Module 6 Flashcards
TBG __________ in pregnancy
increases
free thyroid hormone ___________ in pregnancy
decreases
____ stimulates increase in T3 and T4
hCG
TBG level + T3 and T4 increases lead to decrease in ____, especially in weeks 8-14
TSH
thyroid __________ doesn’t change in pregnancy
function
thyroid mimics ______thyroidism in pregnancy
hypothyroidism
________________ changes support altered carbohydrate, protein and lipid metabolism and changes in basal metabolic rate.
thyroid hormone
TSH is structurally similar to _____ so it decreases in 1st trimester (8-14 weeks) when this increases
hCG
total T3 and T4 ________, the most at 10-15 weeks due to increase in TBG and hCG
increases
Free T3 and T4 ___________ in pregnancy due to increased TBG
decreased
renal iodide clearance __________ in pregnancy due to increased renal blood flow and GFR
increases
there is maternal need for ________ iodine in pregnancy to make thyroid hormones
increased
iodine uptake _________ in pregnancy
increases
pregnant and lactating women need _____ mcg of iodine per day (PNV and iodized salt)
250
______________ cells grow from 20% to 60% of the anterior pituitary
Prolactin-producing
_________ increases during pregnancy and peaks at delivery.
prolactin
increases to prepare breasts for lactation.
bioactive prolactin
Increased estrogen leads to larger ________ gland and changes in morphology
pituitary
__________ immunity is suppressed in pregnancy to protect the fetus from rejection
Cell-mediated
__________ immune response is not changed in pregnancy
Antibody-mediated
Localized _________ response along with systemic responses mediated by __________ factors protect the fetus
uterine; endocrine
Maternal immune system tolerates the fetus (it is aware of the presence of the fetus) through active mechanisms where the mother prevents the recognition of the fetus as foreign and of being rejected.
Fetal ___________ cells help in this process
trophoblastic
______________ in the fetus provide passive immunity against pathogens, epigenetic inheritance of immunity, suppression of tumor development
maternal IgG antibodies
IgG transfer increases after _______ weeks
20-22
Pregnancy stimulates an activation of the ________ system although it is delayed, but the fetus is not rejected
complement
immune system changes that begin at 11 weeks gestation and augment maternal defenses against bacterial infection
complement system changes
inhibits the maternal inflammatory response
PZP (pregnancy zone protein)
Small particles (antigens) from the __________ stimulate systemic inflammatory response
trophoblast
enhance antibody-mediated responses and cause a protective function in maternal-fetal immune relationship while decreasing maternal resistance to bacterial and viral infections
cytokines
If this system is disrupted, _____________ production increases and is increased risk for SAB, preeclampsia, PTL, and FGR
inflammatory cytokine
Maternal _____ antibodies cross the placenta in significant amounts through active transport
IgG
If the cytokine enhanced antibody-mediated response system is disrupted, inflammatory cytokine production __________ which increases risk of ______
increases; SAB
pregnant women have higher rates of fungal infections (yeast) due to effects of ________ on nutrient availability for growth
estrogen
most women do not experience increased __________ infections in pregnancy
bacterial
_______ infections are seen more frequently and more severely in pregnancy, especially in 2nd and 3rd trimesters
viral
- Vasodilation caused by increased progesterone and
- Proliferation of capillaries at the skin surface caused by increased estrogen
lead to…
bleeding gums vascular spiders telangiectasias palmar erythema purpura hyperemia
Nasal congestion (pregnancy rhinitis) occurs in many pregnant women due to the effects of:
estrogen
may occur when superficial blood vessels of the nasal mucosa break
Epistaxis (nose bleed)
This is due to swelling of the mucous membrane of the eustachian tube and changes in fluid and pressure in the middle ear. It resolves soon after birth when estrogen levels decrease.
