Adaptations to Pregnancy Flashcards
1
Q
What are the 6 key hormones of pregnancy?
A
- Human Chorionic Gonadotropin (hCG)
- Progesterone
- Estrogen
- Prolactin
- Relaxin
- Oxytocin
2
Q
What does Human Chorionic Gonadotropin (hCG) do?
A
It supports the function of the corpus luteum.
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
4
Q
What does Estrogen do?
A
Helps the uterus grow, maintains its lining, and helps fetal organs develop
5
Q
What does Prolactin do?
A
Main hormone needed to produce breast milk
6
Q
What does Relaxin do?
A
- Inhibits uterus contraction to prevent premature birth
- Relaxes blood vessels
- Relaxes pelvis and softens cervix
7
Q
What does Oxytocin do?
A
- Oxytocin levels rise at the start of labor, stimulating contractions of uterine muscles.
- Triggers production of prostaglandins
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.
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)
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
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)
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
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
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%
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
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
- Glucosuria can occur in normal pregnancy
24
Q
Describe changes to skin and sweat glands (integumentary system).
A
- Increased Blood flow to the skin
- Increased sweat gland activity
25
Describe changes to skin pigmentation (integumentary system).
- 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
Describe changes to vascular system (integumentary system)
- 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
Describe changes to hair and nails (integumentary system).
- Increased growth
- enhanced hair growth due to hormonal changes
- nails may grow faster and appear stronger
28
What are changes the musculoskeletal system go through?
- 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
What are changes the neurological system goes through?
- 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
What are changes the immune system goes through for first 12 weeks?
- 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
What are changes the immune system goes through for weeks 12-34?
- 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
What are changes the immune system goes through for weeks 34 til birth?
- Maybe more susceptible to viral infections
- Increased risk of bacterial colonization
33
How do we estimate due date?
- Naegele’s Rule:
- First Day of Last Menstrual Period (LMP) - 3 months + 7 days
34
LMP: April 15, when is estimated due date?
EDD: - 3 months (January) + 7 days (22) = January 22
35
Why do we measure fundal height and what does it indicate?
- 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
How is obstetrical history obtained?
- GP:
- **G**ravidity: Total number of pregnancies
- **P**arity: 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
- **T**erm: Born at or after 37 weeks
- **P**reterm: Born 20-36.6 weeks
- **A**bortions: Spontaneous or elective
- **L**iving: Current number of living children
37
What are Presumptive (Subjective) signs of pregnancy?
- Amenorrhea
- Braxton Hicks (patient)
- Breast changes
- Fatigue
- N&V
- Urinary frequency
- Uterine enlargement
- Quickening (Fetal movement)
38
What are Probable (Objective) signs of pregnancy?
- 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
What are Positive (Presence of fetus) signs of pregnancy?
- Visualization of fetus
- Detection of fetal heart tones
- Fetal movement by examiner
