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OB > 3.1a Physiological Adaptations to Pregnancy > Flashcards

3.1a Physiological Adaptations to Pregnancy Flashcards

1
Q

Uterus Size, Shape, Position

A
  • Uterine growth during first trimester do to progesterone and estrogen
  • Early enlargement includes vascularity, hyperplasia, hypertrophy and development of decidua
  • Uterus rises in the abdomen as it grows and rotates to the right (due to rectosigmoid colon)
  • Discomfort may occur with ligament tension during growth of uterus
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2
Q

Hegar’s Sign (6 weeks)

A
  • 6 weeks of gestation

- Softening and compressibility of lower uterine segment (Uterine Ishtimus)

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3
Q

12 Weeks of Gestation

A
  • Uterus changes in shape from pear to spherical

- Uterus rises in pelvis to the abdominal cavity

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4
Q

14th Week of Gestation

A
  • This is when pregnancy “shows”

- Uterus can be palpated above the symphysis pubis gradually to the level of the umbilics

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5
Q

20-22 weeks of getstation

A
  • Uterus should be palpable from the xiphoid process at term
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6
Q

Lightning (30-38 weeks)

A

Fetus begins to descend to the pelvis

Nullipara - Occurs 2 weeks before the onset of labor
Multipara - Occurs at the start of labor

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7
Q

Braxton Hicks Contractions (4th month of pregnancy)

A
  • Intermittent uterine contractions may be felt through the abdominal wall
  • Enhances blood flow through the intervillous spaces
  • Irregular and painless
  • After 28th week they become more definite and usually cease with walking or exercise
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8
Q

Uterine Souffle

A
  • You may hear this sound when auscultating the fetal heart tones
  • Similar to a bruit, this sound will be synchronized with mother’s heart beat
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9
Q

Funic Souffle

A
  • Synchronous with fetal heart rate

- Caused by fetal blood coursing through the umbilical cord

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10
Q

Ballottement (16th-18th week)

A
  • Passive movement of unengaged fetus
  • Identified by examiner
  • Practitioner places finger within the vagina taps upward on the cervix causing the fetus to rise
  • The fetus can be felt moving up and down.
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11
Q

Quickening (14-16th Week)

A
  • First recognizable movement of fetus

- Difficult to distinguish from peristalsis

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12
Q

Goodell Sign (Beginning of 6 weeks)

A
  • Softening of the cervical tip due to increased vascularity, slight hypertrophy, and hyperplasia
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13
Q

Friability

A
  • Tissue is easily damaged and can result in slight bleeding after vaginal examination or coitus
  • Glands near the external OS proliferate and cervix looks velvety
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14
Q

Operculum

A
  • Mucus fills the endocervical canal resulting in formation of a mucus plug early in pregnancy
  • Accuracy of pap tests can also be complicated
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15
Q

Changes in Ovaries

A
  • Ovulation does not occur during pregnancy due to suppression of follicle stimulating hormone (FSH) and luteinizing hormone (LH) by estrogen and progesterone
  • Corpus luteum produces estrogen and progesterone for the first 6-10 weeks and then the placenta becomes the primary source of these hormones
  • Menstrual periods cease (amenorrhea)
  • Periods can be confused with implantation bleeding which occurs 6-12 days after conception
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16
Q

Changes to vagina

A
  • Vaginal mucosa thickens
  • Connective tissue loosens
  • Hypertrophy of smooth muscle
  • Vaginal vault lengthens
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17
Q

Chadwick Sign (6-8th week of pregnancy)

A
  • Increase vascularity results in blue color of vaginal mucosa and cervix
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18
Q

Leukorrhea

A
  • White/Gray mucoid vaginal discharge with musty odor
  • Odor due to microbiome changing and secretions become more acidic
  • Alterations help prevent bacterial infections in the uterus
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19
Q

Changes to the Breast

A
  • Increased levels of estrogen and progesterone make breasts feel heavier and heightened sensitivity
  • Sensitivity varies from tingling to sharp pain
  • Nipples become more pigmented and erectile
  • Stretch marks may appear
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20
Q

Prolactin

A
  • Produced by anterior pituitary gland

- Stimulates production of colostrum by end of first trimester

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21
Q

Montgomery Tubercles

A
  • Hypertrophy occurs

- Sebaceous glands secrete lubricating anti-infectives to protect the nipple during breast feeding

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22
Q

Lactogenesis Stage 1

A
  • Human placental lactogen stimulates secretion of colostrum
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23
Q

Changes in blood Volume

A
  • Total blood volume increases 40-50%
  • Increased blood is protective mechanism
  • Meet the blood volume needs of the enlarged uterus
  • Hydrates fetal and maternal tissue when the woman assumes an erect or supine position
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24
Q

Cardiac Output

A
  • Increases by 30-50%
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25
Q

Blood Pressure

A
  • Influenced by age, activity level, presence of health problems, circadian rhythm, alcohol consumption, smoking, anxiety, pain, and maternal position
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26
Q

Supine Hypotensive Syndrome (Inferior Vena Cava Compression Syndrome)

