Ch 13 Anatomy And Physiology Of Pregnancy

Question 1

Gravidity

Answer 1

Pregnancy

Question 2

Term birth

Answer 2

After 37 weeks

Question 3

Preterm

Answer 3

Born prior to 37 weeks

Question 4

Abortion

Answer 4

Termination of a fetus

Spontaneous or therapeutic

Question 5

Living

Answer 5

Number of children a woman has that are alive

Question 6

Primagravida

Answer 6

Pregnant for first time

Question 7

Multigravida

Answer 7

Been pregnant multiple times

Question 8

Gtpal

Answer 8

1. Gravidity
2. Term
3. Preterm
4. Abortion
5. Living

Question 9

Signs of pregnancy

Answer 9

Presumptive, probable, positive

Question 10

Presumptive signs of pregnancy

Answer 10

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)

Question 11

Probable signs of pregnancy

Answer 11

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)

Question 12

Positive signs of pregnancy

Answer 12

Only attributed to presence of fetus
Ultrasound (as early as 5-6 weeks)
Fetal hr 6 weeks
Palpation of fetal movement

Question 13

Leopold’s maneuver

Answer 13

Palpating the outline of the fetus

Question 14

Reproductive system changes during pregnancy

Answer 14

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

Question 15

Breast changes during pregnancy

Answer 15

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

Question 16

In pregnancy the heart is…

Answer 16

Displaced to the left

Question 17

Cardiovascular changes during pregnancy

Answer 17

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

Question 18

Respiratory system changes during pregnancy

Answer 18

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

Question 19

Renal system changes during pregnancy

Answer 19

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.

Question 20

Integumentary system changes during pregnancy

Answer 20

Vascular changes related to hormones and or stretching of the skin. Examples: melasma, linea nigra, striae gravidarum, angiomas, Palmer erythema

Question 21

Melasma

Answer 21

blotchy Brown spots on face known as The mask of pregnancy

Common in darker complected females. Fades after childbirth.

Question 22

Linea nigra

Answer 22

Dark line that extends across entire length of pregnant belly, midline.

Has no clinical significance, Fades after childbirth.

Question 23

Striae gravidarum

Answer 23

Stretch marks

Question 24

Angiomas

Answer 24

Spider veins

Remain after birth

Question 25

Palmar erythema

Answer 25

Pink or reddish palms

No clinical significance, Fades after childbirth.

Question 26

Musculoskeletal system changes during pregnancy

Answer 26

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.

Question 27

Neurological system changes during pregnancy

Answer 27

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

Question 28

Gastrointestinal system changes during pregnancy

Answer 28

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

Question 29

Endocrine system changes during pregnancy

Answer 29

Increased estrogen, progesterone, hcg, oxytocin, thyroid gland slightly increases in size

Question 30

Progesterone job

Answer 30

Maintains pregnancy

Question 31

Pancreas during pregnancy

Answer 31

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.

Question 32

Higher blood glucose levels have two major effects:

Answer 32

1) makes more glucose available for fetal energy needs

2) stimulates pancreas of healthy woman to make more insulin

Question 33

Can maternal insulin cross the placenta?

Answer 33

No

Question 34

If Mom is hyperglycemic

Answer 34

Baby’s blood glucose level is high too