Ch. 7: Physiological Changes in Pregnancy Flashcards
a woman who is pregnant
gravida:
Pregnancy; pregnant; number times been pregnant
gravidity:
a woman who has had 2+ pregnancies
multigravida:
a woman who has never been pregnant
nulligravida:
capacity to live outside the uterus; use 20 weeks as cut off, greatly varies, but typically 22-24
viability:
the # of pregnancies in which the fetus(es) have reached viability, not the number of fetuses born.
parity:
a woman who has completed 2+ pregnancies to the stage of fetal viability (beyond 20 weeks)
multipara:
a woman who has not completed a pregnancy with a fetus or fetuses who have reached the stage of fetal viability (not reached at least 20 wks)
nullipara:
a woman who is pregnant for the first time.
primigravida:
a woman who has completed one pregnancy with a fetus or fetuses who have reached the stage of fetal viability (20 weeks)
primipara:
a pregnancy that has reached 20 weeks of gestation but before completion of 37 weeks of gestation. (count weeks and days in pregnancy); after 20 weeks
preterm:
miscarriage or elective termination of pregnancy before viability. (before 20 weeks); pregnancy lost before 20 weeks
abortion:
a pregnancy from the beginning of week 38 of gestation to the end of week 42 of gestation.
term:
a pregnancy that goes beyond 42 weeks of gestation.
postdate or post-term:
G = gravidity (gravida ___)
T = term births (after 38 weeks)
P = preterm births (after 20 weeks; 20-end 37th weeks)
A = abortions (before 20 weeks)
L = living children (currently)
GTPAL
3 categories signs prengnacy: possible and felt by women; presuming pregnant
amenorrhea:
nausea and vomiting:
fatigue:
breast changes:
urinary symptoms:
weight gain:
quickening:
Things feel and not corroborate as provider
Possible/presumptive signs - felt by the woman
~4 weeks, missed period
Secondary amenorrhea
amenorrhea:
4 - 14 weeks, 50-75% feel - over ½ women experience morning sickness in first trimester
Having this Not mean pregnant
nausea and vomiting:
~12 weeks
fatigue:
3-4 weeks, tingling, tenderness, pain, increased vascularization
Bilateral or unilateral; may have fibrocystic breast changes
breast changes:
6-12 weeks, urgency, frequency, increased uterine pressure
Pee all time; may have UTI
urinary symptoms:
usually small amount at first - first trimester weight loss - N&V; food aversion and smell aversion
Could be hormone or psychological issue
weight gain:
16-20 weeks, first fetal movement - first time in mom
Something moving in belly - butterflies; OR bad gas
quickening:
Probable signs - not 100% but leaning towards it
Hegar’s Sign:
Goodell’s Sign:
Chadwick’s Sign:
Urine pregnancy tests:
Abdominal changes:
Ballotment:
Possible signs - observed by examiner
6-12 weeks, softening of the lower uterine segment - bimanual exam
Second ½ first trimester
Hegar’s Sign:
~ 5 weeks, softening of the cervix
Bimanual exam
Cervix usually feels like point of nose normally
Goodell’s Sign:
6-8 weeks, bluish or purplish color of the cervix, vagina and vulva - speculum in and see pregnant - usually PALE PINK
Chadwick’s Sign:
detects HCG
PROBABLE SIGNS - not positive signs
Home prengnacy tests delay prenatal care depending on if want pregnancy; if want it get in there soon; pit tumors push off HCG; cancer endometrium, cancer inside uterus
Urine pregnancy tests:
pregnancy may show after 14 weeks, 16 weeks Braxton Hicks - irregular, painless
Feel uterus by belly button - could be that or tumor
Abdominal changes:
16-28 weeks, passive movement of the unengaged fetus when tapped or pushed
Bimanual exam - tap cervix and feel something solid move away then come back - baby or polyp or tumor - weight distribution surrounded fluid
Ballotment:
Heart Tones
Visualizing the fetus via ultrasound - purposeful movements
Palpating the fetal movements - provider putting on belly and feel foot, hand, elbow; gas not do that
Positive signs
Sharper sounds - valves closing
Placenta - wooshing wind in trees
Fast fetal HR - 110-160
Heart Tones
Uterus
Cervix
Adaptations: uterus
Enlargement…Duh!
Braxton Hicks Contractions
Uteroplacental Blood Flow
BIGGER
Uterus
Goodell (Softening of Cervix) and Chadwick (Increase vascularity, violet bluish color of vaginal mucosa).
