Maternal Adaptations to Pregnancy Flashcards
CARDIOVASCULAR SYSTEM
-↑Blood volume (starts at last week of 1st tri)
-↑ Cardiac output by 30-50% (2nd tri)
-↑ RBC volume by 20%
-↑ Plasma volume by 50%
-Pregnancy Hematocrit: 32-42 %↓
Non-preg htc: 38-47%
-Hemoglobin: 10.5-14 g/dl
-Physiologic Anemia of pregnancy/ Dilutional Fale/ Pseudo
-↑ Heart rate during preg. (+ 10-15 bpm)
-↑ WBC: Normal
-↑Platelet + Fibrinogen, clotting factor of the mother (2nd-3rd trimester)
-Fatigue
-Epistaxis
-BP may drop slightly (2nd tri): Peripheral resistance ↓ to circulation as placenta expand.
-Supine Hypotension syndrome (2nd-3rd tri)
-Edema on lower extremities (3rd tri)
-Leg varicosities (3rd tri)
MNGMNT: Elevate/ Stockings when standing/ Walking
-Vulva Varicosities (3rd tri)
***Clotting fx doesn’t cross placenta, as evidence by “Omphalangia”
BP During Pregnancy
↑BP during pregnancy= ABNORMAL
↑before 20 weeks= H-mole
↑ after 20 weeks= P.I.H
HTN Before pregnancy= Chronic Pregnancy HTN
GIT System
-Hypotonic G.I. Tract (2nd-3rd trimester) (↑Progesterone & ↑Relaxin)
-Stomach compressed Upward & Backward
-Delayed Emptying (2nd-3rd trimester)
-Decreased Hydrochloric Acid
-Food cravings
-Softening of gms
-Morning sickness (1st trimester)
↑HCG/ ↑Estrogen/ ↑Progestrone/Hormone lvl
-Hemorrhoids (3rd tri)
MNGMNT: Cold Compress
-Heartburn (2nd-3rd trimester
Due to relaxin or ↑Progesterone
MNGMNT: no sweets/ ↑Acidic (Gas forming)
-Ptyalism (↑Estrogen)
MNGMNT: Mouthwash
-FLatulence (2nd-3rd Trimester)
-Constipation (2nd-3rd Trimester)
CLASSIFICATION OF CARDIAC DSE
CLASS I
-no limitation
-Can do all activities
-✔ Pregnancy ✔Push
CLASS II
-slight limitation
-✔Pregnancy ✘Push (CS)
CLASS III
-moderate limitation
-S/sx: Appears at rest
-✘Pregnancy & push
-Therapeutic Abortion
CLASS IV
-Marked Limit
-✘Pregnancy & push
-Therapeutic Abortion
Types of hemophilia
HEMOPHILIA A/ CLASSIC
Factor Deficiency: 8/ VIII
Inheritance: X-linked Recessive
HEMOPHILIA B/ CHRISTMAS DSE
Factor Deficiency: 9/ IX
Inheritance: X-linked Recessive
HEMOPHILIA C
Factor Deficiency: 1/ XI
Inheritance: Autosomal Recessive
PARAHEMIPHILIA
Factor Deficiency: 5/V
Inheritance: Autosomal Recessive
Von Willebrand Disease
Factor Deficiency: vWF Protein (VIII:vW)
