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NU314 OB > Maternal Adaptation During Pregnancy > Flashcards

Maternal Adaptation During Pregnancy Flashcards

1
Q

Fundus

A

top of the uterus

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2
Q

Leukorrhea

A

the white vaginal discharge with pregnancy

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3
Q

Tubercles of Montgomery

A

sebaceous glands responsible for nipple lubrication during breast feeding

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4
Q

Peristalsis

A

involuntary constriction and relaxation of the muscles of the intestines; creates a “wave-like” motion that pushes contents of bowel forward

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5
Q

Hypercholesterolemia

A

high levels of cholesterol in the blood

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6
Q

Cardiac Output

A

product of heart rate or the number of heartbeats per minute, and the stroke volume

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7
Q

Stroke volume

A

the volume of blood pumped from the ventricle per heartbeat

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8
Q

What is a normal adult cardiac output?

A

4.7 L blood per minute

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9
Q

Tidal Volume

A

the volume of air inhaled

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10
Q

Morphology

A

the study of structure or how something is made

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11
Q

Central Pallor

A

a normal red blood cell has an area of pallor in its center

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12
Q

Trimester

A

three 13 week intervals of pregnancy

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13
Q

Signs and Symptoms of Pregnancy

A 
fatigue 
breast tenderness
nausea and vomiting 
amenorrhea 
urinary frequency
hyperpigmentation of the skin
fetal movement 
uterine enlargement 
breast enlargement
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14
Q

Hyperpigmentation of the skin occurs when?

A

16 weeks

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15
Q

Fetal movement (quickening)

A

16-20 weeks

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16
Q

Uterine enlargement

A

7-12 weeks

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17
Q

Breast enlargement

A

6 weeks

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18
Q

Braxton Hicks contractions

A 
16-28 weeks 
function is to efface or thin the cervix in the last month of pregnancy
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19
Q

When will you see a positive pregnancy test?

A

4-12 weeks

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20
Q

Abdominal enlargement

A

around 14 weeks

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21
Q

Ballottement

A

16-28 weeks

the examiner pushes against the cervix during pelvic exam and feels a rebound from the floating uterus

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22
Q

Goodell’s sign

A

5 weeks

softening of the cervix

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23
Q

Chadwick’s Sign

A

6-9 weeks

vaginal mucosa and cervix take on a bluish color

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24
Q

Hegar’s Sign

A

6-12 weeks

softening of the lower uterine segment

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25
Q

When can an ultra sound verify the embryo?

A

4-6 weeks

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26
Q

When can the physician feel fetal movement?

A

20 weeks

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27
Q

Auscultation of the fetal heart tones via doppler occurs when?

A

10-12 weeks

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28
Q

hCG

A

the earliest biochemical marker for pregnancy

-usually detectable 5-8 days after conception, but definitely by day 11

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29
Q

hCG levels in pregnancy

A

usually double every 48-72 hours until they peak 60-70 days after fertilization

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30
Q

What do physicians use to help differentiate between a normal and abnormal pregnancy?

A

hCG doubling time

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31
Q

Lower levels of hCG may cause?

A

ectopic pregnancy

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32
Q

Higher levels of hCG may cause?

A

molar pregnancy or multiple-gestational pregnancies

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33
Q

What are four other causes of hCG elevation?

A

Ovarian cancer
Choriocarcinoma
Hydatidiform mole

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34
Q

Choriocarcinoma

A

a fast growing cancer that grows in the uterus

-abnormal cells start in the tissue that would become the placenta

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35
Q

Hydatidiform Mole

A

a noncancerous tumor that develops in the uterus as a result of a nonviable pregnancy

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36
Q

Supine Hypotensive Syndrome

A

the heavy/gravid uterus can fall back against the inferior vena cava in the supine position, resulting in vena cava compression

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37
Q

Symptoms of Supine Hypotensive Syndrome

A

reduced venous return
decreased cardiac output and blood pressure
increased orthostatic stress
weakness, light headedness, nausea, dizziness, and syncope

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38
Q

When a patient is experiencing Symptoms of Supine Hypotensive Syndrome what should you have them do?

