Physiology of Pregnancy from First Aid for the Obstetrics and Gynecology Clerkship
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What may cause emotional and psychiatric symptoms in pregnancy?
- Hormonal changes
- Progesterone (fatigue, dyspnea, depression)
- Endogenous corticosteroids (euphoria)
What are some causes of synope in pregnancy?
- 1. Venous pooling in lower extremities leading to dizziness/light-headedness especially with abrupt positional changes.
- 2. Dehydration
- 3. Hypoglycemia
- 4. Postprandial shunting of blood flow to stomach
- 5. Overexertion during exercise.
What causes an increased incidence of gallstones, checystitis, and biliary obstruction in pregnancy?
Cholestasis, plus increase in lipids and cholesterol.
How are drug levels affected during pregnancy?
- Plasma levels of phenytoin fall
- Half life of caffeine is doubled
- Antibiotics are cleared more rapidly by the kidney.
When is the optimal time to screen for glucose intolerance?
At 26-28 weeks gestational age.
In pregnancy what energy source does the mother mainly use...and the fetus?
Availability of glucose increases for the fetus, while the mother utilizes lipids.
When do uterine contractions begin?
At 20 weeks and gradually increase.
How are triglycerides affected in pregnancy?
- reach 2-4 times nonpregnant level at 36wks.
- Increase by 90-570% during pregnancy
How is cholesterol affected during pregnancy?
- Total plasma cholesterol: T1-decreases by 5%, Increases in T2 and T3 by 24-206%
- LDL: increaes by 50-90%
- HDL: increases by 10-23%
How is plasma aldosterone affected by pregnancy?
- T1: increases w/in 2 weeks of conception
- T2: increases 3-5 times nonpregnant level
- T3: increases 8-10 times nonpregnant level.
How does GFR change during pregnancy?
- Increases in T1
- T2: to 60% above nonpregnant levels by 16 weeks.
How does heart rate change during pregnancy?
It increases by 10-15%/min during first trimester.
How does blood pressure change during pregnancy?
- Systolic remains the same
- Diastolic: T1 decreases during 1st trimester. T2 by 16-20 wks it will have decreased by 15mm. 3rd trimester it returns to T1 level.
How much does cardiac output increase during pregnancy?
By 60% during the first trimester.
What happens to insulin sensitivity during pregnancy?
- First 20 weeks: it increases
- -Fasting glucose levels are lower
- After 20 Weeks: Insulin resistance develops and plasma insulin levels rise.
- -A carb load produces a rise in plasma insulin 3-4 times greater than in nonpregnant state, but glucose levels are also higher.
- -This reduces maternal utilization of glucose and induces glycogenolysis, gluconeogenesis and maternal utilization of lipids as energy source
- -Fasting glucose levels less than nonpregnant.
What is an ideal weight gain in a patient with a normal prepregnancy weight?
- 25-35 lb.
- T1: 1.5-3lb gained
- T2 and T3: 0.8 lb/wk
What commonly causes backaches in pregnancy?
Joint changes (pubic symphysis) and postural changes secondary to change in center of gravity result in backaches, and other aches that are common in pregnancy.
What effect does the increase in total body water have on the mother's body?
generalized swelling, corneal swelling, intraocular pressure changes, gingival edema, increased vascularity of cranial sinuses, tracheal edema
How are the trimesters broken down by weeks?
- 1st (T1): 1-12 weeks
- 2nd(T2): 13-28 wks
- 3rd (T3): 28 wks to term
- Term: 38-42 weeks
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