ANTE--PARTUM. Lecture 1. PHYSICAL CHANGES OF PREGNANCY Flashcards
1
Q
What is the etymology of obstetrics?
A
The term “obstetrics” has its origins in the Latin word “obstetricia,” which is derived from the Latin words “obstetrix” (meaning “midwife”) and “obstare” (meaning “to stand before” or “to assist”). The term has been used for centuries to refer to the medical specialty focused on pregnancy, childbirth, and the postpartum period, specifically involving the care of pregnant women and the delivery of babies. In ancient times, midwives played a crucial role in assisting women during childbirth, and the term “obstetrics” has evolved to encompass the broader medical field of managing pregnancy and childbirth.
The etymology of “obstetrics” reflects the historical importance of midwives and their role in providing care and support to expectant mothers. Over time, the field of obstetrics has advanced with medical knowledge and technology, encompassing various aspects of maternal and fetal health, labor and delivery, and postpartum care.
2
Q
Nulligravida
A
Nulligravida: This term refers to a woman who has never been pregnant before and is currently not pregnant.
“Nulli-“ comes from the Latin word “nullus,” which means “none” or “no.”
“Gravida” comes from the Latin word “gravidus,” which means “pregnant.”
3
Q
Nulli- para
A
Nullipara: A nullipara is a woman who has never given birth to a child who reached the stage of fetal viability, typically considered to be around 20 weeks (5 months ) of gestation or weighing about 500 grams.
Coz basically after 5months is as if you had given birth !
4
Q
Prima-gravida
A
Primagravida: This term is used to describe a woman who is pregnant for the first time, regardless of the outcome of the pregnancy.
5
Q
Primi-para
A
Primipara: A primipara is a woman who has given birth to her first child who reached the stage of fetal viability.
6
Q
Multi-gravida
A
Multigravida: This term is used to describe a woman who has been pregnant more than once, regardless of the outcomes of those pregnancies.
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Q
Multipara
A
Multipara: A multipara is a woman who has given birth to two or more children who reached the stage of fetal viability. 5 months/20 weeks
8
Q
What is Hagar’s sign? first 4 to 6 weeks
A
“Hagar’s sign” refers to a physical sign that can sometimes be observed during a pregnancy-related examination. It involves the appearance of a softening or bluish discoloration of the cervix, particularly around the area of the external os (the opening of the cervix into the vagina). This sign is named after Dr. Aharon Hagar, an Israeli obstetrician and gynecologist who described it.
Hagar’s sign is considered a potential indicator of early pregnancy, as it is thought to result from increased blood flow and hormonal changes in the cervix in response to pregnancy. However, it’s important to note that Hagar’s sign is not a definitive or widely relied-upon diagnostic tool. Other signs and tests, such as urine or blood pregnancy tests, ultrasound examinations, and clinical assessments, are more commonly used to confirm pregnancy.
While Hagar’s sign may be mentioned in some medical literature, it is not as commonly used or discussed as other signs and symptoms of pregnancy. It’s always best to consult with a qualified healthcare professional for accurate and reliable information regarding pregnancy-related signs and tests.
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Q
GRAVIDA:
A
The number of confirmed pregnancies a woman has had.
“Gravida” is a term used in medical contexts to indicate the number of times a woman has been pregnant, regardless of the outcome of those pregnancies (whether they resulted in live births, stillbirths, miscarriages, etc.). It’s often used as a prefix along with a number to describe a woman’s obstetric history.
10
Q
GRAVIDA etymology
A
The term “gravid” comes from the Latin word “gravidus,” which means “pregnant” or “heavy with child.” It is derived from the combination of two Latin words: “gravis,” meaning “heavy” or “burdensome,” and “avidus,” meaning “eager” or “desirous.” The word “gravidus” conveys the idea of being burdened or filled with something, in this case, being pregnant and carrying the weight of a developing fetus. In medical terminology, “gravid” is used to describe the state of being pregnant or carrying a developing embryo or fetus within the womb.
11
Q
PARA? Parir
A
PARA: the number of births a woman has had after 20 weeks gestation, living or not.
12
Q
what is GTPAL?
A
Exactly, you’ve provided an accurate breakdown of the GTPAL system used in obstetrics and gynecology to describe a woman’s obstetric history. Each letter in the acronym represents a specific aspect of a woman’s pregnancies:
G (Gravidity): The total number of times a woman has been pregnant, regardless of the outcome (whether the pregnancy resulted in a live birth, stillbirth, miscarriage, or abortion).
T (Term births): The number of pregnancies that reached full term, typically considered to be 37 to 42 weeks of gestation.
P (Preterm births): The number of pregnancies where the fetus was delivered before reaching full term, i.e., before 37 weeks of gestation.
A (Abortions and miscarriages): The number of pregnancies that ended before 20 weeks of gestation due to miscarriage or elective abortion.
L (Living children): The number of currently living children resulting from previous pregnancies.
The GTPAL system is a useful way for healthcare providers to quickly understand a woman’s obstetric history and assess her risk factors for various pregnancy-related conditions.
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Q
G/P
G = Gravidity/P=Parity
A
14
Q
Check tale slide 8
A
MUST
15
Q
A Pregnant woman with four children reports the following history: a still birth at 32 weeks, triplets born via c/s at 30 weeks gestation, SAB at 8 weeks gestation, and a daughter born vaginally at 39 weeks gestation. What accurately expresses this woman’s current obstetric history using
G-T-P-A-L
A
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Q
TERMS TO KNOW
A
Late preterm: 34-36 6/7 weeks
Early term: 37-38 6/7 weeks
Full term: 39-40 6/7 weeks
Late term: 41-41 6/7 weeks
Post term: 42+
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Q
SIGNS OF PREGNANCY: PRESUMPTIVE. definition only
A
CHANGES THAT MAKE THE WOMAN THINK SHE MIGHT BE PREGNANT
Presumptive signs of pregnancy are those changes that a woman might perceive as potential indicators of pregnancy. These signs are based on the woman’s subjective experiences and perceptions. It’s important to note that these signs are not definitive proof of pregnancy and can often be caused by other factors as well. Here are some examples of presumptive signs of pregnancy under the letter “A”:
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Q
SIGNS OF PREGNANCY: PROBABLE. definition
A
CHANGES ON PHYSICAL EXAM THAT MAKE THE EXAMINER SUSPECT THE WOMAN MIGHT BE PREGNANT
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Q
SIGNS OF PREGNANCY: POSITIVE
A
CHANGES THAT CAN ONLY BE EXPLAINED BY PREGNANCY.
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Q
SIGNS OF PREGNANCY 2.0. PRESUMPTIVE. The actual signs
A
Amenorrhea: This refers to the absence of menstrual periods. In the context of pregnancy, it is one of the early signs that may indicate a woman is pregnant since pregnancy often stops regular menstrual cycles.
Enlarged Breasts: Hormonal changes during pregnancy can lead to breast enlargement and tenderness as the body prepares for breastfeeding.
Nausea and Vomiting: Commonly known as morning sickness, many pregnant individuals experience nausea and vomiting, especially during the early stages of pregnancy. It is thought to be related to hormonal changes.
Quickening: (kick) Quickening refers to the first movements of the baby felt by the pregnant person. It’s often described as fluttering sensations in the abdomen. Quickening is generally felt in the second trimester.
Fatigue: Hormonal changes and increased metabolic demands during pregnancy can lead to feelings of tiredness and fatigue.
Urinary Frequency: As the uterus expands and puts pressure on the bladder, pregnant individuals may experience increased urinary frequency, needing to urinate more often.
