ch. 13: a&p of pregnancy Flashcards
What is viability?
capacity to live outside the uterus
What is gravidity?
any pregnancy regardless of duration & outcome
-also includes current pregnancy
What is Nagele’s Rule?
formula to estimate delivery date
1) FIRST DAY OF LAST NORMAL PERIOD
2) MINUS 3 MONTHS
3) ADD 7 DAYS
What is the GTPAL method?
method to record a woman’s pregnancy hx using symbols
What does the G stand for in GTPAL?
Gravida- # of total pregnancies regardless of length and outcome
What does the T stand for in GTPAL?
Full Term (38-40 weeks)
What does the P stand for in GTPAL?
Preterm (20-37 weeks)
What does the A stand for in GTPAL?
Abortion (<20 weeks)
What does the L stand for in GTPAL?
Living- # of total living children
What is the earliest biological marker for pregnancy?
hCG
What do elevated levels of hCG indicate?
abnormal gestation, Downs, or multifetal pregnancy
What do lower levels of hCG indicate?
impending miscarriage, ectopic pregnancy
What urine specimen is the best to use for a pregnancy test?
first one in the morning bc it contains almost the same level of HCG as blood
What hCG blood levels are diagnostic for pregnancy?
> 25
How is fundal height measured?
in cm from the pubic symphysis to the top of the uterus
-cm same as weeks up until week 40 when the fundus drops
What hormones stimulate uterine growth?
estrogen and progesterone
What are Braxton Hicks Contractions
- irregular and painless
- facilitate uterine blood flow
What 3 factors decrease uterine blood flow?
1) low maternal arterial pressure
2) contractions of uterus
3) maternal supine position
What is quickening?
first recognition of fetal movement, “feeling life”
How much does cardiac output increase during pregnancy?
reaches max of 30-50% above nonpregnant level
How much does the blood volume increase?
40-50%
The increase in ____ is more than the increase in RBC mass
plasma volume
-results in hemodilution (physiologic anemia)
How much does the WBC level increase?
- nonpregnant: 5k - 10k
- pregnant: 15k
What coagulation changes occur during pregnancy?
-clotting factors 8, 7, 9, 10 DOUBLE
-fibrinogen increases
-fibrinolytic activity decreases
=HYPER-COAGULATIVE STATE
Since pregnancy is a hyper-coagulative state, what are women at increased risk for?
5-6 fold ↑ risk for thromboembolic event
What results from the enlarged uterus displacing the diaphragm up to 4 cm?
- diaphragm mobility reduced
- resp become mainly thoracic
- ↑ estrogen relaxes ribs, ↑ chest expansion
How does increased vascularity affect the upper resp system?
nasal stuffiness, ears, nose bleeds, voice changes
How is pulmonary function affected by increased estrogen and progesterone?
- CO2 threshold is lowered
- O2 demand and consumption is increased
How is the acid/base balance affected?
- 5mm Hg decrease in pCO2= decreased HCO3, increased pH
- pregnancy is a state of RESPIRATORY ALKALOSIS
- this facilitates transport of CO2 from fetus to mom and O2 release from mom to fetus
What are the anatomic changes of the renal system?
renal pelves and ureters are enlarged/dilated
How does the GFR change in pregnancy?
GFR increases by 50%
What is the result of the increased GFR?
↑ creatinine clearance & reduced serum creat, BUN & uric acid
Why is Na retained?
to meet fetal needs, fluid expansion, & to maintain isotonic state
Can you give diuretics to a pregnant pt?
NO! IT MAY DROP THE BP AND DECREASE PLACENTAL PERFUSION
How is tubular reabsorption of glucose affected?
- it is impaired= glucosuria
- nonpreg excrete 100mg/day
- preg excrete 1-10 g/day ( still have to assess for gestational DM)
What is the abnormal proteinuria level?
> 300 mg/24 hrs
What is the abnormal albuminuria level?
> 30mg/ 24 hrs
What happens if a woman has both proteinuria and HTN?
they are at risk for adverse outcome
What are the effects on the GI system?
nausea, vomiting, indigestion. heartburn (pyrosis), increased r/o hiatal hernia, constipation
