Alterations in Reproductive Function

Question 1

Definition: HPO axis

Answer 1

Hypothalamic pituitary ovarian axis, the main hormonal feedback pathway responsible for the reproductive system

Question 2

Definition: Menarche

Answer 2

The first menstrual cycle achieved

Question 3

Definition: Os

Answer 3

The opening from the uterus through the cervix into the vagina, can measure the dilatation of the os to monitor the progress of labour

Question 4

Definition: Fundus

Answer 4

The top of the uterus, during pregnancy this can be used as 1 measurement point for monitoring the growth of the fetus (symphysis-fundal height), after delivery the fundus is palpated to monitor the resolution phase

Question 5

Definition: Infertility

Answer 5

failure to achieve pregnancy after 1 yr of unprotected intercourse, noting that if the female partner is over 35 yrs, then the interval is shortened to 6 months

Question 6

Definition: IUI

Answer 6

Intra uterine insemination
- where a small catheter is passed into the uterus via the vagina & cervix so that semen may be instilled directly into the uterus

Question 7

Definition: IVF

Answer 7

In vitro fertilization
- process by which the ova & semen are collected from the individuals & mixed to permit fertilization to occur & after 3-5 days later 1-2 growing embryos are returned to the uterus, any remaining fertilized ova can be frozen for future attempts

Question 8

Definition: Prenatal

Answer 8

The period of time from conception to the birth of the infant, also known more commonly within the healthcare community as the antenatal period

Question 9

Definition: Postnatal

Answer 9

period of time from the delivery of the infant until complete resolution of the body to the pre-pregnant state, usually 6-8 weeks

Question 10

Definition: Parity

Answer 10

of deliveries that a woman has had over 20 weeks gestation, when this # is over 5 this is considered to be a state of gran multiparity, or the woman is referred to as a grand multipara

Question 11

Definition: GTPAL

Answer 11

G= Gravida (total # of pregnancies)
T= term, total # of deliveries over 37 weeks gestational age
P= preterm, the total # of deliveries between 20-37 weeks gestational age
A= abortions, which can be spontaneous or therapeutic
L= # of living children

Question 12

Definition: Viability

Answer 12

point at which should a fetus deliver there is a reasonable expectation of survival, usually defined as 500gm or more than 20 weeks gestation.

Question 13

Definition: Macrosomia

Answer 13

Fetal head size has grown larger than can be passed vaginally

Question 14

Definition: Polyhydramnios

Answer 14

The amount of amniotic fluid is more than 2 standard deviations above the norm for gestational age

Question 15

How does sexual differentiation occur?

Answer 15

occurs on the 7th week of gestation, determined by XX or XY
- SRY protein on male or Y chromosome is the testes determining factor

In females: no exposure to SRY, develops vagina, uterus, fallopian tubes (Mullerian ducts)
- ovaries produce 2ndary oocytes & hormone (estrogen, progesterone, inhibin, relaxin)
- at birth, ovaries of female contain all their primary oocytes & secondary oocytes formed after puberty once a month at ovulation
- fallopian tubes transport 2ndary oocyte to uterus
- uterus is site of implantation for fertilized ovum

Question 16

Definition: Endometrium

Answer 16

inner epithelial layer of the uterus
- preparation for implantation , maintenance of pregnancy if implantation occurs, menstruation in absence of pregnancy

Question 17

Definition: Myometrium

Answer 17

Muscular outer layer of the uterus
- expands during pregnancy to hold baby, contract during labor to push baby out

Question 18

Definition: Perimetrium

Answer 18

outer serous layer of the uterus, secrets lubricating fluid that helps reduce friction
- also covers some of the organs of the pelvis

Question 19

Uterus position?

Answer 19

heterogenous for all females
- uterine position will remain the same throughout their lifetime
- clinician can palpate the uterus during a bimanual examination to determine their uterine lie or position (during routine pelvic exam)
- Does not affect fertility
- Can be midline, anteverted, anteflexed, retroverted, retroflexed

Question 20

How are female hormones created?

