Maternal Physiology Flashcards
In early pregnancy, what causes the increase in the size of the uterus?
Estrogen and progestrone
After 12 weeks, what causes the increase in uterine size?
enlarging product of conception
thickening is most marked on which part of the uterus
fundus
when does the uterus become palpated suprapubically
12 weeks
by the 20th week, the fundus can be palpated where?
umbilicus
by the 36th week, the fundus of the uterus has reached where?
Xyphoid process
3 layers of the uterine musculature
outer hood like layer
thick middle layer composed of muscles perforated by blood vessels
inner layer with sphincter like fibers around the cervical os the fallopian tube orifices
What is the shape of the uterus at the start of the pregnancy?
pear shaped
at 12 weeks, the uterus will be shaped as
spherical
at term what is the shape of the uterus
ovoid
the enlarged uterus, when supine rests upon what great vessel?
inferior vena cava and aorta
early in the pregnancy (before 12 weeks) where can the uterus be palpated?
Pelvis
cervical wall thickens during pregnancy? t or f
true
what causes cyanosis and softening of cervix during pregnancy?
increased vascularity, edema hypertrophy and hyperplasia of cervical glands
eversion of the endocervical glands result into?
prolapsed cervical cavities and seen as reddish growth on the cervical os or squamocolumnar junction
this serves as a a mechanical plug that serves a barrier of the cervix from infection coming from the vagina
cervical mucus (rich in Ig and cytokines)
the cervical mucus of pregnant women when spread on a glass slide would show what pattern?
Beaded due to progesterone
if there is amniotic fluid leakage, what would be the pattern of the cervical mucus when spread on a glass slide?
fern due to estrogen
the endocervical gland hyperplasia and hypersecretory appearance is called
Arias Stella reaction
Arias stella reaction can be mistaken as what under pap smear?
atypical glandular cells
the corpus luteum produces progesterone up to how many weeks of pregnancy?
6-7 weeks
after the corpus luteum stops production of progesterone, what replaces it?
Placenta - from 8 weeks onward
besides progesterone, what other substance is produced by the corpus luteum to remodel the cervix and accommodate parturition
relaxin
a benign solid ovarian tumor due to exaggerated luteinization of normal ovary
pregnancy luteoma
benign ovarian tumors resulting from exaggerated follicle stimulation by high levels of HCG
theca lutein cysts
the increased vascularity of the vagina results in a violaceus color, this is called
Chadwick sign
what bacteria causes the vaginal ph to be acidic especially when pregnant
Lactobacillus acidophilus
breast tenderness and paresthesia is normal early in the pregnancy? t or f
true
when can colostrum start to be expressed
2nd trimester
scattered around the areola are sebaceous glands called
Montgomery glands
where does most of the weight gain obtained during pregnancy come from?
uterus and its contents, the breast, increase in blood volume and extravascular extracellular fluids
how many additional kcal per day is needed by the pregnant
300 k/cal per day
what is the total weight gain during pregnancy?
12.5 kg
water retention caused fall in plasma osmolality is about 6.5 liters, how many liters is retained by the fetus, placenta and the amniotic fluid?
3.5L
the other 3L comes from the increase in blood volume, increased size of the uterus and breast
amino acid concentrations are higher in fetal or maternal?
fetal
With regard to carbohydrate metabolism, the normal pregnancy is characterized by,
mild fasting hypoglycemia, postprandial hyperglycemia and hyperinsulinemia
when does maternal hyperlipidemia take place?
3rd trimester
How is increased demand for calcium by the fetus met?
by doubling calcium absorption in the intestines
sodium and potassium concentrations are increased or decreased?
Decreased due to increase in plasma volume
serum phosphate levels are increased, decreased or unchanged?
Unchanged
the blood volume increase by how many percent after the 32-34th week?
40-45%
Which shows a greater increase during pregnancy? erythrocytes or plasma?
Plasma
The much greater increase in plasma than erythrocytes results to?
Dilutional anemia
Hemoglobin at term should be?
12-16g/dL
a hemoglobin concentration of lower than __ is considered as iron deficiency anemia
11 g/dL
What Ig are elevated in the mucus?