Mucus plug - seals off uterus from vaginal canal - protect baby; another layer protection
Mucus increases in amount and thickness
Bloody show: usually a sign of cervical changes
Friability: bleeds easily when scraped or touched - vascular; estrogen makes things vascular - estrogen is high in pregnancy - so is progesterone; estrogen makes things grow; sex and sneezing make bleed
Changes after giving birth
Nullipara vs multipara
Cervix
Some dilation, cervical opening more oval shape
Multipara-
No dilation, cervical opening more round shape
Nullipara-
Leukorrhea: thick white acidic discharge, prevents pathogenic infections - increase WBC - another layer protection for fetus
Glycogen stores increased
Estrogen: Increased vascularity: things swell: edema, varicosities of vulva - varicose veins in labia
Perineum: increased vascularity, hypertrophy of skin and muscles, loosening of connective tissue - perineum has stretch a lot - blood supply going to it making tissue bigger, making muscles bigger, and loosening CT to accommodate baby
Adaptations: vagina
Response to cervical stimulation by estrogen and progesterone
Leukorrhea: thick white acidic discharge, prevents pathogenic infections - increase WBC - another layer protection for fetus
Prone to yeast infections
BV and yeast risk increases; hormone changes; glycogen stores increased
Glycogen stores increased
Increase fullness and size due to increase levels of progesterone and estrogen (makes things grow)
Bigger when pregnant and lactating
Pigmentation changes; areola darkening and bigger and prominent (prime the pumps), nipples more erect (more lubricated)
Stretch marks on them
Montgomery’s tubercles: keeps nipples lubricated for breastfeeding
Striae gravidarum - stretch marks
Colostrum: thick yellow fluid can be expressed from 2nd trimester on - leaking it - priming the pump; not milk
Adaptations: breasts
Lot CV changes
Slight cardiac hypertrophy - ventricular hypertrophy and muscle and ventricles little bigger - pumping harder
Apical pulse shifts to left as belly grows - putting pressure on heart upward - belly bigger pushes everything out way
CO increasing
Everything increases
Heart rate increases ~10 to 15 bpm between 14 and 20 weeks - BMR up; up beating harder and muscle bigger
Murmurs may be present - hear now; HR higher and everything shifting anatomically and hear benign systolic murmurs; after baby, goes away
Undiscovered Anomalies - notice hole in heart - major CV changes and heart showing everything
Adaptation: CV sys
Modifiable factors:
Trends:
Adaptation: BP
Anxiety
Position
Equipment type - use appropriate size BP cuff
Modifiable factors: - Adaptation: BP
Supine hypotensive syndrome - After 20 weeks not lay on back - direct pressure on IVC - sick to stomach and baby not get perfusion - lean more to left side - IVC slightly to right side - can do right but as long as not flat fine
Promotes leakage of fluid from capillaries into the intercellular spaces -> lower extremity edema is frequent finding in late pregnancy
Position
First Trimester:
Second Trimester:
Third Trimester:
Blood in body - 4L; pregnancy up to 50% more; not have vasodilation - have increased BP; add some more volume (more plasma than RBC) and not affect BP - vascular resistance decreases in pregnancy; CO and HR more; more of and SVR decreases; amount of blood up; muscle thicker - pushed to side; resistance dropped because progesterone
Trends: - Adaptation: BP
remains same as pre-pregnancy level (i.e 120/60)
First Trimester:
decrease in blood pressure: related to blood vessel tone decreased and decreased peripheral vascular resistance (ie. 108/52)
Syncopal episodes - decreased tone - caused by progesterone (nice and smooth and relaxed - vessels relaxed - BP lower as a result)
Second Trimester:
returns to first trimester levels/baseline (120/60)
Because make more blood
Third Trimester:
Physiologic anemia: hemodilutional effect of increased plasma - more plasma than RBC components - H&H slightly lower - 11 great number and norm if pregnant; would be anemic if not pregnant
Increase in WBC’s second and third trimester - protective mechanism
Increases in clotting factors
Fluid Increases by 1-2 liters
Cardiac Output increases 30-50% above baseline
Everything up except SVR
Adaptation: blood
greater tendency for blood to clot
Prevent bleeding to death - need clotting factors higher
protective function, to combat childbirth blood loss
More vulnerable to thrombosis (DVT) - higher risk for clotting; not do bed rest
Increases in clotting factors
buffers circulatory system to make up for blood loss during childbirth
meets increased circulatory needs of maternal/fetal unit during pregnancy (protective mechanism)
New organ have perfuse: placenta have perfuse
Fluid Increases by 1-2 liters
Resp sys go faster as well
Increase in maternal oxygen requirements
Diaphragm displaced (rises ~ 4 cm) - shifted up
Progesterone increasing BMR; taking more breaths - hormone changes more breaths and tell it; sitting at rest and SOB
Dyspnea (physiologic) - body have work hard to perfuse another human
Increase in vascularity (from estrogen stimulation) - tissues swell - nasal cavities
Respiratory rate slightly increased (~ 2 breaths per minute)
Increased oxygen requirement – 10 to 20% as a result of increased BMR - heart beating fasting, breathing more and off more CO2
Adaptation: resp sys
Work harder perfuse another human being
nasal and sinus stuffiness entire pregnancy - swelling in nose, nose bleeds
Increase in vascularity (from estrogen stimulation) - tissues swell - nasal cavities
Anatomic changes R/T
Functional changes
Bladder irritability, nocturia, frequency, urgency occurs in early pregnancy and returns near term.
