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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

What adaptations does the pancreas go though (endocrine system)?

A
  • Pancreas produces increased levels of insulin as pregnancy progresses.
  • Placenta secretes an anti-insulin hormone (Human Placental Lactogen or hPL) that keeps blood glucose levels stable as pregnancy progresses.
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9
Q

What adaptions does the reproductive system go through regarding menstrual cycles?

A

Amenorrhea
- no more periods
- due to increase in progesterone and human chorionic gonadotropin (hCG)

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10
Q

What adaptations does the uterine go through (reproductive system)?

A
  • Quickening, ballottement
    • uterus enlarges to accommodate the growing fetus
    • softening of the uterine wall as it adapts to the growing fetus
  • Predictable growth pattern
    • growth reflects the expanding uterine cavity
  • Braxton Hicks
    • contractions help to tone the uterine muscles
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11
Q

What changes does the vagina and cervix go through (reproductive system)?

A
  • Goodell sign – soften of cervix
  • Chadwick sign – bluish color of cervix (results from increased blood flow to the pelvic region)
  • Leukorrhea – increased vascularity (increased vaginal discharge to reduce risk of infection)
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12
Q

What changes do the ovaries go through (reproductive system)?

A
  • Corpus luteum sustains early pregnancy
    • produce hormones that are crucial for maintaining early pregnancy
  • Releases estrogen and progesterone
    • estrogen levels rise during pregnancy, helps uterine growth, blood flow to the uterus, and development of breast tissue in preparation for lactation
    • progesterone is essential for preparing the endometrium (the lining of the uterus) to receive and sustain the fertilized egg
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13
Q

What changes do breasts go though (reproductive system)?

A
  • Estrogen stimulates growth of mammary tissue
    • Become highly vascular (blood flow increases, looks fuller, may be tender)
    • Striae gravidarum may appear (stretch marks)
  • Progesterone stimulates growth and alveoli
    • stimulates growth of alveoli (milk-producing glands)
  • Colostrum appears (12-16wks)
    • nutrient-rich fluid that provides essential antibodies and nutrients (breastmilk)
  • Darkened areola
  • Montgomery glands become pronounced
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14
Q

Describe changes in blood volume (circulatory system).

A
  • blood volume increases by 30-50%
    • necessary to supply adequate oxygen and nutrients to the fetus
    • doesn’t effect BP
  • physiologic anemia
    • hemoglobin concentration appears lower due to dilution
    • H&H still expected to be around 11 g/dL and 32-33%
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15
Q

Describe changes in heart sounds (circulatory system).

A
  • systolic murmurs are common in about 90% of pregnant women
    • result from the increased blood flow across the heart valves due to the higher volume of blood
    • murmurs > grade 2/4 and any diastolic murmurs are abnormal
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16
Q

Describe changes to heart size (circulatory system).

A
  • mild hypertrophy
    • due to increased blood flow and workload
    • helps the heart pump more efficiently
17
Q

Describe changes in heart rate (circulatory system).

A
  • heart rate typically increases by 10-20 beats per minute
    • supports the heightened cardiac output necessary
18
Q

What are changes the respiratory system go through?

A
  • Oxygen consumption increases by about 20%
    • 1/2 used by uterus, fetus and placenta
  • Diaphragm shifts upward, decreasing lung length
    • Diameters of chest wall increase (both antero-posterior & transverse)
    • Widened substernal angle
    • Respiratory rate slightly increases and decreased airway resistance
  • SOB, nasal stuffiness, rhinitis, epistaxis are all common
19
Q

Describe changes to the mouth (GI system).

A
  • Gingivitis – gums bleed easily
    • hormonal
  • Ptyalism – increased salivation
    • hormonal or nausea
20
Q

Describe changes to the esophagus and stomach (GI system).

A
  • N&V (morning sickness)
    • predicted by high hCG and high estrogen level
  • Heartburn and reflux common
    • uterus expands, pressure on stomach, heartburn and/or GERD
  • aggravated by iron supplements in prenatal vitamins
21
Q

Describe changes to the intestines (GI system).

A
  • Increased emptying time/decreased GI motility
    • due to increase progesterone
  • Constipation, hemorrhoids common
22
Q

Describe changes to the liver and gallbladder (GI system).

A
  • Functional changes can lead to gallstones
    • due to altered bile composition and flow
  • Cholestasis – slow bile flow, bile builds up in liver; can result in preterm or stillbirth
23
Q

What are changes the renal system go through?

