Maternal fetal physiology-Table 1 Flashcards
What are the derm changes that happen in pregnancy?
Spider angiomata & palmar erythema (estrogen)
Acne: ↑ sebum production
Hyperpigmentation d/t ↑ melanocyte SH/estrogen driven (striae & linea nigra); pigmented nevi
Scalp hair growth changes
Vaginal condyloma, varicosities
What changes are happening to the breast in the first 8 wks?
- Nipple/areola enlarge & prominent Montgomery tubercles
- Ductal growth & inc’d blood flow
What are common breast complaints in pregnancy?
Breast can grow 2 cup sizes Soreness Stretch marks Pruritus Leaking Change in size See veins under skin Concern about the “bumps”
What are eye changes in pregnancy?
Blurred vision from thickened cornea, decreased intraocular pressure, and increased fluid retention
What changes happen in the thyroid during pregnancy?
Gland increases in size
Does TSH cross the placenta ?
No, doesn’t impact fetus
What happens to thyroid hormones in pregnant?
↑ thyroxine binding globulin (TBG) d/t estrogen
Inc’d TBG production = increase total T3 & T4 - hCG increases in first 12 wks, doubles every 24-48 hrs then levels out
- once this is even you can get accurate read on TSH
What happens to ACTH and aldosterone in pregnancy?
Increase from increased cortisol from estrogen
What is ptyalism?
Women feel like that have excessive salivation for first trimester
What hormone plays a role on changes in the GI tract?
Progesterone
What are the GI changes?
Increased incidence of gastric reflex, delayed gastric emptying, and prolonged transit time from stomach to cecum
Why do women in the later 2-3rd trimester feel their abdomen is itchy?
Histamine rxn from the motility slow down
What are pregnant women at increased risk for?
Cholecytitis and gallstones
What is happen to insulin response in pregnancy?
Reduced tissue response/insulin d/t HPL effect on tissues plus inhibition liver gluconeogenesis
Pancreas/ beta cell hypertrophy
What does HPL do?
increases resistance of peripheral tissues & liver to insulin effects
secretion increases with increased mass of the placenta
Why should women not sleep on their backs in the later stages?
Femoral venous pressure increases d/t uterine compression inferior vena cava & fetal pressure on iliac veins = supine hypotension
What happens to cardiac output in pregnancy?
Increases by 30-50%, uterus receives 2-20% of total output
What happens to the heart in pregnancy?
Heart shifts left and up and the apex shifts laterally
What are the EKG changes in pregnancy?
L axis shift due to diaphragm elevation
QRS up in lead I & AVF (vector is based on wave ventricular depolarization toward + skin electrode)
What happens in hyperdynamic state?
S2 split from increased flow across A-V valves
What happens to the blood during pregnancy? What does this put mom at risk for?
Hyper-coag state
DVT and PE
What factors are increased in the hypercoag state in pregnancy?
Increased factors I, VII, VIII, IX, and X
What increases on the CBC in mom?
Plasma and RBC volume = dilution effect
TIBC
What decreased in blood labs?
Serum iron
Does lung volume expand in pregnancy?
No, lungs are not bigger, just more efficient
What happens to tidal volume?
Increases d/t inspirational capacity
What happens to total lung capacity?
Decreases d/t elevated diaphragm and residual volume reduced
Are moms alkolotic or acidoctic for most of pregnancy?
Progesterone driven state of respiratory alkalosis to protect the fetus from excess CO2
What happens in maternal resp alkalosis?
Dyspnea, hyperventilation and decreased exercise tolerance
What are renal changes?
Enlarged kidneys
Increased residual volume d/t decreased bladder tone
Decreased bladder capacity
Dec BUN Cr and uric acid
What is glucosuria?
Increased urinary glucose excretion common d/t higher GFR
What happens in the MSK during pregnancy?
Increased bone turn over
Decreased total serum calcium and increased PTH
Back pain
Ligament laxity
What are common symptoms in pregnancy?
—HA —Heartburn, constipation, hemorrhoids —LBP, round ligament pain ---Ankle edema ---Fatigue ---Varicose veins ---Leucorrhea
What will tension HA feel like?
Band like pressure around the head
How are tension HA tx in pregnant women?
acetaminophen
What happens to migraines in preggo?
Typically improve
Can give acetaminophen with or without codeine
How can pregnant women try to avoid reflux?
—Avoid triggers & ETOH, acidic fruits, caffeine, carbonated drinks
—Take OTC antacids if dietary changes not helpful
—Avoid food 2-3 hours before lying down
—Elevate head to sleep
Constipation and hemorrhoids just happen. How can you minimize or prevent?
Increase fluid, fiber, and fitness
How can you tx pedal edema?
Elevate, comfy shoes (jokes) and pregnant belt
What hormone is causing fatigue in the 1st trimester?
Progesterone
Whats the deal with all dat discharge?
Nice and white and mucousy and can be until delivery!
What should you make sure to check for if a preggo woman comes in with discharge complaints?
Make sure it is not vaginitis, std, or amniotic fluid leakage
What is umbilical blood flow?
combined output both fetal ventricles proportional to fetal growth so umbilical flow is stable
What is the role of the placenta?
Nutritional and waste removal
Hormone production
Resp and metabolite exchange
Blocks and masks maternal antibodies
What are the hormones produced by the placenta?
Estrogen, progesterone, hCG, and HPL
What does HPL do?
↓ maternal insulin sensitivity which raises maternal blood glucose levels d/t decreased maternal glucose utilization
this allows for adequate fetal nutrition & up regulation of pancreas
What are the resp and metabolite exchanges?
Gas- simple diffusion
Metabolism- glucose with facilitated diffusion
Active transport- amino acids
When is the placenta fully formed?
10-12 weeks
What is developed in the fetus by weeks 5-6?
Formation limb buds, neural tube & umbilical cord
What is developed in the fetus by weeks 7-8?
Ext’l ears, eyes, eyelids & upper lip
What is developed in the fetus by weeks 11-12?
Bones harden, skin & nails grow, can measure crown-rump length (CRL)
What is developed in the fetus by weeks 13-14?
Hair growth begins, roof of mouth forms
What is developed in the fetus by weeks 19-20?
Lanugo covers body, vernix caseosa on skin
What is developed in the fetus by weeks 21-22?
Taste buds
Bone marrow begins production
What is developed in the fetus by weeks 23-26?
Eyebrows & eyelashes, wt gain
What is developed in the fetus by weeks 27-28?
Eyelids unfuse
What is developed in the fetus by weeks 33-34?
Pupillary responses w/light, lanugo almost gone
When is the fetal thyroid gland developed?
By the end of the 1st trimester
When can you detect FHT with Doppler?
12-14wks
What is fetal blood flow measuring?
Indirect measure of fetal growth and well being
When does the fetus have regular chest mvmts with inhalation and exhalation of amniotic fluid?
16wks
When is surfactant produced? Why is this important?
Wk 26 begins better at 28, large quantities at 40
Better lung maturity for fxn and survival
Blood test for surfactant and try to delay delivery
When can fetus start to hiccup?
38 wks
from amniotic fluid in trachea
When does meconium accumulation begin?
18 wks
At what week is the intestinal meconium formed signaling preparedness for the 1st BM?
38 wks
When is there amniotic fluid gonadal differentiation?
6-8 wks
When is the uterus developed in females?
19-20wk
When do the testes descend into the scrotum?
30-34 wks
Are male and female differentiation gene triggered?
No appears that males need gene trigger but females do not
