MATERNAL PHYSIOLOGY

Question 1

Early changes are due in part to the:

Answer 1

1. metabolic demands brought on by the fetus, placenta and uterus
2. increasing levels of pregnancy hormones particularly those of progesterone and estrogen

Question 2

Late changes (starting mid-trimester) are:

Answer 2

1. anatomical in nature

2. caused by mechanical pressure from the expanding uterus

Question 3

In the nonpregnant woman, the uterus is an almost-solid structure weighing about _____ and with a cavity of _____ or less.

Answer 3

70 g

10 mL

Question 4

By the end of pregnancy, the uterus has achieved a capacity that is _____________ times greater than in the nonpregnant state.

Answer 4

500 to 1000

Question 5

___________ is mainly stretching & marked hypertrophy of muscle cells

Answer 5

Uterine enlargement

Question 6

Uterus weight increases from _____ to _____ at term.

Answer 6

70 gm - 1100 gm

Question 7

Volume of cavity is 10ml or less in non-pregnant women and increases to ______ in pregnant women

Answer 7

5-20 liters

Question 8

For the first few weeks, the uterus maintains its original pear shape, but as pregnancy advances, the corpus and fundus assume a more globular form becoming almost spherical by _______.

Answer 8

12 weeks

Question 9

Subsequently, the organ increases more rapidly in length than in width and assumes an _______.

Answer 9

ovoid shape

Question 10

With ascent of the uterus from the pelvis, it usually undergoes rotation to the ______.

Answer 10

right

Question 11

This ________ likely is caused by the rectosigmoid on the left side of the pelvis.

Answer 11

dextrorotation

Question 12

As early as _____ after conception, the cervix begins to undergo pronounced softening and cyanosis.

Answer 12

1 month

Question 13

Due to increased vascularity and edema of the entire cervix, together with hypertrophy and hyperplasia of the cervical glands the endocervical mucosal cells produce copious amounts of a tenacious ____ that obstruct the cervical canal soon after conception.

Answer 13

mucus

Question 14

May act as an immunological barrier to protect the uterine contents against infection from the vagina.

Answer 14

Mucus plug

Question 15

Rich in cytokines & immunoglobulins

Answer 15

Mucus plug

Question 16

The major component of the cervix is ________ although it contains a small amount of smooth muscle.

Answer 16

connective tissue

Question 17

Rearrangement of this collagen-rich connective tissue is necessary for diverse functions such as:

Answer 17

1. maintenance of a pregnancy to term
2. dilatation to aid delivery
3. repair following parturition so that a successful pregnancy can be repeated

Question 18

Pregnancy is associated with both endocervical gland _________ and ________ appearance.

Answer 18

hyperplasia and hypersecretory

Question 19

Endocervical gland hyperplasia and hypersecretory appearance

Answer 19

Arias- Stella Reaction

Question 20

_______ ceases during pregnancy, and the maturation of new follicles is suspended.

Answer 20

Ovulation

Question 21

Ordinarily, only a single _______ can be found in pregnant women.

Answer 21

corpus luteum

Question 22

This functions maximally during the first 6 to 7 weeks of pregnancy in progesterone production.

Answer 22

corpus luteum

Question 23

During pregnancy, increased vascularity and hyperemia develop in the skin and muscles of the ________ and _______ with softening of the underlying abundant connective tissue.

Answer 23

perineum and vulva

Question 24

The pH is acidic, varying from _____ due to increased production of lactic acid from glycogen in the vaginal epithelium by the action of Lactobacillus acidophilus.

Answer 24

3.5 to 6

Question 25

Increased vascularity prominently affects the vagina and results in the violet color characteristic of ________.

Answer 25

Chadwick sign

Question 26

HYPERPIGMENTATION

Answer 26

1. Chloasma or Melasma Gravidarum (Mask of Pregnancy) | 2. Linea Nigra

Question 27

VASCULAR CHANGES

Answer 27

1. Angiomas (vascular or spider) | 2. Palmar erythema

Question 28

Due to hyperestrogenemia

Answer 28

Palmar erythema

Question 29

BREASTS

Answer 29

- tenderness - increase in size - veins more visible - larger, deeply pigmented, more erectile nipples - colostrum expression - broader pigmented areola - elevation of the glands of Montgomery

Question 30

In response to the rapidly growing fetus and placenta and their increasing demands, pregnant women undergo metabolic changes that are numerous and intense. Metabolic rate increased by _____ percent compared with that of the nonpregnant state.

Answer 30

10 to 20

Question 31

Average weight gain is _________.

