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408 Maternity Exam 1 > Adaptations to Pregnancy > Flashcards

Adaptations to Pregnancy Flashcards

1
Q

What are the 6 key hormones of pregnancy?

A
  • Human Chorionic Gonadotropin (hCG)
  • Progesterone
  • Estrogen
  • Prolactin
  • Relaxin
  • Oxytocin
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2
Q

What does Human Chorionic Gonadotropin (hCG) do?

A

It supports the function of the corpus luteum.

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3
Q

What does Progesterone do?

A
  • Helps establish the placenta
  • Stimulates growth of blood vessels that supply the womb and inhibits contraction of the uterus
  • Strengthens pelvic wall muscles for labor
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4
Q

What does Estrogen do?

A

Helps the uterus grow, maintains its lining, and helps fetal organs develop

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5
Q

What does Prolactin do?

A

Main hormone needed to produce breast milk

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6
Q

What does Relaxin do?

A
  • Inhibits uterus contraction to prevent premature birth
  • Relaxes blood vessels
  • Relaxes pelvis and softens cervix
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7
Q

What does Oxytocin do?

A
  • Oxytocin levels rise at the start of labor, stimulating contractions of uterine muscles.
  • Triggers production of prostaglandins
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8
Q

Describe Endocrine Adaptations during pregnancy.

A
  • Pituitary system
  • Adrenal glands
  • Thyroid gland
  • Pancreas
  • Placenta (acts as temporary endocrine gland during pregnancy)
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9
Q

Describe Endocrine-Pancreas Adaptations.

A
  • Pancreas produces increased levels of insulin as pregnancy progresses.
    • But placenta secretes an anti-insulin hormone (Human Placental Lactogen or hPL) that keeps blood glucose levels stable as pregnancy progresses.
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10
Q

Describe Reproductive Adaptations during pregnancy (mentruation, uterine, cervix).

A
  • Amenorrhea
  • Uterine changes
    • Quickening, ballottement
    • Predictable growth pattern
    • Braxton Hicks
  • Vaginal & Cervical changes
    • Goodell sign – soften of cervix
    • Chadwick sign – bluish color of cervix
    • Leukorrhea, increased vascularity
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11
Q

Describe Reproductive Adaptations during pregnancy (ovaries, breasts).

A

Ovaries:

  • Corpus luteum sustains early pregnancy
  • Releases estrogen and progesterone

Breasts:

  • Estrogen stimulates growth of mammary tissue
    • Become highly vascular
    • Striae gravidarum may appear
  • Progesterone stimulates growth and alveoli
  • Colostrum appears (12-16wks)
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12
Q

What are some breast changes during pregnancy?

A
  • Darkened areola
  • Montgomery glands become pronounced
  • Breasts enlarge
  • Begin producing colostrum around 16 weeks
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13
Q

Describe Cardiovascular Adaptations during pregnancy.

A
  • CV changes occur to protect normal physiologic functions while meeting increased metabolic and fetal needs
  • Expanded blood volume (30-50%) increases cardiac output (but not BP)
    • Can result in dilutional anemia; still expect H&H value of ~11 g/dL, 32-33%.
  • Systolic murmur heard in 90% of pregnant women due to increased cardiovascular load
    • Result from aortic and pulmonary artery blood flow
    • Murmurs > grade 2/4 and any diastolic murmurs are abnormal
  • There may be a mild hypertrophy, secondary to the increased blood flow and work of the heart muscle.
  • HR increases 10-20 BPM
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14
Q

Describe Renal Adaptations during pregnancy.

A
  • Renal blood flow increases 50%
    • ↑ urinary frequency in later pregnancy
  • Delayed clearance and incomplete emptying increases risk of urinary tract infection
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15
Q

Describe GI Adaptations during pregnancy.

