6: Pregnancy Changes

Question 1

Why might a libido increase during 2nd trimester?

Answer 1

Increased vascularization of the vagina and pelvic viscera, softening of the connective tissue, and hypertrophy of the smooth muscle are also reproductive system changes noted during pregnancy.

Question 2

T/F Gums may experience hypertrophy.

Answer 2

True. Epulis of pregnancy, or hypertrophy of the gums accompanied by bleeding, may also occur and is due to decreased vascular resistance and increase in the growth of capillaries during pregnancy.

Question 3

T/F Pregnant women are at decreased risk of hyperventilation and increased risk of dyspnea.

Answer 3

False. The risk for hyperventilation AND dyspnea is INCREASED among pregnant women because of their increased respiratory rate and tidal volume; the latter may increase by 30% to 50%.

Question 4

Why might a pregnant woman experience lordosis and kyphosis?

Answer 4

The circumference of the neck enlarges. Noticeable alterations in posture manifest as lordosis and kyphosis; they are due to a shifting center of balance caused by the enlarging uterus.

Question 5

When is Hegar’s sign detected?

Answer 5

May be detectable by 4th month.

Question 6

When is Chadwick’s sign present?

Answer 6

4 weeks

Question 7

What happens to cardiac output?

Answer 7

Increases by 30-50%. It peaks early in 3rd trimester and is maintained until birth. Half of the total increase in cardiac output, however, occurs by the eighth week of pregnancy.

Question 8

How does the position of the heart change?

Answer 8

Displaced upward and to the left.

Question 9

T/F While increased melanocyte activity can cause chloasma on the face, moles and scars lighten.

Answer 9

False. Increased vascularity and pigmentation of the areola, genitalia, abdomen, and face (chloasma gravidarum) may occur. Darkening of moles and scars.

Question 10

What causes urinary frequency and incontinence?

Answer 10

Bladder tone is decreased d/t effects of progesterone.

Question 11

T/F Changes in posture can lead to carpal tunnel in some pregnant women.

Answer 11

True

Question 12

How would you explain to your pregnant patient why she has some dyspnea?

Answer 12

Dyspnia – Chest wall circumference increases and chest compliance decreases. These anatomic findings reduce lung capacity in pregnancy by 5%.

Question 13

When does the cervix become edematous and congested?

Answer 13

4 weeks

Question 14

Why do some (15%) of women have pruritis in the 3d trimester?

Answer 14

Elevation of bile salts.

Question 15

In whom is urinary incontinence most common?

Answer 15

Multiparas

Question 16

How much does breast size increase?

Answer 16

12 ounces by term

Question 17

When does leukorrhea most commonly occur?

Answer 17

2nd trimester

Question 18

Would the FNP expect to see a rise or drop in blood pressure in her pregnant patient in the first and second trimester?

Answer 18

1st trimester has same BP values as pre-pregnancy.
2nd trimester the systolic BP decreases by 2-8 points and diastolic decreases by 5-15 points d/t decreased vascular resistance.
3rd trimester gradually returns to pre-pregnancy values.

Question 19

Why is physiologic anemia common in pregnancy?

Answer 19

A greater increase in intravascular volume compared to red cell mass results in the dilutional or physiologic anemia of pregnancy. This becomes most apparent at 30 to 34 weeks of gestation when plasma volume peaks in relation to red cell volume. Simply put: hemodilution occurs.

Question 20

What causes dyspepsia during pregnancy?

Answer 20

The displacement of abdominal organs and altered esophageal sphincter and gastric tone related to increasing progesterone levels may cause dyspepsia in pregnancy.

Question 21

The pituitary gland increases in size by a factor of _____.

Answer 21

The pituitary gland increases in size by a factor of 3.

Question 22

What causes varicosities?

Answer 22

Increasing venous stasis due to mechanical pressure from the growing uterus and vasodilation may lead to vulvar varicosities. Obesity, poor muscle tone, sedentary lifestyle, and familiar tendencies may exacerbate the increased risk for varicosities.

Question 23

Facial fullness can occur, but facial or lid edema could be indicative of _____.

Answer 23

Facial fullness can occur, but facial or lid edema could be indicative of TOXEMIA.