A

instruct them to lie on her left side, which displaces the uterus and pressure is removed from the vena cava

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39
Q

What causes Goodell’s sign to happen?

A

the cervix begins to soften due to vasocongestion and the influence of estrogen

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40
Q

What will happen along with the cervix softening?

A
  • endo-cervical glands enlarge and increase in number creating more cervical mucous
  • progesterone causes a thick mucous plug to form
  • Chadwick’s sign
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41
Q

What does the cervical mucous plug do?

A

blocks the cervical os and protects against bacterial invasion

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42
Q

How much will the weight of the uterus increase at term?

A

70 g to 1100-1200

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43
Q

How will the capacity of the uterus increase at term?

A

from 10 mL to 5000 mL or greater

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44
Q

As pregnancy progresses how much of the uterine blood flow will go to the placenta?

A

80-90 %

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45
Q

How long will the uterus remain in the pelvic cavity before ascending into the abdomen?

A

the first 3 months

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46
Q

How long are the ovaries enlarged because of increased blood supply?

A

until approximately 14-16 weeks

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47
Q

Why does ovulation stop during pregnancy?

A

because of elevated levels of estrogen and progesterone

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48
Q

When do the ovaries stop becoming active in hormone production for pregnancy?

A

about weeks 6-7 when the placenta takes over the production of progesterone

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49
Q

What happens to the breast during pregnancy?

A
  • begin to grow larger and increase in fullness
  • become more vascular
  • nipples and areolas become deeply pigmented
  • tubercles of Montgomery become prominent
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50
Q

When can colostrum be expressed by the breasts?

A

by the third trimester

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51
Q

Colostrum

A

creamy, yellowish breast fluid that provides nourishment for the breast feeding newborn during the first few days of life

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52
Q

Where does the gastrointestinal system begin and end?

A

begins in the oral cavity and ends in the rectum

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53
Q

What happens to the gums during pregnancy?

A

They become hyperemic, swollen, and friable causing easy bleeding

54
Q

What happens to the saliva during pregnancy?

A

Becomes more acidic

-some complain of excessive salivation-ptyalism

55
Q

Ptyalism

A

excessive salivation

56
Q

What two dental diseases are common during pregnancy?

A

Periodontitis and gingivitis

57
Q

Periodontal disease may cause what?

A

preeclampsia, low-birthweight, stillbirth, and early onset of neonatal sepsis

58
Q

What may be the cause of ptyalism?

A

the decrease in unconscious swallowing by the women when nauseated

59
Q

GI Side Effects of pregnancy

A

constipation
heartburn
hypercholesterolemia
nausea/vomiting

60
Q

What are some causes of constipation during pregnancy?

A 
low-fiber food choices
reduced fluid intake
iron supplements 
decreased activity level
intestinal displacement
61
Q

What causes heartburn during pregnancy?

A

slowed gastric emptying combined with relaxation of cardiac sphincter

62
Q

What can cause hypercholesterolemia?

A

due to the emptying time of the gallbladder secondary to smooth muscle relaxation caused by increased progesterone

63
Q

What can hypercholesterolemia put the patient at risk for?

A

gallstones

64
Q

What medication was recently approved by the FDA as the first drug to specifically treat morning sickness?

A

Diclegis

65
Q

How much will the moms heart rate increase during pregnancy?

A

25%

66
Q

How much will the moms cardiac output increase?

A

30-50%

67
Q

How much will blood volume be increased?

A

1500 mL

68
Q

An increase in what can lead to anemia?

A

increased plasma volume

69
Q

Why do a lot of women experience physiologic anemia?

A

because maternal blood volume expansion happens at a larger proportion than the increase in red blood cells

70
Q

What is the criteria for Physiologic Anemia?

A
  • Hemoglobin of 10g or less
  • Red blood cells 3.5 million/mm3
  • Normal morphology w/ central pallor
71
Q

Why is the increase in blood volume necessary?