IgA and IgG
coagulation factors during pregnancy are elevated except?
factors XI and XIII
spleen enlarges during pregnancy? t or F
true
there is a decrease in the platelet concetration? t or f
true
Placenta transfers iron to the fetus even when there is marked iron deficiency of the mother? t or f?
true
The heart moves to what direction during pregnancy?
Upwards and laterally
The displacement of the heart during pregnancy is caused by
the diaphragm elevating progressively
What happens to the first heart sound during pregnancy?
There is splitting of the heart sound
and an easily heard third heart sound
On chest exam, the mother exhibits cardiac murmurs, is this normal during pregnancy? y or n
Yes
and this disappears after delivery
when does the cardiac output peak? Give all three
at 28 weeks (40%), during labor and right after delivery of placenta
what happens with mean arterial pressure and systemic vascular resistance? increases or decrease?
Decrease
stroke volume elevates by how many during pregnancy?
30%
what is the effect on cardiac output when the gravid uterus compresses on the inferior vena cava?
Decrease due to decreased venous return
which position causes a higher blood pressure in pregnant women? sitting or left lateral decubitus position?
left lateral decubitus position
At supine position, a pregnant women may experience hypotension? t or f?
true
prostaglandins in pregnancy are increased and can cause increase in blood pressure? t or f
true
this substance comes from endothelial and vascular smooth muscles which is a potent vasoconstrictor. It is stimulated by angiotensin II
Endothelin 1
this is a potent vasodilator from endothelial cells
Nitric Oxide
the diaphragm elevates by how many during pregnancy?
4cm
During pregnancy, respiratory rate increases? t or f?
false
the increased respiratory effort experienced in pregnancy is caused by?
progesterone
this is the shift to the left of the oxygen dissociation curve which increases affinity of maternal hemoglobin for oxygen
Bohr effect
mechanical obstruction caused by the uterus results in hydronephrosis? t or f
True
Glomerular filtration rate increases by 50% during pregnancy? t or f?
True
BUN and creatinine clearance is lower in the pregnant women? t or f?
False
What substance may be responsible for the increase in renal blood flow?
relaxin by nitric oxide production and vasodilation
glucosuria may be normal during pregnancy because there is no glucose resorption increase? t or f?
True
ureter compression is greater on which side? left or right?
right
left is cushioned by the sigmoid colon
What hormone can possibly also cause ureteral dilatation?
Progesterone
Ureteral elongation causes what to show on xray?
Folds
During pregnancy, bladder pressure, increase or decrease?
increase
bladder capacity, increase or decrease?
decrease
what cause gum bleeding during pregnancy?
Gums become soft and hyperemic
what do you call the vascular swelling of the gums?
Epulis
the enlarging uterus pushes the intestines and stomach upward causing?
frequent heartburn and decreased gastric emptying time
What GI abnormalities are common during pregnancy?
constipation
hemorrhoids
bile stasis
gallstones
the appendix is displaced where during pregnancy?
Superiorly
what happens to the endocrine system and hormones increase during pregnancy?
Basal metabolic rate increases
thyroid gland can become enlarged
protein bound iodine increases
parathyroid gland size increases and PTH increases
Adrenal gland hormones increase
Pituitary gland size increases and may cause visual disturbances
The placenta produces what enzyme for the degradation of inuslin?
insulinase
slightly depressed lines or streaks in the abdomen and thighs seen during pregnancy?
Striae gravidarum
Strongest risk factors for striae gravidarum?
younger maternal age, family
history and prepregnancy weight and weight gain
during pregnancy
- brownish-black pigmented line in
the middle of the abdomen
Linea Nigra
pigmented spots on the face
Chloasma or “mask of pregnancy”
vascular elevation on
the neck, chest, abdomen, legs and arms
Spider nevi or angiomas
During pregnancy, the mother may experience lordosis or jyphosis?
lordosis
Separation of the recti muscles because of the
abdominal distention
diastasis recti
neurological condition common in the 1st
and 2nd trimester, due to tension and increasing
hormone levels.
Mild frontal headaches
Give common neurological changes during pregnancy
headaches due to tensin and increasing hormone levels
dizziness due to hypotension or hypoglycemia
tingling sensation due to hyperventilation leading to decreased pCO2
difficulty falling asleep
