Anatomy of Pregnancy Flashcards
Gravida
of times a woman has been pregnant
PARA
of deliveries (not children) that have occured after 20 weeks
TPAL
Term Birth, Preterm, Abortions, Living
PRIMIPARA
Woman who has completed 1 pregnancy with a fetus or fetuses
first time moms
TERM
pregnancy beginnning of wk 38 to the end of wk 42
Viability
Capacity to live outside the uterus
MUTIPAROUS
Woman who has completed more than 1 preg
Grandmaltip
at least 5 completed pregnancy
HUMAN CHRONIC GONADOTROPIN
HcG
a hormone produced by the placenta shortly after implantation of a fertilized egg.
Maintaining the Corpus Luteum: hCG signals the corpus luteum (the structure that forms in the ovary after ovulation) to continue producing progesterone. Progesterone is crucial for maintaining the uterine lining and supporting early fetal development.
Stimulating Hormonal Changes: hCG helps regulate other hormones necessary for pregnancy, promoting the growth and development of the placenta.
Monitoring Pregnancy: hCG levels are commonly measured in pregnancy tests, as they rise significantly in the early weeks of pregnancy.
progesterone/estrogen/Hcs
Uterus
Size of the pear to able to hold 5000ml
increase of muscle fiber in length/ width
Uterine Size
12wks
symphsis
Uterine Size
16 wks
~ 1/2 way to umbilicus
Uterine Size
20 wks
at umbilicus
you can palpate fundus at umbilicus
Uterine Size
36 wks
at xiphoid process
ligthening/engagement happens when
2wks before labor
Cervix
soften, increase cx mucous (leukorrhea)
CHADWICK’S SIGN
bluish color of the vagina, d/t increased vascularity
GOODELL’S SIGN
softening of the cervix
MUCOUS PLUG
thick mucous covers canal to protect fetus from infections
VAGINA
Increased vascularity (estrogen) and secretions
OVARIES
enlarges until 12-14 wks
secretes progesterone until wk 6-7 when placenta takes over
Breasts
Become fuller and glandular
* more tender/”tingling” sensation
* increased vascularization
* nipples are larger and more erectile
Under Breasts
COLOSTRUM
is expressed beginning of wk 12 in 3rd trimester
the is the first milk produced
under breasts
Striae
streat marks
CARDIO
plasma volume increases by 40-60%
RBC volume increases by 20-30%
Total volume increases by 30-50%
Changes in blood volume
Hgb 10.5g/dl - 11g /dl
physiological anemia of pregnancy can occur due to hemodilutions
b/c plasma volume increases mmore e than RBC volume (2nd trim)
ANEIMA OCCURS IN PREGNANCY BECAUSE
a woman’s blood volume increases significantly to support both her own body and the developing fetus, and this can dilute red blood cells
TAKE IRON SUPPLEMENTS WITH…
w/ vit C/ orange juice
can also take prenatal vit, and folate acid
can cause consitaption
Cardio Output
Stroke volume increase 50% by wk 2
HR increases 10-20 bpm
silght cardio enlargement
Maternal HR increases 5wk, 10-15 b/min
1st term low BP is normal
stroke increase = CO increases = Tachycardic
BLOOD PRESSURE
BP does not go up, 1st trimester is Low ( norm) and increase gradually to their pre-pregnancy BP
High BP is very concerning in Pregnancy
BLOOD COMPONENT
HYPERCOAGULABLE
Fibrin and fibrinogen increases by 50 % ( protective mechanism to prevent postpartum hemorrhage)
* increases in clotting factors 7, 8, 9, 10
Venous stasis ( long period of standing or sitting)
Increase risk of DVT
assessment for DVT: s/s- unilateral swelling, red, pain, dec pulse
can increase the risk of thrombotic disease
VENA CAVA SYNDROME
(supine hypotensive syndrome)
As the uterus grows, it puts pressure on the vena cava/ iliac veins (blood from lower extremities)
Patients will feel dizzy and will sometimes faint b/c of this
During this, fetus’ heart rate decreases
Teach patients** NOT **to lay flat on back
* Left lateral or right lateral position (lying on side)
* Affects patients as pregnancy is growing
for >= 20 wks
RESPIRATORY CHANGES
O2 consumptions increases by 20%
(RR remain unchanged)
baby takes up more space and presses against diaphragm
Patients often feel slightly out of breath
Starts w/ chest breathing rather than abdominal breathing
Progesterone relaxes smooth muscle
Estrogen leads to increased vascularity and congestion
Nasal/ sinus stuffiness ( cool mist in room, plain saline spray)
epitaxis ( nosebleed)
May also feel like ear canals/eustachian tubes are swollen/cannot hear as well
Sometimes gums will look red and beefy, will sometimes bleed
GI changes
ptyalism/increased salivation
Patients may have a change in taste → dislike usual things and like previous dislikes
May also be cravings for food and items that are not food (pica)
Smooth muscle relaxation (progesterone)
Constipation
Slower emptying/reflux/pyrosis (heartburn)
Increased risk of gallstones
Nausea and vomiting (50-80% of pregnant women)
Usually disappears by the end of the first trimester, around 20 weeks
Prevention → dry crackers, small frequent meals, ginger ale, salty or tart foods (i.e. lemonade and pretzels
Endocrine Changes
Changes throughout the endocrine system
estrogen/progesterone
Pancreas: **insulin fluctuations **(DOES NOT CROSS PLACENTA UNTIL AFTER 14 WKS)
Glucose levels in pregnancy fluctuate
Placental hormones:
HcG, estrogen, progesterone, hCS (growth hormone), relaxin
RENAL/URINARY CHANGES
Increased GFR → pressure of the baby on the bladder = urinary freq
can lead to spilling of glucose in the urine
More prone to UTIs
Progesterons - smooth muscle relaxer and increased GFR - increased “spilling” of glucose in urine
increase workload d/t increase blood volume
* 30-60% increase blood flow
Intergumentary changes
Hyperpigmentation (chloasma) = Brown patches
estrogen/progesterone & melanocyte -stimulating hormone
* Esp around breasts (areola) and face
* Linea nigra → dark line that does from the pubis to the fundus
**Changes to connective tissue **→ striae gravidarum (stretch marks)
Cutaneous vascular changes → increase spider veins, sometimes palmar erythema ( to increase estrogen)
Straie can be genetic
Musculoskeletal changes
Changes are progressive
* Joint softening beginning weeks 10-12
* Swayback posture as center of gravity shifts forward
* Lordosis → cat arch and pelvic lift to relieve pain
Hormone “relaxin” → causes relaxation of pelvic joints
* Causes pregnancy waddle
Teaching for Pregnancy
Travel → some patients are limited
Can’t go to places without clean water or where zika virus is present
If driving in a car, should get out and walk frequently
IMMUNIZATIONS
Live vaccines are contraindicated
EX: MMR, varcella, HPV
But flu and COVID vaccines are safe
Normal weight gain during pregnancy
25-30 lbs, they need to get 300 cal extra
BODY MECHANICS
stay as low to the ground as possible, to prevent from falling and impact
Other changes during pregnancy
water metabolism
reguirements increase, causing dependent edema
Other changes during pregnancy
Carbohydrate metabolism
more insulin is required b/c maternal insulin resistance later in preg (24-26 wks)
sometime have periodic hyperglycemia
gestational dm ( pregnancy induced)
Other changes during pregnancy
Immune system
decrease in resistance to disease
WBC increases during…
second trimester, primarily in the granulocytes