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Q
SIGNS OF PREGNANCY 2.0 PROBABLE
A
Goodell Sign: Softening of the cervix due to increased blood flow and hormone changes. This can be a sign of pregnancy, but it’s not exclusive to it.
Chadwick’s Sign: Bluish or purplish coloration of the cervix, vagina, and labia due to increased blood flow. It’s another sign that can suggest pregnancy but isn’t conclusive.
Hegar’s Sign: Softening and compressibility of the lower uterine segment, which can be felt during a pelvic examination. It’s a sign that the uterus is preparing for pregnancy, but it’s not definitive on its own.
Positive Pregnancy Test: A positive result on a pregnancy test can strongly indicate pregnancy, but additional confirmation through other signs and a medical assessment is usually needed.
Braxton Hicks: These are sporadic, irregular contractions of the uterus that can be felt during pregnancy. While they can be a sign of pregnancy, they can also occur in non-pregnant individuals.
Ballotment: A technique in which the fetus is pushed and then bounces back slightly when touched through the vaginal wall during a pelvic exam. This can suggest pregnancy, but it’s not exclusive to it.
Enlarged Uterus: An enlarged uterus can be a sign of pregnancy, but it can also be caused by other factors.
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Q
SIGNS OF PREGNANCY 2.0 POSITIVE
A
-Visualize the Fetus
-Fetal Heart Tones
-Palpate the fetus
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Q
Hormonal Changes/Adaptation of Pregnancy
A
Estrogen:
Secreted by the corpus luteum until the placenta takes over.
Inhibits secretion of FSH and LH from the anterior pituitary, suppressing ovulation.
Stimulates the growth of maternal tissues such as the uterus, breast tissue, and genitalia.
Relaxes joints and ligaments in the pelvis to facilitate childbirth.
Increases vascularity (blood vessel development).
Progesterone:
Secreted by the corpus luteum until the placenta takes over.
Inhibits secretion of FSH and LH from the anterior pituitary, suppressing ovulation.
Relaxes smooth muscle, leading to decreased uterine contractility and helping to prevent contractions during early pregnancy.
Hormones that Affect Changes During Pregnancy:
Serum Prolactin: Prepares the breasts for lactation, which is the production of milk.
Oxytocin: Stimulates contractions of the uterus during labor and is also responsible for milk ejection (let-down) during breastfeeding.
Human Chorionic Somatomammotropin (Human Placental Lactogen): Acts as a growth hormone for the fetus, decreases the mother’s metabolism of glucose (helping to provide more glucose to the fetus), and increases the availability of fatty acids for the mother’s metabolic needs.
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Q
Physical Changes/Adaptation of Pregnancy
A
UTERUS:
Amenorrhea
Endometrium support growth of embryo/fetus
Increase in elastic properties
Hagar’s sign
Increase in uterine blood flow
Braxton Hicks Contractions
Quickening
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Physical Changes/Adaptation of Pregnancy. Hagar’s Sign?
Probable Sign of Pregnancy,
(6 weeks)
Check osmosis
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Physical Changes/Adaptation of Pregnancy. VAGINA
Increase in Vaginal Mucosa: + mucosa means another layer of protection leading to + protection for the baby. +also it's to make it easier for the baby to slide out hahah
Loosening of Connective Tissue: The hormone relaxin, which is produced during pregnancy, causes the relaxation of various ligaments and connective tissues in the body, including those around the pelvic area. This loosening of connective tissue helps prepare the body for childbirth by allowing the pelvic bones to slightly shift and accommodate the baby's passage through the birth canal.
Lengthening of the Vaginal Vault: As pregnancy progresses, the cervix and vaginal vault may undergo changes to accommodate the growing fetus. These changes are part of the body's preparation for childbirth.
Increase in Vascularity: The increased blood flow to the pelvic region during pregnancy can also lead to increased vascularity in the vaginal area. This increased blood supply is important for supporting the developing fetus and maintaining the health of the reproductive organs.
Chadwick Sign: The Chadwick sign is a bluish or purplish discoloration of the cervix, vaginal walls, and vulva that can occur as early as 6 to 8 weeks of pregnancy. It's caused by increased blood flow to the area due to hormonal changes. This sign can be an early indicator of pregnancy. 6-8 weeks
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Physical Changes/Adaptation of Pregnancy. VAGINA 2.0
Leukorrhea:
Leukorrhea refers to an increased vaginal discharge that is usually thin, white, milky, and mild-smelling. It's a common occurrence during pregnancy due to increased blood flow to the pelvic area and hormonal changes. Leukorrhea helps maintain the cleanliness of the vaginal area and prevent infections by flushing out old cells and debris.
Acidic Environment and Yeast Infections:
During pregnancy, the vaginal pH can rise from its normal acidic range of around 3.8 to 4.5 to a slightly higher (more alkaline) level, typically ranging from 4.5 to 6.0 or even higher in some cases. This increase in pH is due to the hormonal changes, particularly the elevated levels of estrogen, that occur during pregnancy.
The vagina naturally maintains an acidic pH level, which helps keep the vaginal microbiome balanced and healthy. This acidic environment is created by the presence of beneficial bacteria. However, disruptions in this balance can lead to an overgrowth of yeast (Candida) and result in yeast infections. Pregnancy can sometimes alter the vaginal pH balance, increasing the risk of yeast infections.
Mucus Plug (Operculum): on top of cervix but before uterus
The mucus plug, also known as the operculum, is a gelatinous substance that forms in the cervix during pregnancy. Its purpose is to seal the cervical opening, providing a protective barrier that helps prevent the entry of bacteria and other potential contaminants into the uterus, where the developing fetus is located. As labor approaches, the mucus plug may be released or discharged, sometimes indicating that the cervix is beginning to dilate in preparation for childbirth.
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Physical Changes/Adaptation of Pregnancy. BREASTS
- Become larger
Mammary Glands Grow: During the 2nd and 3rd trimesters of pregnancy, the mammary glands (breast tissue) undergo significant changes in preparation for breastfeeding. Hormonal shifts, particularly increased levels of estrogen and progesterone, stimulate the growth of mammary glands. This growth is essential to accommodate the production of milk for the baby after birth.
Increased Pigmentation: (look similar to goosebumps on the nipple and surrounding areola) Many pregnant women experience changes in skin pigmentation due to hormonal fluctuations, primarily an increase in melanin production. This can lead to areas of the skin, such as the areolas and the linea nigra (a dark line that runs vertically down the abdomen), becoming darker and more noticeable. This is a normal and temporary change that typically fades after pregnancy.
Montgomery Tubercles More Pronounced: Montgomery tubercles are small, raised bumps on the areola (the darker area around the nipple). These tubercles become more pronounced and may enlarge during pregnancy. They are thought to play a role in lubricating the nipple and protecting it during breastfeeding.
Increase Vascularity: Increased blood flow and vascularity are common during pregnancy due to the body's need to support both the mother and the developing fetus. This heightened vascularity is especially prominent in areas such as the breasts. The increased blood supply is necessary to provide oxygen and nutrients to the growing mammary glands and the baby.
These changes are all part of the body's natural response to pregnancy and are influenced by hormonal shifts and the physiological demands of gestation. It's important to note that while these changes might be unfamiliar or even concerning, they are typically considered normal during pregnancy. If you have any concerns about your pregnancy or experience unusual symptoms, it's always a good idea to consult with a healthcare professional for guidance and reassurance.
