OB- Maternal Adaptation
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What are some pregnancy adaptations seen in the eyes?
- -Increase cornea thickness
- -Noticable by 10wks, resolves by 6 wks PP
- -Decrease in intraocular pressure
- ***May notice irritation w/ contact lens
What are are GI changes in appetite?
- -Increased appetite
- -N/A (70%), begins 4-9wks and resolving 14-16wks
What are some GI changes seen in the mouth of pregnant women?
- -Hyperptyalism (excess saliva)
- -bleeding, soft, edematous gums
What are some GI changes in the gallbladder that occur during pregnancy?
-Cholestasis--> slower gastric emptying and increased residual volume
What are some GI effects on the liver during pregnancy?
- Mostly unchanged but INCREASE in ALT/cholesterol
- -DECREASE albumin (dilutional)
What are some respiratory effects during pregnancy?
- -Diaphragm shifts up 4cm
- -Increase in tranverse diameter
- -Lower ribs flare
T or F. Despite common nasal congestion in pregnancy, women should NOT use nasal decongestant sprays.
True, maybe may cause atropic mucosal changes
When is maternal dypsnea most prevalent?
Late 1st trimester or early 2nd due to reduced PaCO2 levels (gas exchange)
T or F. Minute ventilation increases 30-40% by later pregnancy.
True--> due to progesterone
What are the 3 respiratory volumes left unchanged in pregnancy?
- 1. Expiratory reserve vol. (ERV)
- 2. Vital Capacity
- 3. Inspiratory reserve vol (IRV)
What respiratory volumes are INCREASED during pregnancy?
- 1. O2 consumption (15%)
- 2. Minute ventilation (30-40%)
- 3. Tidal vol (30%)
What respiratory volumes DECREASE during pregnancy?
- 1. Functional residual capacity
- 2. Residual volume
- 3. Total lung capacity
- 4. total pulm. resistance (b/c rib flaring)
How much does the CO and HR increase during pregnancy?
- CO- 30-50%
- Resting HR -10-15bpm
Because of the changes to the heart during pregnancy, what symptoms may occur?
- -Decreased exercise tolerance
- -peripheral edema, distended neck veins
When does the BP dip slightly in pregnancy?
2nd Trimester (the goes back to baseline)
T or F. There are NO changes in aortic or pulmonic sounds?
True (96% have late systolic murmur)
90% of pregnant women may have what kind of murmer?
How much does the plasma volume increase by during pregnancy?
What happens to fibrinogen and fibrinolysis during pregnancy?
- Fibrinogen increases 3x normal
- -Fibrinolysis decreases
When during pregnancy is an increase in venous stasis seen?
End of 1st trimester
What stimulates lactation after delivery?
drop in E2 and progesterone
GFR increases or decreases during pregnancy?
INCREASES by 50%
T or F. THere is a DECREASE in plasma creatinine and urea during pregnancy?
True (including BUN & creatinine)
T or F. Proteinurea or hematuria are abnormal during pregnancy.
What occurs to the bladder during pregnancy?
Decreased bladder tone, increased residual void, increased frequency
Which gland has an increased secretion causing the "glow of pregnancy"?
Increase in insulin resistance causes what 3 things during pregnancy?
- 1. Hyperglycemia
- 2. Hyperinsulinemia
- 3. Hypertriglyceridemia
What is the effect of pregnancy on the thyroid and thyroid hormones?
-Increased levels of T4 and TBG, but no increase in TSH/T3/FT4 so pregnant women should be euthyroid!
What 3 things occur in the vagina during pregnancy?
- 1. Increased vascularity
- 2. hyperemia
- 3. lactic acid production (pH drops to 3.5)
What is the total amount of weight gain expected in pregnancy?
How many calories are burned in the 2nd, 3rd trimester and while breastfeeding?
- 2nd--> 340
- 3rd--> 452
- Breastfeeding--> 600
T or F. Abnormal weight gain could be a sign of birth defect.
True. Decreased wt gain w/ anencephaly and spina bifida
What are some obesity risks in the 1st/2nd trimester?
- 1. increased miscarriage rate
- 2. congenital anomaly (NTD, heart defects, facial clefting)
- 3. Challenging U/S
What are some obesity risks in 3rd Tri and L&D?
- -unexplained stillbirth
- -shoulder dystocia
- -Surgical risks
- -delayed wound healing
What are 2 fetal risks related to obesity in pregnancy?
- -2x increased risk for childhood obesity
- -48% odds of overweight by age 7
How long are post-GBP women recommended to wait before getting pregnant?
How nutrients may need to be supplemented in women w/ GBP?
-Iron, B12, folic acid, calcium
What 4 screenings should occur in the 1st/2nd trimester?
- 1. HTN, sleep apnea
- 2. folic acid
- 3. GDM
- 4. fetal anomaly u/s mid-trimester
What 2 screenings should be performed during 3rd TM?
- 1. pre-eclampsia
- 2. macrosomnia
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