Physiological Changes During Pregnancy

Physiological Changes During Pregnancy

Q. 1

Which of the following is seen during pregnancy?

 A Respiratory alkalosis
 B Respiratory acidosis
 C Metabolic alkalosis
 D

Metabolic acidosis

Q. 1

Which of the following is seen during pregnancy?

 A Respiratory alkalosis
 B Respiratory acidosis
 C Metabolic alkalosis
 D

Metabolic acidosis

Ans. A

Explanation:

Respiratory alkalosis

REF: Dutta 6th ed p. 55

Pregnancy is a state of respiratory alkalosis, hyperventillation is seen in it.


Q. 2

Which of the following is the least likely physi­ological change in pregnancy : 

 A

Increase in intravascular volume

 B

Increase in cardiac output

 C

Increase in stroke volume

 D

Increase in peripheral vascular resistance

Q. 2

Which of the following is the least likely physi­ological change in pregnancy : 

 A

Increase in intravascular volume

 B

Increase in cardiac output

 C

Increase in stroke volume

 D

Increase in peripheral vascular resistance

Ans. D

Explanation:

Ans. is d i.e. Increase in peripheral vascular resistance

Hemodynamic changes occurring during pregnancy are very important not only from clinical point of view but also from examination point of view.

The most important point to remember is that in normal pregnant patient. circulation is hyperdynamic with high cardiac output.

Hemodynamic changes during Pregnancy in brief

  1. Decreased peripheral vascular resistance°
  2. Decreased pulmonary vascular resistance°
  3. Decreased colloid oncotic pressure
  4. Increased cardiac output°
  5. Increased blood volume°
  6. Increased plasma volume
  7. Increased pulse rate.

Details of physiology of Hemodynamic changes occurring during pregnancy :

Blood volume : Blood volume is raised during pregnancy (as the activity of the uterus along with other systems is increased during pregnancy). Blood volume starts increasing from 6′h week and is maximum at 30 – 32 weeks; it is raised upto 40- 50% above the non pregnant level.

Advantages of Increased blood volume :

Fulfills the need of developing uteroplacental circulation.

2. Protects the mother against the potentially harmful effect of blood loss which occurs at parturition.

Plasma volume : Increases during pregnancy and reaches a maximum at 50%° in a singleton pregnancy (- 85 ml/kg).

Red cell volume : Increases to a maximum of 20 – 30%°.

As the increase in Red cell volume is not proportionate to increase in plasma volume. Therefore, even though there is an increase in hemoglobin mass during pregnancy, it produces a state of hemodilution known as Physiological anemia of Pregnancy.° i.e. Hb conc (gm%) decreases.

Hematocrit and number of red cells decrease.

Cardiac output : Increases during pregnancy. It starts increasing from 5′h week of pregnancy and is maximum at 30 – 34 weeks° 

Peripheral Vascular Resistance : Decreases on both arterial as well as venous side during pregnancy under the influence of placental hormones.

  • The decrease is manifested clinically by decrease in both mean and diastolic blood pressure° (inspite of the increase in cardiac output).
  • The decrease is clearly observed during the second trimester when average blood pressure is 10 – 15 rri,-nHg lower than in non pregnant state.




Q. 3

What are maternal physiological changes in pregnancy :

 A

↑ed cardiac output

 B

↑ed tidal volume

 C

↑ed vital capacity

 D

Option a and b both

Q. 3

What are maternal physiological changes in pregnancy :

 A

↑ed cardiac output

 B

↑ed tidal volume

 C

↑ed vital capacity

 D

Option a and b both

Ans. D

Explanation:

Ans. is a, b


Q. 4

Which cardiovascular change is physiological in last trimester of pregnancy 

 A

Middiastolic murmur

 B

Occasional atrial fibrillation

 C

Shift of apical impulse laterally and upwards in left 4th intercostal space

 D

Cardiomegaly

Q. 4

Which cardiovascular change is physiological in last trimester of pregnancy 

 A

Middiastolic murmur

 B

Occasional atrial fibrillation

 C

Shift of apical impulse laterally and upwards in left 4th intercostal space

 D

Cardiomegaly

Ans. C

Explanation:

Ans. is c i.e. Shift of apical impulse laterally and upwards in the left 4′h intercostal space 

Friends, we have already discussed cardiovascular changes occuring during pregnancy in detail. now lets see each option one by one.

