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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
Q

State the characteristic skin changes that is due to Melanocyte-stimulating hormone (MSH) in pregnancy.

(Face, Nipples & Abdominal wall)

A

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.

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26
Q

What are the 1st signs/symptoms of pregnancy shown on the breasts?

A
  • 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
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27
Q

Average weight gain over pregnancy is?

A

Aprox 12.5kg

28
Q

Most of weight gain in all systems arise from _________- with mean total increase of ______.

A

water retention, 8.5L

29
Q

High weight gain is associated with?

A

Edema & fluid retention

30
Q

Low weight gain is associated with?

A
  • reduced amniotic fluid volume
  • small placenta size
  • impaired fetal growth & adverse outcome
31
Q

What are the effects of progesterone on the alimentary system?

A
  • 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
Q

Changes in the Alimentary system during pregnancy

A
  • Reduced gastric secretion
  • Gall bladder increases in size & empties more slowly (this increase likelihood of gallstones)
33
Q

How much weight is gained up to 18wks in pregnancy?

A

0.3 kg/wk

33
Q

How much weight is gained up to 18wks in pregnancy?

A

0.3 kg/wk

33
Q

How much weight is gained up to 18wks in pregnancy?

A

0.3 kg/wk

34
Q

How much weight is gained between 18 - 28wks in pregnancy?

A

0.5 kg/wk

35
Q

How much weight is gained 28wks until term?

A

0.4 kg/wk

36
Q

Renal parenchymal volume increase by _____ by ____ trimester with marked _______ of calyces, renal pelvis & ureters.

A

70%, 3rd, dilatation

37
Q

Renal changes occur in what trimester? & under influence of what?

A

Occurs in 1st trimester under progesterone influence.

38
Q

Define vesico-ureteric reflux

A

Abnormal flow of urine from the bladder back up to the ureters.

39
Q

Vesico-ureteric reflux & ureteric dilatation promotes?

A

urinary stasis & urinary tract infection (UTI)

40
Q

Does GFR & renal blood flow increase or decrease in pregnancy? results in?

A

Increases resulting in physiologic fall in:
- serum creatinine
- uric acid
- BUN = blood urea nitrogen

41
Q

Glycosuria can be physiologic especially in the ___ trimester, this is due to?

A
  • 3rd trimester
  • due to reduced reabsorption of glucose from the proximal tubules.
42
Q

Explain the respiratory changes seen in pregnancy

A
  • 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
Q

Normal pregnancy is a _________ state.

A

prothrombotic (hypercoagulable)

44
Q

Normal pregnancy is a prothrombotic (hypercoagulable) state due to ?

A
  • marked increase in coagulation factors = fibrinogen, factors II, VII, VIII, X & XII.
  • reduced fibrinolysis
  • increased platelet activity
45
Q

Coagulation system

A

involves clot formation via complex interactions between coagulation factors, platelets & vascular endothelium.

46
Q

Fibrinolytic system

A

Prevents excessive coagulation by removal of fibrin & clot dissolution.

47
Q

Platelets - normal range

A

150,000 - 450, 000 microL

48
Q

Change in platelet count in pregnancy

A

Platelet count decreases as pregnancy progresses, but generally remains within normal range = 150, 000 - 450, 000 microL.

49
Q

HELLP syndrome stands for?

A

H - Haemolysis
EL - Elevated Liver enzymes
LP - Low Platelets

50
Q

Mean WBC count range

A

10,000 - 16,000 cells/microL

51
Q

WBC changes in pregnancy

(neutrophils, lymphocytes, monocytes, basophil & eosinophil)

A

Neutrophils = increase & plateaus in 2nd/3rd trimester
Lymphocytes (T & B) = unchanged
Monocyte = generally stable
Basophil = slightly decreases
Eosinophil = slightly increases

52
Q

Most of increase in cardiac output is distributed to the ______, _______ & ______ to?

A
  • placenta, kidneys & skin
  • To:
    = provide nutrients to the fetus
    = excrete maternal & fetal waste products
    = assist maternal temperature control
53
Q

State the benefits of physiologic anemia in pregnancy

A
  • 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
Q

Increase in plasma volume

A
  • begins at 6 - 12wks
  • expands rapidly until 30 - 34wks then plateaus
55
Q

Increase RBC mass

A
  • increases at 8 - 10wks gestation & steadily rises
  • a lesser increase compared to plasma volume
56
Q

Physiologic anemia

A
  • is due to a greater increase in plasma volume compared to red cell mass.
  • more apparent at 30 - 34wks when plasma volume peaks
57
Q

1st trimester

A

0 - 13wks + 6 days

58
Q

2nd trimester

A

14 - 27wks + 6 days

59
Q

3rd trimester

A

28wks - delivery

60
Q

What happens when a pregnant woman is in a supine position?

A

Supine position reduces cardiac output & stroke volume due to aortocaval compression.

61
Q

Explain the cardiovascular changes in 1st trimester (0 - 13wks + 6 days)

A
  • systemic vasodilation beings = systemic vascular resistance drops & nadirs in the mid-second trimester.
  • CO rises
62
Q

Explain the cardiovascular changes in 2nd trimester (14 - 27wks + 6 days)

A
  • SVR plateaus in mid-second trimester
  • CO continues to rise
63
Q

Explain the cardiovascular changes in 3rd trimester (28wks - delivery)

A
  • CO peaks
  • HR peaks = average 16bpm above non-pregnant values.
  • BP returns to pre-pregnancy levels
64
Q

Placing women in ____________ position releases pressure on the aorta/vena cava.

A

left lateral

HMS303 Reproductive, Ageing & Development (9 decks)

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