A
  • Mouth
    • Gingivitis, gums bleed easily
    • Ptyalism – increased salivation
  • Esophagus and stomach
    • N&V- predicted by high hCG and high estrogen level
    • Heartburn and reflux common
  • Intestines
    • Increased emptying time/decreased motility
    • Constipation, hemorrhoids common
  • Liver and Gallbladder
    • Functional changes can lead to gallstones
    • Cholestasis- slow bile flow, bile builds up in liver; can result in preterm or stillbirth
  • Iron found in prenatal vitamin can worsen N/V/C
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16
Q

Describe Integumentary Adaptations during pregnancy.

A
  • Circulation increases
    • Increased sweat gland activity
  • Hyperpigmentation of skin
    • Linea nigra – pigmented line from symphysis pubis to fundus
    • Striae gravidarum – stretch marks, separation of connective tissue (permanent)
    • Melasma
  • Vascular changes
    • Angiomas, varicose veins
    • Palmar erythema
    • Pruritus (important to differentiate from cholestasis)
  • Hair and Nails
    • Increased growth
17
Q

Describe Immune Adaptations during pregnancy.

A

Conception – 12 weeks:

  • Weakened immune system
  • Allows embryo to implant and invade endometrium
  • Maybe more susceptible to viral infections
  • Increased risk of bacterial colonization

12-34 weeks:

  • Time of rapid growth and fetal development
  • Regulatory T cells (Tregs) protect fetal cells from paternal antigens (otherwise maternal immune cells would attack!)

34 weeks-birth:

  • Maybe more susceptible to viral infections
  • Increased risk of bacterial colonization
18
Q

How do we estimate due date? What is the EDD if the LMP is April 15, 2024?

A

Naegele’s Rule:

  • First Day of Last Menstrual Period (LMP) - 3 months + 7 days
  • Ex. LMP: April 15, 2024
    • EDD: - 3 months (January) + 7 days (22) = January 22, 2025
19
Q

Why do we measure fundal height?

A
  • Estimation of gestational age
  • Number of centimeters should equate to weeks gestation
    • Ex. 28 cm. = 28 weeks ± 2
20
Q

How is obstetrical history obtained?

A

GP:

  • Gravidity: Total number of pregnancies
  • Parity: Number of pregnancies greater than or equal 20 weeks, irrespective of outcome

Parity can be expanded to give more information: TPAL

  • Term: Born at or after 37 weeks
  • Preterm: Born 20-36.6 weeks
  • Abortions: Spontaneous or elective (before 20 weeks)
  • Living: Current number of living children
21
Q

Kim is currently 32 weeks pregnant and has four living children: North (born at 36 weeks), Saint (born at 38 weeks), Chicago (born at 37 weeks), and Psalm (born at 39 weeks). What is her GPTPAL?

A

G: 5
P: 4
T: 3
P: 1
A: 0
L: 4

22
Q

Sam has been pregnant 3 times. They had a miscarriage at 8 weeks, a preterm delivery of a live infant girl at 34 weeks, and a set of twins born at 37 weeks. What is their GPTPAL?

A

G: 3
P: 2
T: 1
P: 1
A: 1
L: 3

23
Q

Describe Presumptive (Subjective) signs of pregnancy.

A
  • Amenorrhea
  • Braxton Hicks (patient)
  • Breast changes
  • Fatigue
  • N&V
  • Quickening (Fetal movement)
  • Urinary frequency
  • Uterine enlargement
24
Q

Describe Probable (Objective) signs of pregnancy.

A
  • Ballottement (Rebound of fetus)
  • Braxton Hicks
  • Chadwick’s sign (Bluish color of vagina/cervix)
  • Goodell’s sign (Softening of cervix)
  • Hegar’s sign (Softening of lower uterine segment)
  • Positive Pregnancy Test
25
Q

Describe Positive (Presence of fetus) signs of pregnancy.

A
  • Visualization of fetus
  • Detection of fetal heart tones
  • Fetal movement by examiner

408 Maternity Exam 1 (5 decks)

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