A

provides adequate hydration of fetal and maternal tissues, to supply blood flow to perfuse the enlarging uterus, provide a reserve during birth, perfusion of kidneys

72
Q

Why does the heart increase in size?

A

to accommodate the increased blood volume and cardiac output

73
Q

How much will the heart rate increase between 14-20 weeks?

A

10-15 bpm

74
Q

What can happen to a woman with preexisting heart conditions?

A

She may become symptomatic and begin to show signs of decompensation during the time the blood volume peeks

75
Q

When should a mom with preexisting heart conditions be monitored more closely?

A

between 28-35 weeks

76
Q

What happens to the moms blood pressure during pregnancy?

A

Declines due to the peripheral vasoconstriction caused by the increased level of progesterone

77
Q

When will you see the blood pressure reach its lowest point?

A

during mod-pregnancy

78
Q

Why should any significant rise in blood pressure be investigated?

A

To make sure the mom has not developed gestational hypertension

79
Q

Gestational Hypertension

A

a clinical diagnosis defined by new onset of systolic BP of 140 mmHg or higher and/or diastolic of 90 mmHg or higher after 20 weeks gestation

80
Q

What changes increase a woman’s risk of developing DVT/PE?

A
  • increase in fibrin and fibrinogen levels

- venous stasis secondary to venous pooling

81
Q

Increase in fibrin and fibrinogen levels along with other clotting factors make pregnancy what kind of state?

A

hypercoagulable

82
Q

What causes the lungs to function differently during pregnancy?

A
  • increased progesterone

- growing uterus pushes lungs up approximately 4 cm above the usual position

83
Q

What will allow for a larger tidal volume?

A
  • increase in diaphragmatic excursion
  • increase in chest circumference
  • increase in transverse diameter
84
Q

How much will the mother’s oxygen consumption increase due to the requirements of the developing fetus?

A

30-40%

85
Q

How does a woman’s breathing change?

A

she will breathe more deeply and faster

86
Q

What influences increased vascularity in the respiratory tract and causes congestion?

A

increased estrogen levels

87
Q

Rising levels of sex hormones and sensitivity to allergens may influence the nasal mucosa causing women to experience what throughout their pregnancy?

A

nosebleeds, rhinitis and congestion

88
Q

What will allow for increase in blood flow to the kidneys during pregnancy?

A

Hormones

89
Q

What are the primary changes in the urinary structure during pregnancy? And why do they occur?

A

Dilation of the renal pelvis and the uterus

-result of increased estrogen and progesterone, pressure from enlarging uterus, and dilation of renal pelvis

90
Q

Why does the glomerular filtration rate (GFR) increase?

A

because of increased blood flow which leads to increased urine flow

91
Q

What happens to the ureters?

A

elongate, widen, and become more curved above the pelvic rim

92
Q

When does activity of the kidneys increase and decrease?

A

increase when lying down and decrease with standing

93
Q

How long can it take after pregnancy for the urinary anatomy to return to normal?

A

up to 3 months

94
Q

What will happen to the mom’s ligaments holding the sacroiliac joint and pubis symphysis in place at 10-12 weeks?

A

begin to soften and stretch and the articulations between the joints widen and become more mobile

95
Q

What is the purpose of the changes to the sacroiliac joint and pubis symphysis?

A

increase the size of the pelvic cavity which will make delivery easier

96
Q

What can cause lower back pain?

A

postural changes coupled with loosening of the sacroiliac joints

97
Q

Lordosis

A

increase in the normal lumbosacral curve

98
Q

What leads to the “waddle” during pregnancy?

A

relaxation and increased mobility of joints because of the hormones progesterone and relaxin
-increased weight gain can make it worse

99
Q

What causes hyperpigmentation?

A

increased estrogen, progesterone, and melanocyte-stimulating hormone levels

100
Q

Where do you must commonly see hyperpigmentation?

