2- Maternal Phsiology Changes in Pregnancy

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Questions and Answers

What is the primary role of the corpus luteum during the early stages of pregnancy?

To stimulate the ovaries for egg maturation

To significantly increase progesterone production

To contribute very little to progesterone production (correct)

To initiate ovulation

Which hormone is secreted by the corpus luteum during pregnancy?

Lactogen

Oxytocin

Estrogen

Relaxin (correct)

What characteristic color change in the vagina during pregnancy is referred to as Chadwick sign?

Green

Violet (correct)

Red

Brown

What condition is associated with the presence of theca-lutein cysts?

Increased serum hCG levels Signup and view all the answers

What effect does pregnancy have on the pH of vaginal discharge?

Increased acidity, varying from 3.5 to 6.0 Signup and view all the answers

Which of the following changes occurs in the breasts during pregnancy?

Increased pigmentation and sensitivity Signup and view all the answers

What is a common symptom associated with hyperreactio luteinalis?

Abdominal pain due to cyst hemorrhage Signup and view all the answers

What causes the increase in serum ionized calcium levels during pregnancy?

Serum ionized calcium levels remain unchanged Signup and view all the answers

What mechanism contributes to elevated leptin levels during pregnancy?

Increased insulin resistance Signup and view all the answers

During pregnancy, why does the concentration of hemoglobin and hematocrit decrease?

Increased plasma volume Signup and view all the answers

What is the primary reason for the requirement of 1000 mg of iron during pregnancy?

Transfer to the fetus and placenta Signup and view all the answers

What type of inflammatory response is characteristic in early pregnancy?

Pro-inflammatory Signup and view all the answers

What role does maternal hyperlipidemia play during pregnancy?

Supports rapidly growing placenta Signup and view all the answers

What condition can abnormally elevated leptin levels during pregnancy be associated with?

Preeclampsia Signup and view all the answers

How does the volume of erythrocytes typically change during pregnancy?

Increases significantly Signup and view all the answers

What is the primary source of the increased blood volume during pregnancy?

Increased plasma volume greater than erythrocytes Signup and view all the answers

What hematologic change occurs in neutrophil activation during pregnancy?

Depressed chemotaxis and adherence functions Signup and view all the answers

How do plasma fibrinogen levels change during pregnancy?

They increase Signup and view all the answers

Which cardiovascular change is NOT observed during pregnancy?

Increased systemic vascular resistance Signup and view all the answers

What effect does pregnancy have on leukocyte count?

It elevates to approximately 15000/mm³ Signup and view all the answers

What happens to the heart's position during pregnancy?

It rotates on its long axis Signup and view all the answers

Which factor's concentration notably decreases during normal pregnancy?

Protein S Signup and view all the answers

What cardiovascular change occurs in the first trimester by week five?

Increased heart rate Signup and view all the answers

What hematologic effect is associated with increased thromboxane A2 production during pregnancy?

Increased platelet aggregation Signup and view all the answers

What factor is responsible for the spleen enlarging by up to 50% by the end of normal pregnancy?

Elevated blood volume Signup and view all the answers

What physiological condition occurs due to venous return compression in late pregnancy?

Supine hypotension Signup and view all the answers

What physiological change is associated with the substance relaxin during normal pregnancy?

Increased glomerular filtration rate (GFR) Signup and view all the answers

Which factor contributes to the right ureteral dilatation observed in 86% of women during pregnancy?

Compression from the dextrorotated uterus Signup and view all the answers

What is the expected change in serum albumin concentration during late pregnancy?

Decreases to near 3.0 g/dL Signup and view all the answers

What is the average creatinine clearance in pregnant women compared to nonpregnant women?

Higher by 30 percent Signup and view all the answers

Which of the following gastrointestinal changes is commonly associated with pregnancy?

Displacement of the appendix upwards and laterally Signup and view all the answers

What change occurs in functional residual capacity (FRC) during pregnancy?

Decreases by 400 to 700 mL Signup and view all the answers

Which of the following is true regarding the changes in the respiratory system during pregnancy?

Expiratory reserve volume decreases by 15 to 20% Signup and view all the answers

What happens to tidal volume (TV) and resting minute ventilation (RMV) during pregnancy?