Answer 20

Onset of puberty, the hypothalamic neurosecretory cells release the GnRH which binds to the anterior pituitary cells called the gonadotrophs & stimulates them to increase the secretion of the FSH & LH
- FSH stimulates growth of follicles of the ovaries to produce estrogen, progesterone & inhibin

LH stimulates the ovulation (LH surge, formation of corpus luteum)

Question 21

Function: Estrogen

Answer 21

responsible for development & maintenance of the female reproductive structures, secondary female characteristics (adipose tissue deposition, voice pitch, broad pelvis, pattern of hair growth)
- estrogren works with HgH, it can increase protein synthesis inclusing bones
- estrogen lowers blood cholesterol (mechanism unknown)

Question 22

Function: Progesterone

Answer 22

secreted mainly by cells of the corpus luteum in the last 2 weeks of the menstrual cycle
- works with estrogen to prepare & maintain the endometrium & to prepare the mammary glands for lactation

Question 23

Function: Relaxin

Answer 23

produced by the corpus luteum & it has a role to play with the relaxation of the uterine smooth muscle

Question 24

Function: Inhibin

Answer 24

secreted by the granulosa cells of the follicles & together with the levels of estrogen & progesterone, these hormones provide feedback for the HPO axis, either stimulating or inhibiting further release of FSH & LH

Question 25

Female Monthly Cycle

Answer 25

Cycle can range from 24-36 days, biggest variation occurring during the pre-ovulatory phase

Day 1-5 (menstrual phase) when uterus sheds all but the deepest layers of the endometrium- aprx. 50-150ml of blood, tissue, fluid, mucus, and epithelial cells
- discharge is due to the decreased amount of progesterone & estrogen
- can be manipulated with exogenous hormones (birth control)
-when woman stops taking active hormones, level of progesterone decreases & withdrawal promotes the bleeding
- Ovarian hormones at the lowest levels & stimulates the secretion of GnRH & FSH & LH

Day 6-14 is the variable pre-ovulatory phase & under the influence of FSH the maturation of the dominant follicle occurs
- proliferative phase of the uterus as estrogen promotes the endometrial growth
at aprx. day 14 ovulation occurs when the secondary oocyte is released into the pelvic cavity, surrounded by the zona pelucida, corona radiate
- leftover cells int he ovary become the corpus luteum under influence of LH & secretes estrogen, progesterone, inhibitin & relaxin

Day 15-28 is the post-ovulatory phase during which the progesterone & estrogen secreted by the corpus luteum
causes further growth & coiling of the endometrial glands & thickening of the endometrium, all in prep for a fertilized ovum.
- without fertilized ovum, corpus luteum degenerates, leading to decreased amount of progesterone
- with the withdrawal of progesterone, menstruation occurs

Question 26

Definition of Fertilized Ovum

Answer 26

Zygote
- In 2 weeks, becomes a blastocyst (collection of rapidly proliferating cells)
- 2-8 weeks an embryo
-8 weeks to birth= fetus

Question 27

Process of Implantation

Answer 27

fertilized zygote must penetrate into the endometrial layer of the uterus
- process takes days - at about day 10-12 post-fertilization you will see a rise in the beta subunit of the glycoprotein called the human chorionic gonadotrope hormone (hCG)
- within a few hrs after implantation, the trophoblast or specialized cells around the blastocyst will begin to produce hCG

Question 28

What is hCG?

Answer 28

Human chorionic gonadotrope hormone
- marker used to detect pregnancy in both urine & blood
-role is to maintain the corpus luteum, which produces the increasing amounts of progesterone needed to support & thicken the uterine lining
- if hCG levels are insufficient, the corpus luteum will regress, progesterone levels will drop, sloughing of the endometrial layer occurs
- beta-hCG will double every 2 days in early pregnancy & is clinically used to support viability of pregnancy or to rule out ectopic pregnancy
- blood test is a more sensitive test (can detect rise above 5 IUs/L) for urine test to be positive must be at 25 IU/L
- best to use first void of morning for home pregnancy test (will be most concentrated)

Question 29

Signs & symptoms of Implantation

Answer 29

Some women will experience spotting or light bleeding at the time that their next menses is due
- will be much lighter than their usual flow
- can signify a potential implantation bleed caused by the burrowing of the zygote through the endometrial layers
-can falsely date a pregnancy when a woman feels that she did have her menses at her normal expected time.

Question 30

Embryogenesis

Answer 30

stage of rapid development of the ectodermal, endodermal, and mesodermal layers for all the structures and systems in the human embryo & fetus

Question 31

Why is the first trimester the most important in trying to ensure that the baby will be healthy

Answer 31

by the end of the 13th week of gestation, all major structures & pathways are formed & the remainder of the pregnancy is more about the growth & fine-tuning of these
- at this time, the developing fetus can be exposed to adverse substances & events such as alcohol ingestion, tobacco smoking & use of recreational drugs (if unplanned)

Question 32

What is the chorion membrane?

