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Pathophysiology (L3), Infertility (failure to conceive after 1 yr [6 mo if…

- - - - Left lateral displacement of the heart results from enlargement of the uterus & subsequent depression of the diaphragm; increased intracardiac vol. & myocardial mass; increased CO; increased blood volume (precipitated by increased aldosterone & subsequent increase in RBC & reticulocyte conc.; increased plasma (disproportionate RBC contributes to anemia; venous congestion secondary to increased venous pressure (CM: Varicose veins, hemorrhoid, dependent edema); decreased systolic & diastolic BP; systolic ejection murmur (sometimes)
    - - Increased tidal volume; increased resting minute ventilation; decreased functional residual capacity & residual volume due to depression of the diaphragm by the uterus
    - - Nipple enlargement + hyperpigmentation; glands of Montgomery (hypertrophic sebaceous glands of areola); increased venous visibility (re. increased blood supply); proliferation of mammary glands; readiness of lactation (inhibited throughout preg. by Estro.)
    - - Increased kidney length & weight; increased pelvic volume (w/ dilated renal calyces); increased urine vol due to ureter dilation (CM: Increased risk of UTI); increased renal blood flow & glomerular filtration (CM: Increased risk of glycosuria & proteinuria)
    - - Striae/stretch marks of the abdomen, breast & thighs; hyperpigmentation due to increased melanocyte stimulating h., estrogen & progesterone which increase melanin (e.g., linea nigra [hyperpigmentation of the abdomen] & chloasma [irregular patches of varying size throughout the face and/or neck])
    - - Increased relaxation of the lower esophageal sphincter due to high abdominal pressure, progesterone & estrogen (CM: Reflux/heartburn); increased nutrient absorption due to decreased stomach & intestinal motility (CM: Constipation); bile stasis & subsequent risk of cholestasis due to enlargement of the gallbladder & subsequent failure to empty
  - - - 16 G Wks: Uterine fundus is palpable halfway b/w the pubic bone & umbilicus
        
        20 G Wks: Uterine fundus is palpable around the umbilicus, ability to measure symphysis height (i.e., fetal growth) - normal: 1-2 cm of # wk preg in singleton preg.
        
        28 G Wks: Uterine fundus is palpable above the umbilicus
        
        36 G Wks: Uterine fundus is palpable at the xiphoid process
- - - - Altered mental status: Glasgow Coma Scale of 13-15
      - RR exceeding 22 BPM
      - SBP less than 100 mmHg
- - - - Gestational HTN (Diagnosis: After 20 wks gestation): SBP equal to or greater than 140 mmHg | DBP equal to or greater than 90 mmHg | Implication: Morbidity & mortality
        
        Severe Gestational HTN: SBP equal to or greater than 160 mmHg | DBP equal to or greater than 110 mmHg | Implication: Stroke
        
        Preeclampsia: HTN & increasing proteinuria preceded by HTN (10-20%) & GHTN (35%) | CM: CNS irritability (reflexes, clonus, headache, visual disturbance, epigastric/chest pain, dyspnea, decreased platelet count, alt. to liver enzymes
        
        Risk Factors: HTN/GHTN, maternal age over 40, first continuing pregnancy, obesity/excess wt gain, family or personal hx, interpregnancy interval of less than 2yrs OR greater than 10, use of reproductive technologies, multiple gestation, elevated BP at initial prenatal visit
        
        Treatment: Beta-blockers, alpha-2-adrenergic agonist, direct vasodilator (ARBs & ACIs are contraindicated)
        
        Implication: MI, stroke, HF, renal failure (maternal) | Placental complication, fetal growth restriction, preterm birth, oligohydraminos (& subsequent intolerance to labour stress causing FHR decelerations or morbidity)
        
        Etiology: Excess feto-placental demand causes endothelial activation by inflammatory & anti-angiogenic mediators who cause maternal syndrome | Outcomes: Organ damage (ARDs, cardiomypoathy, stroke, edema, HTN, glomerular endothelisosis, proteinuria, ATN, liver damage, hematoma, rupture, microangoptahtlic hemolysis), intervillous soup (placental villi meet maternal blood) & oxidative stress
        
        Eclampsia: CM of preeclampsia & seizure activity | Implication: Impaired fetal blood supply | Treatment: Immediate delivery & prevention of reccurrent ep
        
        HELLP Syndrome: Hemolysis, elevated liver enzymes & low platelets | Implication: Disseminated intravascular coagulopathy (coagulation-fibrinolysis imbalance) | Treatment: Immediate delivery, corticosteroids, blood products
- - - - Initiation of positive feedback loop causes greater cell deterioration