Anatomy of Pregnancy

Question 1

Describe the changes in the uterus during the first trimester:

1. walls
2. shape
3. What does the uterus fill by the end of the trimester?

Answer 1

1. walls thicken; uterine hypertrophy
2. shape becomes more globular
3. uterus fills the pelvis

Question 2

How does the cervix change during pregnancy?

Answer 2

Elaboration of mucosa into a honeycomb-like structure; the meshes are filled with a mucus plug

Question 3

In the first trimester, what happens to:

1. kidneys
2. ureters
3. bladder

Answer 3

1. kidneys increase in size
2. ureters dilate (compression by uterus, ovarian veins)
3. bladder compression by expanding uterus

Question 4

Changes in breast during first trimester:

1. nipples/areola
2. vascularity
3. alveoli

Answer 4

1. nipples enlarge and areola darkens
2. increased vascularity
3. alveoli hypertrophy during the third month

Question 5

Changes in respiratory system during first trimester:

1. subcostal angle
2. transverse chest diameter

Answer 5

1. subcostal angle increases from 68 to 103 degrees

2. transverse chest diameter increases 5 - 7cm

Question 6

Why are these symptoms experienced during the first trimester?

1. breast tingling
2. frequent urination
3. pelvic pressure
4. breathlessness
5. nausea

Answer 6

1. engorgement
2. bladder compression
3. enlarging uterus
4. increased tidal volume
5. no anatomic cause for nausea!!

Question 7

Changes in uterus during second trimester:

1. location
2. round and broad ligaments
3. wall

Answer 7

1. enlarges and moves out of the pelvis - contacts abdominal walls, displaces the intestines superiorly and laterally
2. stretching of the round and broad ligaments
3. wall begins to thin and the mother can feel movement

Question 8

Describe the growth/change of the uterus at the fundus (top) during the second trimester

Answer 8

By week 24, the fallopian tubes and round ligaments insert slightly above the middle of the uterus instead of at the fundus

Question 9

By 20 weeks, where has the uterine fundus reached?

Answer 9

Umbilicus

Question 10

How do you measure the uterine size by measuring the distance from the symphysis pubis to the fundus?

Answer 10

1 cm = 1 week gestation

Question 11

Urinary system changes during second trimester:

1. pressure on the bladder
2. ureteral dilation (which side is bigger?)

Answer 11

1. lessens as the uterus moves out of the pelvis

2. up to 2cm diameter; R is bigger than L

Question 12

Changes in skeletal system during second trimester:

1. ligaments of the pelvis and extremeties
2. pubic symphysis
3. spine

Answer 12

1. loosen (hormone relaxin)
2. widening of the symphysis, mainly during 3rd trimester
3. lordosis

Question 13

GI tract changes during second trimester:

1. why are hemorrhoids more common?
2. gall bladder volumes
3. appendix

Answer 13

1. because of pelvic pressure and vasodilation
2. volumes are increased and emptying in slower
3. is compressed by the uterus and moves laterally and upward

Question 14

What diseases correlate with the following anatomic changes?

1. uterine compression
2. lordosis and relaxed joints
3. connective tissue relaxation
4. abdominal and pelvic viscera shift

Answer 14

1. bladder and kidney infection
2. increased risk of trauma from falls
3. ovaries can twist, blood vessels engorge
4. diagnosis of intrabdominal process can be challenging

Question 15

Where has the uterus reached by the 3rd trimester?

Answer 15

Almost reaches the liver

Question 16

Urinary system during third trimester:

1. location of right ovarian vein
2. bladder pressure
3. other bladder characteristics

Answer 16

1. right ovarian vein completely lies obliquely over the right ureter & compresses it
2. bladder pressure returns as the fetal head descends into the pelvis in late pregnancy
3. bladder is engorged, elevated trigone, hyperemic, urethra lengthens

Question 17

Cardio-respiratory system during third trimester:

1. subcostal angle and transverse chest diameter
2. diaphragm
3. axis of the heart

Answer 17

1. increase
2. elevates 4 cm
3. more horizontal because of diaphragmatic elevation

Question 18

What fixes this problem: if women lie flat on their back, the large uterus presses on the vena cava

Answer 18

Dilated paravertebral vessels act as collaterals to preserve blood flow to the heart and maintain cardiac output

Question 19

Cutaneous system (skin) changes during third trimester:

1. striae gravidarum
2. pigmentation
3. vagina

Answer 19

1. occur from stretching of the skin (not correlated with weight gain but rather genetics)
2. increased pigmentation of the nipples, areola, linea nigra
3. vagina - hyperemic, looks bluish, increased discharge

Question 20

What is rectus diastasis?

Answer 20

There’s strain on the rectus abdominis muscles and anterior abdominal wall - the rectus muscles can separate and the uterus can sag forward

Question 21

Why should other complications (example: surgical complications) be dealt with immediately during pregnancy?

Answer 21

Because organs are moved around, infection won’t necessarily be contained within the normal anatomical region