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OB > 7. Normal Pregnancy > Flashcards

7. Normal Pregnancy Flashcards

1
Q

Average gestation (days)

A

266 days

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2
Q 
Average gestation from LMP
•	Days
•	Calendar months
•	Lunar months
•	Weeks
A
  • 280 days
  • 9 calendar months
  • 10 lunar months
  • 40 weeks
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3
Q

Define “Conception”

A

Fertilization: The union of a single egg and sperm. Marks the beginning of pregnancy

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4
Q

Define “Gamete”

A

Reproductive / germ cells – give rise to the sperm and egg

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5
Q

Define “Ovulation”

(When does ovulation occur?)

A

Release of egg (the ovum)

five days before or after day 14

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6
Q

Define “Coitus”

A

Introduction of sperm into female reproductive tract

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7
Q

Define “Fertilization”

A

Union of the gametes

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8
Q

Define “Implantation”

A

Into the uterus

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9
Q

What is a “Graafian Folical? What hormone does it produce?

A
  • A small sac embedded in the ovary that encloses the ovum.

* Produces estrogen

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10
Q

Role of estrogen in becoming pregnant

A

• Prepares the endometrium to receive a fertilized egg

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11
Q

Define “Primordial / Primitive Follicles”

A

Undeveloped egg cell

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12
Q

Changes associated with follicular ripening (4)

A
  • Moves to the surface of the ovary and forms a projection
  • Follicle and ovum within become larger
  • Follicular wall becomes thicker,
  • Fluid collects in the follicle and surrounds the egg
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13
Q

What happens when the graafian follicle becomes fully mature?

A

OVULATION:

Graafian follicle brakes open and releases the ovum, which passes into the uterine tubes.

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14
Q

What 2 hormones cause the ovum to mature?

A
  • FSH

* LH

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15
Q

From where is ovum released?

When does this occur?

A
  • Ovum released from ovarian follicles

* Occurs about 14 days before a woman’s next period would begin

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16
Q 
Corpus Luteum:
•	What is it
•	Timing
•	Hormones (2)
•	Role
A
  • The remaining cells of the follicle after ovulation.
  • Sticks around for 12-14 days
  • Secretes estrogen, progestrone
  • Prepares endometrium for a fertilized ovum
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17
Q

What hormone does the ovum secrete if it becomes fertilized?

A

Secretes chorionic gonadotropin

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18
Q

What happens if the ovum is not fertilized?

• Hormonal changes (4)

A
  • FSH and LH fall to low levels; corpus luteum regresses

* Subsequent decline of estrogen and progesterone.

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19
Q

How is the mature ovum transported through the fallopian tube? (2)

A
  • The musculature of the fallopian tube

* The Cillia

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20
Q

How long does it take the ovum to travel from the ovary to the uterus?

A

3 Days

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21
Q

Where does fertilization ideally take place?

A

In the distal 1/3 of the fallopian tube (AKA the Ampulla), which is close to the ovary.

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22
Q

How many sperm are there in an ejaculation?

A

35,000 to 2 million sperm

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23
Q

The sperm are suspended in what?

A

2-5 mL of seminal fluid

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24
Q

Seminal fluid: Function

A

Nourishment and protection of the sperm from the acidic environment of the vagina

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25
Q

What is mitotic Cellular Replication? (Cleavage)

A

The fertilized egg divides rapidly with no increase in size and smaller cells (blastomeres) are formed with each division

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26
Q

Blastomeres: Definition

A

Rapidly dividing cells that do not increase in size, formed with each division

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27
Q

Morula (Def)

A

When the number of blastomeres reaches 16 – a solid ball of cells

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28
Q

Characteristics of the morula

A
  • Surrounded by a protective coating called the zona

* Secretes a fluid that forms a blastocyst

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29
Q

Blastocyst (def)

A

A sac of cells with an inner cell mass

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30
Q

Trophoblast (def)

A

Part of the cell mass that becomes the PLACENTA

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31
Q

Embryoblast

A

Part of the cell mass that becomes the EMBRYO

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32
Q

Zona

A

Protective coating that surrounds the morula, then degenerates during implantation

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33
Q

The ________ cells displace the _________ cells at the implantation site

A
  • Trophoblast

* Endometrial

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34
Q

During implantation, the _______ embeds in the _______.

A
  • Blastocyst

* Endometrium

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35
Q

What happens 6-10 days after conception?

A

The trophoblast secretes enzymes that enable it to burrow into the endometrium until the entire blastocyst is covered.

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36
Q

When is the pre-embryonic phase? What four things occur during this phase?

A

Conception to day 14

  • Cellular replication
  • Blastocyst formation
  • Yolk sac formation
  • Differentiation begins
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37
Q

Three layers of embryonic disc, and the system that each frms

A

• Ectoderm: Upper layer of embryonic disk. CNS

• Mesoderm: Middle layer
Meso- middle – MUSCLES!

