maternal physiology Flashcards
uterine changes
increase size d/t increase polyamines pyriform shape at 6wks globular at end of 2nd month spherical at end of 3rd month length>width at 20th wk term - volume 2-20L; 1100g
fundic height = AOG
18-32wks
progressive softening of isthmus
hegar’s sign
isthmus changes
term - 7-10cm
site for CS incision
isthmus
LUS begins to develop
braxton-hicks contraction
34 wks
widening of LUS responsible for 2 phenomena
upward migration of low lying placenta
stretching nd shearing of placenta implanted in LUS (placenta previa bleeds)
fetal head often descends to or even thru inlet
lightening
abdomen undergoes shape change
baby dropped
cervix changes
softening and cyanosis d/t increased vascularity and edema
hyperplasia & hypertrophy of glands, muscle & CT
dilation to aid delivery & repair ff parturition
marked opening of cervix
goodell’s sign
uterine vascular system changes
UV - reduce elastin and adrenergic nerve density; dilation
UA - dilation d/t trophoblastic invasion of TM
htn in pregnancy
problem in trophoblastic invasion, ballooning doe not happen
ovaries changes
corpus luteum - function max in 6-7 weeks; prod. progesterone w/c supports pregnancy; persists until 8wks
vagina changes
hyperplasia & hypertrophy of epithelium increased vascularity (6wks) and hyperemia
bluish discoloration of vagina
chadwick’s sign
pelvic floor changes
more vascular
levator ani hypertrophy
less rigid, more distensible
pelvic girdle changes
relaxation of pelvic joint
thickened edematous joint capsule
increase mobility of pelvic bones
breast changes
dark nipples
hyperplasia & hypertrophy of glands
areola broader and deeply pigmented
skin changes
increase pigmentation
melasma
PUPPP
abdominal wall changes
striae gravidarum (silvery white after delivery)
diastasis (recti separation)
linea nigra
vascular changes
angioma d/t hyperestrogenemia
CVS changes
increased CO (30-50% at 25-32 wks)
heart changes
displace to left and upward
ABP changes
decreases at 24-26wks then rises thereafter (D>S)
brachial AP lower when sitting
antecubital VP unchange
femoral VP rises from 8 to 24mmHg at term in supine
varicose veins & hemorrhoids & DVT
renin, angiotensin II, plasma volume
increase d/t augmented estrogen prod.
ANP & BNP
unchange
prostaglandin
elevated
PGE2 markedly elevated during late pregnancy (natriuretic);
PGI2 rises during late pregnancy (vasodilation & plt fx);
endothelin
unchange
vasoconstrictor
nitric oxide
vasodilator
respi changes
dyspnea (upward diaphragm 4cm) subcostal angle widen decreased FRC, ERV, RV, TLC increased IC, TV, RMV unchanged RR, LC, MBC increased total hgb mass and O2 consumption
GI changes
hyperemic and softened gums epulis gravidarum (pyogenic granuloma) pyrosis (heartburn) emptying time unchanged hemorrhoids cholestasis
GUT changes
increase size of kidney, GFR, renal plasma flow
physiologic hydroureter > bacteriuria > UTI
bladder pushed upward with marked tortuosity of vessel, edema & hyperemia
endocrine changes
enlarged pituitary (12mm) inc. prolactin (150ng/mL), oxytocin, GH, thyroid gland, TBG, T3 & T4, iodine, PTH, calcitonin dec. gonadotrophs & somatotroph, GH(36wks) unchanged corticotrophs & thyrotrophs, AVP
placenta changes
hCG - syncytiotrophoblast (8-10d); 10-12wks decline; nadir 20wks
HPL - glucose sparer; syncytiotrophoblast; inc. 34-36wks
estrogen - syncytiotrophoblast; inc
progesterone - syncytiotrophoblast & plasma LDL; relaxant
adrenal changes
inc. cortisol, aldosterone, deoxycorticosterone, androgen
hema changes
inc. BV, RBC, WBC slight, all BM elements, coag fcators, ferritin
hypervolemia
dec hgb conc.(12.5g/dL; <11 abnormal)
iron req. 1000mg/d (300mg fetus & placenta; 500mg RBC prod; 200mg excreted)
skeletal changes
lower back pain
lordosis
musculoskeletal changes
aching, numbness, weakness
immunologic changes
dec. humoral & cell-mediated
early: pro-inflam (implantation) & anti-inflam (uterine epithelium repair)
mid: anti-inflam
parturition: pro-inflam
maternal metab
wt gain 12.5kg / 27lbs
inc. H2O(6.5 L: 3.5 fetal, placenta, AF; 1.5 plasma; 1.5 breast and intestinal tissue) and Na metab, glucose, protein(500g fetus) metab, fat (declines at 3rd trim) metab, pH (mild alkalosis 7.42-7.44)
CNS changes
dec. memory, IOP, corneal sensitivity
krukenberg opacities
difficulty sleeping
PP blues
