Chapter 13: Anatomy & Physiology of Pregnancy Flashcards
Antepartum ?
Conception to labor
Intrapartum ?
Labor to birth of placenta
Postpartum ?
Birth until body return to normal (typically about 6 weeks after birth)
- 6weeks postpartum visit suggested
Gestation ?
Weeks since first day of LMP
Abortion ?
Birth before end of 20 weeks
Preterm ?
Pregnancy reached 20 weeks, but before completing 37 weeks of gestation
Term ?
Beginning of week 38 to end of week 42
Postterm ?
After 42 weeks
Viability ?
Ability to live outside the uterus
- 22-25 weeks
- Fetal weight over 500g
Gravida ?
A women who is pregnant
Parity ?
of pregnancies that reached 20 weeks
Nulligravida ?
Never been pregnant
Primigravida ?
Pregnant for 1st time
Multigravida ?
2 or more pregnancies completed to 20 weeks or more
Nullipara ?
No completed pregnancy that has reached 20 weeks gestation
Primipara ?
One pregnancy completed that has reached 20 weeks gestation
Multipara ?
2 or more pregnancies that reached 20 weeks of gestation
Stillbirth ?
Fetus born dead after 20 weeks
What does GTPAL stand for ?
- Gravida
- Term
- Preterm
- Abortion
- Living
When gathering pregnancy & birth history, what system is preferred ?
5 digit system (GTPAL)
What is the G in GTPAL ?
the number of pregnancies INCLUDING CURRENT PREGNANCY
What is the T in GTPAL ?
The # of pregnancies that were delivered at 37 weeks or later
What is the P in GTPAL ?
The # of pregnancies that were delivered between 20 weeks and 37 weeks
What is the A in GTPAL ?
The # of pregnancies ending in spontaneous or therapeutic abortion
What is the L in GTPAL ?
The # of currently living children
The 2 digit system includes what ?
- Gravida (# of pregnancies INCLUDING current pregnancy)
- Parity (the # of pregnancies that reached 20 weeks or >)
What are Pregnancy tests based on ?
Recognition Human chorionic gonadotropin (hCG)
What is the earliest biochemical marker of pregnancy ?
hCG (human chorionic gonadotropin)
hCG can be tested in what two body fluids ?
- Urine
- Blood
Low hCG may indicate what ?
- impending miscarriage or ectopic pregnancy
True or False: The 1st urine in the am usually contains hCG levels similar to serum blood levels ?
True
hCG is stable until 30 weeks, what happens next ?
It increased until term
Usually increased levels of hCG may mean what ?
- abnormal pregnancy
- Multiple gestation
- Down syndrome
True or False: the production of hCG begins as early as the day of implantation ?
True
True or False: hCG can be detected as early as 7 to 10 days after conception ?
True
What is usually the earliest sign of pregnancy ?
Amenorrhea
What are presumptive ((subjective)usually felt or noticed by women) signs of pregnancy ?
- Amenorrhea
- N/V (d/t increased hCG levels)
- Excessive fatigue (changes to women system occurring)
- Urinary frequency (d/t increase in size of uterus & pressure on the bladder)
- Breast changes (increased tenderness d/t estrogen & progesterone)
- Quickening (14-20 weeks)
(r/t women perception of fetal movement)
What are probable (Objective) signs of pregnancy ?
- Enlargment of the abdomen
- (+) pregnancy test
- Softening of lower uterine segment - Hegar’s sign
- Braxton Hicks contractions
- Abdomina striae
- Uterine souffle
- Changes in skin pigmentation
- Ballottement
True or False: Braxton Hicks contraction are often irregular and painless contractions ?
True
What is Uterine souffle ?
Soft sound made by arteries of the uterus.
- heard when ascultating
What is Ballottement ?
Passive movement of the unengaged fetus when pushing on the cervix
What are positive signs of pregnancy by a healthcare professional ?
- auscultation of fetal heartbeat
- Palpating fetal movement
- Visualization of the fetus
A fetal HR (FHR) is audible with a doppler around how many weeks ?
10-12 weeks
- seen on ultrasound @ 6-7weeks
In a normal pregnancy the uterus grows at a ____________ rate ?
Predictable
Palpation at 12-14 weeks is @ where ?
