11. Changes of Pregnancy

Question 1

Estrogen effects on reproductive organs

Answer 1

Increase blood flow to uterus; Inhibit ovulation; Promote ductal development of breasts

Question 2

Systemic effects of estrogen

Answer 2

Decreased PVR; Renal retention of Na+; Increase in fibrinogen; Softening of fibrous connective tissue

Question 3

Progesterone effects on reproductive organs

Answer 3

Decreased uterine contractility; Stimulates alveolar breast development; Inhibits ovulation

Question 4

Systemic effects of progesterone

Answer 4

Elevated basal body temp; Decreased smooth muscle activity; Increases Na+ excretion; Increased aldosterone production; Increased sensitivity to CO2; Neuroendocrine/behavioral effects

Question 5

Human Placental Lactogen

Answer 5

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

Question 6

Syncytiotrophoblast

Answer 6

Causes elevation of HCG; maintains function of corpus luteum early in preg

Question 7

Relaxin

Answer 7

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

Question 8

Uterine changes

Answer 8

Blood flow increases from 50cc/min to 500 cc/min; Wt increases from 70g to 1100 g; Volume increases from 10cc to 5000g

Question 9

Hagar’s sign

Answer 9

Softening of the uterus

Question 10

When is the maximal functional period of the corpus luteum?

Answer 10

1st 4 wks after conception

Question 11

Vaginal changes

Answer 11

Increased vascularity/mucosa thickness/discharge/acidity

Question 12

Breast changes

Answer 12

Breast enlargement; Increased size of nipples & aerola/pigmentation; Enlargement of Montgomery’s glands;

Question 13

Hematologic changes

Answer 13

Plasma volume increase (50%); RBC mass increase (18%); Physiologic anemia; Increase in WBC; Increase in clotting factors; Bleeding time & clotting time unchanged.

Question 14

Daily iron supplement requirement for pregnant women

Answer 14

300 mg of ferrous sulfate = 60 mg elemental iron

Question 15

Cardiovascular changes

Answer 15

Increased CO; SV; HR (^10-15 beats/min)

Question 16

Normal Heart Tone Changes

Answer 16

Split S2 with inspiration; Low-grade systolic ejection murmur d/t increased volume; Third heart sound after mid-pregnancy

Question 17

Abnormal Heart Tone Changes

Answer 17

Diastolic murmurs

Question 18

Heart position during pregnancy

Answer 18

Upward and to the left

Question 19

GI changes

Answer 19

Decrease intestinal motility & gallbladder emptying

Question 20

Pulmonary changes

Answer 20

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.

Question 21

Thyroid changes

Answer 21

Moderate thyroid enlargement; Free T3 & T4 unchanged.

Question 22

Pancreas changes

Answer 22

Hyperinsulinemia; Hypertriglyceridemia; Reduced tissue response to insulin. Changes d/t increased HPL (feed the baby!)

Question 23

When does a fetus start synthesizing & secreting insulin?

Answer 23

9-11 wks gestation

Question 24

hCG effects on blood

Answer 24

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

Question 25

Effects of Hyperthyroidism during Pregnancy

Answer 25

Miscarriage; PREMATURE birth; low birth wt; CHF

Question 26

Effects of Hypothyroidism during Pregnancy

Answer 26

Miscarriage; ANEMIA; low birth wt; Slowed growth and brain development in first trimester

Question 27

Most accurate measure of thyroid activity

Answer 27

TSH test

Question 28

If TSH levels low, orderﾅ

Answer 28

T3 & T4 test

Question 29

Antihyperthyroid med for 1st trimester

Answer 29

PTU

Question 30

ANtihyperthyroid med after 1st trimester

Answer 30

Methimaxole

Question 31

How often is thyroxine effectiveness checked in pregnancy?

Answer 31

6-8 wks

Question 32

What drug is safe and necessary for fetal development in hypothyroidism?

Answer 32

Thyroxine

Question 33

What spinal deformity is common in pregnancy?

Answer 33

Compensatory lumbar lordosis

Question 34

Diastasis recti

Answer 34

Physiologic separation of the rectus abdominal muscles

Question 35

What can caused blurred vision?

Answer 35

Fluid retention causing thickened cornea;

Question 36

What dental changes can occur?

Answer 36

Gingivitis; Epulis gravidarum