A
  • Happens when pregnant women lie on their back during second half of pregnancy
  • This compresses the vena cava
  • CO reduced by 25-30%
  • Can experience falls in blood pressure up to 30 mmHg
  • After 5 minutes bradycardia is noticed and CO is reduced by half. Women feel faint
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27
Q

Structural Adaptations

A
  • Cardiac Hypertrophy
  • Diaphragm is displaced upward because of enlarged uterus
  • Heart is elevated upward
  • Apical pulse shifts up and laterally 1-1.5cm
  • Maternal heart rate increases at 5 weeks gestation (15-20bmp)
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28
Q

Changes in Blood Components

A
  • RBC mass increases by 20-30%
  • Percentage of RBC depends on iron available
  • Plasma increase is greater than RBC production
  • Decrease in normal hemoglobin and hematocrit values
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29
Q

Anemia That Occurs with Pregnancy

A
  • Vitamin B12 deficiency, folate-deficiency anemia, iron deficiency anemia
  • Iron deficiency anemia is the most common
  • Iron deficiency anemia can lead to low birth weight, premature birth, preeclampsia, and postpartum hemorrhage
  • Signs of anemia include weakness, fatigue, headaches, dizziness, pale or sallow skin, low body temperature, rapid or irregular heartbeat, chest pain, shortness of breath, brittle nails and pica.
  • Best way to prevent anemia is proper nutrition
  • Iron rich foods include red meat, dark green leafy vegetables, eggs, peanuts, fortified cereals etc
  • Folate-Deficiency Anemia can lead to neural tube defects (fetal brain and spinal cord anomalies) including spina bifida and anencephaly
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30
Q

Respiratory Rate during Pregnancy

A
  • Unchanged to slightly increased
31
Q

Tidal Volume for Respirations

A
  • Increased by 40%
32
Q

Vital Capacity

33
Q

Inspiratory Capacity

A
  • Increased by 6%
34
Q

Expiratory Reserve Volume

A
  • Decreased by 20%
35
Q

Total Lung Capacity

A
  • Unchanged to slightly decreased
36
Q

Minute Ventilation

A
  • Increased 30-50%
37
Q

Nausea and Vomiting

A
  • Up to 70% of pregnant women experience nausea
  • Etiology is unknown but may be high levels of hCG and estradiol, psychological predisposition, evolutionary adaptation to protect fetus from dangerous foods
  • Appears 4-6 weeks and peaks around 9 weeks. Subsides by end of first trimester
  • See doctor if lasts beyond first trimester or accompanied by fever/weight loss
    PICA - Non-food cravings and can be due to iron deficiency anemia
38
Q

-Changes in Mouth, Esophagus, Stomach, Intestines

A
  • Gums become hyperemic and bleeds due to high estrogen
  • Increased progesterone slows motility of GI tract and stomach
  • Increased progesterone and slowed peristalsis can also cause constipation
    (Can also be caused by iron supplements, lack of fluid, decreased activity, antiemetic medication, abdominal distension, displacement and compression of intestines)
  • Iron absorbed more readily in small intestines
39
Q

Ptyalism

A
  • Excessive salivation due to decreased swallowing from nausea
40
Q

Epulis (Gingival Granuloma)

A
  • Red nodules on gums that bleed easily
41
Q

Pyrosis

A
  • Acid Indigestion, heartburn.

- Begins in first trimester and intensifies through the 3rd trimester

42
Q

Hiatal Hernia

A
  • Due to upward displacement of stomach by enlarged uterus

- Widens hiatus of diaphragm

43
Q

Changes in Gallbladder/Liver

A
  • Gallbladder is distended due to decreased muscle tone in pregnancy
  • Increased emptying time of gallbladder
  • Hypercholesterolemia due to increased progesterone which can lead to gallstones
  • Liver size is unchanged
  • Serum albumin and total protein reduced (hemodilution)
  • Serum Alkaline Phosphates increased up to 4x
44
Q

Intrahepatic Cholestasis

A
  • May occur in late pregnancy due to placental steroids
  • Retention and accumulation of bile
  • May cause severe itching with/without jaundice
45
Q

Changes in Abdomen

A

Intrabdominal Alterations

  • Pelvic heaviness or pressure
  • Round ligament tension
  • Flatulence
  • Distension
  • Bowel Cramping
  • Uterine Contractions
  • Venous pressure in pelvic organs due to expanding uterus
46
Q

Appendicitis

A
  • Difficult to diagnose in pregnancy because appendix is displaced upward and laterally
  • High and to the right away from McBurney’s point
47
Q

Changes in Renal Structure

A
  • Changes result from hormonal activity of estrogen and progesterone
  • Kidneys enlarge
  • Larger volume of urine held in pelvis
  • Urinary stasis
  • Higher susceptibility to UTI due to urinary stasis and stagnation
  • Urinary frequency and urgency are common
  • Bladder capacity increases to 1500 mL
  • Bladder compressibility causes urge to void even in small volumes
48
Q

