Metabolic - you steal my salt
What is the average weight gain in pregnancy?
27lbs
How does residual lung volume change in pregnancy?
Decreases due to expanding effect of the gravid uterus.
What is the cause of increase LE edema in pregnancy?
Partial vena cava occlusion, decrease in interstitial colloid osmotic pressure mediated by vasopressin secretion
When is cardiac output the highest: 1st, 2nd, 3rd trimester, or postpartum?
Postpartum
Mean arterial pressure and vascular resistance decrease and blood volume and basal metabolic rate increase. As a result, cardiac output increases significantly beginning in early pregnancy. During late pregnancy, the large uterus compresses venous return from the lower body and may also compress the aorta; cardiac filling may be reduced and cardiac output diminished. Immediately postpartum this effect is gone, thus rapidly increasing the cardiac output.
Where is the normal location of the appendix in pregnancy?
The appendix is usually displaced upward and somewhat laterally as the uterus enlarges, can be normal located in the RUQ.
What is the approximate water content of fetus, placenta, and fluid?
3.5L
Which hormone stimulates respiratory drive to increase during pregnancy?
Enhanced respiratory drive is primarily due to the stimulatory action of progesterone.
How much in percent does maternal blood volume expand by the end of pregnancy?
40-45%
Do BNP levels change during normal pregnancy?
BNP levels remain unchanged during normal pregnancy despite greater plasma volume.
1. Altered stomach position
2. Esophageal sphincter tone is decreased.
3. Intraesophageal pressures are lower and intragastric pressures higher in pregnant women.
4. Decreased esophageal peristalsis secondary to progesterone effect
What are the changes to glucose levels and insulin levels in pregnancy?
Normal pregnancy is characterized by mild fasting hypoglycemia, postprandial hyperglycemia, and hyperinsulinemia, largely due to the effects of human placental lactogen.
What is an abnormal creatinine level in pregnancy?
Serum creatinine levels decrease during normal pregnancy from a mean of 0.7-0.5 mg/dL
Values of 0.9 mg/dL or greater suggest underlying renal disease and should prompt further evaluation.
How does physiologic changes in the spleen affect the thrombocytopenic changes typically seen in pregnancy?
Spleen enlarges by up to 50% in the first trimester, thereby increasing platelet consumption.
Which trimester do you expect blood pressure levels to be lowest in?
2nd trimester
What is an endocrine abnormality you might see after a PPH?
Sheehan syndrome (panhypopituitarism)
What is the approximate iron requirement for the entirety of a normal pregnancy?
1000mg
About 300 mg are actively transferred to the fetus and placenta, 200 mg are lost through various normal excretion routes, primarily the gastrointestinal tract, and the other 500mg is required for the increase in the total circulating erythrocyte volume (=450 mL).
What is a non-structural cause of the increased urinary frequency typical in pregnancy?
GFR and renal plasma flow increase early in pregnancy from two principal factors:
1. hypervolemia-induced hemodilution lowers the protein concentration and oncotic pressure of plasma entering the glomerular microcirculation.
2. renal plasma flow increases by approximately 80 percent before the end of the first trimester
As a consequence of this elevated GFR, pregnant women report urinary frequency during pregnancy.
What are the lower limits of Hg levels in each trimester of pregnancy?
10.5, 11.0, 10.5
Because of great plasma augmentation, hemoglobin concentration and hematocrit decrease slightly during pregnancy (dilutional anemia)
What is the effect on fetal oxygen saturation in a laboring woman lies in a lateral recumbent position compared with supine?
Increases by 10%!
What is one factor behind the physiology of cholestasis of pregnancy?
Impaired emptying, subsequent stasis, and an increased bile cholesterol saturation of pregnancy contribute to the increased prevalence of cholesterol gallstones in multiparas and cholestasis of pregnancy -> pruritus gravidarum from retained bile salts.
Which trimester do maternal serum leptin levels peak in?
2nd trimester
Which acid-base disorder is common in pregnancy?
Respiratory alkalosis from the increased respiratory drive lowering blood partial pressure of PCO2.
What is the mechanism by which pregnancy is a prothrombotic state?
Evidence suggests fibrinolytic activity is reduced in normal pregnancy, favoring fibrin formation. Although this is countered by increased levels of plasminogen, the net result is that pregnancy is a procoagulant state.
How does pregnancy affect the left ventricle by the end of pregnancy?
Left ventricular mass increased 30 to 35 percent at term compared with first trimester.
When does the synthesis and secretion of thyroid hormone by the fetal pituitary TSH ensue?
20wks