolism during pregnancy?

-Increased peripheral resistance to insulin by hPL and the body switched to gluconeogenesis and alternative fuels to spare glucose for fetus
-Decreased fasting blood glucose
-Increased post-prandial blood glucose

25

List some risk factors for gestational diabetes

-PCOS
-advancing age
-Ethnicity

26

What is gestational diabetes?

-Increased blood glucose during T3 due to improper insulin response which doesnt persist post partrum

27

What is the outcome on the fetus of poor control of gestational diabeted?

-Macrosomic fetus, still birth, congenital defects

28

What happens to lipid metabolism during pregnancy?

-Increased lipolysis for T2
-Increased plasma free fatty acids on fasting to spare glucose for fetus

29

Why is pregnancy associated with a risk of ketoacidosis?

-If there is inappropriate lipolysis excess FA can get converted to ketones

30

What happens to thyroid metabolism in pregnancy?

-Thyroid binding globulin, T3 and T4 increase so free T4 in normal range
-Decreased TSH due to the effects of hCG

31

Describe the anatomical changes to the GI tract during pregnancy

-Alterations in the disposition of the viscera eg appendix moves to RUQ as uterus enlarges

32

Describe the physiological changes which occur in the GI tract during pregnancy

-Smooth muscle relaxation by progesterone -> delayed emptying -> constipation
-Biliary tract stasis
-Increased risk of pancreatitis

33

Describe the haematological changes which occur during pregnancy

-Prothrombotic state with increased fibrin deposition at implatation site and increased fibrinogen and clotting factors in blood.
-Reduced fibrinolysis and changes in vascular flow due to venodilation
-Anaemia

34

Why cant you give warfarin in thromboembolic disease of pregnancy?

-Warfarin can cross the placenta and is teratogenic

35

What causes anaemia during pregnancy?

-Plasma volume increases more than red cell mass -> physiological anaemia
-Can also be due to Fe or folate deficiencies

36

Describe changes in the immune system during pregnancy

-Non-specific suppression of the local immune responses at the materno-fetal interface

37

Give 2 diseases which can occur due to transfer of antibodies across the placenta

-Haemolytic disease of the newborn
-Graves disease