- Increase vascularity
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Physical Changes/Adaptation of Pregnancy. THE CARDIOVASCULAR SYSTEM
Increase in Blood Volume: The body increases its blood volume by around 40-50% during pregnancy. This additional blood helps provide sufficient oxygen and nutrients to both the mother and the developing fetus.
Increased Heart Rate: The heart rate typically increases by about 10-15 beats per minute. This is a result of the increased demand for oxygen and nutrients by the mother and the fetus. Also to push all that blood.
Increased Cardiac Output: Cardiac output, which is the amount of blood pumped by the heart per minute, increases by 30-50% during pregnancy. This is due to the combination of increased heart rate and increased stroke volume (the amount of blood pumped per heartbeat). makes sense 100%
Vasodilation: Blood vessels undergo vasodilation, which means they widen. This allows for improved blood flow and helps manage the increased blood volume and cardiac output.
Blood Pressure Changes: Blood pressure tends to decrease slightly in early pregnancy due to the vasodilation and hormonal changes. However, around the 32nd week of pregnancy, it starts to gradually return to pre-pregnancy levels. It's important to monitor blood pressure regularly during pregnancy, as high blood pressure can be a concern.
Hypercoagulation: Pregnancy causes the blood to have a higher tendency to clot. This is a protective mechanism to minimize bleeding during childbirth but can also increase the risk of thrombosis. This hypercoagulable state helps prevent excessive bleeding during delivery but also poses a potential risk for blood clots.
Dependent Edema: Edema, or swelling, is common during pregnancy. Due to the pressure exerted by the growing uterus on blood vessels, fluid can accumulate in the lower extremities, causing swelling in the ankles and feet.
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Physical Changes/Adaptation of Pregnancy. Cardiac Hypertrophy
Displaced by the enlarging uterus which pushes up on the diaphragm.
Displaced by the enlarging uterus which pushes up on the diaphragm.
Cardiac Hypertrophy during Pregnancy:
Cardiac hypertrophy refers to the enlargement of the heart muscle, usually due to an increase in the size of individual cardiac muscle cells. During pregnancy, the cardiovascular system undergoes various adaptations to accommodate the increased demands of the developing fetus and changes in the mother's body.
1. Increased Blood Volume: One of the most significant changes is the increase in blood volume to support the growing fetus and the needs of the placenta. This leads to an increase in cardiac output, which is the amount of blood the heart pumps per minute. Cardiac hypertrophy helps the heart to generate a higher cardiac output to meet these increased demands.
2. Hormonal Changes: Hormones like estrogen and progesterone rise significantly during pregnancy. These hormones can have direct effects on the heart, leading to changes in heart rate and cardiac muscle function.
3. Pressure Changes: The enlarging uterus exerts pressure on the diaphragm and displaces abdominal organs. This can lead to changes in thoracic pressure and the position of the heart within the chest cavity. These changes can contribute to palpitations and altered cardiac murmurs.
4. Heart Murmurs, Palpitations, and Arrhythmias: As the heart adapts to the increased workload and hormonal changes, it's common for pregnant women to experience heart murmurs, palpitations, and even arrhythmias. Most of these changes are benign and related to the increased blood flow and hormonal influence on the heart. However, any significant or concerning symptoms should be evaluated by a healthcare provider.
95% women develop systolic murmurs, palpitations and arrhythmias.
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PHYSIOLOGICAL ANEMIA OF PREGNANCY
For adult women: Approximately 12.0 to 15.5 grams per deciliter (g/dL) of blood.
In the first and third trimesters, if the hemoglobin level drops below 11 g/dl, the woman is considered anemic.
In the second trimester, if the hemoglobin level drops below 10.5 g/dl, the woman is considered anemic.
Additionally, if the hematocrit (HCT) level falls below 32%, the woman is considered anemic.
During pregnancy, a woman's blood volume expands to support the growing fetus and provide adequate oxygen and nutrients. However, the increase in plasma volume outpaces the increase in red blood cell production, leading to a dilutional effect on the concentration of red blood cells and hemoglobin in the blood. This can result in slightly lower hemoglobin (it's a component of RBC aka erythrocytes that carries iron and O2) and hematocrit levels. (%of RBC aka erythrocytes )
The hemoglobin and hematocrit thresholds you've mentioned are commonly used as diagnostic criteria for defining anemia in pregnant women. Anemia during pregnancy is defined by different hemoglobin and hematocrit cutoffs compared to non-pregnant individuals due to the changes in blood volume that naturally occur during gestation. The values you provided—hemoglobin levels below 11 g/dl in the first or third trimester, below 10.5 g/dl in the second trimester, or a hematocrit of 32%—indicate the thresholds at which a pregnant woman would be considered anemic.
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Supine hypotensive syndrome (also referred to as inferior vena cava compression syndrome)
Supine hypotensive syndrome, also known as inferior vena cava compression syndrome or aortocaval compression syndrome, is a medical condition that can occur during pregnancy. It primarily affects pregnant women when they lie flat on their backs (in the supine position). The syndrome is caused by the pressure of the growing uterus on the inferior vena cava, a large vein that carries deoxygenated blood from the lower half of the body to the heart.
As the uterus enlarges during pregnancy, especially in the later stages, it can exert pressure on the inferior vena cava when the pregnant woman lies on her back. This pressure can obstruct blood flow, leading to a reduction in the return of blood to the heart and a subsequent decrease in blood pressure. This drop in blood pressure can cause symptoms such as dizziness, lightheadedness, nausea, and even fainting.
To alleviate the symptoms and prevent complications, pregnant women are often advised to avoid lying flat on their backs, especially during the later stages of pregnancy. Instead, they are encouraged to lie on their left side, which helps to relieve the pressure on the inferior vena cava and maintain proper blood flow to the heart and the baby.
It's important to note that while supine hypotensive syndrome is more common during pregnancy due to the physical changes in the body, it can also occur in non-pregnant individuals who experience pressure on the inferior vena cava due to factors such as obesity, certain medical conditions, or the positioning during surgery.
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RESPIRATORY SYSTEM (changes during pregnancy)
Increase in Oxygen Consumption (20%-40%): The growing fetus requires more oxygen for its development, and therefore the pregnant woman's oxygen consumption increases. This is due to the increased metabolic rate and the need to supply oxygen for fetal growth.
Increase in Respiratory Rate (RR): Pregnant women typically experience an increase in their respiratory rate. This change helps to bring in more oxygen and expel carbon dioxide to meet the increased demands.
Diaphragm Pushed Up: As the uterus expands to accommodate the growing fetus, it pushes against the diaphragm, causing it to move upward. This can result in a decrease in the vertical dimension of the chest cavity.
Chest Expansion and Rib Cage Relaxation: The hormone estrogen, which is elevated during pregnancy, contributes to relaxation of the rib cage muscles and ligaments. This relaxation allows for increased expansion of the chest and greater lung capacity.
Decreased Airway Resistance: Another hormone, progesterone, causes smooth muscle relaxation throughout the body, including the bronchial tubes. This relaxation decreases airway resistance and allows for more efficient airflow.
Increase in Carbon Dioxide (CO2) Blown Off: Due to the increased respiratory rate and volume, more carbon dioxide is eliminated from the body. This is necessary to maintain proper blood pH and ensure adequate oxygen supply to the fetus.
Increase in Bicarbonate Secretion from the Kidneys: The kidneys play a role in maintaining the body's acid-base balance. During pregnancy, there is an increase in the secretion of bicarbonate ions by the kidneys. Bicarbonate acts as a buffer, helping to counteract the respiratory changes that result in lower carbon dioxide levels.
