Chapter 13 Flashcards
Pregnancy is also known as ___
Lasts about how many weeks /days ?from her last menstrual period or from 266 from conception
Gestation
40 weeks or 280 days
Maternal physiological adaptions affect all body systems and are attributed to the hormones of pregnancy and to mechanical pressures arising from the enlargement of the uterus
What do you think these adaptions do?
Protect woman’s normal physiologic functioning
Meet metabolic demands
Provide nurturing environment for fetal development
What hormones help stimulate significant uterine growth in the first trimester ? (2)
Estrogen and progesterone
What are 3 things that help early uterine enlargment ?
Think about physical changes in the vagina, and muscles around it
Vascularity ( dilation of blood vessels )
- opening up the uterine
Hyperplasia ( new fibers )
- providing more support
Hypertrophy ( enlarged muscles )
- opening up for more space
So of course, as the uterus is enlarging, it’s going to change shape and position
By __ weeks, the uterus is from non pregnant pear shape to what shape ; and becomes larger and more ovoid as the term contuines
12 weeks
Spherical or globular shape
During the first trimester typically women don’t show signs of pregnancy until 12 weeks have passed, in which we can see a little rise from the
___ into the ___
Take into account that this may differ for every woman however we can see the enraging uterus with tests
Pelvis into the abdominal cavity
As the uterus is growing, how can it be palpated ?
And during which weeks?
Above the symphysis pubis
12th-14th week
When the uterus has grown to the level of umbilicus by ____ it is nearly reaching the diploid process
20-22 weeks
As we come to the end of the pregnancy
( week 38-40 ) we will see a decrease in fundal height, why?
Because the fetus begins to descend into the pelvis ( also called lightening ) in order for birth
What does lightening mean?
When the fundal height decreases near the end of pregnancy in order for birth
When does lightening usually occur?
usually happens 2 weeks before labor
As the uterus enlarges, most organs are going to be displaced, an example of this is how the intestine will move to either side of the abdomen.
However the biggest thing to note is that when a pregnant woman is standing, most of uterus is resting against the abdominal wall, which means this alters her???
Center of gravity
At what weeks of gestation, does softening and compressibility of lower uterine segment occur?
6 weeks
What does hegar sign mean and when does it occur?
Softening and compressibility of the lower uterine segment
6 weeks
The hegar signs results in what for woman?
Urinary frequency because the uterine fundus pressures on the urinary bladder
When do women typically feel the Braxton hicks?
4th month of pregnancy
What are Braxton hicks contractions function?
Enhance blood flow through the intervillous spaces
Are braxton hicks contractions painful?
And how do you relieve?
No
Walking & exercise
Placental perfusion is all dependent on the mother blood flow to the uterus.
So what factors do you think would decrease this blood flow (3)
Low maternal arterial pressure
Uterine contractions
Maternal supine position
( laying on back )
What is a hormone that can help promote this placental perfusion that is dependent on the mother for the baby?
Estrogen!!!
( this helps with baby growth!!! )
What is a machine we use to measure uterine blood flow velocity?
Doppler ultrasound!
What is a uterine soufflé or bruit?
Rushing or blowing sound of maternal blood flowing through uterine arteries that is synchronous to the maternal pulse
What is the funic soufflé ?
Fetal heart rate or fetus heartbeat!
What is a Ballottement ?
Passive movement of unengaged fetus
When can you examine for Ballottement?
Weeks 16-18 of gestation
How can you palpate for a Ballottement?
Place finger inside vagina, pressure upwards on ther cervix, baby will rise & then drop back on the finger and its a gentle tap
What is quickening?
The first recognition of fetal movements ( flutter )
When is quickening occurring ?
14-16 weeks
Do you contuine to feel quickening as you progress pregnancy?
Yes
The cervix changes from a firm non distensible structure during pregnancy to highly elastic and soft why?
Preparing for labor or birth
In a normal unscarred cervix we can see the softening of the cervix at what week?
What is this sign called?
6th
Goodell sign
The glands near the cervix making it velvety in appearance can be easily damaged by deep penetration or examination and results in the term?
Friability
When pregnant you have an increase in mucus resulting in?
Which is?
Operculum
Protects the uterus from bacterial infections
Ovulation of pregnancy doesn’t occur because of?
Estrogen and progesterone stopping the FSH hormone and LH
Where is estrogen and progesterone made before the placenta takes over?
Corpus luteum
( first 6-10 weeks )
What does amenorrhea mean?
Menstrual period cease
What is the Chadwick sign & when ?
Violet blue of vaginal mucosa & cervix
6-8 weeks
Vaginal discharge increased during pregnancy & releases this white gray with odor called?
Leukorrhea
Since muscus in the vagina are there to help remove bacteria infections, it’s unfortunate enough that glucose is high during pregnancy, which woman more at risk for?
Candidiasis
Which does estrogen and progesterone function for in the breast?
Growth of the breast
Proliferation of lacticerous ( milk ducts )
Estrogen - milk
Progesterone - growth
Are you able to breastfeed during pregnancy? Why or why not?
No because while the development is done, lactation needs to wait until progesterone levels decrease after birth to lactate
What are the 3 functions of estrogen?
Suppressing FSH & LH ( stop menstrual )
Growth fetal organs
Maternal growth ( breast & urterus )
Estrogen suppressing the FSH and LH causes the anterior pituitary gland to increase the thyroid gland.
Meanings it increasing what two things?
Metabolism & appetite
Just to review where does progesterone and estrogen come from before the growth of the placenta of week 12?
Corpus luteum
What does striae mean?