Answer 32

is derived from 2 layers of tissue
- inner layer from the ectoderm that becomes the trophoblast
- outer layer that is the mesoderm

Trophoblast divides rapidly & creates small finger-like projections to the uterine myometrium to begin to form the chorionic villi

mesoderm fills in these projections with branches of umbilical vessels so that they become vascularized
- chorion contributes to development of the placenta (parts of the chorion that are in contact with the uterine wall)
- between 8-10 weeks, the placenta develops & take over producing progesterone & hCG (enabling corpus luteum degeneration)
- at 10-14 weeks the chorionic villi & intervillous spaces or maternal sinuses has blood flowing & can facilitate nutrient & gas exchange
- O2 plays a key role in the regulation of the villlious vasculogenesis
- there is increased bloodflow, increased intra-placental O2 demand & increased oxygen tension that may contribute to excess oxidative stress, which can be overwhelming in some pregnancies & can lead to miscarriage
- arteries & veins increase in number & capacity & divide into the 2ndary then tertiary vessels before entering the mainstream villi or umbilical stalk

Question 33

Placental development?

Answer 33

provider of all fetal nutrition during pregnancy
- formed by 10th week, acts to filter nutrients, oxygen, fetal waste products by diffusion between mother & fetus
- placenta forms fingerlike projections or interdigitations into the endometrium that performs these important functions

Question 34

What is Lochia flow?

Answer 34

Dark or bright red blood that a woman experiences after delivery of the baby as a sign that the location of the placenta attachment is healing
- open wound after the separation of the placenta & heals like a scab

Question 35

What is the amnion sac?

Answer 35

membranous sac that surrounds the developing fetus & provides protection as the fetus grows
- appears as a small sac that eventually enlarges & becomes fluid-filled by the 4th or 5th week
- amniotic fluid or liquour, continues to accumulate to be a total of about 1-2L at term
- when water breaks, there is a small opening in the sac that allows fluid to exit
- when membrane rupture, we note the quantity & color of the fluid to determine if fetus has passed meconium prior to birth as this changes delivery protocol

Question 36

Polyhydramnius?

Answer 36

associated with gestational diabetes
- involved an excessive amount of fluid which can over extend the uterine cavity & can lead to poor descent of the presenting part into the pelvis
- shoudl the membranes rupture before adequate descent, there is potential for the prolapse of the umbilical cord which is an obstetrical emergency
- usual symptoms of diabetes (increased thirst & urination- too much fluid)

Question 37

Oligohydramnious?

Answer 37

too little fluid around the baby
- can also be associated with gestational diabetes
- can lead to intolerances of the stresses of labour, such as fetal heart decelerations
- think about what happens with high BP (vessels are constricted thus not much blood passes between the placenta & the fetus)-results in lower volume of blood

Question 38

Purpose of Umbilical Arteries & Vein?

Answer 38

there are 2 arteries & 1 vein
- umbilical vein carries oxygenated blood to the fetus while the arteries remove deoxygenated blood
- delivery of the placenta is the 3rd stage of labour
- cord is always inspected after delivery for the presence of the 3 vessels
- often on routine ultrasound of any pregnancy they will also look for the 3 vessels of the cord
- delivering midwife or physician will examine the placenta to ensure that it is whole & there are no gross abnormalities

Question 39

When would a placenta be sent off to histological studies?

Answer 39

if baby is small for gestational dates, meaning less than 2500 grams at full term birth, post dates, that is born after 41 completed weeks of gestation, or the placenta does not appear normal on gross examination

Question 40

Velamentous abnormality of the umbilical cord?

Answer 40

the major umbilical vessels separate in the fetal membranes before reaching the placental disk
- no major consequences in utero, but could lead to a greater chance for cord trauma with bleeding during delivery

Question 41

Vasa previa abnormality of the umbilical cord?

Answer 41

vessels run unprotected through the membranes

Question 42

Placenta accreta abnormality of the umbilical cord?

Answer 42

Results from a lack of formation of a normal decidual plate
- the decidual plate is the normal cellular boundary of the maternal side of the placenta & the uterus, which usually does not extend past the endometrium
- chorionic villi abnormally extend into myometrium, and the placenta cannot separate normally following delivery & severe hemorrhage results

Question 43

Possible placental Positions?