  • Option “a” Presence of mid diastolic murmur :

In pregnancy, systolic murmur/continuous hissing murmur are heard, and not diastolic murmur. Rather presence of diastolic murmur is a clinical indicator of heart disease during pregnancy. .. Williams Obs. 23/e, p 960

  • Option             Occasional atrial fibrillation :

No where it is mentioned that AF is seen in pregnancy.

Rather again persistent arrythmia is an indicaor of heart disease during pregnancy.

 

  • Option

„r„

Shift of apical impulse laterally and upwards in the left 4th intercostal space :

This is correct as the heart is pushed upwards by elevation of diaphragm and rotated so that the apex beat is felt in the left 4′h intercostal space and lateral to midclavicuiar line.

  • Option            Cardiomegaly :

Pregnant women normally have some degrees of benign pericardial effusion, which may increase the cardiac silhoutte


Q. 5

All of the following may be observed in a normal pregnancy except :

 A

Fall in serum iron concentration

 B

Increase in serum iron binding capacity

 C

Increase in blood viscosity

 D

Increase in blood oxygen carrying capacity

Q. 5

All of the following may be observed in a normal pregnancy except :

 A

Fall in serum iron concentration

 B

Increase in serum iron binding capacity

 C

Increase in blood viscosity

 D

Increase in blood oxygen carrying capacity

Ans. C

Explanation:

Ans. is c i.e. Increase in blood viscosity

In normal pregnancy – as I have already discussed viscosity of blood decreases (not increases) i.e. option “c” is incorrect).° It is due to disproportionate increase in plasma volume and red blood cell volume i.e. pregnancy is a state of hemodilution.°

  • Since total hemoglobin mass increases during pregnancy. Therefore, oxygen carrying capacity of blood also increases (Viiiiiiam 23,e, p 115). Therefore, vtion “d is correct. BEWARE – In pregnancy hemoglobin mass increases(to the extent of 18-20%) but hemoglobin concentration decreases due to hemodilution.
  • Now let’s have a look at Iron metabolism in pregnancy.

–     During pregnancy there is marked demand of extra iron especially in the second half.

–    Even an adequate diet cannot provide the extra demand of iron.

Thus In pregnancy there is always a state of physiological iron deficiency.

Changes in Iron Metabolism during Pregnancy

              Marker                                                                 Change

  • Serum Iron concentration
  • Serum ferritin (Reflecting Iron stores)
  • Serum Total iron binding capacity
  • Percentage saturation (Serum ferritin /
  • Serum Transferrin

Decreases Decreases Increases

TIBC)         Decreases Increases

Fiememebr : The two Ts i.e. Transferrin and TIBC increase during pregnancy, rest all parameters of iron metabolism decrease during pregnancy.


Q. 6

Which of the following is increased in pregnancy:

 A

Globulin

 B

Fibrinogen

 C

Leukocytes

 D

All Correct

Q. 6

Which of the following is increased in pregnancy:

 A

Globulin

 B

Fibrinogen

 C

Leukocytes

 D

All Correct

Ans. D

Explanation:

Ans. is a, b  and c i.e. Globulin; Fibrinogen; Leukocytes; and Transferrin 

List of Metabolites / Hormones ..`increase during pregnancy

–  Hemoglobin° mass

–  Total plasma protein°

–    Globulin°

–     Leucocytes (Neutrophilic leucocytosis) Fibrinogen°

Factors II, VII, VIII, IX, X

–     insulin°

–     Lipids, lipoproteins (LDL and HDL) & apolipoproteins

–     Serum Transferrin°

–      C reactive protein°

Placenta Phosphatase° and Total Alkaline Phosphatase°

–       Growth hormone°

–       Prolactin°

–       Thyroxine binding globulin°

–       Total T3 and T4°

–       Calcitonin°

–       Vitamin D3°

–       Cortisol°

Decrease during pregnancy

–  Hemoglobin concentration

–  Factor XI and XIII°

–   All parameters of iron metabolism except TiBC & transferrin

–      Serum Urea°   As their

–       Serum Uric acid°    clearence

–      Serum creatinine°            increases

(normal in pregnancy is 0.7-0.9 mg/dl

–      Serum Blood Urea Nitrogen°

Serum Na / K / Ca / Mg /12

–      Albumin°



Q. 7

True about various changes in pregnancy is/are:

 A

Fibrinogen levels are increased

 B

Sodium retention

 C

Sr. potassium is decreased

 D

All Correct

Q. 7

True about various changes in pregnancy is/are:

 A

Fibrinogen levels are increased

 B

Sodium retention

 C

Sr. potassium is decreased

 D

All Correct

Ans. D

Explanation:

Ans. is a, b and c i.e. Fibrinogen levels are increased, Sr. potassium is decreased and Sodium retention

  • Pregnancy is a hyper coagulable state. Serum fibrinogen levels are raised by 50% from 200 – 400 mg% in non pregnant to 300 – 600 mg% in pregnancy (i.e. option “a” is correct).
  • Glomerular filtration rate is increased by 50% throughout pregnancy. Increased GFR causes reduction in maternal plasma levels of creatinine, blood urea nitrogen and uric acid (ruling out option “b”).
  • In pregnancy there is active retention of Na’, K+ and water due to increased estrogen, progesterone. aldosterone and renin angiotensin activity (i.e. option “d’ is correct).

And although there are increased total accumulation of sodium and potassium. their serum concentrations are decreased slightly becasue of expanded plasma volume…

This fact is further strengthened by Fernanoo Arias

“The average plasma sodium concentration during pregnancy is 136 meq/L. This slight decrease in plasma sodium concentration during pregnancy is a result of the increased amount of filtered sodium caused by the increased GFR.

In fact during pregnancy the amount of sodium presented to the tubules for reabsorption is approximately 30240 meq/L per day, whereas the non-pregnant woman filters only about 26160 meq11.. per day. Although the efficiency of tubular sodium reabsorption during pregnancy is remarkable, the serum sodium equilibrates at slightly lower level than it does in non-pregnant status.”

So though sodium retention and potassium retention occur in pregnant states, the serum concentrations are ultimately less than their non-pregnant status, i.e. option “c’ and “d” both are correct.



Q. 8

Physiological changes of pregnancy include:

 A

Insulin levels increase

 B

Increased BMR

 C

Hypothyroidism

 D

Option a and b both

Q. 8

Physiological changes of pregnancy include:

 A

Insulin levels increase

 B

Increased BMR

 C

Hypothyroidism

 D

Option a and b both

Ans. D

Explanation:

Ans. is a and b i.e. Insulin levels increase; and Increased BMR

Changes of endocrine glands during pregnancy :

Pituitary Gland ‑

  • Size : Increases (due to hyperplasia of acidophilic prolactin secreting cells).
  • Hormones : – Growth hormone : Increases°

Prolactin : Increases

ACTH and Corticotrophin releasing hormone : Increases

–   TSH : Levels unchanged°

–     FSH and LH : Decreases (as serum estrogen and progesterone are increased).

Thyroid Gland

  • Size : Increases
  • Patients remain euthyroid°
  • Basal metabolic rate : increases°
  • Thyroxine binding globulin : Increases°
  • Total T4 and T3 : Increases°
  • Free T3, T4 & TSH : Unchanged: therefore patient remains euthyroid
  • Serum iodine : Decrease (due to increased renal loss).
  • Iodine demand and protein bound Iodine increases.

Adrenal cortex

  • Size : Increases
  • Hormones :   – Serum aldosterone                      

Deoxycortisone

–  Cortisosteroid binding globulin            

All increase

–    Total and free cortisol Testosterone

–     Androstenedione

Except : Dehydro epiandrosterone sulphate (ohitAb) which decreases.

Pancreas

  • In pregnancy there is hyperinsulinemia (insulin resistance).
  • In general plasma insulin level is increased. So as to ensure continuous supply of glucose to fetus.

To be specific : The overall effect of pregnancy is such that there is maternal fasting hypoglycemia (due to fetal consumption), whereas postparandial hyperglycemia and hyperinsulinemia.


Q. 9

Insulin resistance in pregnancy is because of :

 A

Human placental lactogen

 B

Thyroid hormone

 C

Progesterone

 D

Option a and c both

Q. 9

Insulin resistance in pregnancy is because of :

 A

Human placental lactogen

 B

Thyroid hormone

 C

Progesterone

 D

Option a and c both

Ans. D

Explanation:

Ans. is a and c i.e. Human placental lactogen; Progesterone; and Estrogen Ref. Dutta Obs. 6/e, p 54

During pregnancy insulin levels are increased because of increased insulin secretion as well as increase insulin resistance due to a number of contra insulin factors.

