6: Pregnancy Changes Flashcards
Why might a libido increase during 2nd trimester?
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.
T/F Gums may experience hypertrophy.
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.
T/F Pregnant women are at decreased risk of hyperventilation and increased risk of dyspnea.
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%.
Why might a pregnant woman experience lordosis and kyphosis?
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.
When is Hegar’s sign detected?
May be detectable by 4th month.
When is Chadwick’s sign present?
4 weeks
What happens to cardiac output?
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.
How does the position of the heart change?
Displaced upward and to the left.
T/F While increased melanocyte activity can cause chloasma on the face, moles and scars lighten.
False. Increased vascularity and pigmentation of the areola, genitalia, abdomen, and face (chloasma gravidarum) may occur. Darkening of moles and scars.
What causes urinary frequency and incontinence?
Bladder tone is decreased d/t effects of progesterone.
T/F Changes in posture can lead to carpal tunnel in some pregnant women.
True
How would you explain to your pregnant patient why she has some dyspnea?
Dyspnia – Chest wall circumference increases and chest compliance decreases. These anatomic findings reduce lung capacity in pregnancy by 5%.
When does the cervix become edematous and congested?
4 weeks
Why do some (15%) of women have pruritis in the 3d trimester?
Elevation of bile salts.
In whom is urinary incontinence most common?
Multiparas
How much does breast size increase?
12 ounces by term
When does leukorrhea most commonly occur?
2nd trimester
Would the FNP expect to see a rise or drop in blood pressure in her pregnant patient in the first and second trimester?
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.
Why is physiologic anemia common in pregnancy?
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.
What causes dyspepsia during pregnancy?
The displacement of abdominal organs and altered esophageal sphincter and gastric tone related to increasing progesterone levels may cause dyspepsia in pregnancy.
The pituitary gland increases in size by a factor of _____.
The pituitary gland increases in size by a factor of 3.
What causes varicosities?
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.
Facial fullness can occur, but facial or lid edema could be indicative of _____.
Facial fullness can occur, but facial or lid edema could be indicative of TOXEMIA.
T/F Fetal growth during pregnancy and newborn weight are correlated with the degree of blood volume expansion.
True
Is a systolic murmur concerning in a pregnant woman?
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.
T/F Vaginal rugae become less pronounced during pregnancy.
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.
There may be generalized edema of the labia _____ near term.
There may be generalized edema of the labia MAJORA near term.
How much does blood volume increase and when does it peak?
30-50% and it peaks at 30-34 weeks.
What causes cervical ripening in preparation for labor?
Increasing levels of estrogen and changes in the solubility of collagen.
How much does the uterus hold during pregnancy?
On average, 5 L of fluid
What causes softening of muscles and ligaments?
Progesterone
Relaxin
What happens to the diaphragm and why?
The diaphragm is elevated because of the intra-abdominal pressure from the enlarging uterus and the effects of relaxin and progesterone.
What happens to stroke volume?
Increased 20-30%.
What happens to S1 and S3?
Volume of S1 may be increased with splitting. S3 may be detected.
What causes constipation in pregnancy?
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.
T/F There can be both an increase and decrease of hair in pregnancy.
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.
Why are pregnant women predisposed to gallstone formation?
Sluggish emptying of bile from the gallbladder combined with increased cholesterol saturation during pregnancy.
Why would women with cardiac disease become symptomatic during pregnancy?
Increase in cardiac output. Half of which occurs by 8th week.
How much does the uterine wall thicken?
From 10-25 mm by 16 weeks.
Why might medication levels change in pregnant women?
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.
Why might nose bleeds occur?
Blood vessels in the nose vasodilate, resulting in engorgement of the capillaries, which may result in nose bleeds.
How much is oxygen consumption increased?
30%
Why is there an increased risk of candidiasis during pregnancy?
Vaginal pH increases.
What position does the cervix take near term?
Moves from posterior position to anterior position.
When is urinary frequency most common?
1st and 3rd trimesters
What causes linea nigra?
Increasing levels of melanocyte-stimulating hormone.
A pregnant woman with insulin-dependent DM is at greater risk for _____.
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.
How would you explain to your pregnant patient why she gets dizzy when she gets out of bed sometimes in the morning?
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.
