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Womens Health Exam 1 > Physical And Physiologic Changes In Pregnancy > Flashcards

Physical And Physiologic Changes In Pregnancy Flashcards

1
Q

Define antepartum

A

Begins with the first day of the last menstrual period (LMP)

Ends with true labor

Divided into three trimesters, each approximately three months in length

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2
Q

How is the uterus before and after pregnancy?

A

Prior to pregnancy, it is small, almost solid pear shaped organ, weighing approximately 2 ounces

By the end of the pregnancy, it will reach an average weight of 2.5 pounds

Uterine capacity increases from 10mL in the non-pregnant state to roughly 5000mL at term

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3
Q

How does the circulatory needs of the uterus change during pregnancy?

A

Circulatory needs of the uterus increases as the uterus enlarges and the fetus and placenta develop

By the end of a term pregnancy, 1/6 of the total maternal blood volume is contained with within the vascular system of the uterus

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4
Q

What are Braxton Hicks contractions?

A

Painless, irregular uterine contractions

“False labour”: Does not cause cervical dilation

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5
Q

What is the purpose of Braxton Hicks contractions?

A

Their purpose is to stimulate blood flow through the intervillous spaces of the placenta

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6
Q

What is Goodwells sign and Chadwick’s sign?

A

Goodwells sign: cervical softening

Chadwick’s sign: blue purple discolouration of the cervix

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7
Q

What is the pregnancy hormone?

A

Human Chorionic Gonadotropin (hCG)

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8
Q

What does hCG do?

A

Maintains the corpus luteum, which:

Secretes progesterone to maintain the endometrium until the placenta takes over

Disintegrates when placenta is fully functioning, about 6-8 weeks

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9
Q

What is the precursor for breast milk?

A

Colostrum

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10
Q

How does the vagina change during pregnancy?

A

Estrogen facilitates hypertrophy (increase in size of cells), hyperplasia (increase in number of cells), and increase vascularization of vaginal epithelium

Mucosa thickens, connective tissue loosens, and secretion’s increase

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11
Q

What are vaginal secretions?

A

Secretions are thick, and acidic and helps play a role in preventing infections

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12
Q

How does the respiratory system change due to pregnancy?

A

Between 16 and 40 weeks, oxygen consumption increases 15-20%

Diaphragm is elevated as a result of the growing uterus

Breathing changes from abdominal to thoracic

Nasal stuffiness/ congestion and nose bleeds due to increased estrogen induced edema and vascular congestion of nasal mucosa

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13
Q

Patient teaching for shortness of breath

A

Rising uterus puts pressure on diaphragm so teach patient:

Sit up straight in chair

Use proper posture when standing

Prop head up while sleeping

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14
Q

How does blood volume change during pregnancy?

A

Blood volume progressively increases and peaks at the middle of the third trimester at about 40 to 50% over non-pregnant levels (meaning it doubles)

Decrease in systemic vascular resistance, which enable circulation to adapt to higher blood volume

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15
Q

How does cardiac output change during pregnancy?

A

Cardiac output, which is the amount of blood discharged from ventricles per minute increases and peaks by 25 to 30 weeks gestation, then remains elevated throughout pregnancy

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16
Q

How do vital signs change during pregnancy?

A

Pulse can increase 10 BPM

Blood pressure decreases slightly, and reaches lowest point in second trimester

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17
Q

What happens to femoral venous pressure during pregnancy?

A

It rises as a result of increased uterine pressure

18
Q

What is supine hypotensive syndrome?

A

AKA: vena caval syndrome

The enlarging uterus may put pressure on the vena cava when the woman is supine, causing a decrease in blood pressure with accompanying dizziness, pallor, and clamminess

19
Q

What is physiologic (or dilutional) anemia?

A

Due to the plasma volume increase being greater than the erythrocyte increase, the hematocrit decreases slightly

Plasma volume increases 50%

20
Q

What is the importance of iron?