Capillary Engorgement: The increased blood volume and hormonal changes during pregnancy can lead to capillary engorgement in the respiratory mucosa. This can contribute to symptoms like nasal congestion and epistaxis (nosebleeds) during pregnancy.
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RESPIRATORY SYSTEM 2.0
Increase in Tidal Volume (30%-40%): Tidal volume refers to the amount of air that is inspired and expired during each normal breath. During pregnancy, the body experiences an increase in tidal volume, ranging from 30% to 40%. This increase helps to deliver more oxygen to the mother's body and the developing fetus.
Vital Capacity Unchanged: Vital capacity is the maximum amount of air a person can exhale after taking the deepest breath possible. While some other respiratory parameters change during pregnancy, vital capacity generally remains unchanged. This might be due to a balance between increased tidal volume and decreased expiratory volume.
Inspiratory Volume Increased: Inspiratory volume, or the amount of air inhaled during a deep breath, increases during pregnancy. This change is again aimed at providing more oxygen to the body and supporting the increased metabolic demands of both the mother and the developing fetus.
Expiratory Volume Decreased: Expiratory volume, or the amount of air exhaled during a breath, decreases during pregnancy. This decrease is believed to be a result of the expanding uterus pressing against the diaphragm, which can slightly limit the ability to exhale fully.
Total Lung Capacity Unchanged: Total lung capacity, which is the maximum volume of air the lungs can hold, generally remains unchanged during pregnancy. This might be due to the fact that while individual components like tidal volume and inspiratory volume increase, they are balanced by changes in expiratory volume, resulting in an overall consistent total lung capacity.unchanged
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Renal pelvis and ureters dilate
Dilation of Renal Pelvis and Ureters: The hormonal changes that occur during pregnancy, particularly the increase in progesterone, can cause relaxation of the smooth muscles in the urinary system. This relaxation leads to the dilation (widening) of the renal pelvis and the ureters. This dilation serves to increase the capacity of the urinary system and helps prevent urine from backing up into the kidneys, which could potentially cause urinary tract infections.
Hyperplasia and Hypertrophy of Smooth Muscle Walls: The smooth muscle walls of the ureters undergo both hyperplasia (increase in the number of muscle cells) and hypertrophy (increase in the size of muscle cells). This adaptation is aimed at maintaining proper urine flow despite the dilation of the ureters. The increased muscle mass ensures that urine is still effectively propelled from the kidneys to the bladder.
Relaxation of Muscle Tone: The hormonal changes during pregnancy, especially the effect of progesterone, lead to a relaxation of muscle tone in various parts of the body, including the smooth muscles in the ureters. This relaxation helps prevent the ureters from contracting too strongly, which could potentially impede urine flow.
Elongation and Tortuosity of Ureters: As the uterus expands to accommodate the growing fetus, it can put pressure on the nearby structures, including the ureters. This pressure can cause the ureters to elongate and become more tortuous (twisted or curved). This adaptation is the body's way of ensuring that the ureters can still transport urine effectively despite the mechanical obstruction posed by the expanding uterus.
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THE RENAL SYSTEM
Increase in Blood Flow to the Kidneys: During pregnancy, there is a significant increase in blood flow to the kidneys. This is due to the body's response to support the developing fetus and the increased metabolic demands of the mother. The increased blood flow helps ensure that the kidneys receive enough oxygen and nutrients to effectively filter the blood and remove waste products.
Increase in Glomerular Filtration Rate (GFR) of the Kidneys: GFR is a measure of how efficiently the kidneys filter waste and excess substances from the blood to form urine. During pregnancy, the GFR increases. This is partly due to the increased blood flow and hormonal changes. The increased GFR helps accommodate the increased filtration needs of both the mother's body and the developing fetus.
Increase in Urination and Urine Production: The combination of increased blood flow and higher GFR leads to increased urine production. This is a natural response of the body to efficiently eliminate waste products and extra fluids from the body, which is essential to maintain a healthy environment for both the mother and the fetus.
Pressure from the Uterus on the Ureters: As the uterus expands to accommodate the growing fetus, it can exert pressure on the nearby structures, including the ureters—tubes that carry urine from the kidneys to the bladder. The pressure from the uterus can partially compress the ureters, affecting the flow of urine from the kidneys to the bladder.
Risk of Urinary Stasis and Pyelonephritis: The pressure of the uterus on the ureters can slow down the flow of urine, potentially leading to urinary stasis—where urine remains stagnant in the urinary tract. Stagnant urine can become a breeding ground for bacteria, increasing the risk of urinary tract infections (UTIs), including pyelonephritis, which is a UTI that affects the kidneys. This is why pregnant individuals are at a greater risk of these urinary complications.
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GI SYSTEM Ensure adequate nutrition for embryo/fetus
"Morning Sickness": Morning sickness, characterized by nausea and vomiting, is a common symptom experienced by many pregnant individuals, although it can occur at any time of the day. It's believed to be caused by hormonal changes, particularly the rise in human chorionic gonadotropin (hCG) hormone. While the exact cause isn't fully understood, morning sickness is thought to be an adaptation that helps protect the fetus from potentially harmful substances and encourage the consumption of safer, nutrient-rich foods.
Decreased GI Peristalsis: Peristalsis is the coordinated muscular contractions that move food along the digestive tract. During pregnancy, due to the influence of hormones like progesterone, the GI system experiences decreased peristalsis. This can lead to symptoms such as bloating, constipation, and a feeling of sluggish digestion. This adaptation allows for more time for nutrient absorption, but it can also result in discomfort.
Hemorrhoids: Hemorrhoids are swollen veins in the rectal area that can become more common and exacerbated during pregnancy. The increased pressure on blood vessels (veins) in the pelvic area, combined with the slower GI transit time, can contribute to the development of hemorrhoids.
Ptyalism: Ptyalism, also known as excessive salivation or hypersalivation, is another symptom that some pregnant individuals experience. Hormonal changes during pregnancy can lead to an increase in saliva production, and the exact cause of this is not completely understood.
Bleeding Gums: ----Increased Blood Flow: Hormonal changes cause an increase in blood flow to the gums, making them more engorged and sensitive.Hormonal changes and increased blood flow to the gums during pregnancy can lead to gum sensitivity and sometimes bleeding when brushing or flossing. This is why maintaining good oral hygiene is especially important during pregnancy.
Heartburn: Heartburn, or acid reflux, can become more frequent during pregnancy. The hormone progesterone, which relaxes smooth muscles, also relaxes the valve that separates the stomach from the esophagus. This relaxation allows stomach acid to flow back into the esophagus, leading to the sensation of heartburn.
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Integumentary
Increase in Melanotropin and Increased Pigmentation: During pregnancy, hormonal changes can lead to an increase in melanotropin hormones, which stimulate melanocytes (cells responsible for skin pigmentation). This can result in various areas of the skin becoming darker, a condition known as hyperpigmentation. Common areas affected include the areolas (the darkened area around the nipples), genital areas, and areas with pre-existing scars. Evolutionary Perspective: Some researchers suggest that these pigmentation changes might have evolutionary benefits. For example, darker pigmentation in areas like the areolas might help infants better locate and latch onto the breast for feeding, as the contrast in color makes the nipple area more visible.
Chloasma (Melasma): Chloasma, also known as melasma or "mask of pregnancy," is a condition where brown or grayish-brown patches of pigmentation develop on the face. This is often due to increased melanin production, influenced by hormonal changes. Sun exposure can exacerbate this condition.
