MATERNAL PHYSIOLOGY Flashcards
Early changes are due in part to the:
- metabolic demands brought on by the fetus, placenta and uterus
- increasing levels of pregnancy hormones particularly those of progesterone and estrogen
Late changes (starting mid-trimester) are:
- anatomical in nature
2. caused by mechanical pressure from the expanding uterus
In the nonpregnant woman, the uterus is an almost-solid structure weighing about _____ and with a cavity of _____ or less.
70 g
10 mL
By the end of pregnancy, the uterus has achieved a capacity that is _____________ times greater than in the nonpregnant state.
500 to 1000
___________ is mainly stretching & marked hypertrophy of muscle cells
Uterine enlargement
Uterus weight increases from _____ to _____ at term.
70 gm - 1100 gm
Volume of cavity is 10ml or less in non-pregnant women and increases to ______ in pregnant women
5-20 liters
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 _______.
12 weeks
Subsequently, the organ increases more rapidly in length than in width and assumes an _______.
ovoid shape
With ascent of the uterus from the pelvis, it usually undergoes rotation to the ______.
right
This ________ likely is caused by the rectosigmoid on the left side of the pelvis.
dextrorotation
As early as _____ after conception, the cervix begins to undergo pronounced softening and cyanosis.
1 month
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.
mucus
May act as an immunological barrier to protect the uterine contents against infection from the vagina.
Mucus plug
Rich in cytokines & immunoglobulins
Mucus plug
The major component of the cervix is ________ although it contains a small amount of smooth muscle.
connective tissue
Rearrangement of this collagen-rich connective tissue is necessary for diverse functions such as:
- maintenance of a pregnancy to term
- dilatation to aid delivery
- repair following parturition so that a successful pregnancy can be repeated
Pregnancy is associated with both endocervical gland _________ and ________ appearance.
hyperplasia and hypersecretory
Endocervical gland hyperplasia and hypersecretory appearance
Arias- Stella Reaction
_______ ceases during pregnancy, and the maturation of new follicles is suspended.
Ovulation
Ordinarily, only a single _______ can be found in pregnant women.
corpus luteum
This functions maximally during the first 6 to 7 weeks of pregnancy in progesterone production.
corpus luteum
During pregnancy, increased vascularity and hyperemia develop in the skin and muscles of the ________ and _______ with softening of the underlying abundant connective tissue.
perineum and vulva
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.
3.5 to 6
Increased vascularity prominently affects the vagina and results in the violet color characteristic of ________.
Chadwick sign
HYPERPIGMENTATION
- Chloasma or Melasma Gravidarum (Mask of Pregnancy)
2. Linea Nigra
VASCULAR CHANGES
- Angiomas (vascular or spider)
2. Palmar erythema
Due to hyperestrogenemia
Palmar erythema
BREASTS
- tenderness
- increase in size
- veins more visible
- larger, deeply pigmented, more erectile nipples
- colostrum expression
- broader pigmented areola
- elevation of the glands of Montgomery
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.
10 to 20
Average weight gain is _________.
12.5 kg or 27.5 lbs
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
- increase water retention
- pitting edema of ankles and legs at the end of the day
(WATER METABOLISM)
The products of conception, the uterus, and maternal blood are relatively rich in _______.
protein
By term, the fetus and placenta together weigh about ______ kg and contain approximately _____ of protein.
4 kg
500 grams
CARBOHYDRATE METABOLISM
- mild fasting hypoglycemia
- post-prandial hyperglycemia & hyperinsulinemia
FAT METABOLISM
- increased lipids
- increased lipoproteins and
- increased apolipoproteins
Hypervolemia associated with normal pregnancy averages ___ to ____ percent above the non-pregnant.
40 to 45
Blood volume after ____ weeks begin to increase at ________, most rapid in _______ & slower rate in ________.
32 to 34
1st trimester
2nd trimester
3rd trimester
Hg & Ht concentration _________.
slightly decreased
Blood viscosity __________.
decreased
Markedly _______ WBC during labor and early puerperium ( 25,000/uL).
elevated
__________ platelet count.
Decreased (hemodilution & platelet consumption)
Heart is displaced to the _________ and ________.
left and upward
Results to _____ axis deviation on ECG
left
Cardiac output is _______.
increased
Resting pulse rate increases about _________.
10 beats/minute
_______ peripheral vascular resistance.
Decreased
Blood pressure falls during ______ and returns to normal then.
2nd trimester
The _________ is essentially unchanged.
respiratory rate
___________ and __________ increase significantly as pregnancy advances.
Tidal volume and resting minute ventilation
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 _____________.
progesterone, low, respiratory alkalosis
The functional residual capacity and the residual volume are decreased as a consequence of the elevated __________.
diaphragm
Diaphragm rises _____ from the non-pregnant woman.
4 cm
Primarily as a consequence of this elevated GFR, approximately 60 percent of women report ____________ during pregnancy.
urinary frequency
Kidneys increased in size _____ & weight
(1.5 cm)
Dilatation of ______.
ureters
Elevated Glomerular Filtration Rate (GFR) about _____.
50%
Renal plasma flow increases by ______ in early pregnancy & decreases during the late pregnancy.
75%
_________ is common during pregnancy and is most likely caused by reflux of acidic secretions into the lower esophagus.
Pyrosis (heartburn)
___________ are common during pregnancy caused by constipation and elevated pressure in veins below the level of the enlarged uterus.
Hemorrhoids
________ impairs gallbladder contraction by inhibiting cholecystokinin-mediated smooth muscle stimulation.
Progesterone
Are displaced by the enlarging uterus.
Stomach and intestines
Hepatic blood flow _______.
increases
Physiological changes of pregnancy cause the thyroid gland to increase production of thyroid hormones by ______% to meet maternal and fetal needs.
40 to 100 percent
Maternal plasma levels of ______ increase markedly during normal pregnancy and concentrations are usually ____ fold greater at term —about __________ — compared with nonpregnant women.
prolactin, 10, 150 ng/mL
Pituitary gland enlarges by _______.
135%
Thyroid hormone ________.
increases
Parathyroid hormone plasma concentrations ________.
increases
Decreased motility due to influence of _________.
progesterone
___________ is very common
Lower extremity edema
