Pregnancy Physiologic Changes Quiz

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Questions and Answers

What are the most common physiologic changes in pregnancy?

Pigmentary disturbances (correct)

Endocrine alterations

Metabolic changes

Immunologic changes

Pemphigoid (Herpes Gestationis) is common during pregnancy.

False

What condition is characterized by irregular, blotchy facial hyperpigmentation during pregnancy?

Melasma/Chloasma

Pemphigoid manifests as abrupt appearance of severely pruritic urticarial lesions on a background of __________ skin.

normal Signup and view all the answers

During which trimester does Pemphigoid typically begin?

Second or third trimester Signup and view all the answers

What potential outcomes are associated with Pemphigoid during pregnancy?

Premature delivery Signup and view all the answers

What is the immunologic characteristic seen in Pemphigoid?

DIF shows linear deposition of C3 with or without immunoglobulin IgG. Signup and view all the answers

Pemphigoid can only occur in normal pregnancies.

False Signup and view all the answers

What are some risk factors associated with Dermatitis of Pregnancy (DIP)?

Increased maternal-fetal weight gain Signup and view all the answers

IDIF test is positive in cases of Dermatitis of Pregnancy.

False Signup and view all the answers

What is the average duration of pregnancy when Dermatitis of Pregnancy typically occurs?

35 weeks Signup and view all the answers

The most common pruritic disorder in pregnancy is _____ .

Atopic Eruption of Pregnancy (AEP) Signup and view all the answers

What type of skin changes are characteristic of Atopic Eruption of Pregnancy?

Eczematous and papular Signup and view all the answers

Which laboratory test results can indicate atopic dermatitis in pregnancy?

Total serum IgE Signup and view all the answers

Match the following treatments of Dermatitis of Pregnancy with their purposes:

Topical corticosteroids = Symptomatic relief Oral antihistamine = Management of pruritus Emollients = Moisturizing Benzoyl peroxide = Treatment of truncal and follicular lesions Signup and view all the answers

What is the clinical prognosis for mothers with a history of atopy during pregnancy?

Increased risk for atopic dermatitis in infants Signup and view all the answers

Which of the following is a typical feature of polymorphic eruption of pregnancy?

Intensely pruritic Signup and view all the answers

Melasma may regress postpartum but often persists.

True Signup and view all the answers

What are the common areas affected by stretch marks in pregnancy?

Abdomen, hips, buttocks, and breast. Signup and view all the answers

Which test is considered the gold standard for diagnosing Intrahepatic Cholestasis of Pregnancy (ICP)?

Direct Immunofluorescence (DIF) Signup and view all the answers

The degree of pruritus correlates with ___ concentration in ICP.

bile acid Signup and view all the answers

What is the typical prognosis for maternal health in cases of Intrahepatic Cholestasis of Pregnancy?

Very good, with resolution within weeks, months, or years until complete remission. Signup and view all the answers

What is the most feared complication of Intrahepatic Cholestasis of Pregnancy?

Placental insufficiency Signup and view all the answers

Pustular psoriasis of pregnancy generally has higher incidence rates during winter months.

True Signup and view all the answers

Match the following conditions with their defining characteristics.

Intrahepatic Cholestasis of Pregnancy = Elevated serum bile acids Pustular Psoriasis of Pregnancy = Absence of family history Polymorphic Eruption of Pregnancy = Only occurs in primagravids Striae Gravidarum = Stretch marks in pregnancy Signup and view all the answers

Study Notes

Skin Changes in Pregnancy

Pregnancy induces altered endocrine, metabolic, and immunologic environments, leading to various skin changes.
Common pigmentary disturbances include:
- Linea Nigra: Darkening of the linea alba, reversible post-pregnancy.
- Melasma/Chloasma: Irregular facial hyperpigmentation occurs in 70% of pregnancies, worsened by sun exposure and oral contraceptive use.
Structural changes:
- Striae gravidarum (stretch marks) primarily affect the abdomen, hips, buttocks, and breasts.
- Common vascular changes include spider angiomas.

