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HMS303 Reproductive, Ageing & Development > Anatomical & Physiological Changes in Pregnancy > Flashcards

Anatomical & Physiological Changes in Pregnancy Flashcards

1
Q

2 main reasons for maternal changes

A
  1. To provide suitable environment for nutrition, growth & development of the fetus.
  2. To protect & prepare the mother for parturition (childbirth) & support/nurture of a newborn baby.
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2
Q

Size of uterus in non-pregnant women

A

40 - 100g

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3
Q

Size of uterus of a pregnant woman at 20wks

A

300 - 400g

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4
Q

Size of uterus of a pregnant woman at term (>37 wks)

A

800 - 1000g

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5
Q

Define involution & how long is it completed?

A

Involution in pregnancy means the shrinkage of the uterus after birth & this takes 2 months to be completed.

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6
Q

Explain the growth of the myometrium during pregnancy

A

Smooth muscle cells increase both in size (hypertrophy) & in number (hyperplasia). It is also stretched from the growing conceptus/fetus.

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7
Q

The wall of the uterus consists of?

A

3 concentric layers:
- Endometrium
- Myometrium
- Perimetrium / serosa

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8
Q

The myometrium is formed from how many layers?

A

3 intertwining layers of smooth muscle

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9
Q

Regions of the uterus

A
  1. Fundus
  2. Body
  3. Isthmus
  4. Cervix
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10
Q

Parts of the cervix

A
  • Cervical canal
  • Internal os
  • External os
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11
Q

What is the principal role of the cervix?

A

To retain the conceptus

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12
Q

Explain the 4 changes of the cervix during pregnancy

A
  1. Increased vascularity
  2. Hypertrophy of cervical glands producing an appearance of cervical erosion.
  3. Increase mucous secretory tissue - antibacterial mucus plug
  4. Reduced collagen & increased glycosaminoglycan & water in 3rd trimester leading to changes consistent with cervical ripening.
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13
Q

What is the isthmus?

A

Junctional zone between the cervix & body of uterus

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14
Q

Explain the change of the isthmus in pregnancy

A

By the 28th-week gestation contractions produce stretching & thinning of the isthmus, which results in lower uterine segment formation.

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15
Q

The uterus changes in _____, ______, ______, ______ throughtout pregnancy.

A

size, shape, position, consistency

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16
Q

Explain the changes in the body of the uterus - corpus uteri

A
  • Early pregnancy = pear shape
  • 2nd / 3rd trimester = globular & ovoid
  • uterine cavity = 4ml - 4000ml at term
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17
Q

Myometrium remains ______ until the onset of labor.

A

quiescent (inactive)

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18
Q

Explain the changes that happen to the vessels supplying the uterus.

A
  • undergo massive hypertrophy
  • uterine arteries dilate to 1.5 x non-pregnant state
  • spiral arterioles 30x pre-pregnant diameter
  • uterine blood flow increases from 50 ml/min (10wks) to 500-600 ml/min (at term).
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19
Q

What is the lining of the vagina?

A

Stratified squamous epithelium

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20
Q

The stratified squamous epithelium layer of the vagina consists of 3 layers. Name them.

A
  1. Basal layer
  2. Functional layer
  3. Cornified layer
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21
Q

Explain the changes that occur in the vagina during pregnancy.

A

The lining of the vagina hypertrophies & pH level lowers from 3.5 to 4 to help clear the vagina of bacterial infection.

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22
Q

How does pH level in the vagina lower?

A

Glycogen synthesized by high estrogen levels are broken down by lactobacilli to lactic acid lowering pH to 3.5 - 4

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23
Q

State the changes that happens in the musculoskeletal system

A
  • Increase in lumbar lordosis due to enlarged uterus
  • Foward flexion of the neck & downward movement of the shoulders to compensate for change in center of gravity.
  • Sacroiliac joints & pubic symphysis widen
  • Fluid retention may cause compression of nerves in fascial sheaths e.g. median nerve in carpel tunnel syndrome.
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24
Q

Musculoskeletal system is affected by?

