Ch. 7 Flashcards
Changes in size, shape, position
High levels estrogen and progesterone stimulate sig uterine growth in first trimester
Early uterine enlargement results from increased vascularity and dilation blood vessels, hyperplasia, hypertrophy, development decidua
Uterine weight increases
Uterus enlarges, changes shape and position
As uterus grows, can be palpated above symphysis pubis between 12-14 weeks; uterus rises gradually to umbilcus 20-22 weeks and almost reaches xiphoid process at term
38-40 wks fundal height decreases as fetus begins to descend into pelvis (lightening) preparing for birth
Uterus enlarges and rises in abdomen, rotates to right - increased tension causes discomfort - eventually touches ant abdominal wall and displaces intestines to either side of abdomen
When standing - most uterus against ant abdominal wall altering center gravity
6 wks gestation - softening and comprssibility lower uterine segment (Hegar sign) - results exaggerated uterine anteflexion during first 3 months of prengnacy - fundus presses on bladder cause experience urinary frequency
Uterus
Responsive to hromonal changes of pregnancy
Firm, nondistensible, closed structure that maintains pregnancy
Goodell sign - increased vascularity, hypertrophy, hyperplasia; 6th week
Friability - tissue easily damaged - slight bleeding after vaginal exam or coitus with deep penetration
Operculuum - mucus fills endocervical canal, resulting in formation of mucous plug in early prengnacy which rich Igs and acts barrier against bacterial invasion of uterus
Cervix
Pregnancy hormones prepare vagina for stretching during labor and birth - causing vaginal mucosa to thicken, CT lossen, smooth muscle hypertrophy, vaginal vault lengthen
Chadwick sign - Increased vascularity resulting in violet-blue color of vaginal mucosa and cervix; 6-8 wks
Leukorrhea - white/slight gray mucoid vaginal discharge with faint musty odor
External structures of perineum enlarged because increased vascularity to pelvis
Vagina and vulva
Fullness, heightened sensitivity, tingling, heaviness breasts early weeks gestation response to high levels estrogen and progesterone
Breast sensitivity varies
Nipples and areolas more pigmented; areolas enlarge, nipples more erectile; blood vessels dilate
Striae gravidarum - stretch marks visible
Breasts
Protect norm physiologic functioning, meet metabolic demands of prengnacy, provide fetal developmental and growth needs
Blood volume
CO
BP
Structural adaptations
Blood compoents
CV sys
Increases 40-45%
Peaks 32 weeks at 1200-1600mL then stabilizes/decreases
Protective mechanism - meet blood volume needs hypertrophied vascular sys enlarged uterus, hydrating fetal and materuanl tissues, fluid reserve compensate for blood loss
Greater with multiple gestations
Blood volume
Increases 30-50% during pregnancy
Peak 25-30 wells
Decline 20% at 40 wks
Increased SV, HR - increased tissue demand for O2
CO
Influenced by CO and SVR
Reduced SVR - vasodilation from progesterone, prostaglandins, relaxin; decreases 30-50%; lowest 16-34 weeks; increases gradually to before pregnancy values by term
BP
Slight cardiac hypertrophy secondary to increased blood volume and CO
Diaphragm displaced upward by enlarging uterus; heart elevated upward and rotated forward to left
Auscultatory changes
Increased risk arrhythmias during labor
Structural adaptations
RBC mass 20-30% more
Depends on amount Fe available
WBC count increases 2nd month then levels off
Blood compoents
40% above levels - support body
Can have dyspnea
Structural adaptiations - Resp sys
O2 consumption increases 20-40%
Tidal volume increases 40% during pregnancy
RR not change by minute ventilation increases 30-50% - increased progesterone and BMR
Pulm func - Resp sys
Gyms - hyperemic, spongy, swollen
Bleed easily
Avoid trauma to gu,s
Mouth - GI sys
Decreased tone and mobility sooth muscles
Increased hiatal hernia incidence
Constipation common
Gut microbiome changes - bacterial diversity decreases and with overall increase in totalmicrobiota - influenced by diet
Esophagus, stomach, intestines - GI sys
80% experience nausea with/without vomiting
4-6 weeks gestation; peaks 8-12 weeks; subsides end first trimester
N&V - GI sys
Changes renal structure from hormonal activity, enlarging uterus, increase blood volume
Kidneys enlarge during pregnancy
Urine flow rate slowed
Structural adaptation - Urinary sys
Renal plasma flow rises significantly from early in pregnancy to 60-80% by second trimester
GFR increases 50%
Renal func - Urinary sys
Hyperpigmentation
Linea nigra - symphysis pubis to top fundus in midline - hormone induced pigmentation - some have hair growth with or without this; some not have this
Nail and hair growth accelerated
Integumentary sys
Changes in posture
Pelvis tile forward and abdominal muscle tone decrease and weight bearing increases - require realignment spinal curves - center gravity shifted forward
Waddling gait common
Muscles abdominal wall stretch and lose tone
Leg cramps likely occur
MS sys
Headaches from muscular contraction, tension, migraine without aura
Tension headaches - hormonal changes, eyestrain, emotional tension, nasal congestion, fatigue
Lightheadedness, fairness, syncope common early
Alterations sleep
Ocular changes
Olfactory sense altered - enhanced
Edema - peripheral nerves: carpal tunnel syndrome last semester
Neurologic sys
Hyperplasia and increased vascularity thyroid gland - enlargement and increased production thyroid hormones
Hormones and BMR rise - 25% over pregnancy
Thyroid gland - Endocrine sys
Increases in size - prolactin-producing cells: levels rise 5th week pregnancy and by term increased 10fold
ACTH reduced early; ACTH and cortisol increase steadily as pregnancy progresses
Pit gland - Endocrine sys
After First trimester - insulin needs increase
Hormones pregnancy act as insulin antagonists to ensure adequate glucose supply for fetus
Beta cells in islets of Langerhans hypertrophy and hyperplasia to incrase insulin production
Pancreas - Endocrine sys