A
  • Renal blood flow increases 50%
    • ↑ urinary frequency in later pregnancy
  • UTI
    -Delayed clearance and incomplete emptying increases risk of urinary tract infection
  • ↑GFR → Glucosuria, proteinuria, and albuminuria
    • Glucosuria can occur in normal pregnancy
      • (1-10 g/day)
    • Proteinuria
      • 300mg/24 hours or a Protein/Creatinine ration > 0.3
    • Albuminuria > 30mg/24 hours
24
Q

Describe changes to skin and sweat glands (integumentary system).

A
  • Increased Blood flow to the skin
  • Increased sweat gland activity
25
Q

Describe changes to skin pigmentation (integumentary system).

A
  • Linea nigra – pigmented line from symphysis pubis to fundus
    • due to increased melanin production
  • Striae gravidarum – stretch marks, separation of connective tissue
  • Melasma – dark patches on the face
    • hormonal changes and increased melanin production
26
Q

Describe changes to vascular system (integumentary system)

A
  • Angiomas – benign growths of blood vessels
    • increased blood flow and vascularity
  • Varicose veins
    • increased pressure from the growing uterus
  • Palmar erythema – redness of the palms
    • increased blood flow
  • Pruritus (differnt from cholestasis)
    • increased itching due to stretched skin
27
Q

Describe changes to hair and nails (integumentary system).

A
  • Increased growth
    • enhanced hair growth due to hormonal changes
    • nails may grow faster and appear stronger
28
Q

What are changes the musculoskeletal system go through?

A
  • Abdominal wall
    • Diastis recti: Rectus abdominis muscle (6 pack) separates
  • Relaxin and progesterone – relaxes joints/ligaments
    • Pelvis tilts – symphysis pubis and sacroiliac joints increase mobility to facilitate labor
    • Center of gravity shifts forward → Lordosis and waddle
  • Calcium
    • Fetal demands increase throughout pregnancy
29
Q

What are changes the neurological system goes through?

A
  • Back pain due to lordosis
  • Carpal tunnel syndrome
    • compression of nerves
    • numbness, tingling, and pain in the hands and fingers
  • Lightheadedness, faintness, and syncope due to postural hypotension or hypoglycemia
  • Muscle cramps possibly due to hypocalcemia or mineral deficiency
    • Stretching, magnesium PO
  • Headaches may require evaluation
    • can indicate more serious conditions
30
Q

What are changes the immune system goes through for first 12 weeks?

A
  • Weakened immune system
    • prevent the maternal immune system from rejecting the fetus
    • allows embryo to implant and invade endometrium
  • Maybe more susceptible to viral infections
    • Increased risk of bacterial colonization
31
Q

What are changes the immune system goes through for weeks 12-34?

A
  • Time of rapid growth and fetal development
    • maternal immune system adapts to protect both the mother and the fetus
  • Regulatory T cells (Tregs) protect fetal cells from paternal antigens (otherwise maternal immune cells would attack!)
32
Q

What are changes the immune system goes through for weeks 34 til birth?

A
  • Maybe more susceptible to viral infections
  • Increased risk of bacterial colonization
33
Q

How do we estimate due date?

A
  • Naegele’s Rule:
    • First Day of Last Menstrual Period (LMP) - 3 months + 7 days
34
Q

LMP: April 15, when is estimated due date?

A

EDD: - 3 months (January) + 7 days (22) = January 22

35
Q

Why do we measure fundal height and what does it indicate?

A
  • Estimation of gestational age
  • Number of centimeters should equate to weeks gestation
    • Ex. 28 cm. = 28 weeks ± 2
  • Non-invasive indicator of:
    • Fetal growth
    • Pregnancy complications
      • Amniotic fluid volume
    • Multiple gestation
36
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
      • Primipara: Pregnant for the first time
      • Multipara: 2+ pregnancies
  • 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
    • Living: Current number of living children
37
Q

What are Presumptive (Subjective) signs of pregnancy?

A
  • Amenorrhea
  • Braxton Hicks (patient)
  • Breast changes
  • Fatigue
  • N&V
  • Urinary frequency
  • Uterine enlargement
  • Quickening (Fetal movement)
38
Q

What are 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
39
Q

What are Positive (Presence of fetus) signs of pregnancy?

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

Maternity Exam 1 (5 decks)

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