A

Iron is necessary for hemoglobin production

Hemoglobin is the oxygen carrying component of the erythrocytes

Iron absorption increases in pregnancy, but supplements are usually still necessary

21
Q

Why does nausea and vomiting happen in first trimester?

A

Increase levels of hCG

Stomach smooth muscle relaxation

Slowed peristalsis

Usually decreases by the 16th week

22
Q

What the normal weight gain for pregnancy?

A

Normal weight: 25-35 pounds

Over weight: 15-25 pounds

Obese: 11-20 pounds

Underweight: 28-40 pounds

23
Q

What are some of the common discomforts of pregnancy?

A

Fatigue

Round ligament pain

Low back pain

Upper back pain

Urinary frequency

Hemorrhoids

Constipation

24
Q

Importance of oxytocin in pregnancy?

A

Oxytocin affects uterine contractibility and milk ejection from breasts

Released during times of bonding - makes you feel good

Synthetic oxytocin is called pitocin and it is used for induction and augmentation of labour

Treats postpartum hemorrhages

25
Q

Importance of hCG in pregnancy

A

Secreted by trophoblast in early pregnancy

hCG stimulates progesterone and estrogen production by the corpus luteum until placenta takes over

26
Q

What is human placental lactogen (hPI)?

A

Insulin antagonist: decreases maternal metabolism of glucose to favor fetal growth

It increases amount of circulating free fatty acids from maternal metabolic needs

It is a player in the development of gestational diabetes

27
Q

Importance of estrogen during pregnancy

A

Initially produced by corpus luteum then placenta takes over at around seventh week

Stimulates uterine growth

Develops ductal system of breasts to prepare for lactation

28
Q

What is considered the most crucial hormone in maintaining pregnancy?

A

Progesterone

29
Q

How is progesterone produced?

A

Initially produced by corpus luteum then by placenta

30
Q

Why is progesterone so important in pregnancy?

A

Maintains endometrium

Inhibits spontaneous uterine contractility

Develops breast for lactation

31
Q

Importance of relaxin during pregnancy?

A

Primarily produced by corpus luteum, then in small amounts by placenta and decidua

Inhibits uterine contractibility

Relaxes joints/ligaments

Aids in cervical ripening

32
Q

How is nasal stuffiness a pregnancy discomfort?

A

Estrogen engorged mucus membranes.

Increased nasal discharge

33
Q

What are nasal stuffiness teachings?

A

Ocean spray, nasal spray/cool air vaporizer

Do not use nasal decongestants (afrin) for longer than three days

34
Q

How are varicose veins caused?

A

Weak vein walls, or faulty valves

Enlarge uterus impairs venous circulation

Familial tendency, prolonged sitting/standing

Progesterone relaxes blood vessel walls

Excessive weight gain, advanced maternal age

35
Q

Patient teachings for varicose veins

A

Exercise and good body mechanics

Support hose

Elevate legs every 2 to 3 hours to hip level.. or if possible elevate to heart level

36
Q

Teachings for difficulty sleeping

A

It’s a common occurrence

Often related to other physical factors

37
Q

Suggestions for difficulty sleeping?

A

Warm, caffeine free beverage before bed

Back rub

Relaxation techniques

Pillow support for back/legs

38
Q

What are the signs of pregnancy?

A

The 3Ps

Subjective (presumptive) comes from the patient “I think”

Objective (probable) comes from us, we see signs

Diagnostic (positive) an outside source like an ultrasound

39
Q

What are probable (objective) changes perceived by the examiner?

A

Positive pregnancy test (hCG)

Changes in pelvic organs
Goodells sign- softening of cervix
Chadwick’s sign- deep red to
purple/blue
coloration of cervix,
mucus membranes,
and vagina
Hegar’s sign- softening of the
isthmus of the cervix

Uterine soufflé: soft blowing sound at the same rate as maternal pulse, due to increase vascularization, and blood pulsating through the placenta

Changes in skin pigmentation

40
Q

What are some positive (diagnostic) signs determined by the examiner?

A

Fetal heartbeat

Fetal movement

Visualization of fetus by ultrasound

Womens Health Exam 1 (6 decks)

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