Chapter 15: Pregnancy Flashcards
first stage of pregnancy timing and what happens?
- first 1-2 weeks pre-embryonic
- zygote –> blastomere –> morula –> blastocyst
- implantation occurs
what is a blastocyst?
- cluster of dividing cells made by a fertilized egg
- beginning of differentiation
- implants on endometrium (inner uterus lining)
second stage of pregnancy timing and what happens?
- week 2-8 embryonic
- Formation and development of organs (organogenesis)
what is an embryo?
differentiation is completed
Blastocyst differentiates into 3 germ layers (ectoderm, mesoderm, endoderm), where organs and other structures will originate
third stage of pregnancy timing and what happens?
- 9-38 weeks fetal
- Rapid growth
- Refinement of organs and structures created in embryonic stage
why is fetal circulation different?
- fetus has other routes bc lungs and liver not fully developed
- connected to placenta vein and arteries
- Ductus venosus (bypass liver) → foramen ovale (bypass lungs) → ductus arteriosus (bypass lungs)
placenta functions?
- circulation
- protection
- hormone production
first hormone produced by placenta
HCG
- signals corpus luteum to continue excreting progesterone and estrogen
- keeps uterus and endometrium good environment for pregnancy
second hormone produced by placenta
HCS
- metabolism: increases mom’s insulin resistance and increases circulating glucose
- breasts lactation
third hormone produced by placenta
progesterone
- breast development
- changes metabolism
- relaxes uterine muscles
fourth hormone produced by placenta
estrogen
- breast development
- contraction of uterus
- uterine growth
- blood flow to placenta and uterus
fifth hormone produced by placenta
relaxin
- prepare endometrium for implantation
- softens cervix at end of pregnancy
- joint laxity
- optimize circulatory system during pregnancy
skin changes during preg
- striae
- linea nigra
- chloasma
- palmar erythema
- telangiectasias
- spider angiomas
- thicker and abundant hair
exocrine changes during preg
- Thyroid hormones increase
- Pancreas cells reduced responsiveness to insulin and greater insulin production
- Adrenal glands increase cortisol and aldosterone
- Pituitary gland produces prolactin and oxytocin
respiratory changes during preg
- Increased tidal volume → mild hyperventilation → respiratory alkalosis (all normal but can cause dyspnea)
- congestion of mucous membranes
- deepening of voice
- frequent nose bleeds (epistaxis)
cardiovascular changes during pregnancy
- Increased cardiac output, increased HR, increased stroke volume = minor hypertrophy
- H&H decreases = pseudoanemia
- WBC elevated
- BP decreases
- Sometimes S1 split, systolic murmur, third heart sounds, diastolic murmur
urinary changes during preg
- Larger kidneys
- Small amounts of glucose and protein sometimes spilled into urine
- More thirsty, need to pee more
reproductive changes during preg
- Breasts more sensitive to pain, darkening nipples and areolas, montgomery tubercles hypertrophy
- Ovaries produce progesterone, estrogen, and relaxin
- Uterus grows, size in cm = weeks of gestation (34 weeks gest = 34 cm)
- Braxton hicks contractions: fake, resolved with rest or hydration
- Hegar’s sign, Goodell’s sign, Chadwick’s
- Leukorrhea: white, thick discharge
musculoskeletal changes during preg
- Lordosis
- Softening of joints
- Symphysis pubis dysfunction
- Ligaments may stretch and spasm: sharp, brief, unilateral
- Diastasis recti: muscles separate and part of bowel protrudes through
GI changes during preg
- Reduced peristalsis → constipation, gallstones, heartburn
- Increased metabolic needs
initial visit during pregnancy when and what?
- 6 weeks
- rubella
- pap test if due
- CBC
- Rh factor
monthly visits until how many weeks gestation?
27 weeks
every other week visits when?
27-36 weeks
weekly visits when?
36-40 weeks
trisomies screening
11-13 wks
neural tube screening
15-16 weeks
3D ultrasound screening
16-20 weeks
oral glucose tolerance test when
24-28 weeks
Rh factor screening again with TDaP when?
28 weeks
H&H and STI testing when?
28-36 weeks
group b strep and vagina culture when?
35-37 weeks
