Maternal Adaptations in pregnancy Flashcards
Enlargement from stretching and hypertrophy in uterus is most marked at which area?
Fundus
Layers of the uterus
Outer hoodedlike layer
Middle layer of muscles
Inner sphincter-like fibers
The uterus rotates to which direction? This is caused by the recrosigmoid on the left side of the pelvis
Rotates to the RIGHT (dextrorotation)
accounts for “false labor”; irregular, unpredictable, sporadic contractions which rises in number in the last two weeks of gestation
Braxton-Hicks contractions
Uteroplacental blood flow is mediated by which small molecule?
Nitric oxide (a potent vasodilator)
VEGF and PIGF are attenuated in response to the excess of which hormone?
Soluble FMS-like tyrosine kinase 1 (sFlt-1)
Normal pregnancy has vascular refractoriness to which blood pressure mediator?
Angiotensin II
Increased vascularity and edema causes the cervix to turn to which color?
Bluish (Chadwick’s sign)
This process involves lowering collagen and proteoglycan concentrations and raises water content (compared with nonpregnant cervix)
Cervical ripening
Copious amounts of mucus rich in Ig and cytokines produced by endorcervical glands causes the formation of this structure. This is expelled at the onset of labor (bloody show)
Mucus plug
Char. pattern of cervical mucus seen when it is spread and dried on glass slide; caused by progesterone causes poor crystallization
Beading
Char. pattern of cervical mucus seen when amniotic fluid violates the cervical canal. It is caused by estrogen and salts leading to crystallization
Ferning
Organ that produces hCG which maintains the corpus luteum
Placenta
This ovarian structure produces the progesterone which maintains the endometrium. It functions maximally until 7 weeks of pregnancy.
Corpus luteum (CL)
Loss of polarity, pleiomorphism, intraluminal budding in cervical cells during the pregnancy
Arias-Stella reaction
Marked proliferation of cervical glands leads to the outward displacement of the os.
Eversion
This hormone is produced by the CL, the decidua, and the placenta. It aids in remodelling of reproductive tract connective tissue to accomodate labor
Relaxin
Benign ovarian lesions reflecting physiological follicle stimulation (hyperreaction luteinalis); linked to markedly elevated serum hCG levels (GTD, multifetal gestation)
Theca lutein cysts
Violet discoloration of the vagina and cervix resulting from increased vascularity
Chadwick sign
Thick, yellowish fluid expressed from the nipples by gentle massage
Colostrum
Reddish, slightly depressed skin; in multiparas, glistening, silvery lines from previous striae
Striae gravidarum
Rectus muscles separating in the midline when abdominal walls do not withstand the tension of the expanding pregnancy
Diastasis recti
Develops in 90% of women, usually more accentuated in those with darker complexion; may be due to the melanocyte-stimulating effects of estrogen and progesterone
Hyperpigmentation
Brown-black pigmentation in the midline of the anterior abdominal wall
Linea nigra
Irregular brownish patches of varying sizes appearing on the face and neck
Chloasma
Vascular changes - likely due to which hormone
Estrogen (hyperestrogenemia)
Common on the face, neck, upper chest, and arms; minute, red skin papules with radicles branching out from a central lesion
Vascular spiders/ angiomas
Increased cutaneous blood flow serves to dissipate excess heat generated by augmented metabolism
Palmary erythema
Phases of hair cyclic activity
Periods of hair growth (anagen)
Apoptosis-driven involution (catagen)
Resting period (telogen)
Excessive hair loss in the puerperium
Telogen effluvium
Metabolic rate increase in 3rd trimester
20%
Additional metabolic rate increase with twin gestation
10%
Average weight gain during pregnancy
12.5 kg (27.5 lbs)
Total extra water during pregnancy
6.5 L
(water content from the fetus, placenta, and AF (~3.5L) + expanded maternal blood volume and from uterus and breast growth (3L)
Carbohydrate metabolism characteristics during pregnancy
Mild fasting hypoglycemia, postprandial hyperglycemia, hyperinsulinemia
Secreted by adipose tissue in non-pregnant humans; important for implantation, cell proliferation, and angiogenesis
Leptin
Secreted by adipose tissue in non-pregnant humans; important for implantation, cell proliferation, and angiogenesis
Leptin
Produced in maternal fat, not in the placenta
- inversely correlated with adiposity
- insulin sensitizer
- reduced in patients with GDM
Adiponectin
Secreted by the stomach and placenta in response to hunger
Ghrelin
Elevated levels of this hormone, along with leptin, impair uterine contractility
VISFATIN
This refers to the decrease in hemoglobin concentration due to plasma expansion during pregnancy
Physiologic anemia of pregnancy
All clotting factors increase EXCEPT:
Factors XI and XIII
Most common ECG change during pregnancy
Left axis deviation
Refers to a syndrome caused by compression of the great vessels by the uterus in the supine position
Supine hypotensive syndrome
Refractoriness to angiotensin II is probably due to this hormone
Progesterone
Pulmonary volumes that DECREASE during pregnancy
Functional Residual Capacity (FRC)
Total Lung Capacity (TLC)
Pulmonary volumes that INCREASE during pregnancy
Inspiratory Capacity (IC)
Tidal Volume (may be unchanged or decreased)
Pulmonary volumes that DO NOT CHANGE during pregnancy
Inspiratory Capacity (IC)
Tidal Volume (may be unchanged or decreased)
Causes of elevated minute ventilation in pregnancy
•Enhanced respiratory drive due to PROGESTERONE
•Low expiratory reserve volume
•Compensated respiratory alkalosis
GFR and renal blood flow changes during pregnancy
GFR increases by 25%, Renal blood flow increases by 80%
Pathophysiology of increased risk of cholesterol gallstones in pregnancy
Progesterone inhibits CCK-mediated smooth muscles stimulation –> impairs GB contraction –> impaired emptying stasis –> cholesterol gallstones in pregnancy
Constipation and elevated rectal vessels below the level of the enlarged uterus increases the risk for which GI tract abnormality?
Hemorrhoids
Hormones that ensures lactation in early pregnancy
Prolactin
This carrier protein increases due to ESTROGEN stimulation –> increases TOTAL T4 and T3 BUT do not affect free T4, T3
Thyroid-binding globulin
The fetus relies heavily on maternal production of which thyroid hormone?
T4
Pathophysiology of upper extremity weakness, numbness during pregnancy
Progressive lordosis + anterior neck flexion + shoulder girdle slumping
–> traction on the ulnar and median nerves
Brownish-red opacities in the posterior surface of the cornea; often observed in pregnancy
Krukenberg spindles
