ch. 13 A&P of pregnancy Flashcards
what attributes to maternal physiological adaptations? (2)
- hormones of pregnancy
- mechanical pressure arising from the enlarging uterus and other tissues
what changes occur in the uterus (5)
- 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
braxton hick contractions (what, felt by, helps to, may be confused with)
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
what changes occur in the cervix (4)
- 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)
mucus plug (what, 2)
thick, tenacious seals endocervical canal
- plug is “expelled” when dilation begins
- protects cervix
goodell’s sign (what, 1)
softening of cervix
- cervix usually firm, but thins during pregnancy and opens for labor (insert 2 fingers)
chadwick’s sign (what)
bluish-purple discoloration of cervix
- cervix usually pink
hegar’s sign (what, 2)
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)
braun von fernwald sign (2)
- irregular softening and enlargement at the site of implantaiton
- early uterine change of pregnancy
piskacek sign (2)
tumorlike asymmetric enlargement
- early uterine changes of pregnancy
approximate height of the fundus (2)
umbilicus: 20 weeks indicator
under ribcage: approximately 36 weeks
ovary changes in pregnancy (5)
- cease ovum production during pregnancy
- production of FSH/LH ceases
- theca cells form
- hCG forms
- corpus luteum
theca cells (what, becomes active in, known as)
cells lining the follicles
- become active in hormone production
- known as the interstitial glands of pregnancy
hCG (human chorionic gonadotropin) (3)
maintains corpus luteum (persists and produces hormones until 6-8 weeks of pregnancy)
- early placenta takes over
- EXAM: BIOMARKER FOR PREGNANCY
corpus luteum
secretes progesterone to maintain endometrium until placenta produces enough progesterone to maintain pregnancy
- then disintegrates slowly
TIP:
- increase hCG causes N/V
changes in the vagina pregnancy (5)
- 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
secretions in the vagina during pregnancy (2)
- plays a role in preventing infection
- favors growth of yeast
why does the vagina become relaxed in late pregnancy (2)
- permits distention of the tissues
- allows passage of the baby
changes in the breast during pregnancy (6)
- 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)
colostrum in the breast (3)
after 12 weeks (3 months), may leak during last trimester
- similar to human milk
- may be taboo in some cultures
respiratory changes during pregnancy (7)
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
cardiac changes during pregnancy (8)
- 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
blood volume increase during pregnancy (
pregnancy induced hemodilation
- AKA physiologic anemia of pregnancy (pseudoanemia)
causes of increased stagnation of blood in LE (2)
reduction in plasma colloid osmotic pressure maintains fluid in extravascular space (increased risk DVT)
supine hypotensive syndome: vena cava syndrome
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!!
GI changes during pregnancy (6)
- nausea/vomiting
- hyperemia, softening and bleeding gums
- gallbladder changes
- smooth muscle relaxation d/t progesterone
- heartburn (pyrosis)
- hemorrhoids (d/t constipation)
causes of n/v increase in pregnancy
increased hCG in 1st trimester
hyperemia/softening and bleeding of gum (5)
- 50-70% of women expereince some level of gingivitis
- ask mother about last DENTAL visit
- epulis
- ptyalism
- PICA eaters
epulis (3)
gingival granuloma
- benign, growths on gums
- goes away after birth
ptyalism
secretion of excess saliva
PICA eaters
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
gall bladder changes in pregnancy (3)
- emptying time delayed
- gallstones may develop: may need to be removed
- pruitis (itching) d/t retained bile salts
smooth muscle relaxation due to progesterone cause (3)
- delayed gastric emptying
- decreased peristalsis -> progesterone caused
- constipation
TIP:
- decreased progesterone/HCG: miscarriage
heartburn causes (2)
relaxation of sphincter
- reflux of acid secretions
kidneys/urinary tract changes during pregnancy (5)
- 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
causes of dilation of kidneys/urine
progesterone effects on smooth muscle
increased renal function causes (3)
- increased clearance of urea & creatinine
- lower blood urea & nonprotein nitrogen values
- creatinine clearance: provides accurate look at renal function in pregnancy
skin changes during pregnancy (8)
- 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
musculoskeletal changes (4)
- 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)
postural changes during pregnancy
women develop increasing lordosis of the lumbosacral spine and increasing curvative of the thoracic area
eye, cognitive, and metabolic changes (5)
- 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
endocrine changes (6)
- 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
hCG (human chorionic gonadotropin) review (2)
- trophoblast secretes in early pregnancy
- hCG stimulates progesterone & estrogen production by the corpus luteum to maintain pregnancy until placenta can take over
human placental lactogen (hPL) review (3)
- produced by syncytoptiophoblast
- insulin antagonist
- increases circulating free fatty acids for maternal metabolic needs & decreases maternal metabolism of glucose of fetal growth
estrogen review (4)
- 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
progesterone review (3)
- produced initially by corpus luteum, then placenta
- MAINTAINS PREGNANCY
- helps to develop acini & lobules in breasts in preparation for lactation
relaxin review (3)
- inhibits uterine activity (contractability)
- aids in softening of the cervix
- primary source corpus luteum, then placenta (relaxes until labor)
home pregnancy tests - hCG earliest biomarkers (4)
- 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)
a number of changes in the integumentary system occur pregnancy. what change persists after birth?
striae gravidarum