Answer 43

Complete, Partial, Marginal, Low Lying

Question 44

Placental Positions?

Answer 44

location of where the placenta develops happens by chance, there are risk factors for the development of placenta previa which includes grand multiparity, recurrent abortions or miscarriages or uterine surgery
- condition where the placenta forms so that it is completely or partially covering the uterine os
- position is always commented on during routine antenatal ultrasound (this is done at 18-20 weeks of gestation)
- if there is abnormal placentation, they measure how close the leading edge of the palcent is to the uterine os, which is the opening of the uterus to the cervix (guides clinician for delivery options)
- there is a chance that the placental position can change as uterus grows during the pregnancy & repeat US will be taken
- big risk is an antepartum hemorrhage (recommendation for complete pelvic rest)

Question 45

What do they do if the placenta completely covers the os?

Answer 45

delivery will be planned by c-section

Question 46

What do they do with a low-lying or marginal previa?

Answer 46

may consider vaginal delivery, usually with a double setup- that is being prepared to perform a c-section at a moments notice

Question 47

What is antepartum hemorrhage?

Answer 47

bleeding from or into the Genital tract occuring from 24+ weeks of pregnancy & prior to birth
- complication can be fetal as well as maternal
- maternal complications include malpresentation, premature labour, PPH, sepsis, shock, retained placenta
- fetal complications: prematurity, low birth weight, intrauterine death, congenital malformation, birth asphyxia

Question 48

How can hCG increase circulating thyroid hormones?

Answer 48

it has the capcity with its thyroid stimulating hormone-like activity (TSH-like activity), to stimulate the maternal thyroid gland to increase circulating thyroid hormones

Question 49

Role of maternal thyroxin?

Answer 49

crosses the placenta & facilitates fetal development & in some studies, maternal thyroid dysfunction can be associated with an increased risk of preeclamsia, gestational hypertension, low birth weight, preterm delivery, perinatal morbidity and mortality.

Question 50

What is hCS (human chorionic somatomammotropin)?

Answer 50

protein hormone with immunological & biological similarities to the pituitary growth hormone & called the human placental lactogen
- referred to as the GH of pregnancy with anti-insulin characteristics- namely decreased glucose uptake & increased FFA being released
- also has potent prolactin-like or lactinogenic bioactivity
- secreted by the placenta into the maternal circulation with very little reaching the fetal circulation
the maternal plasma concentrations are linked to placental mass

Question 51

What is hCC (Human chorionic corticotrophin)?

Answer 51

human chorionic adrenocorticotropin
- levels of hCC can be detected in both maternal & fetal circulations
- maternal adrenocorticotrophin hormone (ACTH) does not reach fetus & the thinking is that the placental hCC is not under the feedback regulations by maternal glucocorticoids
-

Question 52

What are pregnancy Proteins?

Answer 52

PAPP-A (Pregnancy associated plasma proteins) used for Down’s syndrome screening
- there are also macroglobulins, placental proteins, placental membrane proteins & although these have been isolated, their functions have yet to be fully delineated

Question 53

What is placental CRH (Corticotrophin releasing factor)?

Answer 53

another placental synthesized hormone, which is different than hCC
- has similar characteristics of the hypothalamic CRH
- CRH in a non-pregnant woman is aprx. 5-10 picomoles/L but during pregnancy this increases to 100 early in the 3rd trimester & up to 500 picomoles/L in the last 5-6 weeks of gestation
- can rise another 2-3fold with the onset of labour
- much of its role in regulation are unknown but it has been postulated that it plays a major role in the timing of parturition, wiht the increased levels of CRH near the end of pregnancy, the smooth muscle are relaxing, and there is increased formation of prostaglandins
- other role that is associated with this is the fetal lung maturation & development of fetal surfactant
- cortisol signals the lungs to start producing surfactant so that the lungs may in turn, turn into functioning tissues upon delivery
- in the fetal state the lungs do not function in the manner that they do once in extra-uterine life
- while the organ develops and it grows, it does not function in-utero to provide oxygenated blood to the tissues

Question 54

What is celestone or Betamethasone used for?

Answer 54

corticosteroid medications given in 2 doses (12-24 hrs apart by IM injection)
- if threatened with premature labour
- mimic the effects of the natural cortisol & to promote maturation of the fetal lung

Question 55

What is placental progesterone?