Symphysis pubis
At what weeks does the uterus rise to the level of the umbilicous ?
22-24 weeks
When does the uterus rise to the level of the xiphoid process ?
@ term
Changes in the uterus size, shape and position are stimulated by what hormones ?
Estrogen & progesterone
Changes in the uterus size, shape, and position can be seen at ____, _____, and _____ weeks ?
7, 10, and 12 weeks
Palpation of the uterus occurs between what weeks ?
12 -14 weeks
Enlargement of the uterus is determined by what ?
Fundal height
What is Hegar’s sign ?
Softening of the lower uterine segment @ about 6 weeks
When do Braxton Hicks usually occur ?
> 16 weeks (4 months)
Increase in vascularity with growth due to what ?
- Increased levels of estrogen & progesterone
- Dilation of blood vessles
- Hyperplasia
(production of new muscle fibers & tissue) - Hypertrophy
(enlargement of existing muscle fibers & tissue)
Uteroplacental bloodflow depends on what ?
Maternal blood flow to the uterus
*compromised blood flow, compromises the fetus
Goodells sign is a cervical change and is seen at week ?
6th week
What is Goodells sign ?
Softening of the cervical tip from increased vascularization
Due to increased cervical vascularity, the cervix also becomes more what ?
friable
- tissue is easily damaged. May have more bleeding after an exam or intercourse
What is a bacterial barrier during pregnancy ?
Mucous plug (operculum)
True or False: It is extremely important to have uncompromised uterine placental blood flow to the uterus ?
True
True or False: Blood flow increases rapidly as uterine size increases ?
True
What is Hegars sign ?
The softening of lower uterine segment
palpated on bimanual exam
Between 38 and 40 weeks the fetus begins to do what ?
Descend & engage in the pelvis
Lightening occurs @ 38-40weeks (fetus drops)
What is a major sign that labor is approaching ?
Lightening
What is lightening ?
When the baby drops lower into the mothers pelvis
What is Chadwick sign ?
is a bluish discoloration of the cervix, vagina, and labia resulting from increased blood flow.
Observed between 6-8 weeks
Acidity increases in the vagina to maintain what ?
To maintain a protective environment
What hormone prepares the vagina for birth ?
Estrogen
Pregnancy hormones are preparing the vagina for what ?
- Stretching during labor and birth causing vaginal mucosa to thicken, connective tissue to loosen, & the vaginal vault to lengthen
True or False: Breast may become very sensitive for pregnant women: full, heavy, & tingling
True
When talking about breast changes, what is Glandular hyperplasia ?
Increase in # of cells
When talking about breast changes, what is hypertrophy ?
Enlargement of muscle fibers
What breast changes are seen in pregnancy ?
- Glandular hyperplasia and hypertrophy
- Darkened areolae
- Superficial veins prominent
- Striae may develop
- Colostrum is secreted
- Montgomery tubercles
- 2nd and 3rd trimester: progressive breast enlargement
(high levels of hormones)
What are striae gravidarium ?
reddish streak on abdomen & breast which may not go away
1st milk may be secreted as early as when ?
16 weeks
Lactation is inhibited until when ?
until a decrease in estrogen occurs after birth
_____________________ are sebaceous glands in the areola which have a protective role in keeping the nipple lubricated for breastfeeding ?
Montgomery tubercles
What respiratory changes occur in pregnancy ?
- Structural adaptations occur (Diaphragm pushes up and out) - Tidal volume increases - O2 consumption increases - Breathing changes from abdominal to thoracic - Vascular congestion of nasal mucosa
Why does the Tidal volume increase in pregnancy ?
D/t increased metabolic rate & fetal needs –> so maternal O2 requirements increase due to this
Why is there vascular congestion of nasal mucosa in pregnancy ?
D/t an increase in estrogen that causes vascular response & capillaries become more engorged causing nasal stuffiness, nosebleeds. Can also cause Eustachian tubes to swell resulting in impaired hearing, earaches, or a sense of fullness in the ears
What are Cardiovascular changes that are seen in pregnancy ?