Stretch marks
Do we have high blood pressure in pregnancy? Why?
No
Because progesterone relaxes smooth muscles, meaning it dilates in order to pump blood
How much blood flow is increased in a pregnant woman?
40-50%
What is a very dangerous syndrome that woman can get if they lay on there back?
Supine postural hypotensive syndrome
What is supine postural hypotensive syndrome?
Where the uterus pushes so much pressure on the inferior vena cava ( which runs from the back to the top )
That it lowers the blood pressure even more
Uterus pressure - > no good blood flow - > hurt the baby
How do you resolve supine postural hypotensive syndrome?
Lay on your left side
( since the heart moves left a little due to uterus pressure )
Since estrogen is helping growth the breast and the utreus, what is it going to do when it compresses the pelvic blood vessels ?
Cause varicose veins because lack of venous return
The uterus is also pushing up on the diaphragm making it hard to breathe and on the stomach causing GERD & heart burn, but what happens later on that causes further complications near Labor Day?
Drops down and drops on bladder ; making peeing more frequent
Since the lungs are requiring more oxygen, the progesterone is telling the body to breathe more but that results in more CO2, so the way our body regulates that is through the secretion of?
When this is secretion it either makes the blood (2)?
Bicarbonate
Normal or alkolydic ( basic )
Since our blood flow and GFR are causing more peeing to occur, pregnant woman are more prone to?
( because of the stasis and enlargment of the urine and uterus )
UTI or pyelonephritis
( kidney infection, flank pain )
How much weight does a pregnant women normally gain?
25-35 pounds
Blood volume - 4 pounds
Fat - 3-10 pounds
Fetus - 7-8 pounds
Placenta 6 pounds
Breast 3-4 pounds
___weeks can be palpated above symphysis
___weeks level of umbilicus
___ fungal height = weeks pregnant
___weeks fundal height will drop
12-14 weeks
20-22 weeks
24 weeks
( so 24cm height should match 24 weeks )
38-40 weeks
What is lightening ?
Multip ( more pregnant ) - start of labor
Primip ( first baby ) - 2 weeks prior of labor
Fundal height decreases at 38 weeks and drops down to prepare for delivery
What is hegar sign?
When is hegar sign?
Softening of lower uterine segment of often feels like the uterus and cervix
( feels like two things if you were doing an exam )
Before the goodell sign
6 weeks
What is Ballottement ?
And when ?
Passive movement of unegaged fetus
16-18 weeks
What is quickening ?
When is it?
First feeling of fetal movement
14-16 weeks
What is goodell sign?
When is this?
Softening of cervical tip
6th week
What is Chadwick sign
And when?
Violet blue color of vaginal mucosa
6-8 weeks
What is physiologic anemia of pregnancy?
Plasma volume increases more quickly than red cell mass
( not true anemia, this is because we increase mom blood flow with so much blood, that we have diluted the RBC, giving this fake illusion of anemia )
What is presumptive signs ? (6)
This is felt by mom
Breast changes
Amenorrhea
Nausea
Urinary frequency
Fatigue
Quickening
Presumptive signs anagram
BAN
UF(C)Q
What is probable signs
( examiner feels this might be pregnant ) (6)
Goodell sign - softening of uterine
Chadwick sign - blue on cervix
Hegar sign - separation of urteus & cervix
Positive pregnancy test
Braxton hicks contractions
Ballottement
Probable signs anagram
Good
Chad
Hates
Positive
Brax
Ball
What is positive signs ? (3)
( 100% pregnant )
Ultrasound & x ray
Fetal heart tones
Fetal movement/visual by examiner
(PALPATED BY EXAMINER )
Why is positive pregnancy test a probable sign and not positive?
Because a false positive can be from like cancer
Notes
HCG - maintains corpus luteum production of estrogen and progesterone until placenta takes over ( week 10 )
Progesterone
- main hormone to maintain the pregnancy
- suppress FSH & LH
- relaxing smooth muscles & descrease uterine contractility
- fat deposits in subcutaneous tissue
Estrogen
- suppress FSH & LH
- promotes fetal growth
- promotes enlargment of breast
- increase vascularity
- relaxes pelvic ligaments and joints
Blood volume increased by how much?
Cardic output increased what ?
Because of the increase blood volume and the progesterone rexlaxes the smooth muscles, this causes low blood pressure in the first-second trimester
40-50%
30-50% during pregnancy
Post patrum mothers and pregnant moms Are in this state of hypercoagulable state meaning?
More prone to blood clots
Maternal oxygen consumption increases by?
20-40%
The chest breathing replaces abdominal breathing because of?
The displacement of the diaphragm
And it causes SOB
You want to be careful with mothers respiratory since they do have SOB however we always want to provide and encourage breathing since pregnancy is always in a state of
Respiratory alkalosis
Hyperpigmentation is a very common sign of condition in pregnancy and it’s caused by the APH ____
Melanotropin
Melanotropin can increase
Melasma?/chloasma ?
Linea nigra?
Straie gravidarum ?
Angiomatas?
Palmar erythema?
Pruritus gravidarum?
Face mask, black marks on face
Black line on stomach
Stretch marks
Red raised areas
Red hands
Increased Itching
( terribly during pregnancy ) ^^
Nausea and vomitting will peak at what week?
9 weeks
What is pica ?
No food cravings
What is ptyalism?
Excessive salivation
What is pyrosis?
Heartburn
You’ll have an increase total body water of __ by term
6.5-8.5L
Mothers will have lordosis meaning?
Bump first and back is bent
Headaches are common in pregnancy
What’s the difference?
If headaches aren’t relieved by medication then it’s more serious
