physiology of pregnancy

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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


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