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• Usmle Step 2 Ck Kaplan Videos Free Download For Pc
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Kaplan USMLE STEP 2 CK Lecture Notes 2018 Obstetrics and Gynecology Ebook PDF download

Kaplan USMLE STEP 2 CK Lecture Notes 2018 Obstetrics and Gynecology Ebook PDF download Red blood cells (RBC)—RBC mass increases by 30% in pregnancy; thus, oxygen-carrying capacity increases. However, because plasma volume increases by 50%, the calculated hemo- globin and hematocrit values decrease by 15%. The nadir of the hemoglobin value is at 28–30 weeks’ gestation. This is a physiologic dilutional effect, not a manifestation of anemia.

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Kaplan USMLE STEP 2 CK Lecture Notes 2018 Obstetrics and Gynecology Ebook PDF download White blood cells (WBC)—WBC count increases progressively during pregnancy with a mean value of up to 16,000/mm3 in the third trimester.
Erythrocyte sedimentation rate (ESR)—ESR increases in pregnancy because of the increase in gamma globulins.
Platelet count—Platelet count normal reference range is unchanged in pregnancy. Coagulation factors—Factors V, VII, VIII, IX, XII, and von Willebrand factor increase pro-
gressively in pregnancy, leading to a hypercoagulable state.

Kaplan USMLE STEP 2 CK Lecture Notes 2018 Obstetrics and Gynecology Ebook PDF download Gastrointestinal Stomach—Gastric motility decreases and emptying time increases from the progesterone effect on smooth muscle. This increase in stomach residual volume, along with upward dis- placement of intraabdominal contents by the gravid uterus, predisposes to aspiration pneu- monia with general anesthesia at delivery.
Large bowel—Colonic motility decreases and transit time increases from the progesterone effect on smooth muscle. This predisposes to increased colonic fluid absorption resulting in constipation.

Arterial blood pressure—Systolic and diastolic values both decline early in the first trimester, reaching a nadir by 24–28 weeks, then they gradually rise toward term but never return quite to prepregnancy baseline. Diastolic falls more than systolic, as much as 15 mm Hg. Arterial blood pressure is never normally elevated in pregnancy.
Venous blood pressure—Central venous pressure (CVP) is unchanged with pregnancy, but femoral venous pressure (FVP) increases two- to threefold by 30 weeks’ gestation.
Plasma volume—Plasma volume increases up to 50% with a significant increase by the first trimester. Maximum increase is by 30 weeks. This increase is even greater with multiple fetuses.
Systemic vascular resistance (SVR)—SVR equals blood pressure (BP) divided by cardiac out- put (CO). Because BP decreases and CO increases, SVR declines by 30%, reaching its nadir by 20 weeks. This enhances uteroplacental perfusion.
Cardiac output (CO)—CO increases up to 50% with the major increase by 20 weeks. CO is the product of heart rate (HR) and stroke volume (SV), and both increase in pregnancy. HR increases by 20 beats/min by the third trimester. SV increases by 30% by the end of the first trimester. CO is dependent on maternal position. CO is the lowest in the supine position because of inferior vena cava compression resulting in decreased cardiac return. CO is the highest in the left lateral position. CO increases progressively through the 3 stages of labor.
Murmurs—A systolic ejection murmur along the left sternal border is normal in pregnancy owing to increased CO passing through the aortic and pulmonary valves. Diastolic murmurs are never normal in pregnancy and must be investigated.

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Usmle Step 2 Ck Kaplan Videos Free Download Pc

Kaplan USMLE STEP 2 CK Lecture Notes 2018 Obstetrics and Gynecology Ebook PDF download

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