• Endoderm: Lower Layer
Digestive tract, respiratory tract

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38
Q

Four hormones produced by the placenta

A
  • Human Chorionic Gonadotropin (hCG)
  • Human Placental Lactogen (hPL)
  • Progesterone (P)
  • Estrogen (EE)
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39
Q

Human chorionic gonadotropin (hCG) function

A

Hormone that preserves the function of the corpus luteum to maintain early pregnancy

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40
Q

Human Placental Lactogen (HPL)

4 functions

A

o Stimulates maternal metabolism to supply needed nutrients (Similar to a growth hormone)

o Increases the resistance to insulin

o Facilitates glucose transport across placental membrane

o Stimulates breast development to prepare for lactation

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41
Q

Progesterone (P) - 2 roles

A

Stimulates maternal metabolism and development of breast alveoli

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42
Q

Estrogen (EE) - 2 roles

A

o Stimulates uterine growth and uteroplacental blood flow

o Causes proliferation of glandular breast tissue

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43
Q

Metabolic functions of the placenta (3)

A
  • Respiration (Oxygen diffuses from the maternal blood across)
  • Storage / Nutrition
  • Excretion
44
Q

The main exchange of material between the mother and the embryo or fetus occurs through _____

A

The branch villi in the placenta

45
Q

The decidua (def)

A

Endometrium becomes the decidua, which lines the uterus during pregnancy is and is shed with the afterbirth

46
Q

What are scattered over the entire surface of the decidua?

A

Endometrial veins

47
Q

Fetal hemoglobin compared to maternal hemoglobin (2)

A

o Fetal hemoglobin carries 20-30% more oxygen than maternal hemoglobin
o Fetal hemoglobin concentration is 50% greater than that of maternal

48
Q

Nutrients stored in the placenta (4)

A
  • Carbs
  • Proteins
  • Calcium
  • Iron
49
Q

How are nutrients passed to fetus?

A

By facilitated and active transport in the placenta

50
Q

How are water and electrolytes passed to the fetus?

A

By passive diffusion

51
Q

Intrauterine membranes (2)

A
  • Chorion: Outer cell membrane

* Amnion: Inner cell membrane

52
Q

Role of amniotic fluid

A

• Helps maintain a constant body temp

53
Q

Umbilical cord roles (2)

A
  • Arteries: Carry deoxygenated blood and waste to chorionic villi
  • Vein: Returns oxygenated blood and nutrients to fetus
54
Q

Physiologic changes of the uterus during pregnancy (3)

A

o Enlarges and thickens
o Braxton Hicks contractions (painless)
o Softening of the lower uterine segment.

55
Q

Four physiological changes that occur to the cervix

A
  • Softens
  • Mucus plug
  • Friable
  • Changes position with impending labor
56
Q
  • What is the goodell sign?

* When does it occur?

A
  • Cervix can be compressed, feels a little softer.

* Occurs after the 6th week

57
Q

How is the mucus plug formed? What is its purpose?

A
  • Forms when copious mucoid vaginal fluid fills the endocervical canal
  • Due to increased estrogen
58
Q

How does the cervical position change with impending labor?

A

Moves posterior to anterior before delivery

59
Q

Physiological changes of the vagina (3)

A

o Leukorrhea
o Bluish color (“Chadwick’s Sign”)
o External structures may be enlarged

60
Q

Physiological changes of the breasts (6)

A
  • Increased size
  • Tingling
  • Tenderness
  • Fullness
  • Superficial veins prominent
  • Leakage of colostrum
61
Q

What is leukorrhea? What causes it?

A
  • White or slightly gray mucoid discharge with a faint musty odor.
  • In response to cervical by estrogen and progesterone
62
Q

What causes Chadwick’s sign?

A

• Occurs due to an increase in vascularity

63
Q

Why may external vaginal structures become enlarged?

A

• Reason: Hormones that prepare the vagina stretching during labor and birth causes the smooth muscles to hypertrophy

64
Q

Discomforts of pregnancy (13)

Don’t memorize; just review

A
  • Breast changes
  • Urinary frequency
  • N/V
  • Varicose veins
  • Hemorrhoids
  • Backache
  • Leg cramps
  • Constipation
  • Headaches
  • Round ligament pain
  • Insomnia
  • Braxton Hicks
65
Q

How does blood volume change during pregnancy?

A

Increases 50%

66
Q

How does HR change during pregnancy?

A

Increases 10bpm (due to increased blood volume)

67
Q

How do WBCs change during pregnancy?

A

Increase to an average of 15,000

68
Q

How does cardiac output change during pregnancy?

A

Increases 30-50%

69
Q

How does blood pressure change during pregnancy?

A
  • Remains the same in the 1st and 3rd trimesters

* Lowers by 10-15 mmhg in 2nd trimester

70
Q

How does oxygen consumption change in pregnancy?

