LIFECYCLE EXAM 2

Increase in total T4/T3, no change in free T4 (not hyperthyroid even though levels are increased)

What happens to the thyroid system in pregnancy?

Increase in thyroid binding globulin

Why is there no change in free T4 during pregnancy?

Suppressed due to hCG stimulation

What can happen to TSH during early pregnancy?

Human placental lactogen (hPL)

leads to increased lipolysis, insulin resistance, increased insulin secretion and creates a condition of “accelerated starvation” during pregnancy

Ensure fetal glucose supply

What is the purpose of hPL making the mother slightly insulin resistant during pregnancy?

Yes

Does the uterine mass increase during pregnancy?

from 70g to 1100g

What is the weight increase of uterus during pregnancy?

from  50 mL/min (nonpregnant) to 500–750 mL/min

What is the change to the blood supply to the uterus during pregnancy?

Hemorrhage during or after pregnancy

Why can the increase in blood supply to the uterus be dangerous?

Cervix

holds the fetus in uterus during pregnancy, during labor softens, shortens (effaces), and opens (dilates) to allow the baby to pass through the birth canal

Tidal volume

What has the greatest impact on the increased minute ventilation during pregnancy– the tidal volume or the respiratory rate?

Increased tidal volume and  minute ventilation

How does respiration change in a pregnant person?

Progesterone-mediated respiratory drive

Why is there an increase in tidal volume and minute ventilation during pregnancy?

Respiratory alkalosis (decreased CO2 levels)/ hyperventilation 

 helps facilitate oxygen transfer to fetus, and CO2 perfusion from fetus to mother

Respiratory alkalosis

What is the result of progesterone-mediated respiratory drive?

Aldosterone

Helps expand blood volume and maintain blood pressure during pregnancy

Increases (50%)

What happens to GFR in pregnancy?

Serum creatinine decreases (due to increased GFR)

What lab would change on the basic metabolic profile of a pregnant woman?

Increased renal blood flow (maternal kidneys eliminating for two)

What causes the increased GFR during pregnancy?

Optimize placental perfusion

What is the function of cardiovascular changes during pregnancy?

increased cardiac output (HR and SV), decreased systemic vascular resistance

Cardiovascular changes during pregnancy

Supine hypotension

pregnant uterus compresses the inferior vena cava when laying flat on back

place pillow under right hip

How to avoid Supine hypotension in pregnant patients?

turn patient to left side

What to do if patient experiences symptoms of Supine hypotension

Physiologic anemia

normal dilutional drop in hemoglobin and hematocrit due to plasma volume expanding more than red blood cell mass during pregnancy

Pregnancy is hypercoagulable state (due to increased coagulation factors)

What happens to the coagulation system during pregnancy?

300 million

how many sperm enter the vagina during fertilization 

cervix opening during ovulation

what allows the sperm to pass fromt the vagina into the uterus

a few dozen

how many sperm are actually able to reach the egg

40 weeks from first day of most recent menses

duration of human gestation

0-13 

1st trimester weeks 

14-24 

2nd trimester weeks 

24-delivery

3rd trimester weeks

elevated human chorionic gonadotropin (hCG)

how is pregnancy detected?

placenta

creates a low resistance vasculature graft onto the maternal circulation

placenta

helps protect fetus from attack by maternal immune system

placenta 

helps protect from maternal infections 

hCG, progesterone, and estriol

hormones synthezised by placenta

hCG

first hormone produced by the placenta

fetus

does the placenta belong to the mother or the fetus (GENETICALLY)?

spontaneous abortion/ miscarriage

loss of a pregnancy before 20 weeks of gestation without any medical or surgical intervention

aneuploidy or implantation problem

cause of most spontaneous abortion’s/ miscarriage’s

smoking, cocaine/meth, binge drinking, increasing age

risk factors for spontaneous abortion/ miscarriage

aneuploidy

genetic abnormality in which a cell has an abnormal number of chromosomes — either too many or too few

teratogen 

agent or influence that causes physical defects in the development of an embryo or fetus 

first 2 weeks

when can teratogens cause DEMISE of fetus

weeks 3-12

when are teratogens likely to cause MAJOR MALFORMATIONS

weeks 13-38

when are teratogens likely to cause MINOR MALFORMATIONS

tetracycline (doxycycline)

category D drug that causes permanent discoloration of teeth, enamel hypoplasia, should NEVER be used during pregnancy

coumadin, methotrexate, accutane

category X drugs that pose significant risk to fetus 

coumadin

causes nasal hypoplasia, shortened limbs, growth restriction, deafness, scoliosis, microphthalmia of fetus 

unshielded xrays, tetracycline, ciprofloxacin

what to avoid with pregnant women 

toxoplasmosis, OTher, rubella, CMV, HSV

TORCH infections that can be teratogenic

congenital syphilis 

hutchinsons incisocors, mulberry molar, interstial keratitis, eight cranial nerve deafness are symptoms of?

ectopic pregnancy 

pregnancy that has implanted somewhere other than uterus 

can cause hemorrhage

why is ECTOPIC PREGNANCY potentially life-threatening

trisomy 21,13, and 18, monosomy X, 47 XXY 

what autosomal aneuplodies survive birth?

