Changes In Pregnancy Flashcards
What is a symptom?
Something the patient complains of
What is a sign?
Something the doctor can see that represents disease
What are symptoms of pregnancy?
- Sickness
- breast tenderness
- change in taste and sense of smell
- food cravings/aversions
- increased hunger
- unusual vaginal bleeding, spotting, cramps
- missed period
- urinary frequency increased
- swollen ankles
- tired
- heatburn
What are the signs of pregnancy?
- increases in pigmentation e.g. darker nipples
- dark line down the centre of the abdomen (linea nigra)
- abdominal swelling
- ill fitting bra
What is hyperemesis gravidarum?
Extreme persistent nausea and vomiting during pregnancy
What hormone does the hypothalamus release during the menstrual cycle?
GnRH
Which hormone is present in high concentration in the first trimester of pregnancy?
hCG
Which hormones increase towards the end of pregnancy?
Progesterone and oestrogen
When is pregnancy measured from?
The first day of the last menstrual period
What does hCG do?
- maintains the corpus luteum
- stimulates the CL to produce oestrogen/progesterone
- maintains the endometrium
Where is hCG secreted from?
The trophoblast
What does progesterone do?
- t is a smooth muscle relaxant
- regulates homeostatic functions (respiratory centre, kidney/adrenal renin angiotensin aldosterone system)
What does progesterone act on?
- uterus
- blood vessels
- GI tract
- ureters
- bronchi
- vagina
- ligaments
How does progesterone affect the respiratory system?
- progesterone increases chemoreceptor sensitivity to CO2 in the brain
- ventilation increases
- reduced partial pressure of CO2
How does progesterone affect the blood vessels
- relaxation of smooth muscle in vessel walls
- vasodilation
- increase in blood flow
- reduction in blood pressure
How does progesterone affect the GI tract?
- relaxation of smooth muscle
- delayed gastric emptying
- indigestion
- increased risk of aspiration under anaesthetics
How does progesterone affect the urinary tract?
- relaxation of smooth muscle
- stasis of urine
- increased risk of urinary tract infection
What does the placenta do?
- produces steroid homones to support pregnancy (oestrogen and progesterone)
- becomes primary support for growing foetus by 10-12 weeks
- produces peptides (hPL and hCG)
What happens to the cervix during pregnancy?
- becomes soft and swollen
- increased vascularity
- increased mucus production
- remodelling of cervical collagen
What effect does vasodilation have?
- decreased haemoglobin haematocrit serum albmin
- increased blood flow
- increase stroke volume
What happens to the blood?
- increase erythrocyte production
- decrease in red blood cell conc (due to fluid retention)
- Hb falls
- increased white blood cells
- increase in neutrophils compared to T or B lymphocytes
- decreased platelet count
- increase in younger larger platelets
What is a hypercoagulable state?
Clotting is more likely to occur
Why is a hypercoagulable state important for pregnancy?
For placental separation
What complication does a hypercoagulable state present?
Clots more likely to occur e.g. deep vein thrombosis
How is the cardiovascular system affected?
- increase in stroke volume
- heart sounds representative of hyperdynamic circulation
What is Starlings Law?
The strength of heart contractions is directly proportional to diastolic expansion
What is blood pressure regulated by normally?
Renin angiotensin system
What happens to the renal system?
- enal blood flow determines the rate of filtration
- filtration rate increases
What does Human Placental Lactogen do?
Acts as anti insulin
What can happen if the placenta fails?
Hypoglycaemia
What changes affect respiration?
-increased O2 demand
-increased CO2 production (due to foetal metabolism)
increasing size of foetus reduces space for lung expansion
What happens to the breasts?
- the lactiferous ducts develop
- 8-14lobes - each one drains to a mammary duct
- secretory alveoli develop at the end of the ducts
- oxytocin - milk ejection
- prolactin and placental lactogen in the presence of oestrogens, progesterones and growth factors