Answer 31

12.5 kg or 27.5 lbs

Question 32

Is due to the accumulation of fluid, which may amount to a liter or so, which is caused by increased venous pressure below the level of the uterus as a consequence of partial vena cava occlusion

Answer 32

- increase water retention - pitting edema of ankles and legs at the end of the day (WATER METABOLISM)

Question 33

The products of conception, the uterus, and maternal blood are relatively rich in _______.

Answer 33

protein

Question 34

By term, the fetus and placenta together weigh about ______ kg and contain approximately _____ of protein.

Answer 34

4 kg | 500 grams

Question 35

CARBOHYDRATE METABOLISM

Answer 35

- mild fasting hypoglycemia | - post-prandial hyperglycemia & hyperinsulinemia

Question 36

FAT METABOLISM

Answer 36

- increased lipids - increased lipoproteins and - increased apolipoproteins

Question 37

Hypervolemia associated with normal pregnancy averages ___ to ____ percent above the non-pregnant.

Answer 37

40 to 45

Question 38

Blood volume after ____ weeks begin to increase at ________, most rapid in _______ & slower rate in ________.

Answer 38

32 to 34 1st trimester 2nd trimester 3rd trimester

Question 39

Hg & Ht concentration _________.

Answer 39

slightly decreased

Question 40

Blood viscosity __________.

Answer 40

decreased

Question 41

Markedly _______ WBC during labor and early puerperium ( 25,000/uL).

Answer 41

elevated

Question 42

__________ platelet count.

Answer 42

Decreased (hemodilution & platelet consumption)

Question 43

Heart is displaced to the _________ and ________.

Answer 43

left and upward

Question 44

Results to _____ axis deviation on ECG

Answer 44

left

Question 45

Cardiac output is _______.

Answer 45

increased

Question 46

Resting pulse rate increases about _________.

Answer 46

10 beats/minute

Question 47

_______ peripheral vascular resistance.

Answer 47

Decreased

Question 48

Blood pressure falls during ______ and returns to normal then.

Answer 48

2nd trimester

Question 49

The _________ is essentially unchanged.

Answer 49

respiratory rate

Question 50

___________ and __________ increase significantly as pregnancy advances.

Answer 50

Tidal volume and resting minute ventilation

Question 51

The increase in minute ventilation is caused by several factors including enhanced respiratory drive primarily due to the stimulatory effects of _________, ____ expiratory reserve volume, and compensated _____________.

Answer 51

progesterone, low, respiratory alkalosis

Question 52

The functional residual capacity and the residual volume are decreased as a consequence of the elevated __________.

Answer 52

diaphragm

Question 53

Diaphragm rises _____ from the non-pregnant woman.

Answer 53

4 cm

Question 54

Primarily as a consequence of this elevated GFR, approximately 60 percent of women report ____________ during pregnancy.

Answer 54

urinary frequency

Question 55

Kidneys increased in size _____ & weight

Answer 55

(1.5 cm)

Question 56

Dilatation of ______.

Answer 56

ureters

Question 57

Elevated Glomerular Filtration Rate (GFR) about _____.

Answer 57

50%

Question 58

Renal plasma flow increases by ______ in early pregnancy & decreases during the late pregnancy.

Answer 58

75%

Question 59

_________ is common during pregnancy and is most likely caused by reflux of acidic secretions into the lower esophagus.

Answer 59

Pyrosis (heartburn)

Question 60

___________ are common during pregnancy caused by constipation and elevated pressure in veins below the level of the enlarged uterus.

Answer 60

Hemorrhoids

Question 61

________ impairs gallbladder contraction by inhibiting cholecystokinin-mediated smooth muscle stimulation.

Answer 61

Progesterone

Question 62

Are displaced by the enlarging uterus.

Answer 62

Stomach and intestines

Question 63

Hepatic blood flow _______.

Answer 63

increases

Question 64

Physiological changes of pregnancy cause the thyroid gland to increase production of thyroid hormones by ______% to meet maternal and fetal needs.

Answer 64

40 to 100 percent

Question 65

Maternal plasma levels of ______ increase markedly during normal pregnancy and concentrations are usually ____ fold greater at term —about __________ — compared with nonpregnant women.

Answer 65

prolactin, 10, 150 ng/mL

Question 66

Pituitary gland enlarges by _______.

Answer 66

135%

Question 67

Thyroid hormone ________.

Answer 67

increases

Question 68

Parathyroid hormone plasma concentrations ________.

Answer 68

increases

Question 69

Decreased motility due to influence of _________.

Answer 69

progesterone

Question 70

___________ is very common

Answer 70

Lower extremity edema