Part 2 - TNB: Mother Baby Flashcards
• Stretch marks (abdomen, breasts, hips, etc.)
• May cause itching
Striae gravidarum
Brownish hyperpigmentation of the skin (cheeks, nose & forehead)
Chloasma “mask of pregnancy”
Red, mottled, blotchy appearance of the hands
Palmar Erythema
Linea nigra
• Means “black line”
• Presents as vertical line on belly
during pregnancy
Montgomery Glands/Tubercles
• Small rough / nodular / pimple-like
appearance of the areola (nipple)
Integumentary Pregnancy Physiology Changes
- Striae gravidarum
- Chloasma
- Palmar erythema
- Linea nigra
- Montgomery
- Increased hair & nail growth
Center of gravity shifts forward leading to an inward curve of the spine
Lordosis
Edema causes pressure on the peripheral nerves
Carpal Tunnel Syndrome
The growing uterus causes stretching of the abdominal wall
Diastasis recti abdominis
Musculoskeletal Pregnancy Physiology Changes
- Lordosis
- Low back pain
- Carpal tunnel syndrome
- Calf cramps
- Diastasis recti abdominis
Renal Pregnancy Physiology Changes
- Increased GFR from increased plasma volume
- Smooth muscle relaxation of bladder and renal pelvis
- Increased risk for UTIs
- Increased urgency, frequency & nocturia
- Increased progesterone = decreased tone of bladder, ureter & urethra
Hematological Pregnancy Physiology Changes
- Decreased hemoglobin & hematocrit
- Increased fibrinogen
Why is there a decrease of hemoglobin & hematocrit during pregnancy?
This is due to HEMODILUTION - increased blood volume is diluting Hgb & Hct.
Plasma volume is greater than the amount of red blood cells (RBCs) = hemodilution
This results to PHYSIOLOGICAL ANEMIA.
What is the effect of INCREASED FIBRINOGEN?
Pregnant women are hypercoagulable which increases the risk for DVTs
Fibrinogen normal level for non-pregnant women
200-400 mg/dL
Fibrinogen level pregnant women
Up to 600 mg/dL
This hormone relaxes smooth muscle during pregnancy.
Relaxin & Progesterone
This hormone aids in growth of the uterus, the placenta, growth of new blood vessels, etc.
Estrogen
hCG meaning
Human Chorionic Gonadotropin
What produces hCG during pregnancy and what does it do?
The placenta produces hCG during
pregnancy & it prevents menstruation
Cardiovascular Pregnancy Physiologic Changes
- Increased cardiac output
- Blood pressure may stay the same or have a slight decrease
- Increase in blood volume
- Heart enlarges
- Cardiac rhythm: May experience palpitations and cardiac dysrhythmias
- Hypercoagulable: Increase risk for DVTs
Increased in blood volume may cause…
Edema
Respiratory Pregnancy Physiology Changes
- Increased basal metabolic rate (BMR)
- Increased O2 needs
- Mild respiratory alkalosis
- Chest increases in size to allow for fetal growth and lung expansion
- Increased vascularity of URT
Gastrointestinal Physiology Pregnancy Changes
- Nausea & vomiting
- Pyrosis (heartburn)
- Constipation
- Hemorrhoids
- Pica (craving substances that are not considered food)
- Swollen mouth & gums
When is “morning sickness” most common?
First trimester
What happens when there is increased progesterone?
Lower esophageal sphincter relaxes
Decreased gut motality
These are drugs that can cause birth defects in the developing fetus.
Teratogenic Drugs
What are TERATOGENIC DRUGS?
“TERA-TOWAS”
T- Thalidomide
E- epileptic medications (valproic acid, phenytoin)
R - retinoid (vit A)
A - Ace inhibitors, ARBs
T - Third element (lithium)
O - oral contraceptives
W - warfarin (coumadin)
A - Alcohol
S - sulfonamides & sulfones
What are considered as TORCH infections (infections that can cross the placenta, harm pregnant women and the developing fetus)?
T - Toxoplasmosis
O - Other infections
R - Rubella
C - Cytomegalovirus (CMV)
H - Herpes simplex virus (HSV)
The poor intake of this increases fetal risk for neural tube defects (NTDs)
Folic Acid
How much folic acid should be consumed daily?
600-800 mcg/day
- Needed for tissue growth
- Great sources of protein: lean meats, eggs, cheese, milk, nuts, legumes
Protein
- DHA intake (300 mcg/day)
- Needed for brain development for the growing fetus
Omega-3 fatty acids
How much should you gain in the first trimester?
About 2.2-4.4 lbs (1-2 kg)
How much should you gain in 2nd and 3rd trimester?
0.5-1 lb per week
- Iron intake (25–30 mg/day)
- ↑ risk for iron defi ciency due to ↑ iron requirements during pregnancy
- Adequate intake is needed to supply the fetus with iron
Iron
- Same intake as non-pregnant (1,000 mg/day)
Calcium
How many calories should be increased in first trimester?
No increase
How many calories should be increased in second & third trimester?
Additional 300-400 calories per day
Foods to avoid during pregnancy
✘ Unpasteurized milk
✘ Unwashed fruits & vegetables
✘ Deli meat
✘ Liver
✘ Raw fi sh/raw meat
✘ Fish high in mercury
(shark, tilefi sh, swordfi sh, etc.)
✘ Alcohol
Excess amount of caffeine intake contribute to what?
Intrauterine Growth Restriction (IUGR)