Answer 55

essential to maintain the pregnancy especially the uterine linings

Question 56

Importance of Estrogen in pregnancy?

Answer 56

primarily formd from DHEA which is secreted by the zona reticularis layer of the adrenal cortex of both the mom, but larger quantities by the fetus, and is transported to the placenta where it is converted to estradiol , estrone, and estriol
- cause enlargement of the uterus, breast ductal structure & the pregnant woman’s external genitalia
- also works with relaxin to relax the pelvic ligaments - the symphysis pubis become elastic to allow for easier passage of the fetus during delivery
- relaxed pelvic girdle promotes “waddly gait” in pregnancy

Question 57

What are the 2 major subunits of hCG?

Answer 57

alpha & beta
- the beta subunit is measured with pregnancy tests of blood & urine

Alpha- used in fertility treatments to promote ovulation
- used to be poorly promoted for weight loss

during pregnancy, levels of estrogen & progesterone continue to rise, this is to support the changes in the breast tissue to permit breast feeding & to keep the endometrial lining thick & plentiful to support the utero-placental unit

Question 58

Changes in Pregnancy?

Answer 58

12 weeks
- can begin to palpate the uterus above the pelvic bone while doing a pelvic examination
- may be able to auscultate the fetal heartbeat with an ultrasound doppler using the appropriate transmission gel
- uterus will be about the shape of a large avocado or the size of a softball

At 16 weeks
- fundus of the uterus will be about halfway between the pubic bone & the umbilicus

20 weeks
- fundus should be around the umbilicus
- you can start to measure the symphysis-fundal height (SFH), which is a quick clinical measure of fetal growth, expect SFH to be within 1-2cm of the number of weeks pregnant

Question 59

What decides the term?

Answer 59

before 37 weeks
- pre-term

between 37-42 weeks
- term

after 42 weeks
- post-term

Question 60

Weight gain in pregnancy?

Answer 60

common misconception that a woman is eating for 2 (early stages of pregnancy, caloric needs are not significantly greater)
- excessive weight gain puts woman & fetus at risk
- conditions such as gestational diabetes, gestational hypertension, fetal macrosomia & dystonic labour can occur

Question 61

Dystonic labour?

Answer 61

uterus cannot get into a concerted, rhythmic pattern of contractions to affect delivery
- usually the labour can be augmented if this occurs

Question 62

Uterine size: 8 weeks

Answer 62

Tennis ball or orange
- Hegar’s sign
-Goodell’s sign
- Chadwick’s sign

Question 63

Uterine size: 10 weeks

Answer 63

Baseball
- first fetal heart sounf by doppler (10-12 weeks)

Question 64

Uterine size: 12 weeks

Answer 64

softball or grapefruit
- palpable through abdominal wall

Question 65

Uterine size: 16 weeks

Answer 65

halways between symphysis pubis & umbilicus
- quickening for multigravida (about 18 wks for primagravida)

Question 66

Uterine size: 20-36 weeks

Answer 66

1cm gain in fundal height per week
- 20 weeks uterine fundus at umbilicus, usually concordant with gestational age +/- cm for singleton

Question 67

How to calculate the due date or EDC (expected date of confinement)

Answer 67

imperative to use the first day of the LMP (last normal mestrual cycle)
- *be aware that the interval from the last menses to ovulation is included in the EDC calculation
- once EDC has been established & confirmed with an ultrasound, it has to stay consistent, shouldnt’ be changed
- not a nursing responsibility to change due date

Pregnancy wheel
- line up arrow for LMP day and follow around the circle until you come to the EDC day

Pregnancy calculator

Naegele’s Rule
- subtract 3 months & add 7 days to the first day of the LMP date

Question 68

How is the position of the fetus evaluated during delivery?

Answer 68

palpate for the anterior & posterior fontanelles of the infant during a vaginal exam
- anterior fontanelle is a diamond-shaped soft spot created where the skull bones come together
-posterior fontanelle is triangle shaped

purpose of determining the fontanelles is to see which way the occiput or back of the skull is pointing.
- occiput anterior presents the fetus in the best position to effect vaginal delivery, as the widest part of the head goes into the widest part of the pelvis, conversely occiput transverse & posterior presentations put the wide part of the head into he narrow part of the pelvis & can result in failure to progress or descend

Question 69

The uterus during full-term pregnancy?

