Adaptations to Pregnancy Flashcards
What are the 6 key hormones of pregnancy?
- Human Chorionic Gonadotropin (hCG)
- Progesterone
- Estrogen
- Prolactin
- Relaxin
- Oxytocin
What does Human Chorionic Gonadotropin (hCG) do?
It supports the function of the corpus luteum.
What does Progesterone do?
- 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
What does Estrogen do?
Helps the uterus grow, maintains its lining, and helps fetal organs develop
What does Prolactin do?
Main hormone needed to produce breast milk
What does Relaxin do?
- Inhibits uterus contraction to prevent premature birth
- Relaxes blood vessels
- Relaxes pelvis and softens cervix
What does Oxytocin do?
- Oxytocin levels rise at the start of labor, stimulating contractions of uterine muscles.
- Triggers production of prostaglandins
What adaptations does the pancreas go though (endocrine system)?
- 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.
What adaptions does the reproductive system go through regarding menstrual cycles?
Amenorrhea
- no more periods
- due to increase in progesterone and human chorionic gonadotropin (hCG)
What adaptations does the uterine go through (reproductive system)?
- 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
What changes does the vagina and cervix go through (reproductive system)?
- 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)
What changes do the ovaries go through (reproductive system)?
- 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
What changes do breasts go though (reproductive system)?
- 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
Describe changes in blood volume (circulatory system).
- 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%
Describe changes in heart sounds (circulatory system).
- 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
Describe changes to heart size (circulatory system).
- mild hypertrophy
- due to increased blood flow and workload
- helps the heart pump more efficiently
Describe changes in heart rate (circulatory system).
- heart rate typically increases by 10-20 beats per minute
- supports the heightened cardiac output necessary
What are changes the respiratory system go through?
- 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
Describe changes to the mouth (GI system).
- Gingivitis – gums bleed easily
- hormonal
- Ptyalism – increased salivation
- hormonal or nausea
Describe changes to the esophagus and stomach (GI system).
- 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
Describe changes to the intestines (GI system).
- Increased emptying time/decreased GI motility
- due to increase progesterone
- Constipation, hemorrhoids common
Describe changes to the liver and gallbladder (GI system).
- 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
What are changes the renal system go through?
- 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
Describe changes to skin and sweat glands (integumentary system).
- Increased Blood flow to the skin
- Increased sweat gland activity
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
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
Describe changes to hair and nails (integumentary system).
- Increased growth
- enhanced hair growth due to hormonal changes
- nails may grow faster and appear stronger
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
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
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
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!)
What are changes the immune system goes through for weeks 34 til birth?
- Maybe more susceptible to viral infections
- Increased risk of bacterial colonization
How do we estimate due date?
- Naegele’s Rule:
- First Day of Last Menstrual Period (LMP) - 3 months + 7 days
LMP: April 15, when is estimated due date?
EDD: - 3 months (January) + 7 days (22) = January 22
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
How is obstetrical history obtained?
- 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
What are Presumptive (Subjective) signs of pregnancy?
- Amenorrhea
- Braxton Hicks (patient)
- Breast changes
- Fatigue
- N&V
- Urinary frequency
- Uterine enlargement
- Quickening (Fetal movement)
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
What are Positive (Presence of fetus) signs of pregnancy?
- Visualization of fetus
- Detection of fetal heart tones
- Fetal movement by examiner