As belly bigger bladder right beneath
Bladder has increased capacity, walls hypertrophy/bigger in later pregnancy, more susceptible to injury and trauma at birth. - little more capacity; also because where is more susceptible to injury where is - underneath bladder - thicker protect itself
Adaptation: renal sys
Hormonal activity,
Pressure from the growing uterus,
Increase in blood volume
Anatomic changes R/T
Increased GFR - Peeing more - GFR 50% greater; hormone changes, increased HR and GFR causing more pee - more volume; as belly bigger, uterus putting pressure on bladder
results in urinary stasis - may have this; because of progesterone; makes everything chill; ureters smooth muscle and relax; deep relaxing
increases susceptibility to UTI’s in pregnancy - asymptomatic; not feel same when pregnant; test have with that
Functional changes
Not matter on cream; genetics - all about elasticity
May fade but not always go away because tissue stretched - not automatically go back together
Hyperpigmentation
Accelerated nail growth - cut nails twice a week
Massive swelling across face; acne
Palmar erythema
Mechanical stretching
Adaptation: integumentary sys
Linea Nigra - tell had belly
Nipples - darker
Vulva - darker
Axillae - darker
pH changing; some women get the glow
Hyperpigmentation
striae gravidarum: stretch marks, 50-80% of gravidas
Mechanical stretching
Alterations in posture (lordosis) - walk: wide stance, leaned back; throw all weight towards back (normally center gravity in pelvic) - center gravity shifts upward and outward - risk falls greater so situate stance - lot more lordosis
Musculoskeletal discomforts
Relaxation and increased mobility of the pelvic joints
Diastasis recti abdominus - Rectus abdominus - stretches - persist and go get PT; toned abdominal muscles before pregnancy and cont work on it while pregnant stay toned - separation: lot work; multiple pregnancies to term more issues
Relaxin - everything relaxed; all joints more relaxed; more clumsy; center gravity diff; joints changed
Adaptation: MS sys
uterine ligaments stretching
legs cramping
Musculoskeletal discomforts
Change in gait
Relaxin & Progesterone
Relaxation and increased mobility of the pelvic joints
Pressure on nerves; sciatic pain
Paraesthesia in hands
Compression of nerves or vascular stasis sensory changes in legs (sciatica)
Dorsolumbar lordosis
Carpal tunnel syndrome - estrogen swell
Acroesthesia (numbness and tingling of hands)
Tension headache - hormonally driven
Lightheadedness, faintness, syncope
Seen more often in second - syncope - with drop BP
Adaptation: neurologic sys
Appetite and food intake fluctuate
Mouth
Esophagus, Stomach, and Intestine
Adaptation: GI sys
morning sickness, nausea and vomiting
alteration in sense of taste and smell - love to eat no longer; taste aversions or cravings
Appetite and food intake fluctuate
Epulis - overgrowth gums; Estrogen make things grow even things not supposed be there
Pytalism - excessive salivation
Mouth
Increased progesterone causes decreased tone and motility (pyrosis, constipation) - everything relaxed - gastric reflux; slowing lower intestine (constipation)
Displaced appendix - can have appendicitis; not contracting and severe pain, fever - appendix up near ribs; may need do appendectomy
Esophagus, Stomach, and Intestine
Pelvic heaviness or pressure
Round ligament tension
Flatulence - gas
Distention
Bowel cramping
Uterine contractions
Abdominal discomfort
Estrogen
Progesterone
RELAXIN
Prolactin
Oxytocin
Adaptation: Endocrine sys
Promotes enlargement of genitals, uterus, breasts
Increase in size and number of myometrial cells
Produced by corpus luteum until ~ 14 days, then the placenta
Relaxation of pelvic ligaments and joints
Increases vascularity and vasodilation
Water retention
Decreases maternal ability to use insulin
PROMOTES GROWTH AND VASCULARIZATION; EVERYTHING BIGGER
Makes muscle uterus bigger - water retention
This with progesterone affect ability use own insulin
Estrogen
Produced by corpus luteum until ~ 14 days, then the placenta
Increases significantly and is essential in maintaining the pregnancy
Relaxes smooth muscle
Decreases maternal ability to use insulin
Keeps everything in check; esp estrogen
This with estrogen affect ability use own insulin
MAINTAINS PREGNANCY
SMOOTH AND RELAX
Progesterone
Placental hormone
Affects tone ESP AT LEVEL OF JOINTS
RELAXIN
Produced by the anterior pituitary
Begins to rise early in the first trimester, increases progressively to term.
Responsible for initial lactation
High levels of progesterone and estrogen inhibit lactation by blocking the binding of prolactin to breast tissue until after birth
LACTATION
KEPT IN CHECK BY ESTROGEN
Not start lactating until placenta delivered - unless already breastfeeding
Prolactin
Produced by the posterior pituitary
Increases in amount as the fetus matures
Stimulate uterine contractions during pregnancy and labor
Progesterone prevents contractions until near term. PROGESTERONE KEEPS IN CHECK
Stimulates let-down or milk-ejection reflex after birth
ORGASM, MILK LET DOWN, BABY DELIVERED
LOVE HORMONE
Oxytocin
