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NUR 4020 > ch. 13 A&P of pregnancy > Flashcards

ch. 13 A&P of pregnancy Flashcards

1
Q

what attributes to maternal physiological adaptations?

A
  • hormones of pregnancy
  • mechanical pressure arising from the enlarging uterus and other tissues
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2
Q

what changes occur in the uterus

A
  • enlargement d/t hypertrophy of myometrial cells (increase in size)
  • limited hyperplasia (increase in number)
  • thickening of the walls d/t effects of estrogen/progesterone (enlarges more around placental insertion site and fundus)
  • increase in vascular and lymphatic system (EXAM: 1/6 of total maternal blood volume is contained within vasculature system of uterus)
  • braxton hicks contractions
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3
Q

braxton hick contractions

A

irregular painless intermittent contractions throughout pregnancy
- can be felt by: 4 months
- helps to stimulate movement of blood through intervillous spaces of the placenta
- may later be confused with preterm labor

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4
Q

what changes occur in the cervix

A
  • primarily connective tissue
  • glandular tissue stimulated by estrogen (hyperplasia: increase in cell number, becomes hyperactive)
  • development of a mucus plug (protective coating around cervix)
  • increased vascularization results in hypertrophy and engorgement of vessels below the growing uterus (3 signs: goodell’s, chadwicks, hegars)
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5
Q

mucus plug

A

thick, tenacious seals endocervical canal
- plug is “expelled” when dilation begins
- protects cervix

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6
Q

goodell’s sign

A

softening of cervix
- cervix usually firm, but thins during pregnancy and opens for labor (insert 2 fingers)

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7
Q

chadwick’s sign

A

bluish-purple discoloration of cervix
- cervix usually pink

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8
Q

hegar’s sign

A

softening of lower uterine segment (junction posterior cervix) that is palpable in the 2/3 month of pregnancy (indication of pregnancy)
- 8-10 weeks
- top of cervix where perimetruim meets (cervical isthmus)

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9
Q

braun von fernwald sign

A
  • irregular softening and enlargement at the site of implantaiton
  • early uterine change of pregnancy
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10
Q

piskacek sign

A

tumorlike asymmetric enlargement
- early uterine changes of pregnancy

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11
Q

approximate height of the fundus

A

umbilicus: 20 weeks indicator
under ribcage: approximately 36 weeks

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12
Q

ovary changes in pregnancy

A
  • cease ovum production during pregnancy
  • production of FSH/LH ceases
  • theca cells form
  • hCG forms
  • corpus luteum
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13
Q

theca cells

A

cells lining the follicles
- become active in hormone production
- known as the interstitial glands of pregnancy

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14
Q

hCG (human chorionic gonadotropin)

A

maintains corpus luteum (persists and produces hormones until 6-8 weeks of pregnancy)
- early placenta takes over
- EXAM: BIOMARKER FOR PREGNANCY

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15
Q

corpus luteum

A

secretes progesterone to maintain endometrium until placenta produces enough progesterone to maintain pregnancy
- then disintegrates slowly

TIP:
- increase hCG causes N/V

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16
Q

changes in the vagina pregnancy

A
  • hypertrophy, increased vascularization, hyperplasia
  • changes are ESTROGEN INDUCED
  • increase in secretions, thick and acidic (becomes more toxic to sperm/bacteria)
  • loosening of connective tissue
  • becomes relaxed in late pregnancy
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17
Q

secretions in the vagina during pregnancy

A
  • plays a role in preventing infection
  • favors growth of yeast
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18
Q

why does the vagina become relaxed in late pregnancy

A
  • permits distention of the tissues
  • allows passage of the baby
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19
Q

changes in the breast during pregnancy

A
  • increase breast size and nodularity (early lactogenesis)
  • changes are ESTROGEN and PROGESTERONE INDUCED
  • grandular hyperplasia and hypertrophy
  • areolar darken, superficial veins prominent
  • striae may develop (stretch marks)
  • colostrum is secreted (from breast, as early as 3 months)
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20
Q

colostrum in the breast

A

after 12 weeks (3 months), may leak during last trimester
- similar to human milk
- may be taboo in some cultures

21
Q

respiratory changes during pregnancy

A

pulmonary function is modified during pregnancy
- small degree of hyperventilation
- tidal volume increases steadily (40%)
- chest circumference may increase as much as 6cm (compensates for elevated diaphragm)
- oxygen consumption increases (15-20% -> has to adequately oxygenate mother/baby)
- breathing changes from abdominal to thoracic
- nasal stuffiness & rhinitis common (epistaxis may also occur, congestion) -> d/t estrogen induced edema & congestion of nasal mucosa

22
Q

cardiac changes during pregnancy

A
  • blood volume increases 40-50% (vasculature -> abdomen)
  • decrease in systemic and pulmonary vascular resistance
  • increase in cardiac output (30-50% -> exposes cardiac issues)
  • increase HR (10-15 BPM)
  • BP decreases slightly then gradually increases
  • femoral venous pressure slowly rises
  • increases stagnation of blood in lower extremities
  • FATIGUE
23
Q

blood volume increase during pregnancy

A

pregnancy induced hemodilation
- AKA physiologic anemia of pregnancy (pseudoanemia)

24
Q

causes of increased stagnation of blood in LE

A

reduction in plasma colloid osmotic pressure maintains fluid in extravascular space (increased risk DVT)

25
Q

supine hypotensive syndome: vena cava syndrome

A

when mother lays on her back, the vena cava that runs along vertebrae of back pinches, leading to decreased in BP and decrease HR in newborns

TIP: don’t want moms on back!!