A

Increases in the second half of pregnancy

71
Q

How does body’s response for CO2 change in pregnancy

A

Lowered threshold

72
Q

How does the respiratory rate change in pregnancy?

A

Unchanged

73
Q

Why does respiratory congestion occur in pregnancy?

A

Increased vascularity of the upper respiratory tract

74
Q

How does BMR change during pregnancy?

A

Increases 15-20%

75
Q

Why does the BMR increase during pregnancy?

A

• Increased maternal cardiac work due to Uterine-fetal-placental unit

76
Q

Changes in the renal system during pregnancy (4)

A
  • Urinary frequency
  • GFR increases 50%
  • Dilation of renal pelvis and ureters increases (slows urine)
  • Water retention
77
Q

What clinical implications does dilation of the renal pelvis have during pregnancy?

A
  • Allows a larger amount of urine to be held in the ureters

* Stagnant urine → Susceptibility to UTIs

78
Q

Changes in the integumentary system during pregnancy (5)

A
  • Increased pigmentaiton (aereola, nipples, vulva)
  • Lina negra
  • Chloasma
  • Stretch marks
  • Oily skin, acne
79
Q

GI changes during pregnancy (8)

A
  • Appetite changes
  • Nausea and vomiting
  • Heartburn
  • Constipation
  • Gums swell and bleed
  • Pytalism (Increased drooling)
  • Hemorrhoids
80
Q

GI Discomforts of pregnancy - timing
• 1st trimester
• 3rd trimester

A
  • N/V: 1st trimester

* Constipation: 3rd trimester

81
Q

Musculoskeletal changes during pregnancy (3)

A
  • Pelvic joints relax
  • Change in posture and center of gravity
  • Exaggerated lumbosacral curve
82
Q

Psychological changes of pregnancy: first trimester (3)

A
  • Accepts biological fact of pregnancy
  • Body image changes
  • Ambivilence
83
Q

Psychological changes of pregnancy: second trimester (2)

A
  • Acceptance of reality of child

* Introspective

84
Q

Psychological changes of pregnancy: Third trimester (2)

A
  • Prepare for birth and parenting

* Anxiety

85
Q

Three phases of “Paternal” Adaptation

A

1) The announcement phase
• Accept biological fact of pregnancy
• Ambivalence is common

2) The moratorium phase
• Adjust to the reality of pregnancy

3) The focusing phase
• Active involvement with pregnancy and relationship with unborn child

86
Q

Maternal weight gain: First trimester

A

3-4 lbs weight gain (total)

87
Q

Maternal weight gain: 2nd and 3rd trimester

A

1 lb per week

88
Q

What four nutrients should a mother increase during pregnancy?

A
  • Kcals
  • Protein
  • Iron
  • Calcium
89
Q

Increase during pregnancy: Kcals

A

+300 per day

90
Q

Increase during pregnancy: Protein

A

+60g per day

91
Q

Increase during pregnancy: Iron

  • Elemental
  • Ferrous sulfate
A
  • Elemental: +30-60 per day

- Ferrous sulfate: +350 mg per day

92
Q

Patient teaching re: iron supplements

A
  • Vitamin C increases absorption
  • Milk, bran and tea decrease absorption
  • Take between meals
  • Increase fiber
93
Q

Pregnancy requirements – calcium

A

2500 mg of calcium per day.

** At least 3 servings of milk, cheese or yogurt.

94
Q

Normal weight gain. 10 pounds by…

A

20 weeks gestation

95
Q

Total pregnancy weight gain for “normal” BMI (19.8-26)

A

25-35 lbs

96
Q

Total pregnancy weight gain for “obese” BMI (>29)

A

15 lbs

97
Q

3 cautions with pregnancy exercise

A
  • Dehydration
  • Avoid impact sports
  • Pain, SOB, dizziness → STOP
98
Q

What is physiologic anemia of pregnancy?

A

• Hemodilution

Occurs because the increase in blood volume is greater than the increase in RBCs.

(NORMAL)

99
Q

Iron deficiency anemia

  • Causes (2)
  • Result (1)
A

Causes:
• Inadequate intake
• Poor absorption

Results:
• Results in decreased O2 carrying capacity of the blood

100
Q

Diagnostic criteria for Iron Deficiency anemia (2)

A

• HCT <10.5-11

101
Q

Treatment for anemia

A

Prophylactic:

• Iron supplementation is often prescribed for all pregnant women by the second trimester to prevent anemia

102
Q

6 risks of anemia

A
  • Poorly prepared to tolerate PPH
  • Cardiac failure during labor
  • PP infections
  • Poor wound healing
  • Preterm labor
  • Neonatal IDA
103
Q

Hyperemesis Gravidarum (def)

A

Excessive n/v that persists past the first trimester.

104
Q

Hyperemesis Gravidarium: Diagnostic criteria

A

5% weight loss of the pre-pregnancy weight

105
Q

Two results of hyperemesis gravidarium

A
  • Dehyration

* Electrolyte imbalance

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