Both increase significantly as pregnancy advances Signup and view all the answers

By what percentage does the glomerular filtration rate (GFR) increase by the second week after conception?

25% Signup and view all the answers

How is the oxygen consumption changed during labor compared to previous pregnancy stages?

Increases by 40 to 60% Signup and view all the answers

What effect does hypervolemia-induced hemodilution have on the plasma entering glomerular microcirculation?

Lowers oncotic pressure Signup and view all the answers

What role does progesterone play in pregnancy related to airway conductance?

Decreases airway resistance Signup and view all the answers

Which measurement reflects the size increase of the diaphragm during pregnancy?

Rises about 4 cm Signup and view all the answers

What happens to the total oxygen-carrying capacity during normal pregnancy?

Increases appreciably Signup and view all the answers

What is noted in the kidney size changes during pregnancy?

Increases approximately 1.5 cm Signup and view all the answers

Study Notes

Maternal Physiological Changes in Pregnancy

Anatomical, physiological, and biochemical adaptations in pregnancy are profound.
Physiological adaptations of normal pregnancy can be misinterpreted as pathological, and can mask or worsen pre-existing diseases.
Physiological changes occur in the nervous system, musculoskeletal system, endocrine system, cardiovascular system, respiratory system, urinary system, and reproductive tract.

Reproductive Tract: Uterus

Uterus stretches and hypertrophies.
Corpus walls thicken during early pregnancy, then gradually thin.
Uterine myometrium is 1-2 cm thick at term.
Estrogen and progesterone likely influence uterine hypertrophy.
Uterine size increases more rapidly in length than width during pregnancy, assuming an ovoid shape.

Reproductive Tract: Cervix

Softening and cyanosis of the cervix result from increased vascularity and edema.
Cervical glands proliferate and may extend or evert.
Cervical mucus is rich in immunoglobulins and cytokines acting as an immunological barrier.
Progesterone-induced changes in cervical mucus (ferning) may be observed.

Reproductive Tract: Ovaries

Ovulation ceases during pregnancy.
A single corpus luteum is present during the first 6-7 weeks post ovulation.
Relatively little progesterone is produced after the initial weeks.
An extrauterine decidual reaction occurs on and beneath the ovarian surface, commonly.
Ovarian vascular pedicle diameter increases during pregnancy, from approximately 0.9 cm at early gestation to 2.6cm at term.

Reproductive Tract: Relaxin

A protein hormone secreted by the corpus luteum and placenta.
Its pattern of secretion mimics human chorionic gonadotropin (hCG).
Involved in remodeling reproductive tract connective tissue.
Related to augmented renal hemodynamics, decreased serum osmolality, and uterine artery compliance associated with normal pregnancy.

Reproductive Tract: Theca-Lutein Cysts

Benign ovarian lesions resulting from exaggerated physiological follicle stimulation (hyperreactio luteinalis).
Associated with high hCG levels.
Asymptomatic, but hemorrhage can cause abdominal pain.
Maternal virilization may be observed.

Reproductive Tract: Vagina and Perineum

Increased vascularity and hyperemia develop in the skin and muscles of the perineum and vulva.
Increased vascularity results in the characteristic violet color of Chadwick's sign.
Mucosal thickness, connective tissue loosening, and smooth muscular cell hypertrophy occur.
Vaginal discharge (thick, white) is acidic due to increased lactic acid production from glycogen.

Reproductive Tract: Breasts

Tenderness and paresthesias are common.
Breast size and delicate veins become visible closer to the surface.
Nipples become more erectile, larger, and more deeply pigmented.
Colostrum (thick, yellowish fluid) can be expressed from nipples.
Areolae become broader and more deeply pigmented, appearing with small elevations (Montgomery glands).

Abdominal Wall

Striae gravidarum (stretch marks) or reddish, depressed streaks, appear on abdominal skin.
Increased melanocyte-stimulating hormone, estrogen, and progesterone contribute to pigmentation.
Diastasis recti: rectus muscles separate, potentially forming a ventral hernia.
Chloasma (melasma gravidarum): may occur as irregular patches on the face and neck.
Linea nigra darkening of the midline of the anterior abdominal wall.

