physiology of pregnancy
what causes a decrease peristalsis throughout the GI tarct in pregnancy women
increase progesterone levels
what cardiovascular changes would you see on a PE of a pregnant woman
increase split S2 systolic ejection murmur heart best at the left sternal border is present in > 90% of gravid women non specific T wave changes (on EKG) flipped T waves (on EKG) left axis deviation (on EKG)
what vaginal changes occur during pregnancy
increased genital flow in mid trimester hyperemic formation of redundant vaginal tissue secondary to progesterone effect increased secretions
what endocrine changes occur during pregnancy
increased levels of T3 and T4 insulin resistance that increases throughout pregnancy lipids increase
what skin changes occur during pregnancy
increased number of nevi palmar erythema chloasma linea alba becomes hyper pigmented (linea nigra - can be permanent) increased hair growth
if someone is obese prior to pregnancy, how much weight should she gain during her pregnancy
11-20 lbs
if someone's weight is < ideal body weight prior to pregnancy, how much weight should she gain during her pregnancy
15-25 lbs
what causes ureteral peristalsis during pregnancy
it is a part of the progesterone effect
during the second half of pregnancy, what is the increased cardiac output due to
it is due to an increased heart rate the stroke volume returns to non pregnant levels at this point
during the first half of pregnancy, what is the increased cardiac output due to
it is due to increase stroke volume
what causes an increase in insulin resistance during pregnancy
it is due to the production of human placental lactogen (HPL) by the placenta
what renal changes occur during pregnancy
kidneys, ureters, renal pelves, and calyces enlarge/dilate renal plasma flow increases by 75% GFR increases by 40% - may even see glucosuria decrease in ureteral peristalsis decreased renal function tests (BUN, Cr)
what breast changes occur during pregnancy
larger nipples with more deeply pigmented areolae production of colostrum after 20 weeks GA
if someone gains and excessive amount of weight during pregnancy, what are they at risk for
longer labor increased risk of C section newborn and childhood obesity childhood or adult onset DM
when does the embryo produce IgG and IgM
by 12 weeks gestations so the fetus benefits from both passive immunity and its only innate immunity
what causes hemorrhoids in pregnant women
there is a decreased venous return due to the mechanical suppression of the IVC by the gravid uterus, so it can cause this
what causes an increase in T3 and T4 levels during pregnancy
estrogen triggers hepatic synthesis of thyroid binding globulin which causes an increase of total T3 and T4 levels
if someone is at an ideal body weight prior to pregnancy, how much weight should she gain during her pregnancy
25-35 lbs
if someone's weight is > ideal body weight prior to pregnancy, how much weight should she gain during her pregnancy
28 - 40 lbs
what GI changes occur during pregnancy
80% of gravid women develop some degree of nausea and vomiting during pregnancy - this will generally improve by 15 weeks decrease peristalsis constipation GI reflux (due to relaxation of lower esophageal sphincter) hemorrhoids increased alk phos
what is the only immunoglobulin that can significantly cross the placenta
IgG
how do you treat GI reflux in pregnant patients
avoidance of supine position after eating antacids
what causes separation of symphysis pubis during pregnancy
because of relaxin (produced by the placenta) and progesterone, relaxation of the ligamentous attachments occurs and causes this
what cervical changes occur during pregnancy
becomes softer, cyanotic in early pregnancy (chadwick's sign) eversion, increased mucus production
what are the most dramatic changes that take place during pregnancy
cardiovascular changes
what opthalmic changes occur during pregnancy
changes in the shape of the cornea occur due to change in plasma volume contact lens wearers may not irritability when wearing old lenses may cause blurred vision
what hematological changes occur during pregnancy
dilutional anemia increase in some clotting factors
what causes an increase number of nevi in pregnant women
due to increased production of melanocyte stimulating hormone (MSH)
what causes palmar erythema in pregnant women
due to increased vasodilation
what causes an increase in alkaline phosphatase in pregnant women
due to production of alk phos by the placenta as well as by the liver and bone
what blood pressure changes occur during pregnancy
during the 2nd trimester blood pressure decreases, but is normally during 1st and 3rd trimester this is due to the decrease in systemic vascular resistance the lower BP in 2nd trimester causes and increased risk of syncope
changes in clotting factors during pregnancy
fibrinogen and fibrin split products increase by 50%*** factors VII, VIII, and X increase by 50% factors II, V, and XII are unchanged activated protein C and S decrease
if women are obese during pregnancy what are they at risk for
gestational diabetes millitus hypertensive disorders of pregnancy
what uterine changes occur during pregnancy
goes from holding 10 cc to 5000cc becomes softer, more spongy in 1st trimester (hegar's sign)
why do pregnant women feel dyspnea and hypocapnia more
gravidas are more sensitive to CO2 and thus do not tolerate it as well as non pregnant individuals you will not find anything on PE but will see respiratory alkalosis on an arterial blood gas which might be normal
what musculoskeletal changes occur during pregnancy
lumbar lordosis occurs later in pregnancy - causes low back pain separation of the symphysis pubis
what cardiovascular changes occur during pregnancy
many musculoskeletal attachments are loosened or relaxed due to secretion of the hormone relaxin from the placenta due to the relaxin: the position of the heart changes as it is displaced upward and to the left, and the apex of the heart moves laterally due to the increasing height of the diaphragm there is also an increase in ventricular muscle mass due to increase in cardiac output
what causes constipation in pregnant women
mechanical obstruction from increasing weight of the gravid uterus
what causes systemic vascular changes to occur during pregnancy
progesterone effect arteriovenous shunting to uterus and placenta increased levels of prostaglandins, NO, etc
what causes the dilutional anemia in pregnant women
since there is a 40% increase in blood volume, 19% of that is RBCs and 81% of that is plasma, so there is a dulitional anemia during pregnancy
what causes the relaxation of the lower esophageal sphincter during pregnancy
the increased progesterone levels
what causes an increase in the size of the kidneys and ureters during pregnancy
the increased weight and size of the uterus compresses them and causes them to enlarge
why do pregnant women experience nasal congestion during pregnancy
the nose has estrogen receptors so it causes the nasal congestion that may persist throughout pregnancy
what is the source of passive immunity between the mother and fetus
the placenta
what respiratory changes occur during pregnancy
there is an increase in total body oxygen consumption of 20% above the non pregnant level there is an increase in diaphragmatic levels that causes 20% reduction of residual volume and 5% reduction of total lung volume there is an increase of 40% in tidal volume and minute ventilation therefore respiratory rate is essentially unchanged
what changes in cardiac output occur during pregnancy
there is an increase of 40% blood during pregnancy - mostly composed of plasma volume an increase in cardiac output peaks at 32 weeks gestational age (GA) and CO output must increase by 40% in order for the patient to survive the increased blood volume
what renin-angiotensin-aldosterone changes occur during pregnancy
these increase dramatically during pregnancy due to estrogenic effects, but most patients are resistant to these changes so they do not become hypertensive
why do physiological changes occur during pregnancy
this is to permit a healthy woman to accommodate tot he development of the embryo and later, the fetus also helps to inform us as to why a woman with significant disease may become ill during pregnancy due to her underlying illness
chadwick's sign
this is when the cervix becomes softer and cyanotic occurs around 6 weeks gestation
hegar's sign
this is when the uterus becomes softer and more spongy occurs around 6 - 8 weeks gestation
complications of ureteral peristalsis during pregnancy
urinary stasis causes an increase in asx bacteriuria urinary incontinence is common at term and during peurperium