Striae Gravidarum (Stretch Marks): Striae gravidarum are pink, red, or purplish streaks that appear on the skin, typically on the abdomen, breasts, hips, and thighs. These stretch marks are a result of the skin stretching rapidly due to the growth of the uterus and the weight gain associated with pregnancy. Over time, they may fade to a silvery color.
Linea Nigra: Linea nigra is a dark line that can appear vertically down the center of the abdomen during pregnancy. It is caused by hormonal changes that stimulate increased pigmentation in this area. The line usually extends from the navel to the pubic bone.
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Check slide 45
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THE MUSCULOSKELETAL SYSTEM
Shifting Center of Gravity: As the uterus grows to accommodate the developing fetus, a pregnant woman's center of gravity shifts forward. This adjustment is due to the weight of the uterus and the growing baby. To compensate for this change, pregnant women often adapt their posture by tilting the pelvis forward and leaning backward slightly.
Increased Lordosis: The shifting center of gravity and the natural changes in the spine's curvature can lead to an increased lumbar lordosis, which is the inward curvature of the lower back. This can contribute to back pain and discomfort during pregnancy, especially in the lower back region.
Loosening of Ligaments: Hormonal changes, particularly the increase in the hormone relaxin, lead to the relaxation and loosening of ligaments in various parts of the body, including the pubic symphysis (the joint at the front of the pelvis) and the sacroiliac joints (the joints connecting the pelvis to the spine). This increased flexibility is necessary to accommodate the growing uterus and facilitate childbirth, but it can also lead to joint instability and discomfort.
Abdominal Muscle Changes: The muscles of the abdomen, particularly the rectus abdominis muscles (the "six-pack" muscles), undergo stretching as the uterus expands. This stretching can cause these muscles to separate in the midline, a condition known as diastasis recti abdominis. This separation can result in a visible bulge in the midline of the abdomen and weakened abdominal support.
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DIASTASIS RECTI?
"Diastasis recti" (also known as "rectus diastasis," "abdominal separation," or "diastasis of the rectus abdominis muscles") refers to the separation of the rectus abdominis muscles, which are the paired muscles that run vertically down the front of the abdomen and are commonly referred to as the "six-pack" muscles. This separation occurs along the linea alba, which is the midline of connective tissue that runs down the center of the abdomen, from the ribcage to the pubic bone.
During pregnancy, as the uterus expands to accommodate the growing fetus, the rectus abdominis muscles can stretch and separate at the midline. This separation can result in a visible bulge or gap in the abdominal area. While diastasis recti can occur in both men and women, it is most commonly associated with pregnancy due to the increased pressure and stretching on the abdominal muscles during this time.
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Immune System
Innate Immunity:
Adaptive Immunity:
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Nutrition
Prenatal Vitamins: Prenatal vitamins are supplements specifically designed to provide essential nutrients that are important for a healthy pregnancy. They usually contain a combination of vitamins and minerals such as folic acid, iron, calcium, vitamin D, and others. These nutrients support the increased demands on the body during pregnancy and help prevent deficiencies that could affect both the parent and the baby's health.
Folic Acid: Folic acid, a type of B vitamin, is crucial during pregnancy, especially during the first few weeks when the baby's neural tube is forming. Adequate folic acid intake can help prevent neural tube defects like spina bifida. It's often recommended that individuals who are planning to become pregnant or are already pregnant take a folic acid supplement in addition to consuming foods rich in folate, such as leafy greens, beans, and fortified grains.
Increased Caloric Intake: During pregnancy, energy requirements increase to support the growth and development of the baby. The average recommended calorie intake for pregnant individuals varies, but it generally involves consuming about 300 extra calories per day compared to their pre-pregnancy intake. This increase is necessary to provide the energy needed for the baby's growth, increased metabolism, and bodily changes.
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Fetal viability?
Fetal viability refers to the point in a pregnancy at which the fetus has developed enough to have a reasonable chance of surviving outside the womb, with medical assistance. This typically involves the ability of the fetus to breathe and maintain essential bodily functions with medical intervention, such as being placed in a neonatal intensive care unit (NICU).
around 20 weeks
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Chadwick Sign:
The Chadwick sign is a bluish or purplish discoloration of the cervix, vaginal walls, and vulva that can occur as early as 6 to 8 weeks of pregnancy. It’s caused by increased blood flow to the area due to hormonal changes. This sign can be an early indicator of pregnancy. 6-8 weeks
a non-specific, early sign of pregnancy (aka presumptive) that is typically characterized by a bluish discoloration of the cervix, vagina, and vulva
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The vaginal vault?
The vaginal vault is the expanded region of the vaginal canal at the internal end of the vagina.
The word "vault" in this context refers to a space or chamber, often with an arched or dome-like shape.
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Chadwick Sign:
The Chadwick sign refers to a bluish or purplish discoloration of the cervix, vaginal walls, and vulva. It's caused by increased blood flow to the area due to hormonal changes, particularly increased estrogen levels. The Chadwick sign can typically be observed as early as 6 to 8 weeks into pregnancy. It serves as an early visual indicator that a woman might be pregnant.
hegar's sign INDICATION of EARLY PREGNANCY
~ NOT DEFINITIVE
* COMPRESSIBILITY & SOFTENING of
CERVICAL ISTHMUS in FIRST 4-6wks
Hegar's sign is a physical finding that can sometimes be indicative of early pregnancy, although it's not considered a definitive diagnostic criterion. It involves the compressibility and softening of the cervical isthmus, which is the narrow portion of the cervix that connects the uterine body to the vaginal portion of the cervix.
This sign typically becomes noticeable around 6 to 12 weeks of gestation, although in some cases it might be detectable as early as 4 weeks. The softening of the cervical isthmus is caused by hormonal changes that occur during pregnancy, particularly an increase in estrogen and progesterone levels.
It's important to note that while Hegar's sign can suggest the possibility of early pregnancy, it's not a standalone diagnostic tool. Pregnancy diagnosis is usually confirmed through a combination of signs and symptoms, as well as medical tests like pregnancy tests (urine or blood tests) and ultrasound examinations.
Goodell Sign:
The Goodell sign refers to the softening of the cervix that occurs during pregnancy. As pregnancy progresses, the cervix undergoes changes in preparation for childbirth. Increased blood flow and hormonal influences cause the cervix to become softer and more elastic. The Goodell sign is one of the classic signs of pregnancy and can be detected during a pelvic examination.
all of them PROBABLE la segunda
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Dependent Edema: Edema, or swelling, is common during pregnancy. Due to the pressure exerted by the growing uterus on blood vessels, fluid can accumulate in the lower extremities, causing swelling in the ankles and feet.
During pregnancy, there are several changes that contribute to the development of edema, particularly in the lower extremities (such as the ankles and feet):
Hormonal Changes: Hormones like progesterone can lead to increased fluid retention in the body's tissues.
Increased Blood Volume: Pregnant women experience an increase in blood volume to support the developing fetus. This increased blood volume can put pressure on blood vessels and cause fluid to leak into surrounding tissues.
Uterine Pressure: As the uterus expands to accommodate the growing fetus, it can put pressure on the blood vessels that return blood from the lower body to the heart. This pressure can impede the normal flow of blood and cause fluid to accumulate in the legs and feet.
Gravity: The force of gravity can also contribute to the accumulation of fluid in the lower extremities, especially when a pregnant woman spends a lot of time standing or sitting.