Skin Changes

Vascular Changes (hyperestrogenemia): angiomas (spider veins), red skin elevations (branching out from a central lesion), and palmar erythema appear.

Metabolic Changes

Weight gain averages 12.5 kg.
Increased water retention occurs.

Electrolyte Metabolism

Glomerular filtration rate (GFR) of Na and K increases, despite excretion remaining unchanged because of tubule resorption.
Serum Ca levels decrease.
Serum Mg also decreases.
Iodine requirements increase.

Carbohydrate Metabolism

Mild fasting hypoglycemia and postprandial hyperglycemia.
Hyperinsulinemia.
Suppression of glucagon.
Increased insulin resistance and estrogen stimulation affect metabolism.

Fat Metabolism

Maternal hyperlipidemia.
Increase in lipids, lipoproteins, and apolipoproteins.
Increase in insulin resistance and estrogen stimulation.
Leptin levels rise to regulate maternal energy demands to regulate fetal growth.
Elevated leptin levels correlate with preeclampsia and gestational diabetes mellitus (GDM).

Hematologic Changes

Increased blood volume (40-45%).
Meets metabolic demands of enlarging uterus and supports rapidly growing placenta.
Plasma increases more than erythrocytes. Erythrocyte volume increase to 450 ml.
Moderate erythrocyte hyperplasia occurs; reticulocyte count increases.
Serum iron is required in larger amounts, with 1000 mg needed during normal gestation.

Cardiovascular System

Cardiac output increases.
Systemic vascular resistance decreases.
Brachial systolic and diastolic blood pressure decrease.
Central systolic blood pressure is also lower.
Resting pulse rate increases by approximately 10 beats/min.
Plasma volume expansion from weeks 10-20.
Ventricular performance impacted by changes in systemic vascular resistance and pulsatile arterial flow.

Respiratory System

Diaphragm rises 4 cm.
Functional residual capacity decreases (20-30%).
Expiratory reserve volume decreases (15-20%).
Residual volume increases (20-125%).
Inspiratory capacity increases (5-10%).
Total lung capacity remains unchanged or decreases by less than 5%.

Urinary System

Kidney size increases (approximately 1.5 cm).
Glomerular filtration rate (GFR) and renal plasma flow increase early in pregnancy.
GFR increases to 25–50% of its initial value by mid-pregnancy.

Renal Changes in Normal Pregnancy

Decreased bicarbonate threshold.
Progesterone stimulates respiratory center.
Significant changes to osmolarity for AVP release and thirst are noted.
Serum creatinine decreases with normal gestation.
Alterations in various parameters like kidney size, and dilatation, renal function, and maintenance of acid-base, with clinical relevance.

Gastrointestinal Tract

Pregnancy gingivitis: gums becoming hyperemic and softened with potential bleeding when traumatized.
Epulis gravidarum: highly vascular swelling of the gums.
Stomach and intestines displaced by enlarging uterus.
Appendix displacement upward and somewhat laterally as uterus enlarges.

Pyrosis (heartburn)

Esophageal reflux of acidic secretions.
Danger of regurgitation and aspiration during general anesthesia.

Hemorrhoids

Constipation and elevated venous pressure within the enlarged uterus likely contribute.

Endocrine System

Pituitary gland enlarges (approximately 135%).
Growth hormone predominantly secreted from the maternal pituitary during the first trimester.
Growth hormone secretion from placenta increases by week 17.
Prolactin levels increase markedly.

Musculoskeletal System

Progressive lordosis is characteristic.
Sacroiliac, sacrococcygeal, and pubic joints have increased mobility.
Symphyseal separation accompanies deliveries, with significant pain when greater than 1cm.

Central Nervous System

Pregnancy-related memory decline is limited to third trimester.
This decline is not attributable to depression, anxiety, sleep deprivation, or other physical changes in pregnancy.
Intraocular pressure decreases and is attributed to increased vitreous outflow.
Corneal sensitivity decreases.
Krukenberg spindles are brownish-red opacities in posterior surface of cornea.

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Test your knowledge on the physiological changes during pregnancy with this quiz. Explore topics such as the role of the corpus luteum, hormone secretion, and various symptoms associated with early pregnancy. Challenge yourself to deepen your understanding of this fascinating stage of human development.