26
Q

GI changes during pregnancy

A
  • nausea/vomiting
  • hyperemia, softening and bleeding gums
  • gallbladder changes
  • smooth muscle relaxation d/t progesterone
  • heartburn (pyrosis)
  • hemorrhoids (d/t constipation)
27
Q

causes of n/v increase in pregnancy

A

increased hCG in 1st trimester

28
Q

hyperemia/softening and bleeding of gum

A
  • 50-70% of women expereince some level of gingivitis
  • ask mother about last DENTAL visit
  • epulis
  • ptyalism
  • PICA eaters
29
Q

epulis

A

gingival granuloma
- benign, growths on gums
- goes away after birth

30
Q

ptyalism

A

secretion of excess saliva

31
Q

PICA eaters

A

women eats weird things (nonfood items)
- ice
- dirt
- clay
- burnt match sticks

what to worry about: iron deficient anemia, can lead to impaction, colon/bowel obstruction

32
Q

gall bladder changes in pregnancy

A
  • emptying time delayed
  • gallstones may develop: may need to be removed
  • pruitis (itching) d/t retained bile salts
33
Q

smooth muscle relxation due to progesterone cause

A
  • delayed gastric emptying
  • decreased peristalsis -> progesterone caused
  • constipation

TIP:
- decreased progesterone/HCG: miscarriage

34
Q

heartburn causes

A

relaxation of sphincter
- reflux of acid secretions

35
Q

kidneys/urinary tract changes during pregnancy

A
  • 1st trimester: pressure on bladder causes frequency
  • dilation of kidneys and urine
  • increased GFR and renal plasma flow
  • blood flow to kidneys increases by 50-80% (BV increased 40-50%)
  • increased renal function
36
Q

causes of dilation of kidneys/urineq

A

progesterone effects on smooth muscle

37
Q

increased renal function causes

A
  • increased clearance of urea & creatinine
  • lower blood urea & nonprotein nitrogen values
  • creatinine clearance: provides accurate look at renal function in pregnancy
38
Q

skin changes during pregnancy

A
  • hyperpigmentation
  • straie
  • linea nigra (black line on umbilical straight down)
  • chloasma (raccoon face)
  • vascular spide nevi (surface veins) results in high estrogen levels
  • decreased hair growth (fewer follicles go into resting phase)
  • nails grow FASTER
  • hyperactive sweat and sebaceous glands
39
Q

musculoskeletal changes

A
  • pelvic joints relax
  • center of gravity changes
  • separation of the rectus abdominus muscle (main abdomen muscle, faschia, tear rectus abdominus muscle bc it allows for better healing)
  • lower extremity edema (keep legs up)
40
Q

postural changes during pregnancy

A

women develop increasing lordosis of the lumbosacral spine and increasing curvative of the thoracic area

41
Q

eye, cognitive, and metabolic changes

A
  • decreased intraocular pressure
  • thickening of cornea
  • reports of decreased attention, concentration, and memory
  • extra water, fat, and protein are stored
  • fats are more completely absorbed
42
Q

endocrine changes

A
  • increase t4 and BMR, decreased TSH
  • concentration of parathyroid hormone increases
  • thyrotropin and adrenotropin alter maternal metabolism
  • prolactin (EXAM): responsible for lactation -> need for lactogensis
  • secretion of oxytocin and vasopressin (ADH) (keeps BP down, manages uterine contractions)
  • increased aldosterone
43
Q

hCG (human chorionic gonadotropin) review

A
  • trophoblast secretes in early pregnancy
  • hCG stimulates progesterone & estrogen production by the corpus luteum to maintain pregnancy until placenta can take over
44
Q

human placental lactogen (hPL) review

A
  • produced by syncytoptiophoblast
  • insulin antagonist
  • increases circulating free fatty acids for maternal metabolic needs & decreases maternal metabolism of glucose of fetal growth
45
Q

estrogen review

A
  • secreted originally by corpus luteum
  • produced primarily by placenta as early as 7th week gestation
  • stimulates uterine development
  • helps develop ductal systems of breasts in preparation for lactation
46
Q

progesterone review

A
  • produced initially by corpus luteum, then placenta
  • MAINTAINS PREGNANCY
  • helps to develop acini & lobules in breasts in preparation for lactation
47
Q

relaxin review

A
  • inhibits uterine activity (contractability)
  • aids in softening of the cervix
  • primary source corpus luteum, then placenta (relaxes until labor)
48
Q

home pregnancy tests - hCG earliest biomarkers

A
  • enzyme immunoassay tests
  • false positive results low
  • false negative results higher
  • many women perform home test before seeking prenatal care (hcg/progesterone, wait a week & do another home pregnancy test)
49
Q

a number of changes in the integumentary system occur pregnancy. what change persists after birth?

A

striae gravidarum

NUR 4020 (6 decks)

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