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what does this mean 34-36 6/7 weeks
The notation "34-36 6/7 weeks" refers to a range of gestational weeks in a pregnancy. Let's break down what each part of this notation means:
34 weeks: This is the lower end of the range and indicates that the pregnancy has reached 34 weeks since the woman's last menstrual period. It means the baby has been developing for 34 weeks in the womb.
36 6/7 weeks: This is the upper end of the range. It means the pregnancy has reached 36 weeks. The "6/7" part signifies that the pregnancy is almost at the point of 37 weeks.
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components of Erythrocytes (rbc)
Hemoglobin (Hb): Hemoglobin is the most crucial component of erythrocytes. It is a protein composed of four subunits, each containing a heme group. The heme groups contain iron, which binds to oxygen in the lungs and releases it in the tissues. Hemoglobin is responsible for the red color of blood and the oxygen-carrying capacity of RBCs.
Iron: Iron is an essential element for hemoglobin to function properly. Each heme group contains an iron atom that binds to oxygen. Iron deficiency can lead to anemia, a condition characterized by low hemoglobin levels and reduced oxygen-carrying capacity.
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Blood is made up of:
blood a secas don't confuse with RBC
Blood is made up of:
Plasma: Plasma is the liquid component of blood, making up about 55% of the total blood volume. It is a pale-yellow fluid that carries various substances throughout the body, such as water, electrolytes, proteins, hormones, waste products, and gases.
Cellular Elements:
Red Blood Cells (Erythrocytes): These are specialized cells that carry oxygen from the lungs to the body's tissues and transport carbon dioxide from the tissues back to the lungs for exhalation.
White Blood Cells (Leukocytes): These cells are part of the immune system and help defend the body against infections and foreign invaders.
Platelets (Thrombocytes): These are cell fragments involved in blood clotting and wound healing.
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Hematocrit: less than 32% in pregnant women is anemia
Hematocrit (Hct) is a measurement of the volume of red blood cells (erythrocytes) relative to the total volume of blood. It is expressed as a percentage. and of course of the volume of plasma which is a component of blood goes up but the RBC (erythrocytes) doesn't the % of hematocrit goes down because it goes hand in hand with RBC (erythrocytes)
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Maturation of Fetal Circulation: By the third trimester, the fetal circulatory system is more developed, and the placenta has matured. This means that the demands on the mother's cardiovascular system might stabilize somewhat.
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why does the rate of increase in plasma volume might slow down compared to the second trimester
Maturation of Fetal Circulation: By the third trimester, the fetal circulatory system is more developed, and the placenta has matured. This means that the demands on the mother's cardiovascular system might stabilize somewhat. As a result, the need for further expansion of plasma volume to support the growing placenta and fetus could decrease, leading to a potential slowdown in the rate of increase.
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define metabolic rate
(amount of energy needed to keep homeostasis) amount, energy needed for housekeeping
Metabolic rate refers to the rate at which an organism or system undergoes chemical reactions and energy transformations within the body. It represents the total amount of energy (in the form of calories) that the body requires to maintain its basic physiological functions, such as breathing, circulating blood, digesting food, and maintaining body temperature, while at rest.
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progesterone and relaxin = relax ?
Smooth muscle
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G (Gravidity):
The total number of times a woman has been pregnant, regardless of the outcome (whether the pregnancy resulted in a live birth, stillbirth, miscarriage, or abortion).
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T (Term births):
The number of pregnancies that reached full term, typically considered to be 37 to 42 weeks of gestation.
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P (Preterm births):
The number of pregnancies where the fetus was delivered before reaching full term, i.e., before 37 weeks of gestation.
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A (Abortions and miscarriages):
The number of pregnancies that ended before 20 weeks of gestation due to miscarriage or elective abortion.
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ptyalism etymology : (pronounced payalism)
ptyalism etymology
The term "ptyalism" is derived from the Greek word "ptyalon," which means "spittle" or "saliva," combined with the suffix "-ism," which is used to denote a condition or state. Ptyalism refers to the excessive production of saliva or the condition of excessive salivation. It is often used in medical contexts to describe a symptom that can be caused by various factors, such as certain medications, medical conditions, or dental issues.
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Chloasma (Melasma):
The term "melasma" originates from the Greek words "melas," meaning "black," and "asma," which translates to "a condition" or "a sign.
Chloasma, also known as melasma or “mask of pregnancy,” is a condition where brown or grayish-brown patches of pigmentation develop on the face. This is often due to increased melanin production, influenced by hormonal changes. Sun exposure can exacerbate this condition.
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Striae Gravidarum etymology
The term "striæ gravidarum" is derived from Latin and is often referred to as "stretch marks of pregnancy" in English. Let's break down the etymology:
Striæ: The word "striæ" is the plural form of "stria," which is derived from the Latin word "stria," meaning "a furrow, stripe, or groove." In the context of stretch marks, "striæ" refers to the lines or streaks that appear on the skin due to stretching.
Gravidarum: The word "gravidarum" is the genitive form of "gravid," which is a Latin word meaning "pregnant" or "full of young." In medical terminology, the term "gravidarum" is used to indicate a condition related to pregnancy.
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linea nigra
In social species, including humans, visual cues can play a role in communication and bonding within social groups. The presence of the linea nigra could signal to others, such as partners, family members, or caregivers, that a woman is pregnant. This information might have been evolutionarily advantageous for providing support and care to pregnant individuals.
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Lordosis etymology
The term "lordosis" is derived from the Greek word "lordōsis," which means "bending backward" or "curving inward."
greek
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Hormone relaxin =?
it relaxes ligaments and joints
a reproductive hormone produced by your ovaries and the placenta.
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In the context of pregnancy, the terms "probable," "positive," and "presumptive" are used to categorize different types of signs and diagnostic criteria for determining whether a woman is pregnant. These terms help healthcare professionals differentiate between signs that strongly indicate pregnancy, signs that are more likely to be associated with pregnancy, and signs that could be related to pregnancy but are less specific.
Presumptive Signs of Pregnancy: These are subjective signs and symptoms experienced by the woman that could potentially be indicative of pregnancy but are not necessarily specific to pregnancy. These signs are more likely to be associated with other conditions as well. Examples of presumptive signs include missed periods, nausea and vomiting (morning sickness), breast changes, increased frequency of urination, and fatigue.
Probable Signs of Pregnancy: These are signs that are more likely to be associated with pregnancy but are not definitive proof of pregnancy on their own. They include signs that can be detected through medical examinations, such as Hegar's sign (softening of the cervix), Chadwick's sign (bluish discoloration of the cervix and vagina), and positive pregnancy tests (both urine and blood tests). These signs make pregnancy more probable, but they can also have other causes.
Positive Signs of Pregnancy: These are signs that provide definitive evidence of pregnancy. They can only be attributed to the presence of a developing fetus. Positive signs include fetal heartbeat detection (usually through ultrasound or Doppler), visualization of the fetus via ultrasound, and fetal movement felt by a healthcare provider.
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is Gravidity the same as gravida ?
No, "gravidity" and "gravida" are related terms used in the context of pregnancy, but they have different meanings.
Gravida: Gravida is a term used to describe a pregnant woman. It refers to the number of times a woman has been pregnant, regardless of the pregnancy outcome. For example, a woman who is pregnant for the first time is referred to as a "primigravida," while a woman who has been pregnant multiple times is called a "multigravida."
Gravidity: Gravidity, on the other hand, refers to the total number of times a woman has been pregnant, including both pregnancies that resulted in a live birth and those that ended in miscarriage, stillbirth, or abortion.