ear stuffiness/ mild hearing loss
ear stuffiness is caused by increase in:
estrogen
increased blood flow and swelling of the mouth/gums during pregnancy is caused by:
estrogen
hair is in a _________ growth phase in pregnancy
longer
the hair shaft _______ in pregnancy
thickens
growth of hair in usually male patterns
hirsutism
skin changes in pregnancy generally result from hormones of pregnancy, primarily ___________
estrogen
some skin changes __________ during the postpartum period
disappear
nail changes can occur in the ____ trimester
1st
\_\_\_\_\_\_\_ changes in pregnancy: brittleness grooves discoloration white coloring
nail
growth phase of hair
anagen phase
___________ and ____________ blood flow to the scalp results in increased number of anagen phase hairs
estrogen; increased
when estrogen is removed after delivery, most hair will go into ____________ phase which means it will shed (PP hair loss)
telegen
extreme hair loss after pregnancy is called:
telegen efluvium
hair loss usually resolved by about ___ months PP
9
Skin pigment changes occur due to the stimulating effect of ____________ and _____________ on the melanocyte-stimulating hormone (MSH) secretion from the anterior pituitary
estrogen and progesterone
stimulates melanocytes in certain areas of the skin to darken in color
MSH (melanocyte-stimulating hormone)
The ___________ effect is seen on the nipple, areola, midline of the abdominal area (linea nigra), and, in some women as “the mask of pregnancy” (melasma)
skin-darkening
presents as brownish patches on the face and neck and is more prevalent in women with darker complexions
melasma
may persist after birth in about 1/3 of affected women and increase when a woman uses oral contraceptives
melasma
Connective tissue changes are caused by increased ___________, _______________, and _______________along with stretching that occurs as the gravid uterus grows and maternal weight increase
estrogen, adrenocorticoids, and relaxin
hormones of pregnancy cause collagen adhesiveness to ________ and fibers to __________
relax; separate
Striae are more prevalent in _____________women in their first pregnancy
young caucasian
Sebaceous and eccrine sweat glands become more active under the influence of increased __________ in pregnancy
androgen
Sebaceous glands of the areola ____________(called Montgomery’s tubucles) and secrete more sebum to lubricate the nipple
hypertrophy
acne may __________ during pregnancy
improve
sweat glands that cover the trunk and extremeties
eccrine sweat glands
increased activity of these sweat glands on the trunk and arms/legs help cool the body
eccrine
Unilateral ptosis may occur in pregnancy or during labor and is thought to be caused by:
hormonal/fluid changes or stress
unilateral ptosis may be a complication of ____________ in labor
lumbar anesthesia
Hoarseness, deepening of the voice, and cough have been attributed to larynx changes of pregnancy and are thought to be due to the effects of:
estrogen and progesterone
luekorrhea starts in the ___ trimester
1st
leukorrhea is caused by:
increased pelvic blood flow
_________ causes vaginal secretions to be more acidic in pregnancy to protect mother and fetus
estrogen
tiny dilated blood vessels that present as small bright red spots on the trunk, arms/legs, and sometimes the face
spider angioma
spider angiomas usually appear between weeks _____
8-20 weeks
trauma-informed care tool in which the provider sets safe boundaries with respect to woman’s physical and emotional space
containment
trauma-informed care tool in which the provider is present with her therapeutically so she feels seen and heard
connection
trauma-informed care tool in which the provider
empathetically accepts her experience for what she perceives it
compassion
maternal task of seeking the means to assure a safe and healthy pregnancy and childbirth for herself and her fetus/newborn
safe passage
maternal task of letting go of old ways of being to make way for the new ways of being by reflecting on her current life, on past relationships, and aspirations for mothering
acceptance by others
maternal task of establishing a direct form of experience between mother and her fetus/infant
binding-in
maternal task that is the most complex and demanding in which the mother embraces the changes willingly and sees their purpose in giving to her child for the child’s benefit and well-being
giving of oneself
seeking elements of mothering that are valued to incorporate into her vision of mothering
replication
trying on different aspects of mothering through mental contemplation
fantasy
synthesizing elements of replication and fantasy work into a single role of mother
dedifferentiation
melasma is more common in _______ women
Asian, Latina, and African
_____ is the most sensitive index for thyroid function in pregnancy
TSH
slightly __________ thyroid is normal in pregnancy
enlarged
healthy pregnant woman will have __________ fasting glucose levels than nonpregnant women
lower
some _____ antibodies are harmful to the fetus such as, the antibodies a Rh- mother produces in response to antigens in Rh+ RBC of the fetus
IgG
________ antibodies against can cross the placenta and attack fetal RBC causing severe hemolytic disease of the fetus
IgG
RhoGAM prevents maternal ___________ production resulting in __________ immunity
antibody; passive
consists of the reformation and change of the woman’s view of self
maternal tasks of pregnancy
evaluation of the woman’s relationship with her own mother occurs in the ____ trimester
2nd
bound thyroid hormones are not ___________ during pregnancy
bioavailable
during pregnancy, total body iodine pool is decreased due to :
decreased iodide absorption in the small intestines
The U.S. is _____ iodine deficient that Europe and SE Asia
more
maternal chemotaxis is NOT _________ in pregnancy
increased
foreign tissue from the same species but different antigenetic make-up
semiallograft
the phase of pregnancy with the most marked inflammation at the maternal-placental interface
embryonic
immune factors that protect the fetus from rejection also:
protect mother from viruses and bacteria
concerning skin conditions in pregnancy
eczema
prurigo
pruritic folliculitis
“prickly heat” feeling is caused by
increased eccrine sweat gland activity
HPA function __________ during pregnancy
increases
HPA function changes in pregnancy is mediated primarily by:
placental hormones (ACTH, GH, CRH) alterations in liver function alteration in kidney function
What lab test would you use to screen for altered thyroid function in pregnancy?
TSH
has structure similar to thyroid-stimulating hormone (TSH), so stimulates increased T3 and T4 leading to negative feedback to the pituitary gland and a decrease in TSH
hCG
What happens during pregnancy to decrease the iodine pool?
