11. Changes of Pregnancy Flashcards
Estrogen effects on reproductive organs
Increase blood flow to uterus; Inhibit ovulation; Promote ductal development of breasts
Systemic effects of estrogen
Decreased PVR; Renal retention of Na+; Increase in fibrinogen; Softening of fibrous connective tissue
Progesterone effects on reproductive organs
Decreased uterine contractility; Stimulates alveolar breast development; Inhibits ovulation
Systemic effects of progesterone
Elevated basal body temp; Decreased smooth muscle activity; Increases Na+ excretion; Increased aldosterone production; Increased sensitivity to CO2; Neuroendocrine/behavioral effects
Human Placental Lactogen
FEED THE BABY!!! Decreases materinal insulin sensitivity to increase glucose levels; Decreased maternal glucose utilization to feed fetus; Increased lipolysis to fuel fetal growth; Potent lactogenic properties
Syncytiotrophoblast
Causes elevation of HCG; maintains function of corpus luteum early in preg
Relaxin
Produced by corpus luteum; softens & ripens cervix; softens ligaments and pubic symphysis; Mediates uterine quiescence; Mediates hemodynamic changes of preg;
In males, enhances sperm motility
Uterine changes
Blood flow increases from 50cc/min to 500 cc/min; Wt increases from 70g to 1100 g; Volume increases from 10cc to 5000g
Hagar’s sign
Softening of the uterus
When is the maximal functional period of the corpus luteum?
1st 4 wks after conception
Vaginal changes
Increased vascularity/mucosa thickness/discharge/acidity
Breast changes
Breast enlargement; Increased size of nipples & aerola/pigmentation; Enlargement of Montgomery’s glands;
Hematologic changes
Plasma volume increase (50%); RBC mass increase (18%); Physiologic anemia; Increase in WBC; Increase in clotting factors; Bleeding time & clotting time unchanged.
Daily iron supplement requirement for pregnant women
300 mg of ferrous sulfate = 60 mg elemental iron
Cardiovascular changes
Increased CO; SV; HR (^10-15 beats/min)
Normal Heart Tone Changes
Split S2 with inspiration; Low-grade systolic ejection murmur d/t increased volume; Third heart sound after mid-pregnancy
Abnormal Heart Tone Changes
Diastolic murmurs
Heart position during pregnancy
Upward and to the left
GI changes
Decrease intestinal motility & gallbladder emptying
Pulmonary changes
Increased O2 consumption; Increased Tidal volume; Decreased residual volume. RESPIRATORY RATE IS UNCHANGED! Dyspnea experienced by 2/3 of women starting in late 1st trimester.
Thyroid changes
Moderate thyroid enlargement; Free T3 & T4 unchanged.
Pancreas changes
Hyperinsulinemia; Hypertriglyceridemia; Reduced tissue response to insulin. Changes d/t increased HPL (feed the baby!)
When does a fetus start synthesizing & secreting insulin?
9-11 wks gestation
hCG effects on blood
hCG & estrogen lead to increased levels of thyroid hormone in blood; hCG has mild stimulatory effects on thyroid; Estrogen produces higher levels of thyroid binding globulin
Effects of Hyperthyroidism during Pregnancy
Miscarriage; PREMATURE birth; low birth wt; CHF
Effects of Hypothyroidism during Pregnancy
Miscarriage; ANEMIA; low birth wt; Slowed growth and brain development in first trimester
Most accurate measure of thyroid activity
TSH test
If TSH levels low, orderﾅ
T3 & T4 test
Antihyperthyroid med for 1st trimester
PTU
ANtihyperthyroid med after 1st trimester
Methimaxole
How often is thyroxine effectiveness checked in pregnancy?
6-8 wks
What drug is safe and necessary for fetal development in hypothyroidism?
Thyroxine
What spinal deformity is common in pregnancy?
Compensatory lumbar lordosis
Diastasis recti
Physiologic separation of the rectus abdominal muscles
What can caused blurred vision?
Fluid retention causing thickened cornea;
What dental changes can occur?
Gingivitis; Epulis gravidarum