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Relaxes joints and ligaments in the pelvis to facilitate childbirth.
estrogen and relaxin
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Spina bifida folic acid correlation
Spina bifida is a congenital birth defect that affects the spinal column. It occurs when the neural tube, which is the structure that develops into the brain and spinal cord during early fetal development, does not close completely. This incomplete closure can lead to a range of spinal and neurological abnormalities. olic acid, a type of B-vitamin, plays a crucial role in the development of a healthy neural tube in a developing fetus. The neural tube eventually develops into the brain and spinal cord. Insufficient intake of folic acid during early pregnancy can increase the risk of neural tube defects, including spina bifida.
Research has shown that taking folic acid supplements before and during early pregnancy can significantly reduce the risk of neural tube defects
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Underweight: BMI less than 18.5
Normal weight: BMI 18.5 to 24.9
Overweight: BMI 25 to 29.9
Obesity (Class I): BMI 30 to 34.9
Obesity (Class II): BMI 35 to 39.9
Obesity (Class III): BMI 40 or higher
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Pregnant women should not eat refrigerated meats or smoked seafood unless it is part of a cooked dish. Why ?
Pregnant women are advised to avoid certain types of foods, including refrigerated meats and smoked seafood that are not part of a cooked dish, due to the risk of foodborne illnesses, specifically Listeriosis. Listeriosis is a bacterial infection caused by the bacterium Listeria monocytogenes. This infection can have serious consequences for pregnant women and their unborn babies.
Here's why pregnant women are cautioned about these foods:
Listeria Risk: Listeria monocytogenes can be present in certain foods, including refrigerated meats and smoked seafood. These bacteria can grow at refrigeration temperatures and are not always killed by normal cooking temperatures. Pregnant women are more susceptible to Listeriosis due to changes in their immune systems during pregnancy, which can make them more susceptible to infections.
Cross-contamination: Refrigerated meats and smoked seafood can come into contact with other contaminated surfaces in the refrigerator or during handling, which increases the risk of Listeria contamination.
Transmission to the Fetus: Listeriosis can lead to serious complications during pregnancy, such as miscarriage, stillbirth, premature birth, or serious health issues for the baby after birth.
Cooking Eliminates Risk: Cooking foods to a safe internal temperature can kill the Listeria bacteria and reduce the risk of infection. This is why it's safer to consume these foods if they are part of a cooked dish, as cooking at appropriate temperatures can make the food safe to eat.
To minimize the risk of Listeriosis and other foodborne illnesses during pregnancy, it's recommended that pregnant women:
Avoid consuming raw or undercooked seafood, poultry, eggs, and meat.
Choose pasteurized dairy products and avoid unpasteurized versions.
Wash fruits and vegetables thoroughly before consumption.
Follow proper hygiene practices while preparing and handling food.
Store and handle food properly to prevent cross-contamination.
Reheat leftovers to a safe temperature before consuming.
why can't pregnant women eat smoked food ?
Listeria Risk: Smoked foods, including smoked fish, meat, and poultry, can be susceptible to contamination with Listeria monocytogenes, a bacteria that can cause listeriosis, a serious infection. Pregnant women are more vulnerable to listeriosis, which can lead to miscarriage, stillbirth, preterm labor, or severe illness in newborns.
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Normal A specific gravity range and what does it indicate
Specific gravity is a measure of the density of a substance relative to the density of a reference substance, usually water. In various contexts, specific gravity can provide information about the composition, concentration, and physical properties of a material. In the medical field, urine specific gravity is often measured as a way to assess hydration status and kidney function.
Normal urine specific gravity typically ranges from 1.005 to 1.030. Here's what different ranges of urine specific gravity can indicate:
Low Specific Gravity (<1.005): This can indicate overhydration, where the urine is more diluted because the body has an excess of fluids. Conditions like diabetes insipidus, which affects water balance, can also result in low specific gravity.
Normal Specific Gravity (1.005-1.030): A normal range suggests a balance between hydration and concentration. It's generally indicative of adequate fluid intake and kidney function.
High Specific Gravity (>1.030): Elevated specific gravity can indicate dehydration, where the urine becomes more concentrated due to insufficient fluid intake. High specific gravity can also be associated with conditions that affect kidney function, such as acute kidney injury or chronic kidney disease.
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Human Chorionic Gonadotropin (hCG) is a hormone produced by the placenta during pregnancy. It's often used as a marker to detect and monitor pregnancy, as its levels rise rapidly in the early stages of pregnancy. The hCG levels can vary widely between different individuals and pregnancies, but here's a general guideline:
An hCG level lower than 5 mIU/mL (5 IU/l) is considered negative for pregnancy, and anything higher than 25 mIU/mL (25 IU/l) is considered positive for pregnancy.
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A Pregnant woman with four children reports the following history: a still birth at 32 weeks, triplets born via c/s at 30 weeks gestation, SAB at 8 weeks gestation, and a daughter born vaginally at 39 weeks gestation. What accurately expresses this woman’s current obstetric history using
G-T-P-A-L
The woman's G-T-P-A-L obstetric history is G4 (four pregnancies), T1 (one term birth), P1 (one preterm birth), A1 (one abortion), and L4 (four living children).
So the triplets are considered 1 preterm birth ?
Yes, that's correct. In the G-T-P-A-L obstetric history, multiple births (such as triplets) are typically counted as one birth event when calculating preterm births. So, in this case, the triplets born via c-section at 30 weeks gestation are considered as one preterm birth.
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"Lightening" refers to the phenomenon when a pregnant person's baby drops lower into the pelvis in preparation for labor. This typically occurs during the later stages of pregnancy, around 2 to 4 weeks before labor begins. As the baby's head engages in the pelvis, the pressure on the diaphragm may ease, allowing the pregnant person to breathe more easily.
The nurse teaches a primigravida client that lightening occurs about 2 weeks before the onset of labor. Themother will most likely experience a reduction of which of the following at that time?
A) Dysuria b) Dyspnea C) Constipation D)Urinary frequency
Answer: Dyspnea
Lightening, also known as "engagement" or "dropping," refers to the baby's head descending into the pelvis as labor approaches. This relieves pressure on the diaphragm, leading to improved lung capacity and easier breathing. Therefore, the pregnant person is most likely to experience a reduction in dyspnea (difficulty breathing) during this time.
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The GTPAL system is a way to categorize a woman's obstetric history, particularly her pregnancy outcomes. Each letter in the acronym represents a different aspect of pregnancy history:
1. **G:** Gravida - This number indicates the total number of pregnancies a woman has had, including the current one, if applicable.
2. **T:** Term births - This number represents the total number of pregnancies that reached full term (usually defined as 37 weeks gestation or beyond).
3. **P:** Preterm births - This number represents the total number of pregnancies that ended in a preterm birth, which is a birth that occurs before 37 weeks of gestation.
4. **A:** Abortions - This number includes the total number of pregnancies that were terminated before 20 weeks of gestation, whether due to miscarriage or elective abortion.
5. **L:** Living children - This number represents the total number of children a woman has who are currently living.
For example, if a woman has been pregnant twice (including the current pregnancy), gave birth to one child at full term, had one preterm birth, had no abortions, and has one living child, her GTPAL would be "2-1-1-0-1."
The GTPAL system is used by healthcare providers to quickly summarize a woman's pregnancy history and can provide valuable information when assessing risks and making decisions about current and future pregnancies.
