ch 13 - anatomy and physiology of pregnancy Flashcards
duration of pregnancy (from first day of last normal menstrual period)
280 days
40 weeks
9 months
EGA
estimated gestational age
how long is 1st trimester
0-13 weeks
how long is 2nd trimester
14-26 weeks
how long is 3rd trimester
27-40 weeks
of times a woman has been pregnant including current
gravida
first pregnancy
primigravida
2 or more pregnancies
multigravida
of times a woman has carried a pregnancy > 20 weeks (not counting current pregnancy until after birth)
para
4 parts para is divided into
TPAL:
Term
Preterm
Abortion
Living children
division of para: # of births greater than or equal to 37 weeks
term
division of para: # of births between 20 weeks to 36 weeks + 6 days
preterm
division of para: # pregnancies ending before 20 weeks
abortion
division of para: # of children currently living
living children
what are presumptive signs of pregnancy considered
subjective
presumptive/subjective S+S pregnancy (6)
-breast changes
-N/V
-urinary frequency
-fatigue
-perception of fetal movement
-amenorrhea
what are probable signs of pregnancy considered
perceived by examiner
probable S+S pregnancy (7)
-abdominal enlargement
-chadwicks sign (vaginal mucosa and blue-ish cervix)
-goodell’s sign (pelvic congestion and cervical softening)
-hegar’s sign (softening of lower uterine segment)
-positive serum/pregnancy test
-braxton hicks contractions
-bollottment
probable sign: vaginal mucosa and cervix blue-ish
chadwicks sign
mother’s perception of fetal movement (around 16-20 weeks)
quickening
probable sign: pelvic congestion and cervical softening
goodell’s sign
probable sign: softening of lower uterine segment/isthmus
hegar’s sign
3 categories of S+S of pregnancy
-presumptive signs (subjective)
-probable signs (observed by examiner)
-positive signs (can only be caused by pregnancy)
positive S+S of pregnancy (4)
-visualization of fetus on ultrasound
-auscultation of fetal heart sounds
-palpation of fetal movement by examiner
-visualization of fetal movement by examiner
when examiner pushes up on cervix and baby pushes cervix back down
bollottment
earliest biochemical marker for pregnancy
hCG (human chorionic gonadotropin)
action of estrogen during pregnancy (3)
hypertrophy (enlargement of cells)
hyperplasia (growth of additional cells)
hyperemia (increased blood production, blue-ish)
action of progesterone during pregnancy
relaxation (muscles, joints, capillary system, intestines)
physical changes of the female repro system during pregnancy
-size and shape
-contractility
-blood flow (500 mL/min at term)
-quickening (16-20 wks)
-ballottement
-lightening (38 wks)
-braxton hicks
swooshing sound heard on a doppler due to increased uterine blood flow; pulsating at mother’s heart rate
uterine souffle
swooshing sound heard on a doppler due to increased uterine blood flow through umbilical cord; pulsating at baby’s heart rate
funic souffle
at how many weeks pregnant does the uterus grow above the pubis symphysis
12 weeks
at how many weeks pregnant does the uterus grow above umbilicus
20 weeks
way to measure with tape measurer how many weeks pregnant
from pubis symphysis to top of fundus (in cm) = how many weeks
reasons for uterus measuring bigger than expected during pregnancy (4)
-excess amniotic fluid
-gestational diabetes
-multiple babies
-dates are wrong
vaginal and vulval changes during pregnancy (3)
-leukorrhea (white discharge)
-edema
-varicosities (swollen veins)
cervical changes during pregnancy (2)
-friability (can cause vaginal bleeding, especially after SVE or intercourse)
-mucus plug (operculum)
purpose of cervical plug
extra layer of protection against ascending organisms
changes in breasts during pregnancy (5)
-increased sensitivity
-pigmentation (darker)
-dilation of blood vessels
-striae and enlargement
-colostrum (as early as 16 wks)
cardiovascular system changes during pregnancy (4)
-slight hypertrophy of heart
-blood volume and composition (increases by 40-50%; physiologic anemia, bp maintained because of vasodilation)
-cardiac output increases 30-50% near 30 wks
-hyper-coagulability
heart rate changes during pregnancy
increases 15-20 bpm
consequence of hyper-coagulability during pregnancy
DVT
respiratory system changes during pregnancy (4)
-increased vascularity of upper resp tract w/ edema
-structural adaptation (raised diaphragm, chest expansion)
-pulmonary function (increased sensitivity CO2, increased tidal volume, increased O2 consumption)
-increased basal metabolism rate (increased sweat)
-acid base balance (compensated resp alk: brings more O2 to baby)
normal pH level for pregnant woman
7.4-7.45
vital sign changes during pregnancy (3)
-resting pulse increased 10 bpm
-blood pressure (slightly decreased, vena cava syndrome)
-increased temp
what is vena cava syndrome
-supine hypotension
-pregnant uterus compresses vena cava, blocking blood flow to right side of heart
-decreased oxygenation to fetus
skin changes during pregnancy (7)
-melasma/chloasma (blue/brown discoloration of nose and cheeks)
-linea nigra
-hyperpigmentation
-striae gravidarum
-spider angiomas
-palmar erythema
-pruritus gravidarium (rare condition: PUPP)
what is PUPP
rare condition: puritic uticarial papules and plaques of pregnancy
GI changes during pregnancy
-appetite (N/V/morning sickness)
-mouth (hyperemia, epulis, ptyalism)
-decreased tone and motility (slower stomach emptying, reflux, constipation, hemorrhoids)
swelling of the gums
epulis
excessive salivation
ptyalism
why might appendicitis be difficult to diagnose during pregnancy
appendix is displaced upward and to the right
term for heartburn
pyrosis
musculoskeletal changes during pregnancy (4)
-lordosis (center of gravity changes)
-round ligament discomfort
-common leg cramps
-diastasis recti
renal system and bladder changes during pregnancy (10)
-GFR and renal plasma bloodflow increase
-increased creatinine clearance
-decreased serum creatinine, BUN and uric acid
-renal pelves and ureters dilate (larger volume urine held: stagnate urine, can lead to UTI and pyelonephritis)
-increased glucose (higher chance infection)
-bladder irritability (nocturia, increased frequency)
-increased bladder vascularity
-decreased bladder tone (increased capacity to 1500 mL)
-fluid and electrolytes (increased excretion glucose, protein and albumin)
-urinalysis may have trace protein and +1 glucose
what position during pregnancy increases renal perfusion and function
lateral recumbent
neurological system changes during pregnancy (4)
-sensory changes and muscle cramps in legs
-pain in back
-headache (can have altered vision)
-feeling faint
endocrine changes during pregnancy (4)
-increased estrogen and progesterone
-hCG (increases until produced by placenta)
-prolactin (suppressed until placenta is delivered)
-oxytocin (causes uterine contractions)
normal Hct v pregnant Hct
normal: 37-47%
pregnancy: >33%
normal platelet count v pregnant platelet count
normal: 150,000-400,000
pregnancy: no change until 3-5 days after birth then increases rapidly