Dermatoses with Fetal Risk

Pemphigoid (Herpes Gestationis)

Rare condition, seen in 1 in 50,000 pregnancies, occurs in mid-to-late pregnancy and postpartum.
Characterized by pruritic urticarial lesions; may lead to small-for-gestational age and premature deliveries.
Immunologically mediated with diagnostic features including:
- DIF showing linear deposition of C3 and IgG.
- Elevated serum bile acids indicating Intrahepatic Cholestasis of Pregnancy (ICP).

Intrahepatic Cholestasis of Pregnancy (ICP)

Rare and reversible cholestasis typically arises in late pregnancy due to high estrogen levels.
Symptoms include severe pruritus, especially localized to palms and soles in the third trimester.
Correlates with increased risk of fetal complications: prematurity, fetal distress, stillbirth.
Diagnosed through elevated serum bile acids and liver function tests.
Management may involve UDCA (ursodeoxycholic acid) to lower bile acid levels and improve symptoms.

Pustular Psoriasis of Pregnancy (Impetigo Herpetiformis)

Very rare variant of pustular psoriasis occurring in the third trimester but can onset as early as the first trimester.
Characterized by erythematous patches with subcorneal pustules, often associated with constitutional symptoms like fever and malaise.
Diagnosis includes CBC with leukocytosis, careful consideration of differential diagnoses such as pemphigoid gestationis.

Dermatoses Not Associated with Fetal Risk

Polymorphic Eruption of Pregnancy

A common, benign condition typically seen in primagravida, presenting in the third trimester.
Etiology remains unknown; pathogenesis may involve maternal immunoreactivity linked to abdominal distention.
Clinically diagnosed based on typical presentation and locations at the end of pregnancy, with biopsy reserved for uncertain cases.### Developmental Inflammatory Dermatitis (DIF) and PEP
Increased progesterone receptor noted in lesional PEP.
Granular or absent C3, IgM, or IgA at the dermoepidermal junction, particularly around blood vessels.
IDIF is negative in most cases.
Multiple gestations (twins and triplets) identified as a risk factor.
Unexplained associations with male fetuses and cesarean sections.
Increased maternal-fetal weight gain also noted.
Harmless to mother and fetus, but pruritus observed to be intense and unremitting.
Symptomatic relief can be achieved through various treatment options.

Cutaneous Findings in PEP

Typically seen in primagravids during the last trimester, average at 35 weeks.
Presents as polymorphous erythematous urticarial papules with a narrow pale halo.
Eruptions often begin in the abdomen (notably in the striae gravidarum) and have periumbilical sparing, spreading to thighs, buttocks, breasts, and arms.
Severe pruritus may interfere with sleep patterns.

Atopic Eruption of Pregnancy (AEP)

Most common pruritic skin disorder in pregnancy; occurs in about 50% of all pregnancies.
Pregnancy influences cytokine profiles, favoring T-helper 2 cell expression.
Personal or family history of atopy is a significant risk factor.
Clinical manifestations include flare-ups in 20% of patients with preexisting atopic dermatitis.

Subtypes of AEP

E-type (Eczematous): Typically affects flexural surfaces and face.
P-type (Popular): Involves individuals with atopic backgrounds or elevated serum IgE levels, presenting as prurigo of pregnancy with itchy, excoriated papules mainly on extensor surfaces.

Diagnosis of AEP

Diagnosis determined clinically and supported by histopathology, which appears nonspecific.
Laboratory tests typically show elevated total serum IgE in 20-70% of cases.

Clinical Course and Prognosis

Onset usually occurs in the third trimester and generally responds well to therapy.
Prognosis for both mother and fetus is excellent.
Infants of mothers with a history of atopy have an increased risk for developing atopic dermatitis.

Treatment and Management of AEP

Emollients recommended for skin hydration.
Midpotency topical corticosteroids are commonly used.
Antihistamines can be given to control itching.
Benzoyl peroxide may be used for truncal, follicular, and non-viral bullae.

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Description

This quiz explores the common physiologic changes during pregnancy, including conditions such as Pemphigoid (Herpes Gestationis) and facial hyperpigmentation. Test your knowledge on the symptoms, outcomes, and typical timelines associated with these conditions in expectant mothers. Get ready to deepen your understanding of pregnancy-related physiological changes.