Here are some MCQs relating to the Block 5 Maternal Adaptations lecture
Reviewed by Jonathan Loomes-Vrdoljak
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Which of these statements referring to maternal adaptations in the blood is false?
Plasma volume and red cell mass increase
Hb, haematocrit and RBC increase
Circulating blood volume increases
There is haemodilution
Blood becomes pro-thrombotic
Question 1 Explanation:
Plasma volume expands by 45% from the 10th week. Red cell mass (total volume of all RBCs) increases by 15%. However, if you look at the ratios, there is actually haemodilution and the mother will have physiological anaemia by 28-34 weeks. Therefore Hb, haematocrit and RBC all FALL. The circulating blood volume increases by 50% by term. The blood becomes pro-thrombotic (clotting time decreases) in order to prepare the mother for all the blood loss that occurs during child birth.
How much blood loss at birth is defined as a post-partum haemorrhage?
Question 2 Explanation:
The average blood loss at birth is 250ml, it can be more with a C-section. Blood loss more than 500ml within the first 24h after birth is considered a primary post-partum haemorrhage.
You can find some more information here: https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-heavy-bleeding-after-birth-postpartum-haemorrhage.pdf.
Which of these statements referring to adaptations in the renal system is false?
Kidneys get bigger
Creatinine clearance increases
Renal plasma flow increases
Question 3 Explanation:
The ureters and urethra dilate due to the increase in progesterone (smooth muscle relaxant).
You see a patient during an antenatal check who is 32 weeks pregnant with twins. During the check-up, you find that her HR is 85 bpm, BP is 140/90, she has proteinuria and oedema. What condition would you be particularly worried about?
Question 4 Explanation:
There are three clinical crucial signs with pre-eclampsia: high blood pressure, proteinuria and oedema.
Which of these is not a risk factor for pre-eclampsia?
18 years or younger
BMI of 35 or above
Pre-existing renal disease
Question 5 Explanation:
Being 40 years or older is also a risk factor for pre-eclampsia. See this NICE Quality Standard.
What risks can gestational diabetes mellitus cause to the baby?
Question 6 Explanation:
Gestational diabetes appears in roughly 4% of pregnancies. It tends to recur in future pregnancies, increases risk for Type 2 DM later in life and increases risk to baby of macrosomia.
One of your pregnant patients is having trouble breathing. The consultant asks you to do an ABG. If everything is normal, which of these would you be most likely to see in a normal pregnant patient.
Mild respiratory acidosis
Mild respiratory alkalosis
Mild metabolic acidosis
Mild metabolic alkalosis
Question 7 Explanation:
During pregnancy, there is an increased respiratory rate, increased alveolar exchange and an increased tidal volume. There is also a slight drop in pCO2 (to approximately 32 mmHg or 4.3 kPa). All these maternal adaptations to the respiratory system lead to mild respiratory alkalosis.
What is the cardiac output roughly during pregnancy?
Question 8 Explanation:
Cardiac output is normally 5L, this increases to 7L during pregnancy. This is due to both an increase in heart rate (by 10-15bpm) and an increase in stroke volume.
What happens to the mean arterial pressure during pregnancy?
Rises by 20 mmHg
Falls by 30 mmHg
Rises by 5 mmHg
Rises by 10 mmHg
Falls by 10 mmHg
Question 9 Explanation:
MAP falls by about 10mmHg and rises to normal as term approaches.
Dizziness and fainting during pregnancy can be attributed to which of these?
Decrease in BP
Decrease in tidal volume
Decrease in vascular resistance
Decrease in respiratory rate
Decrease in plasma volume
Question 10 Explanation:
During pregnancy, there is an increase in progesterone which relaxes smooth muscles. This leads to decreased vascular resistance and a decreased BP. Tidal volume, vascular resistance and plasma volume all increase during pregnancy.
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