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OBGYN - 3. OB normal > Maternal Physio - Repro > Flashcards

Maternal Physio - Repro Flashcards

1
Q

Compare the uterus in nonpregnant and pregnant woman

  • General morphology
  • Weight
  • Capacity
    • Nonpregnant
    • Pregnant
A
  • General morphology
    • Nonpregnant
      • Almost-solid structure
    • Pregnant
      • Thin-walled muscular organ
  • Weight
    • Nonpregnant
      • 70 g
    • Pregnant
      • 1,100 g
  • Capacity
    • Nonpregnant
      • 10 mL or less
    • Pregnant
      • 5 to 20 L (500 to 1,000X greater)
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2
Q

Cause of enlargement of uterus

Hypertrophy or hyperplasia

A

Hypertrophy rather than hyperplasia

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3
Q

Uterine hypertrophy early in pregnancy probably is stimulated by:

A
  • Early in pregnancy – estrogen
  • After 12 weeks – pressure exerted by the expanding products of conception

Memory aid:

  • _E_strogen
  • _E_nlarges the uterus
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4
Q

T/F. Hypertrophy of early pregnancy occurs entirely due to mechanical distention

A

False; similar uterine changes are observed with ectopic pregnancy

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5
Q

Uterine enlargement is most marked in this portion of the uterus

A

Fundus

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6
Q

The position of the placenta also influences the extent of uterine hypertrophy. Why?

A

The portion of the uterus surrounding the placental site enlarges more rapidly than does the rest

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7
Q

Describe the attachment of the tubes and the ovarian + round ligaments to the fundus

  • Early month of pregnancy
  • Later months of pregnancy
A
  • Early month of pregnancy
    • only slightly below the apex of the fundus
  • Later months of pregnancy
    • slightly above the middle of the uterus
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8
Q

Describe the shape of the uterus as pregnancy progresses

A
  • Pre-pregnancy – pear shape
  • First few weeks (8-10 weeks) – pear shape
  • 12 weeks – almost spherical
  • Subsequent – ovoid
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9
Q

Describe the location of the uterus as pregnancy progresses

A
  • 12 weeks - too large to remain entirely within the pelvis
  • As uterus enlarges, it:
    • contacts the anterior abdominal wall
    • displaces the intestines laterally
    • superiorly reaches almost to the liver
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10
Q

With ascent of the uterus from the pelvis, it usually undergoes what? This is caused by what? What is the implication?

A
  • Phenomenon
    • Dextrorotation
  • Cause
    • Rectosigmoid on the left side of the pelvis
  • Implication
    • The round ligament must be avoided in lower uterine incision
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11
Q

Softening of the uterine isthmus

A

Hegar sign

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12
Q

Arrangement of uterine muscle cells and description (indicate the main portion of the uterine wall)

A
  • Outer hoodlike layer
    • Arches over the fundus and extends into various ligaments
  • Middle layer
    • Main portion of uterine wall
    • Figure of 8 configuration
    • Perforated by blood vessels
  • Internal layer
    • With sphincter-like fibers around the fallopian tube orifices and internal os of the cervix

Memory aid:

  • _M_ain
  • _M_iddle
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13
Q

Uteroplacental blood flow increases progressively, with estimates ranging ___ in near term

A

450 to 650 mL/m

  • Summary:*
  • More or less half liter
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14
Q

Physiologic reason for increase in uterine blood flow

A
  • Increase in maternal-placental blood flow – vasodilation d/t estrogen action
  • Increase fetal-placental blood flow – a continuing growth of placental vessels
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15
Q

Uterine finding on bimanual exam

A

Uterus feels soft and elastic

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16
Q

Fundal height by weeks 12, 15, 20, 28, 32, 36, 40 weeks

A
  • 12 – barely palpable above pubic symphysis
  • 15 – midpoint between pubic symphysis and umbilicus
  • 20 – at the umbilicus
  • 28 – 6 cm above the umbilicus
  • 32 – 6 cm below the xyphoid process
  • 36 – 2 cm below xyphoid process
  • 40 – 4 cm below xiphoid process
17
Q

Cervical changes and the physiologic mechanism for such change

A
  • Goodell’s sign
    • Due to increased vascularity and edema of cervix
  • Cervical mucus beading
    • Due to progesterone
  • Arias-Stella reaction
    • Endocervical gland hyperplasia and hypersecretory appearance
18
Q

What is Goodell’s sign?

A

Cervical softening and cyanosis due to increased vascularity and edema of the entire cervix

19
Q

Cervical mucus beading occurs as a result of ____

A

Progesterone

20
Q

What is Arias-Stella reaction?

A

Endocervical gland hyperplasia and hypersecretory appearance

21
Q

Cervix palpation on pregnant versus nonpregnant

A
  • Nonpregnant
    • feels like the cartilage of the nose
  • Pregnant
    • feels like the lips of the mouth
22
Q

Physiologic mechanism for mucus plug formation

A

↑ in gland activity leads to the formation of a mucous plug

23
Q

Mucous plug composition and function

A

Immunoglobulins and cytokines, which act as a barrier to bacteria

24
Q

Corpus luteum

  • Origin
  • When does it maximally function
  • Produces what hormome
A
  • Origin
    • Remains of the ovarian follicle that has released a mature ovum during a previous ovulation
  • When does it maximally function
    • First 6-7 weeks of pregnancy
  • Produces what hormome
    • Progesterone
  • Memory aid:*
  • corProgesterone
25
Q

The set of changes in the endometrium of the uterus that prepare it for implantation of an embryo

  • Phenomenon
  • Description
A
  • Phenomenon
    • Decidual reaction
  • Description
    • Elevated patches of tissue which bleed easily
26
Q

Relaxin

  • Produced by
  • Action
A
  • Produced by
    • Corpus luteum, deciduas, placenta
  • Action
    • Remodelling of reproductive tract connective tissue to accomodate pregnancy

Memory aid:

  • RElaxin
  • REmodelling
27
Q

Beading versus ferning

A
  • Not pregnant – estrogen effect → ↑ NaCl in mucus → crystallization → ferning
  • Pregnant – progesterone effect → ↓ NaCl in mucus → no crystallization → beading

Memory aid:

  • Beaded (circle like a pregnant tummy)
  • _B_ead _B_untis _B_aba NaCl
  • _P_regnant – _P_rogesterone
28
Q

Describe the vaginal secretion during pregnancy and the physiology of each

A
  • Thicker with a white color due to influence of progesterone
  • More acidic in nature as a result of ↑ Lactobacillus acidophilus
  • Memory aid:*
  • Puti Pepet Progesterone
29
Q

Effect of Lactobacillus acidophilus

A

Inhibits growth of most pathogens and favors growth of yeasts

30
Q

Vaginal pH during pregnancy

A

3.5 to 6

31
Q

Description of vaginal discoloration and rationale

A

Blood flow increases → vagina appears dark bluish or purplish-red

32
Q

Sign described as bluish discoloration of the vaginal and cervical mucosa

A

Chadwick’s sign

33
Q

Chadwick sign

Presumptive, probable or positive sign?

A

Presumptive

  • Note:*
  • Of the three signs (with Hegar and Goodel, this is the only presumptive sign)
34
Q

When is Chadwick sign observed?

A

6th week

  • Note:*
  • All of the 3 signs are seen at 6 weeks

OBGYN - 3. OB normal (41 decks)

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