These are :  

  • Estrogen                                                Progesterone
  • Human placental lactogen                          Cortisol
  • Prolactin                                               Free fatty acids
  • Increased tissue resistance to insulin

Q. 10

During pregnancy the maternal blood volume increases by nearly :

 A

5 – 10%

 B

15 — 20%

 C

50%

 D

70%

Q. 10

During pregnancy the maternal blood volume increases by nearly :

 A

5 – 10%

 B

15 — 20%

 C

50%

 D

70%

Ans. C

Explanation:

Ans. is c i.e. 50%

Friends, we have dealt with hemodynamic changes during pregnancy in detail earlier but here lets quickly revise a few changes asked quite often.

Most important physiological changes during pregnancy (for 11th hour revision)

  • Net weight gain in pregnancy is 11 kg (24 lb).°
  • Blood volume T’s by 40-50%.°
  • Blood volume reaches maximum at 30-32 weeks.°
  • Plasma volume T’s by 50%.°
  • RBC volume T’s by 20-30%.°
  • TLC is increased, specifically Neutrophilic leucocytosis occurs.°
  • Total plasma proteins increase.°
  • Plasma protein concentration decreases.°
  • Albumin level decreases, globulin levels (specially IgA) slightly increase.°
  • Fibrinogen levels increase by 50%.°
  • ESR is increased.°
  • All clotting factors except XI and XIII increase.°
  • Platelet count decreases (Gestational Thrombocytopenia).°
  • Cardiac output (stroke volume) increases to 40-50% by 30-34 weeks.°
  • Peripheral vascular resistance decrease.°
  • Diastolic BP decreases.°
  • Uterine blood flow increases near term.°
  • Plasma insulin levels increase.°
  • S. Prolactin levels increase.°
  • Vital capacity and respiratory rate remain constant.°
  • Renal plasma flow and GFR increase.°
  • All LFT’S remain unchanged, with exception of alkaline phosphatase which increases (specially heat stable alkaline phosphatase produced by placenta).°

Q. 11

Which is not increased in pregnancy :

 A

Vital capacity

 B

Blood volume

 C

Extracellular fluid

 D

Weight

Q. 11

Which is not increased in pregnancy :

 A

Vital capacity

 B

Blood volume

 C

Extracellular fluid

 D

Weight

Ans. A

Explanation:

Vital capacity


Q. 12

Following change occurs in pregnancy :

 A

Plasmin level decreases

 B

Fibrinolytic activity decreases

 C

Hemodilution does not occur

 D

Fibrinogen level increases

Q. 12

Following change occurs in pregnancy :

 A

Plasmin level decreases

 B

Fibrinolytic activity decreases

 C

Hemodilution does not occur

 D

Fibrinogen level increases

Ans. D

Explanation:

Ans. is d i.e. Fibrinogen level increases

Lets see each option separately :

Option -a” Plasmin activity decreases : it is incorrect as COGDT clearly says :

“Plasminogen levels increase Concomitantly with fibrinogen levels, causing an equilibration of clotting and lytic activity.”

Option “b” Fibrinolytic activity decreases : This is still a debatable issue studies are going on, Williams says‑

“Studies of the fibrinolytic system in pregnancy have produced conflicting results, although

the majority of evidence suggests that fibrinolytic activityis actually reduced in normal preg‑

nancy.”

So option ‘b’ can be kept in +/- status, if we don’t have a better option, it can be our answer of choice.

Option “c” Hemodilution does not occur :

“The dispropotionate increases in plasma and RBC volume produces a state of hemodilution during pregnancV”

So, option “c is incorrect.

As far as option `d’ is concerned : We have studied time and again that fibrinogen level is raised by 50% in pregnancy. Therefore, option Tr is absolutely correct and is our answer of choice.



Q. 13

Maximum increase in cardiac output occurs by what stage of pregnancy :

 A

10th week

 B

20th week

 C

30th week

 D

At the onset of labour

Q. 13

Maximum increase in cardiac output occurs by what stage of pregnancy :

 A

10th week

 B

20th week

 C

30th week

 D

At the onset of labour

Ans. C

Explanation:

30th week


Q. 14

Net weight gain in pregnancy is :

 A

11 lb

 B

24 lb

 C

36 lb

 D

42 lb

Q. 14

Net weight gain in pregnancy is :

 A

11 lb

 B

24 lb

 C

36 lb

 D

42 lb

Ans. B

Explanation:

24 lb


Q. 15

In pregnancy all occurs except:

 A

Increased cardiac output

 B

Decreased blood volume

 C

Increased MCV

 D

Increased glomerular flow

Q. 15

In pregnancy all occurs except:

 A

Increased cardiac output

 B

Decreased blood volume

 C

Increased MCV

 D

Increased glomerular flow

Ans. B

Explanation:

Decreased blood volume


Q. 16

Which of the following changes is false regarding a normal pregnancy?