- increased renal iodide clearance
- increased iodine needed to make thyroid hormones
- increased loss of renal iodide due to increased renal blood flow, increased GFR, and placental transfer of iodine to the fetus
Of the total thyroid hormone in the body in pregnancy, where is most of the thyroid hormone found?
bound to TBGs
Why does the free thyroid hormones remain within normal limits while total thyroid hormone levels increase in pregnancy?
because most of the thyroid hormone is bound to TBGs
____________ levels increase and peak at term to prepare for breastfeeding
prolactin
T3 and T4 levels peak at __ - __ weeks gestation
10-15
T3 and T4 levels plateau at ___ - ____% higher than nonpregnant values (and most are bound to TBGs)
40-100%
How are thyroid hormones (T3 and T4) transported through the body?
attached to TBGs
consequences of iodine deficiency in pregnancy
preventable mental retardation
increased risk of spontaneous abortion
increased risk of stillbirths
immune system alteration that is responsible for pregnant women being more at risk for viral, bacterial and fungal infections (especially viruses + opportunistic pathogens)
suppression of cell-mediated immunity
these enhance the antibody-mediated response which protects the fetus and delays the maternal response to infection
cytokines
Reasons why IgG is _________ in pregnancy:
hemodilution of pregnancy
enhanced loss of IgG in the urine
transfer of maternal IgG to the fetus in 3rd trimester
IgG is decreased
maternal antibody that provide passive immunity to the fetus/neonate (e.g. against tetanus, diphtheria, polio, measles, mumps, GBS, E Coli, HBV)
IgG
a critical component of cervical changes in preparation for parturition and labor onset
3rd trimester inflammatory processes
may delay maternal response to infection
chemotaxis
Faster _________ helps protect the mother from having a cell-mediated response to fetal cells in her circulation, thus preventing her from recognizing fetal cells as foreign and attacking them.
phagocytosis
Localized _________ response along with systemic responses mediated by endocrine factors protect the fetus
uterine
Fetal ____________ cells help in the process and help maternal immune systems not reject it
trophoblastic
changes that occur with the initial contact between the embryonic trophoblast and maternal tissues during implantation and the remodeling of maternal blood vessels
the inflammatory process at implantation
Immunologic factors that may cause _____________:
•Activation of an immune response secondary to microbial infection (chlamydia, listeria, parvo, toxoplasmosis),
-Exaggerated maternal immune response to trophoblastic invasion,
-Cytokine-induced failure of the ovary to produce sufficient progesterone,
-Presence of autoimmune antibodies such as antiphospholipid antibodies that interfere with placentation.
spontaneous abortion
treatment for molloscum fibrosum gravidarum
may regress or clear spontaneously following delivery, although many remain
Remaining skin tags can be excised
gradual increase in ______________ activity may be due to increased thyroid activity, increased body weight, and metabolic activity.
eccrine sweat gland
Eccrine glands are important in ______________ at the skin surface. Increased activity reflects dissipation of excess heat from increased metabolic activity of woman and fetus.
thermoregulation
increased eccrine sweat gland activity leads to increased:
sweating
Disruption of lacrimal acinar cells can lead to:
dry eyes
Reasons for __________ in pregnancy:
Mild corneal edema and thickening (worse in 3rd trimester can change eye topography and alter refractory power of the eye.
Corneal hyposensitivity may develop due to increased thickness and fluid retention.
dry eyes
Modifications in fluid dynamics and vascular permeability, increased protein synthesis, vasomotor alterations of the autonomic nervous system, increased vascularity, hormonal influences (especially estrogen) influences lead to:
nasal stuffiness
hearing changes in pregnancy
transient/mild hearing loss
increased risk of serous effusion (infection)
reasons for ear stuffiness in pregnancy
changes in mucous membranes of the eustachian tube
edema of the nasopharynx
alterations in fluid dynamics/pressures of the middle ear
May develop around 20 weeks; fine new hairs disappear by 6 wk pp, coarser hairs may remain
hirsutism
occurs most often in primiparous women, usually during the last month of pregnancy or immediate postpartum.
PUPPs
abrupt appearance of intensely pruritic urticarial papules and plaques usually on trunk and extremities- rarely involve the face, palms, or soles that usually resolves within 7-10 days postpartum.
PUPPs
rare pruritic specific dermatosis usually presents with sudden onset pruritus in late second or third trimester, usually on palms and soles of feet.
-Evaluate for elevated liver enzymes and bile acids.
ICP (Intrahepatic Cholecystitis of Pregnancy)
three self-systems described by Rubin
ideal self
actual self
body-image self
four absolute contraindications to sexual intercourse in pregnancy
vaginal bleeding
placenta previa
Premature cervical dilation
PROM
Seeking safe passage
Acceptance by others
Binding in
Giving of Oneself
maternal tasks of pregnancy
factors that threaten prenatal attachment
substance abuse
anxiety
depression
N/V in pregnancy has been correlated with alterations in ____________ hormones
thyroid