- Slight cardiac hypertrophy
- HR increases 10 -15bpm
- BP
- systolic: slight or no decrease from pre-pregnancy
- Diastolic: slight decrease mid-pregnancy
- return t normal @ end of pregnancy - Supine hypotensive syndrome
_____________ vasodilation maintains a normal BP despite an increase in blood volume
Peripheral
Why is slight cardiac hypertrophy seen in pregnancy ?
D/t increased cardiac output
True or False: The slight cardiac hypertrophy that is seen in pregnancy will return to normal after pregnancy ?
True
True or False: You may hear murmurs due to cardiac changes in pregnancy ?
True
What is Supine hypotensive syndrome ?
Occurs when the women is lying on her back, compressing the vena cava.
- Some women may have a decrease in BP, bradycardia occurs, & women may feel faint
Biochemical, physiologic, and anatomic adaptations that occur during pregnancy revert to what after birth and lactation?
Nonpregnant state
Are maternal adaptations attributed to the hormones of pregnancy and mechanical pressures exerted by enlarging uterus and other tissues?
Yes
What is the most popular method of pregnancy testing that includes monoclonal antibody technology?
ELISA
Do presumptive, probable, and positive signs of pregnancy aid in the diagnosis of pregnancy?
Yes
What positive pregnancy signs establish a diagnosis of pregnancy?
- Fetal heartbeat
- Verification of fetal movement
- Visualization of fetus
Adaptations to pregnancy protect the women normal physiological functioning, meet the metabolic demands of pregnancy and provide for what?
Fetal development and growth
Although the pH of the pregnant women vaginal secretions is more acidic, she is more vulnerable to vaginal infections, especially what kind?
Yeast infections
Increased vaginal and pelvic vascularity and sensitivity may lead to increased what?
Sexual interest and arousal
Can pregnancy result in discomfort such as fatigue, urinary frequency, nausea, and breast sensitivity?
Yes
As pregnancy progresses, balance and coordination are affected by what changes?
In joints and center of gravity
What stimulates uterine contractions?
Oxytocin
What prevents uterine contractions until near term?
Progesterone
What stimulates let down reflex after birth for breastfeeding?
Oxytocin
Does oxytocin assist in the control of bleeding after birth?
Yes
What produces oxytocin as the fetus matures?
Pituitary
Do many endocrine changes occur in pregnancy?
Yes
Is progesterone essential for maintaining pregnancy, relaxing smooth muscles, decreasing uterine activity, and preventing miscarriage?
Yes
What hormone promotes enlargement of genital, uterus, and breasts?
Estrogen
What hormone increases vascularity causing vasodilation and also causes the pelvic joints to relax?
Estrogen
What hormones cause fat stores to increase which serves as energy source during labor, birth, and lactation?
Progesterone and estrogen
What is produced by the pituitary and is responsible for lactation after birth?
Prolactin
Are estrogen and progesterone produced by the pituitary?
Yes
Why is there separation of the rectus abdominus during pregnancy?
To allow abdominal content to move forward
Compression of pelvic nerves ay result in what for the mom?
Sensory changes in the legs
When is carpal tunnel syndrome r/t to edema often seen ?
during last trimester
Are tension headaches common in pregnancy when anxiety is present?
Yes
Can lightheadedness, faintness, or syncope result in pregnancy from hypotension or hypoglycemia?
Yes
Changes in mom’s posture during pregnancy compensate for what?
Weight of uterus (low back pain common)
How does a women center of gravity change with pregnancy?
Shifts forward due to weight of abdomen
Do changes in center of gravity often result in a “waddling gait”?
Yes
How do pelvic joints relax?
Softening of connective tissue
Do pelvic joints relax to permit enlargement of pelvic structure to accommodate labor and birth?
Yes
Is there separation of the rectus abdominus as a result of advancing pregnancy?
Yes
Do abdominal muscles stretch and lose tone during pregnancy?
Yes
Why is there separation of the rectus abdominus during pregnancy?
To allow abdominal intent to move forward
During pregnancy when is Hgb & Hct considered abnormal ?
Hemoglobin: <11
Hematocrit: < 33
During pregnancy, blood volume increases to ___ -____% ?
40-45%
There is a Large increase in what blood component during pregnancy ?
Large increase in plasma volume
True or False: There is an increase in RBCs during pregnancy ?
True
True or False: During pregnancy plasma volume exceeds RBCs, so women have hemodilution ?