Answer 69

uterus enlarges from a 50gm size to 1100gms & the volume increases from 10ml to hold an avg. of 5000 ml or 5L and in some extreme cases up to 20L
- initially the shape of a pear but becomes more spherical by 12 weeks & then an ovoid shape with an increased length compared to width for the rest of the pregnancy
- starts in the pelvic cavity but after 12 weeks rises towards the anterior abdominal wall & starts to displace intestines laterally & superiorly
- as pregnancy progresses the hypertrophic uterus becomes more elastic & fibrous in response to estrogen & progesterone lvls
- position of placenta influences where the uterus becomes more hypertrophic because of the area of the placenta site enlarges more rapidly than the rest
- uterine isthmus becomes soft & compressible (Hegar’s sign)

Question 70

Breast during full-term pregnancy?

Answer 70

nipple enlargement & increased pigmentation during pregnancy
- increased blood supply the veins become more visible & in the 2nd & 3rd trimester the proliferation of mammary glands occur related to pregnancy hormones
- more pronounced elevations noted on the areola are hypertrophic sebaceous glands (glands of Montgomery or Montgomery’s tubercles)
- mammary glands are ready for lactation during the pregnancy however this is prevented with high levels of estrogen- so after delivery when the estrogen drop, lactation can occur
- pre-pregnant breast size & post delivery milk production do not correlate

Question 71

Cardiovascular system during full-term pregnancy?

Answer 71

as uterus enlarges & pushes against the diaphragm, the heart becomes laterally displaced to the left which directly impacts the PMI landmark
- heart size increases both in intracardiac volume & myocardial mass by aprx. 12% to accommodate the demands.
- mother’s Cardiac output increases 30-40% & peaks at around 24wks
- BV increases 40-50% during pregnancy & this hypervolemia helps meet metabolic demands of the placenta & enlarging uterus
- while BV increases, there is a disproportional increase in plasma compared to erythrocytes that can lead to a physiological anemia of pregnancy
- the higher the BV is precipitated by an increase in circulating aldosterone (water retention in kidneys), and increases bone marrow RBC production & reticulocytes being released due to higher maternal erythropoietin lvls
- due to all these increases it is not uncommon to hear a systolic ejection murmur
- although both systolic & diastolic BP levels decline slightly during the pregnancy, they reach their pre-pregnancy levels by aprx 36 weeks
- venous pressure increases in the later part of pregnancy in the lower extremities leading to venous congestion in the form of varicose veins, hemorrhoids, and dependent edema

Question 72

Respiratory system during full-term pregnancy?

Answer 72

although RR remains unchanged, tidal volume & resting minute ventilation increase whereas the functional residual capacity & the residual volume are decreased as the uterus elevates the diaphragm

Question 73

GI system during full-term pregnancy?

Answer 73

reflux symptoms or heartburn affects anywhere from 30-80% of pregnant women related to the more relaxed lower esophageal sphincter
- partly due to increased progesterone & estrogen & partly due to increase in abdominal pressure as pregnancy progresses
- decreased stomach & intestinal motility occurs allowing for greater absorption of nutrients but also can lead to constipation
- enlarge gallbladder during pregnancy contracts slower & this can limit its abiilty to completely empty
- can lead to bile stasis & increase risk of gallstones forming , causing cholestasis

Question 74

Renal system during full-term pregnancy?

Answer 74

• kidneys can increase in length & weight & there can be an increased volume in the renal pelvis with dilated renal calyces
• ureters can dilate increasing urine volume & predispose to UTI’s
• due to increased renal bloodflow & GFR, small amounts of physiological glucosuria & proteinuria can occur
• urine is evaluated at each antenatal visit for the presence & amount of protein & glucose
• increasing amounts above the usual baseline required more evaluation

Question 75

Skin during full-term pregnancy?

Answer 75

Striae or stretchmarks are common in 50% of women often developing on the abdomen, breast, thighs late in the 2nd trimester
- hyperpigmentation occurs in up to 90% of women & more noticeable with the darker complexions
- the linea nigra is a hyperpigmented line on the abdomen & the chloasma or mask of pregnancy are irregular patches of different size on the face or neck
- hyperpigmentation is attributed to higher lvls of the melanocyte-stimulating hormone, estrogen & progesterone which all have properties to stimulate the melanocyte to produce more melanin