A

Maternal weight gain & hormonal influence

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25
State the characteristic skin changes that is due to Melanocyte-stimulating hormone (MSH) in pregnancy. (Face, Nipples & Abdominal wall)
Face - chloasma / Melasma (mask of pregnancy) Nipples - areola (dark circles of skin - dark pigmentation) Anterior abdominal wall - linea alba becomes linea nigra (dark line) Striae gravidarum (stretch marks) - seen on the abdominal wall, lateral aspect of thighs & breasts.
26
What are the 1st signs/symptoms of pregnancy shown on the breasts?
- breast tenderness & increase in size - enlarged nipples - increased vascularity & pigmentation of areola (dark circles around the nipples - dark pigmentation) - prominent montgomery tubercles (hypertrophic sebaceous glands) = small bumps around the areola
27
Average weight gain over pregnancy is?
Aprox 12.5kg
28
Most of weight gain in all systems arise from _________- with mean total increase of ______.
water retention, 8.5L
29
High weight gain is associated with?
Edema & fluid retention
30
Low weight gain is associated with?
- reduced amniotic fluid volume - small placenta size - impaired fetal growth & adverse outcome
31
What are the effects of progesterone on the alimentary system?
- lower esophageal sphincter (LES) relaxation = increases GERD - slow gastric emptying (contents of stomach are moved into the duodenum) - decreased motility in small & large bowel = constipation = hemorrhoids (due to constipation & increased abdominal pressure)
32
Changes in the Alimentary system during pregnancy
- Reduced gastric secretion - Gall bladder increases in size & empties more slowly (this increase likelihood of gallstones)
33
How much weight is gained up to 18wks in pregnancy?
0.3 kg/wk
33
How much weight is gained up to 18wks in pregnancy?
0.3 kg/wk
33
How much weight is gained up to 18wks in pregnancy?
0.3 kg/wk
34
How much weight is gained between 18 - 28wks in pregnancy?
0.5 kg/wk
35
How much weight is gained 28wks until term?
0.4 kg/wk
36
Renal parenchymal volume increase by _____ by ____ trimester with marked _______ of calyces, renal pelvis & ureters.
70%, 3rd, dilatation
37
Renal changes occur in what trimester? & under influence of what?
Occurs in 1st trimester under progesterone influence.
38
Define vesico-ureteric reflux
Abnormal flow of urine from the bladder back up to the ureters.
39
Vesico-ureteric reflux & ureteric dilatation promotes?
urinary stasis & urinary tract infection (UTI)
40
Does GFR & renal blood flow increase or decrease in pregnancy? results in?
Increases resulting in physiologic fall in: - serum creatinine - uric acid - BUN = blood urea nitrogen
41
Glycosuria can be physiologic especially in the ___ trimester, this is due to?
- 3rd trimester - due to reduced reabsorption of glucose from the proximal tubules.
42
Explain the respiratory changes seen in pregnancy
- increased O2 consumption to meet increased metabolic requirement. - elevated diaphragm = appears more barrel-shaped - increased minute ventilation leads to decreased CO2 = results in mild respiratory alkalosis that helps CO2 diffuse across the placenta from fetal to maternal circulation.
43
Normal pregnancy is a _________ state.
prothrombotic (hypercoagulable)
44
Normal pregnancy is a prothrombotic (hypercoagulable) state due to ?
- marked increase in coagulation factors = fibrinogen, factors II, VII, VIII, X & XII. - reduced fibrinolysis - increased platelet activity
45
Coagulation system
involves clot formation via complex interactions between coagulation factors, platelets & vascular endothelium.
46
Fibrinolytic system
Prevents excessive coagulation by removal of fibrin & clot dissolution.
47
Platelets - normal range
150,000 - 450, 000 microL
48
Change in platelet count in pregnancy
Platelet count decreases as pregnancy progresses, but generally remains within normal range = 150, 000 - 450, 000 microL.
49
HELLP syndrome stands for?
H - Haemolysis EL - Elevated Liver enzymes LP - Low Platelets
50
Mean WBC count range
10,000 - 16,000 cells/microL
51
WBC changes in pregnancy (neutrophils, lymphocytes, monocytes, basophil & eosinophil)
Neutrophils = increase & plateaus in 2nd/3rd trimester Lymphocytes (T & B) = unchanged Monocyte = generally stable Basophil = slightly decreases Eosinophil = slightly increases
52
Most of increase in cardiac output is distributed to the ______, _______ & ______ to?
- placenta, kidneys & skin - To: = provide nutrients to the fetus = excrete maternal & fetal waste products = assist maternal temperature control
53
State the benefits of physiologic anemia in pregnancy
- decreased blood viscosity = reduced resistance to flow which facilitates placental perfusion. - total intravascular volume increases to approx 50% above non-pregnant valves near term = which provides some reserve against normal blood loss during birth (300 - 500mls for NVD & 600 - 1000mls for c-section)
54
Increase in plasma volume
- begins at 6 - 12wks - expands rapidly until 30 - 34wks then plateaus
55
Increase RBC mass
- increases at 8 - 10wks gestation & steadily rises - a lesser increase compared to plasma volume
56
Physiologic anemia
- is due to a greater increase in plasma volume compared to red cell mass. - more apparent at 30 - 34wks when plasma volume peaks
57
1st trimester
0 - 13wks + 6 days
58
2nd trimester
14 - 27wks + 6 days
59
3rd trimester
28wks - delivery
60
What happens when a pregnant woman is in a supine position?
Supine position reduces cardiac output & stroke volume due to aortocaval compression.
61
Explain the cardiovascular changes in 1st trimester (0 - 13wks + 6 days)
- systemic vasodilation beings = systemic vascular resistance drops & nadirs in the mid-second trimester. - CO rises
62
Explain the cardiovascular changes in 2nd trimester (14 - 27wks + 6 days)
- SVR plateaus in mid-second trimester - CO continues to rise
63
Explain the cardiovascular changes in 3rd trimester (28wks - delivery)
- CO peaks - HR peaks = average 16bpm above non-pregnant values. - BP returns to pre-pregnancy levels
64
Placing women in ____________ position releases pressure on the aorta/vena cava.
left lateral

HMS303 Reproductive, Ageing & Development (9 decks)

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