7. Normal Pregnancy Flashcards
1
Q
Average gestation (days)
A
266 days
2
Q
Average gestation from LMP • Days • Calendar months • Lunar months • Weeks
A
- 280 days
- 9 calendar months
- 10 lunar months
- 40 weeks
3
Q
Define “Conception”
A
Fertilization: The union of a single egg and sperm. Marks the beginning of pregnancy
4
Q
Define “Gamete”
A
Reproductive / germ cells – give rise to the sperm and egg
5
Q
Define “Ovulation”
(When does ovulation occur?)
A
Release of egg (the ovum)
five days before or after day 14
6
Q
Define “Coitus”
A
Introduction of sperm into female reproductive tract
7
Q
Define “Fertilization”
A
Union of the gametes
8
Q
Define “Implantation”
A
Into the uterus
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
10
Q
Role of estrogen in becoming pregnant
A
• Prepares the endometrium to receive a fertilized egg
11
Q
Define “Primordial / Primitive Follicles”
A
Undeveloped egg cell
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
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.
14
Q
What 2 hormones cause the ovum to mature?
A
- FSH
* LH
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
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
17
Q
What hormone does the ovum secrete if it becomes fertilized?
A
Secretes chorionic gonadotropin
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.
19
Q
How is the mature ovum transported through the fallopian tube? (2)
A
- The musculature of the fallopian tube
* The Cillia
20
Q
How long does it take the ovum to travel from the ovary to the uterus?
A
3 Days
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.
22
Q
How many sperm are there in an ejaculation?
A
35,000 to 2 million sperm
23
Q
The sperm are suspended in what?
A
2-5 mL of seminal fluid
24
Q
Seminal fluid: Function
A
Nourishment and protection of the sperm from the acidic environment of the vagina
25
What is mitotic Cellular Replication? (Cleavage)
The fertilized egg divides rapidly with no increase in size and smaller cells (blastomeres) are formed with each division
26
Blastomeres: Definition
Rapidly dividing cells that do not increase in size, formed with each division
27
Morula (Def)
When the number of blastomeres reaches 16 -- a solid ball of cells
28
Characteristics of the morula
* Surrounded by a protective coating called the zona
| * Secretes a fluid that forms a blastocyst
29
Blastocyst (def)
A sac of cells with an inner cell mass
30
Trophoblast (def)
Part of the cell mass that becomes the PLACENTA
31
Embryoblast
Part of the cell mass that becomes the EMBRYO
32
Zona
Protective coating that surrounds the morula, then degenerates during implantation
33
The ________ cells displace the _________ cells at the implantation site
* Trophoblast
| * Endometrial
34
During implantation, the _______ embeds in the _______.
* Blastocyst
| * Endometrium
35
What happens 6-10 days after conception?
The trophoblast secretes enzymes that enable it to burrow into the endometrium until the entire blastocyst is covered.
36
When is the pre-embryonic phase? What four things occur during this phase?
Conception to day 14
* Cellular replication
* Blastocyst formation
* Yolk sac formation
* Differentiation begins
37
Three layers of embryonic disc, and the system that each frms
• Ectoderm: Upper layer of embryonic disk. CNS
• Mesoderm: Middle layer
Meso- middle – MUSCLES!
• Endoderm: Lower Layer
Digestive tract, respiratory tract
38
Four hormones produced by the placenta
* Human Chorionic Gonadotropin (hCG)
* Human Placental Lactogen (hPL)
* Progesterone (P)
* Estrogen (EE)
39
Human chorionic gonadotropin (hCG) function
Hormone that preserves the function of the corpus luteum to maintain early pregnancy
40
Human Placental Lactogen (HPL)
| 4 functions
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
41
Progesterone (P) - 2 roles
Stimulates maternal metabolism and development of breast alveoli
42
Estrogen (EE) - 2 roles
o Stimulates uterine growth and uteroplacental blood flow
| o Causes proliferation of glandular breast tissue
43
Metabolic functions of the placenta (3)
* Respiration (Oxygen diffuses from the maternal blood across)
* Storage / Nutrition
* Excretion
44
The main exchange of material between the mother and the embryo or fetus occurs through _____
The branch villi in the placenta
45
The decidua (def)
Endometrium becomes the decidua, which lines the uterus during pregnancy is and is shed with the afterbirth
46
What are scattered over the entire surface of the decidua?
Endometrial veins
47
Fetal hemoglobin compared to maternal hemoglobin (2)
o Fetal hemoglobin carries 20-30% more oxygen than maternal hemoglobin
o Fetal hemoglobin concentration is 50% greater than that of maternal
48
Nutrients stored in the placenta (4)
* Carbs
* Proteins
* Calcium
* Iron
49
How are nutrients passed to fetus?
By facilitated and active transport in the placenta
50
How are water and electrolytes passed to the fetus?
By passive diffusion
51
Intrauterine membranes (2)
* Chorion: Outer cell membrane
| * Amnion: Inner cell membrane
52
Role of amniotic fluid
• Helps maintain a constant body temp
53
Umbilical cord roles (2)
* Arteries: Carry deoxygenated blood and waste to chorionic villi
* Vein: Returns oxygenated blood and nutrients to fetus
54
Physiologic changes of the uterus during pregnancy (3)
o Enlarges and thickens
o Braxton Hicks contractions (painless)
o Softening of the lower uterine segment.
55
Four physiological changes that occur to the cervix
* Softens
* Mucus plug
* Friable
* Changes position with impending labor
56
* What is the goodell sign?
| * When does it occur?
* Cervix can be compressed, feels a little softer.
| * Occurs after the 6th week
57
How is the mucus plug formed? What is its purpose?
* Forms when copious mucoid vaginal fluid fills the endocervical canal
* Due to increased estrogen
58
How does the cervical position change with impending labor?
