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What are some pregnancy adaptations seen in the eyes?
- -Increase cornea thickness
- -Noticable by 10wks, resolves by 6 wks PP
- -Decrease in intraocular pressure
- ***May notice irritation w/ contact lens
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What are are GI changes in appetite?
- -Increased appetite
- -PICA
- -N/A (70%), begins 4-9wks and resolving 14-16wks
-
What are some GI changes seen in the mouth of pregnant women?
- -Hyperptyalism (excess saliva)
- -bleeding, soft, edematous gums
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What are some GI changes in the gallbladder that occur during pregnancy?
-Cholestasis--> slower gastric emptying and increased residual volume
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What are some GI effects on the liver during pregnancy?
- Mostly unchanged but INCREASE in ALT/cholesterol
- -DECREASE albumin (dilutional)
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What are some respiratory effects during pregnancy?
- -Diaphragm shifts up 4cm
- -Increase in tranverse diameter
- -Lower ribs flare
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T or F. Despite common nasal congestion in pregnancy, women should NOT use nasal decongestant sprays.
True, maybe may cause atropic mucosal changes
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When is maternal dypsnea most prevalent?
Late 1st trimester or early 2nd due to reduced PaCO2 levels (gas exchange)
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T or F. Minute ventilation increases 30-40% by later pregnancy.
True--> due to progesterone
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What are the 3 respiratory volumes left unchanged in pregnancy?
- 1. Expiratory reserve vol. (ERV)
- 2. Vital Capacity
- 3. Inspiratory reserve vol (IRV)
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What respiratory volumes are INCREASED during pregnancy?
- 1. O2 consumption (15%)
- 2. Minute ventilation (30-40%)
- 3. Tidal vol (30%)
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What respiratory volumes DECREASE during pregnancy?
- 1. Functional residual capacity
- 2. Residual volume
- 3. Total lung capacity
- 4. total pulm. resistance (b/c rib flaring)
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How much does the CO and HR increase during pregnancy?
- CO- 30-50%
- Resting HR -10-15bpm
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Because of the changes to the heart during pregnancy, what symptoms may occur?
- -dyspnea
- -Decreased exercise tolerance
- -peripheral edema, distended neck veins
-
When does the BP dip slightly in pregnancy?
2nd Trimester (the goes back to baseline)
-
T or F. There are NO changes in aortic or pulmonic sounds?
True (96% have late systolic murmur)
-
90% of pregnant women may have what kind of murmer?
gallop (s3)
-
How much does the plasma volume increase by during pregnancy?
50%
-
What happens to fibrinogen and fibrinolysis during pregnancy?
- Fibrinogen increases 3x normal
- -Fibrinolysis decreases
-
When during pregnancy is an increase in venous stasis seen?
End of 1st trimester
-
What stimulates lactation after delivery?
drop in E2 and progesterone
-
GFR increases or decreases during pregnancy?
INCREASES by 50%
-
T or F. THere is a DECREASE in plasma creatinine and urea during pregnancy?
True (including BUN & creatinine)
-
T or F. Proteinurea or hematuria are abnormal during pregnancy.
TRUE
-
What occurs to the bladder during pregnancy?
Decreased bladder tone, increased residual void, increased frequency
-
Which gland has an increased secretion causing the "glow of pregnancy"?
-Eccrine (watery)
-
Increase in insulin resistance causes what 3 things during pregnancy?
- 1. Hyperglycemia
- 2. Hyperinsulinemia
- 3. Hypertriglyceridemia
-
What is the effect of pregnancy on the thyroid and thyroid hormones?
-Increased levels of T4 and TBG, but no increase in TSH/T3/FT4 so pregnant women should be euthyroid!
-
What 3 things occur in the vagina during pregnancy?
- 1. Increased vascularity
- 2. hyperemia
- 3. lactic acid production (pH drops to 3.5)
-
What is the total amount of weight gain expected in pregnancy?
~25l
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How many calories are burned in the 2nd, 3rd trimester and while breastfeeding?
- 2nd--> 340
- 3rd--> 452
- Breastfeeding--> 600
-
T or F. Abnormal weight gain could be a sign of birth defect.
True. Decreased wt gain w/ anencephaly and spina bifida
-
What are some obesity risks in the 1st/2nd trimester?
- 1. increased miscarriage rate
- 2. congenital anomaly (NTD, heart defects, facial clefting)
- 3. Challenging U/S
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What are some obesity risks in 3rd Tri and L&D?
- -GDM
- -Pre-eclampsia
- -unexplained stillbirth
- -shoulder dystocia
- -C/S
- -Surgical risks
- -delayed wound healing
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What are 2 fetal risks related to obesity in pregnancy?
- -2x increased risk for childhood obesity
- -48% odds of overweight by age 7
-
How long are post-GBP women recommended to wait before getting pregnant?
-12-24mo
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How nutrients may need to be supplemented in women w/ GBP?
-Iron, B12, folic acid, calcium
-
What 4 screenings should occur in the 1st/2nd trimester?
- 1. HTN, sleep apnea
- 2. folic acid
- 3. GDM
- 4. fetal anomaly u/s mid-trimester
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What 2 screenings should be performed during 3rd TM?
- 1. pre-eclampsia
- 2. macrosomnia
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