Ch 13 Anatomy And Physiology Of Pregnancy Flashcards
Gravidity
Pregnancy
Term birth
After 37 weeks
Preterm
Born prior to 37 weeks
Abortion
Termination of a fetus
Spontaneous or therapeutic
Living
Number of children a woman has that are alive
Primagravida
Pregnant for first time
Multigravida
Been pregnant multiple times
Gtpal
- Gravidity
- Term
- Preterm
- Abortion
- Living
Signs of pregnancy
Presumptive, probable, positive
Presumptive signs of pregnancy
Subjective (experienced by Mom)
Amenorrhea, fatigue, breast changes(heaviness or darkened areola), nausea, increased urinary frequency, quickening (movement of fetus felt by patient, 16-20 weeks)
Probable signs of pregnancy
Observable by examiner
1) Goodell sign: noted as early as 5 weeks after conception, softening of the cervix
2) Chadwick sign: week 6-8, bluish purple discoloration of the cervix
3) Hegar sign: week 6-12 softening of the lower segment of the uterus
Uterus presses on bladder, hcg test (4-12 weeks), ballotanet (weeks 16-28, tap on cervix and feel fetus bounce inside)
Positive signs of pregnancy
Only attributed to presence of fetus
Ultrasound (as early as 5-6 weeks)
Fetal hr 6 weeks
Palpation of fetal movement
Leopold’s maneuver
Palpating the outline of the fetus
Reproductive system changes during pregnancy
Uterus increases in size and weight. can be palpated between the synthesis pubis between weeks 12 and 14 and then moves up to the umbilicus weeks 22 to 24
Cervix increases in vascularity, softens, increase in mucus production known as a mucus plug (barrier against infection)
Vagina has increase in secretions called leukorrhea (response to increasing estrogen and progesterone) and Chadwick sign (purplish blue color to the cervix is noted through vaginal canal)
Perineum supports the pelvic structures and can be lacerated during delivery
Breast changes during pregnancy
Stimulated by hormones to prepare for lactation
Colostrum can be noted in the pregnant woman as early as 16 weeks, complete lactation can not occur during pregnancy, until estrogen levels lower after delivery
Striae gravidarum stretch marks on breasts
In pregnancy the heart is…
Displaced to the left
Cardiovascular changes during pregnancy
Cardiac volume increases so cardiac output also increases (about 30-50%)
Heart rate increases 10-15 beats above baseline
BP stays the same in beginning, drops at 20 weeks due to progesterone, by term returns to baseline (increase in BP is abnormal)
Edema can happen because the uterus compresses the iliac veins and inferior vena cava
Pregnancy is considered a hypercoagulable state. Clotting factors increase as a protective mechanism against hemorraging during and after childbirth. Risk for blood clots
Respiratory system changes during pregnancy
Diaphragm is pushed up higher
RR unchanged
Can see slight hyperventilation
Oxygen consumption increases about 15 to 20% from baseline
Respiratory tract becomes highly vascular in response to estrogen leading to increased nasal stuffiness and epistaxis
Dyspnea
Renal system changes during pregnancy
The bladder has a reduced capacity and ureters and kidneys increase in size. Bladder becomes more sensitive because of uterus pressing against it leading to increased urinary frequency.
Urine formation is slightly increased and nocturia is common.
Integumentary system changes during pregnancy
Vascular changes related to hormones and or stretching of the skin. Examples: melasma, linea nigra, striae gravidarum, angiomas, Palmer erythema
Melasma
blotchy Brown spots on face known as The mask of pregnancy
Common in darker complected females. Fades after childbirth.
Linea nigra
Dark line that extends across entire length of pregnant belly, midline.
Has no clinical significance, Fades after childbirth.
Striae gravidarum
Stretch marks
Angiomas
Spider veins
Remain after birth
Palmar erythema
Pink or reddish palms
No clinical significance, Fades after childbirth.
Musculoskeletal system changes during pregnancy
Exaggerated lordosis and wider stance due to change in center of gravity
Hormones influence pelvic expansion, increased softening and elasticity of ligaments, abdominal muscles stretch.
Muscle cramps also common. Educate about importance of fluids and electrolytes and watch for correlation between high blood pressure and muscle cramps.
Neurological system changes during pregnancy
Carpal tunnel can happen related to edema from pressure on the median nerve
Usually occurs in late third trimester
May or may not resolve after pregnancy, patient may need physical therapy after. Would experience paresthesia, pain, and swelling to the wrist
Gastrointestinal system changes during pregnancy
There is an increase in salivation, appetite and thirst.
Nausea and vomiting are common. excessive nausea and vomiting is called hyperemesis gravidarum.
Delayed gastric emptying and intestinal motility
GERD increase and softening of tone in esophagus due to progesterone.
Delayed gallbladder emptying
Pica
Endocrine system changes during pregnancy
Increased estrogen, progesterone, hcg, oxytocin, thyroid gland slightly increases in size
Progesterone job
Maintains pregnancy
Pancreas during pregnancy
Fetus relies on maternal glucose so the fetus pulls glucose from maternal supplies which depletes maternal stores and can result in a decreased blood glucose during first trimester. During the second trimester maternal tissue sensitivity to insulin begins to decline.
Higher blood glucose levels have two major effects:
1) makes more glucose available for fetal energy needs
2) stimulates pancreas of healthy woman to make more insulin
Can maternal insulin cross the placenta?
No
If Mom is hyperglycemic
Baby’s blood glucose level is high too