 A

Fall in free T4/T3 in 3rd trimester

 B

TSH falls in the first and second trimester but increases in the third trimester

 C

TSH rises in the first and second trimester but falls in the third trimester

 D

There is an increase in Thyroid binding globulin

Q. 16

Which of the following changes is false regarding a normal pregnancy?

 A

Fall in free T4/T3 in 3rd trimester

 B

TSH falls in the first and second trimester but increases in the third trimester

 C

TSH rises in the first and second trimester but falls in the third trimester

 D

There is an increase in Thyroid binding globulin

Ans. C

Explanation:

In pregnancy there is a relative iodine deficiency and increased renal excretion.

Ref: Karla Philip, 33rd Edition, Page 304

Q. 17

Which of the following is a false physical parameter during pregnancy?

 A

It’s a prothrombotic condition

 B

Blood fibrinogen levels are increased

 C

Clotting and bleeding times are reduced

 D

There is lowering of serum protein levels

Q. 17

Which of the following is a false physical parameter during pregnancy?

 A

It’s a prothrombotic condition

 B

Blood fibrinogen levels are increased

 C

Clotting and bleeding times are reduced

 D

There is lowering of serum protein levels

Ans. C

Explanation:

On an average the non pregnant levels of blood fibrinogen is 260mg%.

But in pregnancy it can reach an average value of 388 mg% (288 – 576 mg%) even then the clotting and bleeding times remains unchanged.

Ref: Mudaliar and Menon’s Clinical Obstetrics, 9th Edition, Page 41.

 


Q. 18

All of the following are physiological changes which occur during pregnancy, EXCEPT:

 A

Reabsorption of glucose decreases

 B

Creatinine decreases

 C

Urea decreases

 D

Decrease in renal plasma flow

Q. 18

All of the following are physiological changes which occur during pregnancy, EXCEPT:

 A

Reabsorption of glucose decreases

 B

Creatinine decreases

 C

Urea decreases

 D

Decrease in renal plasma flow

Ans. D

Explanation:

During pregnancy the renal plasma flow is increased by 50- 75%. It reaches the maximum value by 16 weeks and is maintained until 34 weeks.

During pregnancy:
  • Kidney enlarges in length by 1cm.
  • GFR is increased by 50%. Increase in GFR causes reduction in maternal plasma level of creatinine, BUN and uric acid.
  • Ureter becomes atonic, there is elongation, kinking and outward displacement of the ureter.
  • Urinary bladder: Becomes congested with hypertrophy of the muscles and elastic tissues of the wall.
Ref: Textbook of Obstetrics By D C Dutta, 6th edn, page 55-6

 


Q. 19

Which of the following statement regarding Prolactin levels is TRUE?

 A

Lowest in pregnancy and increases after delivery

 B

Highest during pregnancy and fall during lactation

 C

Unaffected by pregnancy and lactation

 D

Variable in every pregnancy

Q. 19

Which of the following statement regarding Prolactin levels is TRUE?

 A

Lowest in pregnancy and increases after delivery

 B

Highest during pregnancy and fall during lactation

 C

Unaffected by pregnancy and lactation

 D

Variable in every pregnancy

Ans. B

Explanation:

Maternal plasma levels of prolactin increase markedly during normal pregnancy and concentrations are usually 10-fold greater at term—about 150 ng/mL—compared with nonpregnant women. Paradoxically, plasma concentrations decrease after delivery even in women who are breast feeding.

During early lactation, there are pulsatile bursts of prolactin secretion in response to suckling. 

Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 5. Maternal Physiology. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e. 

Q. 20

Which of the following is NOT right regarding respiratory function during late trimester of normal pregnancy?

 A

Tidal volume and resting minute ventilation increase during late trimester

 B

Functional residual capacity and the residual volume are decreased

 C

Lung compliance is decreased

 D

Total pulmonary resistance reduced

Q. 20

Which of the following is NOT right regarding respiratory function during late trimester of normal pregnancy?