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The GTPAL system is a way to categorize a woman's obstetric history, particularly her pregnancy outcomes. Each letter in the acronym represents a different aspect of pregnancy history:
1. **G:** Gravida - This number indicates the total number of pregnancies a woman has had, including the current one, if applicable.
2. **T:** Term births - This number represents the total number of pregnancies that reached full term (usually defined as 37 weeks gestation or beyond).
3. **P:** Preterm births - This number represents the total number of pregnancies that ended in a preterm birth, which is a birth that occurs before 37 weeks of gestation.
4. **A:** Abortions - This number includes the total number of pregnancies that were terminated before 20 weeks of gestation, whether due to miscarriage or elective abortion.
5. **L:** Living children - This number represents the total number of children a woman has who are currently living.
For example, if a woman has been pregnant twice (including the current pregnancy), gave birth to one child at full term, had one preterm birth, had no abortions, and has one living child, her GTPAL would be "2-1-1-0-1."
The GTPAL system is used by healthcare providers to quickly summarize a woman's pregnancy history and can provide valuable information when assessing risks and making decisions about current and future pregnancies.
The GTPAL system is important in the field of obstetrics and maternal healthcare for several reasons:
1. **Clinical Assessment:** The GTPAL system provides a standardized and concise way for healthcare providers to assess a woman's pregnancy history. This information is crucial for determining the potential risks and complications associated with a current pregnancy.
2. **Risk Stratification:** By categorizing pregnancies based on factors like term births, preterm births, and previous pregnancies, the GTPAL system helps healthcare providers identify any patterns or trends that could indicate an increased risk of certain complications in the current pregnancy. This allows for more personalized and targeted care.
3. **Decision Making:** Understanding a woman's GTPAL helps healthcare providers make informed decisions about prenatal care, monitoring, and potential interventions. It can also influence decisions about the mode of delivery and whether certain precautions or treatments are needed.
4. **Communication:** The GTPAL system provides a standardized way for healthcare providers to communicate a patient's pregnancy history to colleagues, specialists, and other members of the healthcare team. This ensures that important information is accurately conveyed.
5. **Research and Statistics:** The GTPAL system facilitates the collection of consistent and comparable data across different populations and studies. This data is valuable for research, epidemiological studies, and assessing trends in maternal and neonatal outcomes.
6. **Patient Counseling:** The GTPAL system helps healthcare providers effectively counsel pregnant individuals about potential risks, outcomes, and choices. It allows for clear communication of the impact of their previous pregnancies on the current one.
Overall, the GTPAL system streamlines the assessment and communication of pregnancy history, leading to better-informed decision-making, improved patient care, and enhanced maternal and neonatal outcomes.
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Is it still birth at week 32 considered a preterm birth, and the GTPAL system?
Yes, a birth that occurs at week 32 of pregnancy is still considered a preterm birth. Preterm birth refers to any birth that occurs before 37 completed weeks of gestation.
The GTPAL system is a way to classify a woman's obstetric history based on the number of pregnancies and outcomes she has experienced. It stands for:
- G: Gravida (total number of pregnancies)
- T: Term births (number of full-term pregnancies, after 37 weeks)
- P: Preterm births (number of pregnancies delivered before 37 weeks but after 20 weeks)
- A: Abortions (number of pregnancies that ended before 20 weeks)
- L: Living children (number of children currently alive)
So, if someone has had a birth at week 32, it would be classified as a preterm birth, and their GTPAL score would reflect that as well.
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signs of pregnancy : presumptive, probable, and positive (nursing )
ChatGPT
Certainly, the signs of pregnancy are often categorized into three groups: presumptive, probable, and positive. These categories help healthcare professionals and individuals differentiate between potential indications of pregnancy. Here's how they are classified:
Presumptive Signs of Pregnancy:
Presumptive signs are those experienced by the woman herself, but they are not definitive proof of pregnancy. They can be caused by other factors as well and might include:
Missed Menstrual Period: One of the most common signs; a missed period can indicate pregnancy.
Breast Changes: Increased sensitivity, tenderness, and enlargement of breasts.
Nausea and Vomiting: Often referred to as morning sickness, though it can occur at any time of day.
Fatigue: Increased tiredness and lack of energy.
Frequent Urination: A result of hormonal changes and increased blood flow to the pelvic area.
Changes in Appetite: Food cravings or aversions might occur.
Probable Signs of Pregnancy:
Probable signs are more reliable indicators than presumptive signs, but they still do not provide definitive proof of pregnancy. They include:
Positive Pregnancy Test: A home pregnancy test or a blood test performed by a healthcare professional detects the presence of the hormone hCG (human chorionic gonadotropin) in the body.
Changes in the Cervix: The cervix might soften, change position, and turn bluish in color.
Changes in the Uterus: Enlargement and softening of the uterus can be felt during a pelvic examination.
Skin Changes: Darkening of the areolas (the areas around the nipples) and the appearance of a dark line (linea nigra) on the abdomen.
Positive Signs of Pregnancy:
Positive signs are considered definitive proof of pregnancy and are usually detected by healthcare professionals. These signs include:
Fetal Heartbeat: A healthcare provider can use a Doppler device to listen to the baby's heartbeat.
Fetal Movement: As the pregnancy progresses, the woman might feel the baby's movements (quickening).
Visualization of the Fetus: Through techniques like ultrasound, the fetus can be seen inside the uterus.
Chadwick's sign, Goodell's sign, and Hegar's sign. GIVE me one characteristic distinction for each one of them so that I can remember them for a test. Then tell me if they are signs of signs of presumptive, probable, and positive pregnancy (by the way I am a nursing student )
Absolutely, I understand that distinguishing these signs is important for your nursing studies. Here's a simple characteristic distinction for each sign, along with their categorization as presumptive, probable, or positive signs of pregnancy:
Chadwick's Sign:
Characteristics: Bluish discoloration of the cervix and vaginal walls.
Category: Probable sign of pregnancy.
Goodell's Sign:
Characteristics: Softening of the cervix due to increased blood supply.
Category: Probable sign of pregnancy.
Hegar's Sign:
Characteristics: Softening and compressibility of the lower uterine segment.
Category: Probable sign of pregnancy.
These signs are categorized as probable signs of pregnancy because they are observed by healthcare professionals during physical examinations. While they are strong indicators of pregnancy, they still do not provide definitive proof.
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So are you saying that the hormones estrogen and progesterone make the muscles in the area softer the is it because they are getting ready to carry the baby and therefore they become softer to be abele to expand and fit the baby ?
Absolutely, you've got it right. The softening of the cervix (Goodell's sign) and the lower uterine segment (Hegar's sign) is indeed a preparatory mechanism to accommodate the growing fetus and facilitate childbirth.
As a woman's body goes through pregnancy, it undergoes a series of changes to create an environment conducive to the developing fetus and the impending delivery. The softening of these structures serves a crucial purpose:
Cervix Softening (Goodell's Sign):
The cervix, which is normally firm and closed, needs to change to allow for the passage of the baby during labor. As the pregnancy progresses, the cervix softens due to increased blood flow, hormonal changes (particularly estrogen), and the influence of progesterone that relaxes muscle tissues. This softening allows the cervix to gradually efface (thin out) and dilate (open) as labor approaches.
Lower Uterine Segment Softening (Hegar's Sign):
The lower uterine segment, also known as the isthmus, is the part of the uterus just above the cervix. It needs to become more flexible and soft to accommodate the growing fetus. As pregnancy advances, the influence of hormones like progesterone leads to the relaxation and softening of the lower uterine segment. This softening allows the uterus to stretch and expand as the baby grows.