Inheritance: Autosomal Recessive
**Autosomal recessive is a pattern of inheritance characteristic of some genetic disorders
**Families with an X-linked recessive disorder often have affected males, Female are the carrier.
-Bleeding in joint spaces
-Common in children
Hemarthrosis
Omphalangia
Cord Bleeding
Common site: Umbilicus
Hyperemesis Gravidarum
Alkalosis
Prolonged Hyperemesis Gravidarum
Acidosis
GTK
No laxatives during pregnancy
✔ Mild stool softener as ordered
SKIN
(2nd half of pregnancy/ 5 months)
-Linea nigra (2nd-3rd trimester)
-Palmar Erythema (2nd-3rd tri) ↑Estrogen
-↑Perspiration (↑sweat gland)
- Chloasma (2nd-3rd tri)
-Phlegmsia/Alba dolens/ Milk leg
Pressure in iliac vein (2nd-3rd tri) ↑MSH
-All skin changes are presumptive Sign
-Striae Gravidarum
Urinary System
-Kidney ↑ Renal Plasma
Volume Flow: 30-50%
-Kidney size ↑
-↓ Glucose Threshold due to ↑ renal blood flow (2nd tri)
-↑urination (1st & 3rd tri)
-↑Bladder capacity (1500 ml) (2nd tri)
-↑ Diameter of ureters (2nd tri)
Musculoskeletal System
-Softening and relaxation of ligaments & joints of pelvis (Waddling Gait)
-Enlarge Uterus may cause diastasis Recti
-Lordosis (2nd & 3rd tri): Helps to maintain balance
-Low back pain
MNGMNT:
-Pelvic Rocking Exercises
-Firm Mattress with proper Alignment of back
REPRODUCTIVE SYSTEM
- Uterus ↑ 20 times (↑ estrogen)
-Goodell sign: Softening of Cervix
-Cervix becomes vascular
-Cervix has mucus plug (Operculum)
-Leukorrhea
-Hegar sign: Softening of lower uterine uterine
-Chadwick sign: The vagina ↑ vascularity : Vasocongestion
-Vaginal Secretions become more acidic
-Egg production stops in the ovaries
-Breast changes such as fullness, tingling, dark areola, tenderness due to estrogen
(6 weeks)
-Colostrum production (4th month)
-Involution/ Uterine Involution (6 weeks)
-Endometrium is formed 3 weeks after delivery except on placenta side of implantation at 6 weeks.
-Resumption of Menses
a) Non-lactating: 6-8 weeks
b) Lactating: after 6 months
MILESTONES OF PREGNANCY
1ST TRIMESTER:
-Acceptance of Pregnancy
-Ambivalence
-Most critical: Organogenesis
-1 prenatal visit before 4 months
2ND TRIMESTER
-Acceptance of the baby
-Quickening
-Most comfortable
-Fetal length
-1 Prenatal visit (6 months)
3RD TRIMESTER
-Responsible Parenting
-Nest Building (Preparing)
-Most Rapid Growth
-Weight Fetal gaining
-2 Prenatal visit (8-9 months)
What is normal change in urine in pregnant women?
Presence of glucose + Glocusoria
↓Glucose Threshold
+2= Abnormal
Best test to check glucose during pregnancy
Blood sugar
GTK
Prolactin inhibits ovulation
Not<8 Breastfeeding
↑Prolactin = Breastfeeding
DURING PREGNANCY
PLACENTA
PLACENTA
↓
↑Estrogen
↓
x FSH
↓
No maturation of ovum
PLACENTA
↓
x LH
↓
No Ovulation
Resumption of Menses
Non-lactating mothers
-after 6-8 weeks
Lactating Mothers
-after 6 months
-Due to lactation amenorrhea Method (LAM)
*All contraception with estrogen are not safe for lactating mothers. Otherwise, Estrogen can be used for Non-Breastfeeding
AFTER DELIVERY
LACTOGENESIS
↓ in progesterone
↓
APG
↓
Prolactin
↓
Acini Cells (Milk Production)
↓
Milk Production
↓
LACTOGENESIS
LET DOWN REFLEX
SUCK
↓
PPG
↓
OXYTOCIN
↓
MYOEPITHELIAL CELLS CONTRACTION
↓
LACTIFEROUS DUCTS
↓
MILK EJECTION
LOCHIA
“Really-Sore-After”
RUBRA
1-3 days
Bright Red
SEROSA
4-7 days
Pinkish/brown
ALBA
10-21 days
Whitish/yellow
DSE/ILLNESS/PROBLEMS DURING PREGNANCY
1ST TRIMESTER
-Ectopic Pregnancy
-Abortion
2ND TRIMESTER
-H-mole
-Incompetent Cervix
3RD TRIMESTER
-Abruptio Placenta
-Placenta Previa
First sign of Pre-eclampsia
Weight gain: due to developing edema
Late sign of pre-eclampsia
Aura: Impending Convulsion; Stomach pain
gtk
Prematurity is ↑in abruptio placenta
than placenta previa
Earliest rupture of ectopic pregnancy
6weeks-14 weeks
MECHANISM OF FETAL MOVEMENT
ED FIEERE
ENGAGEMENT
DESCENT
FLEXION
INTERNAL ROTATION
EXTENSION
EXTERNAL ROTATION
RESTITUTION
EXPULSION
***Starts when cervix is fully dilated and effaced ends on expulsion
https://quizlet.com/210627776/mechanisms-of-labor-cardinal-movements-ed-fire-ere-flash-cards/