1st trimester

when during pregnancy do MOST spontaeous abortions happen?

no (only about half)

does everryone who bleeds during pregnancy end up with a miscarrage?

gestatinal trophoblastic disease (molar pregnancy)

group of diseass in which trophoblasts (placental cells) grow in uncontrolled fasion, no normal fetus development 

malignant potential

what is the danger of gestational trophoblastic disease (molar pregnancy)

partial (2 sperm/1egg) and complete (2 sperm/ no ovum DNA)

COMMON forms of gestational trophoblstic disease (LOWEST MALIGNANT POTENTIAL)

invasive mole and choriocarcinoma

RARE, MALIGNANT forms of gestation trophoblastic disease

pre gestational diabetes 

diabetes before pregnancy 

high blood glucose is teratogenic 

why is diabetes dangerous during pregnancy 

blood sugar control prior to pregnancy

important risk reduction in patients with pre gestation diabetes

gestational diabetes

diabetes because of pregnancy

human placental lactogen (HPL)

cause of glucose intolerance in pregnant patients?

type 2 diabetes

what does gestational diabetes increase the mothers risk for?

macrosomia (lage baby), perinatal mortality, neurocognitive effects, hypoglycemia at birth

fetal risk of diabetes

hyperinsulinemia in response to high glucose

why might a baby born to mother with diabetes have hypoglycemia at birth

diabetic ketoacidosis, operative delivery/difficult wound repair, hypertensive disorders (of pregnancy)

maternal risks of diabetes

chronic hypertnesion 

hypertension prior to pregnancy, ELEVATED BP BEFORE 20 WEEkS

gestational hypertension

hypertension alone without any other changes AFTER 20 WEEKS gestation

pre-eclampsia

severe hypertensive diseases of pregnancy

>140/90 after 20 weeks with proteinuria

diagnosis criteria of pre-eclampsia

headache (especially in 3rd trimester)

BAD SIGN (of pre-clampsia) in pregnant person with any form of hypertension

seizures (eclampsia), stroke, fetal/maternal death, liver failure, hemorrhage, DIC (disseminated intravascular coagulopathy)

symptoms of pre-eclampsia 

pre-eclampsia 

contributes up to 60% of maternal deaths worldwide 

magnesium

what is given to patients during labor rand delivery to stabilize their cerebral vasculature so they don’t seize or stroke

20-37 weeks 

what is considered PRETERM DELIVERY 

periodontal disease, hypertensive diseases, smoking, previous preterm delivery 

associated with an increased risk of preterm birth

abruption

placental separation before baby is delivered, HIGH RISK OF FETAL DEATH

placenta previa 

placenta grown over cervical opening, REQUIRES C-section 

placenta malfunction

most common cause of growth restriction of fetus

multiple gestation (twins+)

at higher risk of ALL pregnancy complications 

mitosis issue (monozygotic twins) or double ovulation (dizygotic twins)

causes of twin/multiple pregnancies 

stillbirth

death of a fetus after 20 weeks of gestation (or when the fetus weighs ≥ 350–500 grams, depending on local definitions) before or during deliver

hemorrhage and infection

most common causes of mothers dying in childbirth

uterus fails to contract after delivery

most common cause of POSTPARTUM HEMORRHAGE

chorioamnionitis

infection during labor, can lead to endometritis

group B strep 

life threatening INFECTION in NEWBORNS 

alveoli

where is milk produced in breast? 

bromocriptine (dopamine agent)

treatment for prolactinoma

dopamine (from hypothalamus)

supresses PROLACTIN, released from hypothalamus

progesterone

normally supresses prolactin, SIGNIFICANTLY DROPS when placenta delivers to allow milk production

prolactin 

stimulates the breast to make milk 

oxytocin 

stimulates milk let downthrough contraction of myoepithelial cells

decreased malocclusion, decreased caries, improved orofacial structure

benefits of breastfeeding for infant

immunosupressants, isotretinoin (rentin A), lithium, metronidazole

medications that should not be taken when breastfeeding