Moves posterior to anterior before delivery
59
Physiological changes of the vagina (3)
o Leukorrhea
o Bluish color (“Chadwick’s Sign”)
o External structures may be enlarged
60
Physiological changes of the breasts (6)
* Increased size
* Tingling
* Tenderness
* Fullness
* Superficial veins prominent
* Leakage of colostrum
61
What is leukorrhea? What causes it?
* White or slightly gray mucoid discharge with a faint musty odor.
* In response to cervical by estrogen and progesterone
62
What causes Chadwick's sign?
• Occurs due to an increase in vascularity
63
Why may external vaginal structures become enlarged?
• Reason: Hormones that prepare the vagina stretching during labor and birth causes the smooth muscles to hypertrophy
64
Discomforts of pregnancy (13)
| Don't memorize; just review
* Breast changes
* Urinary frequency
* N/V
* Varicose veins
* Hemorrhoids
* Backache
* Leg cramps
* Constipation
* Headaches
* Round ligament pain
* Insomnia
* Braxton Hicks
65
How does blood volume change during pregnancy?
Increases 50%
66
How does HR change during pregnancy?
Increases 10bpm (due to increased blood volume)
67
How do WBCs change during pregnancy?
Increase to an average of 15,000
68
How does cardiac output change during pregnancy?
Increases 30-50%
69
How does blood pressure change during pregnancy?
* Remains the same in the 1st and 3rd trimesters
| * Lowers by 10-15 mmhg in 2nd trimester
70
How does oxygen consumption change in pregnancy?
Increases in the second half of pregnancy
71
How does body's response for CO2 change in pregnancy
Lowered threshold
72
How does the respiratory rate change in pregnancy?
Unchanged
73
Why does respiratory congestion occur in pregnancy?
Increased vascularity of the upper respiratory tract
74
How does BMR change during pregnancy?
Increases 15-20%
75
Why does the BMR increase during pregnancy?
• Increased maternal cardiac work due to Uterine-fetal-placental unit
76
Changes in the renal system during pregnancy (4)
* Urinary frequency
* GFR increases 50%
* Dilation of renal pelvis and ureters increases (slows urine)
* Water retention
77
What clinical implications does dilation of the renal pelvis have during pregnancy?
* Allows a larger amount of urine to be held in the ureters
| * Stagnant urine → Susceptibility to UTIs
78
Changes in the integumentary system during pregnancy (5)
* Increased pigmentaiton (aereola, nipples, vulva)
* Lina negra
* Chloasma
* Stretch marks
* Oily skin, acne
79
GI changes during pregnancy (8)
* Appetite changes
* Nausea and vomiting
* Heartburn
* Constipation
* Gums swell and bleed
* Pytalism (Increased drooling)
* Hemorrhoids
80
GI Discomforts of pregnancy - timing
• 1st trimester
• 3rd trimester
* N/V: 1st trimester
| * Constipation: 3rd trimester
81
Musculoskeletal changes during pregnancy (3)
* Pelvic joints relax
* Change in posture and center of gravity
* Exaggerated lumbosacral curve
82
Psychological changes of pregnancy: first trimester (3)
* Accepts biological fact of pregnancy
* Body image changes
* Ambivilence
83
Psychological changes of pregnancy: second trimester (2)
* Acceptance of reality of child
| * Introspective
84
Psychological changes of pregnancy: Third trimester (2)
* Prepare for birth and parenting
| * Anxiety
85
Three phases of "Paternal" Adaptation
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
Maternal weight gain: First trimester
3-4 lbs weight gain (total)
87
Maternal weight gain: 2nd and 3rd trimester
1 lb per week
88
What four nutrients should a mother increase during pregnancy?
* Kcals
* Protein
* Iron
* Calcium
89
Increase during pregnancy: Kcals
+300 per day
90
Increase during pregnancy: Protein
+60g per day
91
Increase during pregnancy: Iron
- Elemental
- Ferrous sulfate
- Elemental: +30-60 per day
| - Ferrous sulfate: +350 mg per day
92
Patient teaching re: iron supplements
* Vitamin C increases absorption
* Milk, bran and tea decrease absorption
* Take between meals
* Increase fiber
93
Pregnancy requirements -- calcium
2500 mg of calcium per day.
| ** At least 3 servings of milk, cheese or yogurt.
94
Normal weight gain. 10 pounds by...
20 weeks gestation
95
Total pregnancy weight gain for "normal" BMI (19.8-26)
25-35 lbs
96
Total pregnancy weight gain for "obese" BMI (>29)
15 lbs
97
3 cautions with pregnancy exercise
* Dehydration
* Avoid impact sports
* Pain, SOB, dizziness → STOP
98
What is physiologic anemia of pregnancy?
• Hemodilution
Occurs because the increase in blood volume is greater than the increase in RBCs.
(NORMAL)
99
Iron deficiency anemia
- Causes (2)
- Result (1)
Causes:
• Inadequate intake
• Poor absorption
Results:
• Results in decreased O2 carrying capacity of the blood
100
Diagnostic criteria for Iron Deficiency anemia (2)
• HCT <10.5-11
101
Treatment for anemia
Prophylactic:
| • Iron supplementation is often prescribed for all pregnant women by the second trimester to prevent anemia
102
6 risks of anemia
* Poorly prepared to tolerate PPH
* Cardiac failure during labor
* PP infections
* Poor wound healing
* Preterm labor
* Neonatal IDA
103
Hyperemesis Gravidarum (def)
Excessive n/v that persists past the first trimester.
104
Hyperemesis Gravidarium: Diagnostic criteria
5% weight loss of the pre-pregnancy weight
105
Two results of hyperemesis gravidarium
* Dehyration
| * Electrolyte imbalance