True
Why is there an increase in cardiac output during pregnancy ?
d/t increased HR & demands from tissues
True or False: There is a decrease in systemic and pulmonary vascular resistance ?
True
Why are pregnant women in a hyper coagulable state during pregnancy ?
D/t an increase in clotting factors, which is a protective mechanism to prevent bleeding complications.
- But there is an increased risk of blood clots.
- Check for Homans sign for s/s of a developing clot
Are there appetite changes seen during pregnancy?
Yes
N/V often results due to increased hCG levels seen at 4-6 wks but usually subsides by when?
End of first trimester
What is hyperemia?
Softening and bleeding of gums
Hyperemia is often due to increased estrogen levels causing what?
Vascularity
What is PICA?
Eating non nutritive substances
Should women with N/V eat dry crackers before arising, rise slowly, eat small frequent meals, and avoid overdistension of the stomach?
Yes
Have women with PICA been found to have low Hgb levels?
Yes (consider iron deficiency)
What are possible GI complications of pregnancy?
- Constipation
- Abd discomfort
- Heartburn
- Hemorrhoids
Can constipation during pregnancy also be a result of inactivity, decreased water intake, iron supplementation, and compression of the intestines?
Yes
Pyrosis= ?
Heartburn
Increasing fluids, fiber, roughage, and exercise can help with what GI complication during pregnancy?
Constipation
Should a women discuss her heartburn with her MD?
Yes
May a women with heartburn need an antacid, small frequent meals, and 8-10 glasses of fluid a day?
Yes
An increase in progesterone may cause decreased tone and mobility of smooth muscle resulting in slowed mobility, slower emptying of stomach causing what as a result?
Heartburn and indegestion
Increased progesterone levels may cause a n increase in water absorption and result in what?
Constipation
Does the gallbladder become distended and has decreased tone during pregnancy?
Yes
Is there an increased emptying time of the gallbladder and thickening of bile during pregnancy?
Yes (normal)
During pregnancy are women more prone to developing gallstones?
Yes
Does abdominal discomfort in pregnancy result from: -increased uterine size -ligaments stretching -contractions -gas pains ?
Yes (watch for what is not normal)
During pregnancy there is increased stasis of urine, which increases a risk for what ?
UTI
True or False: you may see dependent edema as a renal change in pregnancy ?
True
True or False: During pregnancy their is decreased bladder tone, due to dilation ?
True
Do the kidneys absorb of the glucose during pregnancy /
No, some it spills into the urine
Pregnant women have more nutrients in the urine, which places them at increased risk for developing what ?
UTIs
Why is there an increase in renal function during pregnancy ?
B/c the kidneys have to manage increases in urine output
Why does increased urine frequency occur in the 3rd trimester ?
D/t pressure on the bladder
Why doe pregnant women have more frequent urination in the 1st trimester ?
d/t increased bladder sensitivity
What causes an increased GFR in pregnancy ?
Caused by
- hormones
- increased blood volume
- physical activity
- nutritional uptake
What position increases renal perfusion during pregnancy ?
Side lying position
True or False: you may see edema in lower extremities during pregnancy ?
True
True or False: Tubular reabsorption of glucose is impaired
- may have glycosuria
- Must rule out diabetes
True
When women lay on there side what things happen ?
- Renal perfusion is increased
- increased urinary output
- decreases edema
What happens when women ly on there back during pregnancy, what happens ?
Uterine comprises the vena cava & aorta, and everything is slowed.
- As a result, the blood flow to the brain and heart is continued as the expense of other organs including the kidneys
What changes occur to the integumentary system during pregnancy ?
- Hyperpigmentation
- Striae gravidarium (stretch marks)
- Chloasma
- Vascular spider nevi
- Hyperactive sweat and sebaceous glands - d/t increased BMR & increased blood supply to the skin
Hormones & mechanical stretching are responsible for what during pregnancy ?
Most skin & hair changes
What is Chloasma (integumentary) ?
Brownish hyper pigmentation over the face
What is linea nigra (Latin for “black line”) ?
Pigmented line from symphysis pubis to fundus
What are vascular spider nevi ?
(angiomas) reddish-blue tiny star shaped spots on the neck, throat, face, & arms.
- Disappear after birth
- result from increased estrogen levels