 A

Tidal volume and resting minute ventilation increase during late trimester

 B

Functional residual capacity and the residual volume are decreased

 C

Lung compliance is decreased

 D

Total pulmonary resistance reduced

Ans. C

Explanation:

The respiratory rate is essentially unchanged, but tidal volume and resting minute ventilation increase significantly as pregnancy advances.

The functional residual capacity and the residual volume are decreased as a consequence of the elevated diaphragm.

Lung compliance is unaffected by pregnancy, but airway conductance is increased and total pulmonary resistance reduced, possibly as a result of progesterone.
 
Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 5. Maternal Physiology. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.

 


Q. 21

Which of the following is decreased during third trimester of a normal pregnancy?

 A

Heart rate

 B

Stroke volume

 C

Systemic vascular resistance

 D

Cardiac output

Q. 21

Which of the following is decreased during third trimester of a normal pregnancy?

 A

Heart rate

 B

Stroke volume

 C

Systemic vascular resistance

 D

Cardiac output

Ans. C

Explanation:

Late pregnancy was associated with the expected increases in heart rate, stroke volume, and cardiac output.

Systemic vascular and pulmonary vascular resistance both decreased significantly, as did colloid osmotic pressure.
 
Also know:
  • During normal pregnancy, mean arterial pressure and vascular resistance decrease, while blood volume and basal metabolic rate increase. As a result, cardiac output at rest, when measured in the lateral recumbent position, increases significantly beginning in early pregnancy.
Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 5. Maternal Physiology. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.

 


Q. 22

All of the following are placental hormones, EXCEPT:

 A

Chorionic gonadotropin

 B

Chorionic thyrotropin

 C

Chorionic corticotropin

 D

Chorionic calcitonin

Q. 22

All of the following are placental hormones, EXCEPT:

 A

Chorionic gonadotropin

 B

Chorionic thyrotropin

 C

Chorionic corticotropin

 D

Chorionic calcitonin

Ans. D

Explanation:

Many hormones are secreted by the syncytiotrophoblast of the chorion, and a few additional hormones are produced by the decidual cells. Placental hormones include,

  • Chorionic gonadotropin
  • Chorionic thyrotropin
  • Chorionic corticotropin
  • Estrogens
  • Progesterone
  • Prolactin
  • Placental lactogen
Ref: Paulsen D.F. (2010). Chapter 23. Female Reproductive System. In D.F. Paulsen (Ed), Histology & Cell Biology: Examination & Board Review, 5e.

Q. 23

A reduction in which of the following clotting factors is consistent with normal pregnancy?

 A

Fibrinogen

 B

Factor XIII

 C

Factor VIII

 D

Factor X

Q. 23

A reduction in which of the following clotting factors is consistent with normal pregnancy?

 A

Fibrinogen

 B

Factor XIII

 C

Factor VIII

 D

Factor X

Ans. B

Explanation:

Clotting factors that decrease during pregnancy are factor XI and XIII.

Clotting factors increase during pregnancy are X, IX, VIII, VII, and II.

Fibrinogen level is raised by 50% from 200-400 mg% in non-pregnant to 300-600 mg% in pregnancy.

Ref: Dutta, 6th ed, Page 52


Q. 24

Change noticed in diastolic blood pressure in pregnancy is:   

March 2010

 A

Decline of 10-20 mm of Hg

 B

Decline of 5-10 mm of Hg

 C

Elevation of 10-20 mm of Hg

 D

Elevation of 5-10 mm of Hg

Q. 24

Change noticed in diastolic blood pressure in pregnancy is:   

March 2010

 A

Decline of 10-20 mm of Hg

 B

Decline of 5-10 mm of Hg

 C

Elevation of 10-20 mm of Hg

 D

Elevation of 5-10 mm of Hg

Ans. B

Explanation:

Ans. B: Decline of 5-10 mm of Hg

Systemic blood pressure declines slightly during pregnancy. There is a little change in systolic blood pressure, but diastolic pressure is reduced (5-10mm Hg) from about 12-26 weeks. Diastolic pressure increases thereafter to prepregnancy levels by about 36 weeks.

The obstruction posed by the uterus on the inferior vena cava and the pressure of fetal presenting part on the common iliac vein can result in decreased blood return to the heart. This decreases cardiac output, leads to a fall in blood pressure, and causes edema in the lower extremities.

Peripheral resistance equals blood pressure divided by cardiac output. Because blood pressure either decreases or remain the same during pregnancy and cardiac output increases appreciably, there is good evidence that peripheral resistance declines markedly.



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