Question 24

T/F Fetal growth during pregnancy and newborn weight are correlated with the degree of blood volume expansion.

Answer 24

True

Question 25

Is a systolic murmur concerning in a pregnant woman?

Answer 25

No. A systolic ejection murmur (up to grade 2/4) over the pulmonary and tricuspid areas are regularly detected upon cardiac auscultation and is not a sign of CV disease, but rather a normal finding in some pregnant women.

Question 26

T/F Vaginal rugae become less pronounced during pregnancy.

Answer 26

False. During pregnancy, the vaginal mucosa thickens and rugae (vaginal folds) become more pronounced, allowing for expansion of the vagina without trauma during the birthing process.

Question 27

There may be generalized edema of the labia _____ near term.

Answer 27

There may be generalized edema of the labia MAJORA near term.

Question 28

How much does blood volume increase and when does it peak?

Answer 28

30-50% and it peaks at 30-34 weeks.

Question 29

What causes cervical ripening in preparation for labor?

Answer 29

Increasing levels of estrogen and changes in the solubility of collagen.

Question 30

How much does the uterus hold during pregnancy?

Answer 30

On average, 5 L of fluid

Question 31

What causes softening of muscles and ligaments?

Answer 31

Progesterone

Relaxin

Question 32

What happens to the diaphragm and why?

Answer 32

The diaphragm is elevated because of the intra-abdominal pressure from the enlarging uterus and the effects of relaxin and progesterone.

Question 33

What happens to stroke volume?

Answer 33

Increased 20-30%.

Question 34

What happens to S1 and S3?

Answer 34

Volume of S1 may be increased with splitting. S3 may be detected.

Question 35

What causes constipation in pregnancy?

Answer 35

Peristalsis slows. Constipation may also stem from the displacement of the intestines by the gravid uterus, fluid reabsorption changes, and increased progesterone levels, all of which can result in decreased intestinal contractility.

Question 36

T/F There can be both an increase and decrease of hair in pregnancy.

Answer 36

True. May notice increased oiliness of scalp and straighter hair. There can be both an increase and a decrease in hair during pregnancy. Rarely, late in pregnancy loss at frontal and parietal areas can occur. May notice more hair in hairbrush.

Question 37

Why are pregnant women predisposed to gallstone formation?

Answer 37

Sluggish emptying of bile from the gallbladder combined with increased cholesterol saturation during pregnancy.

Question 38

Why would women with cardiac disease become symptomatic during pregnancy?

Answer 38

Increase in cardiac output. Half of which occurs by 8th week.

Question 39

How much does the uterine wall thicken?

Answer 39

From 10-25 mm by 16 weeks.

Question 40

Why might medication levels change in pregnant women?

Answer 40

GFR increases. It peaks at 180 mL/min by the end of 1st trimester. This alters clearance of meds excreted by kidneys. Protein, albumin, and glucose excretion are also affected.

Question 41

Why might nose bleeds occur?

Answer 41

Blood vessels in the nose vasodilate, resulting in engorgement of the capillaries, which may result in nose bleeds.

Question 42

How much is oxygen consumption increased?

Answer 42

30%

Question 43

Why is there an increased risk of candidiasis during pregnancy?

Answer 43

Vaginal pH increases.

Question 44

What position does the cervix take near term?

Answer 44

Moves from posterior position to anterior position.

Question 45

When is urinary frequency most common?

Answer 45

1st and 3rd trimesters

Question 46

What causes linea nigra?

Answer 46

Increasing levels of melanocyte-stimulating hormone.

Question 47

A pregnant woman with insulin-dependent DM is at greater risk for _____.

Answer 47

A pregnant woman with insulin-dependent DM is at greater risk for DIABETIC KETOACIDOSIS. The 30% increase in oxygen consumption that occurs during pregnancy may further compromise respiration in women with conditions such as chronic asthma, obesity, or maternal smoking. However, higher PaO2 levels and lower PaCO2 levels create respiratory alkalosis. To compensate for these effects, the renal system excretes bicarbonate.

Question 48

How would you explain to your pregnant patient why she gets dizzy when she gets out of bed sometimes in the morning?

Answer 48

Dizziness – As pregnancy progresses, the risk for inferior vena cava and aortic compression leading to supine hypotension increases when the woman lies in a supine position.