A

nipples, areolas, umbilicus, perineum, and axilla

101
Q

Melasma

A

“Mask of pregnancy”

-increased pigmentation on the face

102
Q

Linea Nigra

A

skin in the middle of the abdomen that has developed a pigmented line running from the umbilicus to the pubic area

103
Q

Where are varicosities most commonly seen?

A

legs, vulva, perineum

104
Q

What are varicose veins often the result of?

A

distention, instability, and poor circulation secondary to prolonged standing or sitting and the heavy gravid uterus placing pressure on the pelvic veins preventing complete venous return

105
Q

Interventions to reduce varicosities

A
  • elevating both legs
  • avoid prolonged sitting or standing-change positions frequently
  • resting in left lateral position
  • walking daily
  • avoid tight clothing and knee high stockings
  • TED hose
106
Q

Vascular Spiders

A

small blood vessels

  • appear on the neck, thorax, face, and arms
  • especially obvious in Caucasian women
107
Q

What is the pinker area on the palmer surface of the hands called?

A

palmer erythema

108
Q

Hair during pregnancy

A

hair growth declines followed by subsequent hair loss after delivery

109
Q

Nails during pregnancy

A
  • typically grow faster, but are more brittle
  • whitish discolorations or distal separation of the nailbeds
  • transverse grooves
110
Q

Thyroid gland

A
  • enlarges and becomes more active
  • increases TSH during 1st trimester and tapers off within a few weeks after birth
  • essential for proper brain development
111
Q

Hypothyroidism

A

will compromise fetal neurologic development

112
Q

Pituitary Gland

A
  • enlarges during pregnancy

- produces multiple hormones

113
Q

Why are FSH and LH most likely blocked during pregnancy?

A

because of the hCG hormone as well as increased levels of prolactin

114
Q

What is thought to be the reason for morning sickness?

A

elevated levels of hCG and decreased levels of TSH during the first trimester

115
Q

What inhibits the direct influence of prolactin on the breasts during pregnancy?

A

high levels of progesterone secreted by the placenta

116
Q

When does lactogenesis begin?

A

at birth after the placenta is expelled and there is a sharp drop in progesterone

117
Q

Where is prolactin released and what is it in response to?

A

Released from the anterior pituitary gland in response to suckling by the newborn

118
Q

Oxytocin

A

responsible for uterine contractions both before and after delivery

119
Q

What is believed to be the initiator of labor?

A

decrease in progesterone

120
Q

What do contractions lead to?

A
  • cervical thinning and dilation

- exert pressure which helps descend fetus into the pelvis

121
Q

What does oxytocin do for the body after delivery?

A

causes the myometrium to contract, which decreases blood flow, which decreases the amount of bleeding during and after delivery

122
Q

Pancreas

A

an exocrine organ which supplies digestive enzymes and buffers

123
Q

How many cell types are in the pancreas and which one produces insulin?

A

4; beta cells produce insulin

124
Q

How does a women develop gestational diabetes?

A

she has an inadequate number of beta cells so she may be unable to produce enough insulin and will develop glucose intolerance during pregnancy

125
Q

What regulates carbohydrate and protein metabolism and is helpful with stress?

A

Cortisol

126
Q

During pregnancy Cortisol will:

A
  • helps keep up the level of glucose
  • breaks down protein to repair tissues and manufacture enzymes
  • has anti-insulin, anti-inflammatory, and anti-allergic actions
  • needed for precursors of adrenaline
127
Q

Immunologic Alterations help prevent what from happening?

A

the mother’s immune system from rejecting the fetus

128
Q

Because of immunologic alterations the mother is more at risk for?

A

infections such as UTI’s and influence the course of chronic disorders such as autoimmune disease

129
Q

Inadequate nutritional intake can result in what?

A

preterm birth, low birth weight, and congenital anomalies

130
Q

Excessive nutritional intake is connected with?

A

fetal macrosomia leading to difficult birth, neonatal hypoglycemia, and continued obesity for mom and baby, and metabolic syndrome

131
Q

Normal weight/BMI

A

BMI = 18.5-24.9 total weight gain = 15-25 lbs.

NU314 OB (21 decks)

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