Bloody Mess
Metabolism & Hormones
What Goes Up Might Come Down
Da Baby
100
The increase in stroke volume and this cardiac property often gives pregnant patients feelings of palpitations
What is heart rate/cardiac output?
*PVCs and PACs also can occur but are not usually pathologic
100
This is the main compound that provides energy for fetal development
What is glucose?
*Placental hormones (like HPL) increase insulin resistance in the mother and lead to gestational diabetes!
100
Progesterone
What is up?
*Corpus luteum increasingly dominates with progesterone and estrogen production
100
After 8-10 weeks, progesterone production is dominated by this structure rather than the corpus luteum
What is the placenta?
*This way premature labor is not induced while also allowing corpus luteum to degenerate
200
A pregnant patient often becomes anemic because this value increases quicker than RBC mass
What is plasma volume?
*This is dilutional/physiologic anemia of pregnancy
200
While PUD risk seems to lower during pregnancy, gastric motility problems may contribute to this condition instead
What is GERD?
*Relaxation of gastroesophageal sphincter and more pressure from a larger uterus also contribute
200
Mean arterial pressure
What is down?
*Progesterone relaxes BV smooth muscle! This causes RAAS to kick in from initially lowered volume status
200
This hormone class helps soften/ripen the cervix and promote uterine contractions
What are prostaglandins?
*Hence why misoprostol can induce labor!
300
The functional residual volume and expiratory reserve volume decrease over time because of this physiologic change
What is elevated diaphragm (or uterine expansion)?
*There is physically less space available
300
While an increased GFR will excrete more BUN, Cr, uric acid, and glucose, this electrolyte is spared by downregulating channels like ROMK
What is potassium?
*Sodium is also spared but its regulation is more through higher RAAS activation
300
Tidal volume
What is up?
*Progesterone and brain respiratory drive triggers more breathing, and can cause mild respiratory alkalosis!
300
This hormone is produced in the placenta and mimics LH to maintain the corpus luteum
What is hCG?
*The beta subunit is what we can most easily detect for screening
400
During this stage of pregnancy WBC counts can rise up to 20-30K/uL
What is labor?
*Since childbirth is a major stressor and the baby needs immune protection a lot of neutrophils flood in, so only worry if infection is suspected
400
To help keep the center of gravity above the pregnant patient's legs, this phenomenon of the spine occurs
What is lumbar lordosis?
*This increases the inward curvature but often causes lower back pain
400
TSH in 1st trimester
What is down?
*hCG can be a mimic for thyroid hormone receptors and produce more T4 to give negative feedback! It eventually balances out
400
The placenta can use this compound made in fetal adrenal glands to make estrogens
What is dehydroepiandrosterone or DHEA(S)?
*We can screen for estradiol once it is made via quad screening!
500
Aortic stenosis and pregnancy both have this heartbeat finding when listening
What is systolic ejection murmur?
*Crescendo-decrescendo during systole. Remember a loud S1 and split S1/S2 can also be heard!
500
Name this feature often seen in pregnant patients
What is chloasma/melasma/mask of pregnancy?
*Hyperpigmentation often from increased MSH, and you also see a rosier glow from increased blood flow
500
Demand for calories in 1st trimester
What is none?
*350 in 2nd trimester, and 450 in 3rd. Normal BMI patients can expect 25-35 lb. increase, and BMI and weight increase are inversely related
500
This hormone relaxes pelvic ligaments, floor muscles, and the cervix to allow body flexibility during childbirth
What is relaxin?
*This is generally done via matrix metalloproteinase remodeling of connective tissue via cAMP and PKA pathways