Changes in Renal Function

A
  • Rise in renal plasma flow (RPF)
  • GFR increased by 50% during first trimester and remains elevated throughout pregnancy
  • Changes caused by hormones, increased blood volume, posture, physical activity, nutrition intake
  • Increased GFR leads to increased creatinine clearance, reduction in serum creatinine, BUN, and uric acid levels
49
Q

Changes in F&E

A
  • Total body water increase from 6.5 to 8.5 L
  • This is because of expansion of maternal blood volume, water content in fetus, placenta and amniotic fluid, increase in intra and extracellular fluid, increase in adipose tissue
  • Kidneys increase tubular re-absorption
  • Additional sodium to maintain isotonic state
50
Q

Hyperpigmentation of Skin (16 weeks)

A
  • Caused by melanotropin

- Darkening of nipple, axillae, vulva

51
Q

Melasma (chloasma or mask of pregnancy)

A
  • Hyperpigmentation (blotchy brown) over cheeks, nose, forehead
  • Fades after birth but can come back with oral contraceptives or subsequent pregnancies
52
Q

Linea Nigra

A
  • Pigmented line extending from pubis to fundus midline
53
Q

Striae Gravidarum

A
  • Stretch marks during second half of pregnancy
  • Could be due to genetics
  • After birth they fade but dont disappear
  • No topical therapy affects stretch marks
54
Q

Angiomatas (Vascular Spiders)

A
  • Star shaped arterioles usually found in neck, thorax, face and arms
  • Results from increase blood flow due to rising estrogen
  • Disappears within 3 months post-partum
55
Q

Palmar Erythema

A
  • Red blotches over hand due to increased estrogen
56
Q

Pruritis Gravidarum

A
  • Itchiness across abdomen (resolves during post partum)
57
Q

Integumentary Changes

A
  • Nail growth accelerated
  • Hirsutism
  • Increased fine course hair growth
  • Hair loss slows
58
Q

Musculoskeletal System

A
  • Compensatory curve to maintain balance
  • Weakness of upper extremities
  • Symphysis widens causing pain and difficult walking
  • Waddling gait
  • Leg cramps from changes in calcium and phosphorus
  • Restless leg syndrome is common
59
Q

Diastasis Recti Abdominis Muscle Separation

A
  • After birth muscles regain tone but separation of muscle can persist
60
Q

Neurological System

A
  • Tension headaches due to hormonal changes, eye strain, emotional tension, nasal congestion and fatigue
  • Lightheadedness and syncope (fainting) are common
    (Due to motor instability, postural hypotension, hypoglycemia)
  • First-Trimester Fatigue
  • 2nd and 3rd trimester difficulty sleeping
  • Increased edema cause ocular changes (thickening of cornea and decreased intraocular pressure)
  • Corneal changes can cause problems with contact lenses
  • Enhanced sense of smell and sensitivity
61
Q

Carpal Tunnel Syndrome

A
  • Edema involving peripheral nerves

- Paresthesia and pain in hand which radiates to elbow

62
Q

Changes in endocrine System

A
  • Enlarged thyroid gland
  • T3 and T4 levels rise
  • Basal Metabolic Rate increases
  • Pituitary gland increases in size
  • Prolactin levels increase
  • Insulin needs increase
63
Q

Human Chorionic Gonadotropin (HcG)

A

Maintains Corpus Luteum production of estrogen and progesterone until placenta takes over

64
Q

Progesterone

A
  • Suppresses secretion of FSH and LH
  • Maintains pregnancy by relaxing smooth muscle, decreasing uterine contractility, causes fat to get deposited around the body, decreases maternal ability to use insulin
65
Q

Prolactin

A
  • Prepares breasts for lactation
66
Q

Oxytocin

A
  • Stimulates uterine contraction

- Stimulates milk ejection from breasts after birth

67
Q

Human Chorionic Samotomammotropin

A
  • Growth Hormone
  • Breast development
  • Decreases maternal glucose metabolism
  • Increases fatty acids for metabolic needs
68
Q

Parathyroid Hormone

A
  • Controls calcium and magnesium metabolism
69
Q

Insulin

A
  • Increased levels of insulin due to antagonism of placental hormones
70
Q

Cortisol

A
  • Increases peripheral resistance to insulin

- Stimulates production of insulin

71
Q

Aldosterone

A
  • Stimulates re-absorption of sodium
72
Q

Estrogen

A
  • Suppresses FSH and LH
  • Deposits fat around maternal body
  • Promotes enlargement of genitals uterus and breasts
  • Increases level of total body proteins
  • Promotes retention of sodium and water
  • Decreases mother ability to use insulin
73
Q

Immune System

A
  • Pregnancy is not a state of immunosuppression
  • First and early second trimester represents proinflammatory state to allow establishment of pregnancy
  • Second trimester is anti-inflammatory phase with rapid growth of fetus
  • 3rd trimester is proinflammatory state with influx of immune cells in myometrium which contributes to initiation of labor, cervical ripening, membrane rupture, uterine contractions
  • Changes in immune system can cause rheumatoid arthritis. When pregnancy is over there can be exacerbations of symptoms

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