Physiology of Pregnancy Flashcards
3 changes to uterus during pregnancy
-increased size (20x)/strength/distensibility
-increased contractile proteins and number of mitochondria
-softening of uterine isthums
what sign is associated w. softening of the uterine isthmus during pregnancy
hegar’s sign
3 changes to cervix during pregnancy
-formation of mucus plug -> seals endocervical canal
-increased vascularity -> purple/blue color
-softening - esp in third trimester
what sign is associated w. cervical softening during pregnancy
goodell’s sign
what does the placenta secrete (4)
estrogen
progesterone
relaxin
hCG
3 changes to the vagina during pregnancy
-increased vascularity -> purple/blue color
-loosening of CT -> distensibility
-leukorrhea -> antibiotic properties
pH of the vagina during pregnancy
3.5-6.0
5 changes to the breasts during pregnancy
-increased size/nodularity/vascularity
-areola/nipples darken
-increased activity of montgomery’s tubercles
-increased progesterone -> alveolar-lobular development -> inhibits prolactin
-estrogen increase -> growth of lactiferous ducts
when does colostrum secretion begin
16 weeks
7 cardiovascular changes during pregnancy
-mild hypertrophy
-S2 S3 more easiliy auscultated
-heart displaced upward. forward, left
-HR increased by 15-20 bpm
-stroke volume/CO increased
-BP decreased
-increased pressure on LE veins -> slowed venous return
what causes decreased BP in pregnancy despite increased CP
progesterone induced vasodilation
3 consequences of decreased venous return of LE veins during pregnancy
-dependent edema
-varicose veins
-hemorrhoid
what causes supine hypotensive syndrome during pregnancy
uterus pushing on IVC
4 hematologic changes during pregnancy
-increased blood volume
-increased total RBC
-increased WBC
-increased clotting factors
5 respiratory changes during pregnancy
-increased O2 consumption
-increased subcostal angle/AP diameter/tidal volume
-upward pressure on diaphragm -> elevates 4 cm
-hyperventilation -> mild respiratory alkalosis
-nasal congestion/epistaxis
maternal blood pH
7.40 - 7.45
what causes nasal congestion during pregnancy
estrogen induced edema
5 GI changes associated w. pregnancy
-bleeding/friable gums
-delayted peristalsis/gastric emptying
-n/v/heartburn/GERD
-cholestasis -> increased risk of cholelithiasis
-increased saliva (ptyalism)
urinary/bladder changes associated w. first trimester of pregnancy
-increased pressure on bladder -> increased frequency/nocturia/stress incontinence
urinary/bladder changes associated w. second trimester of pregnancy
-uterus occupies abd space -> decreased urinary frequency
urinary/bladder changes associated w. third trimester of pregnancy
-presenting part descends into pelvis -> increased urinary frequency/notcuria/stress incontinence
3 renal changes associated w. pregnancy
-increased GFR/urinary output
-increased kidney size
-hydronephrosis
2 UA findings during pregnancy
-glycosuria
-proteinuria
4 integumentary changes associated w. pregnancy
-hyperpigmentation -> melasma/linea nigra/darkening of nipples, areola, vulva
-increased cutaneous bood flow -> “pregnancy glow”
-decreased CT strength -> stretch marks
-estrogen induced vascular permeability -> telangiectasias, angiomas, palmar erythema
5 MSK changes associated w. pregnancy
-abd distension -> lordosis
-enlarging uterus -> diastasis recti
-increased progesterone/relaxin -> increased joint mobility/waddling gait
-widening of symphysis pubis
-high bone turnover
6 endocrine changes associated w. pregnancy
-increased size of pituitary gland -> increased risk of postpartun infarction
-increased PTH
-hypercortisolism -> increased glucocorticoids
-diabetogenic state -> hypertrophy/hyperplasia of pancreatic beta cells
-decreased TSH -> enlarged thyroid
-increased reproductive hormones
how are FSH/LH affected by pregnancy
suppressed due to feedback from estrogen/progesterone/inhibin
describe oxytocin levels during pregnancy/labor
-throughout pregnancy: decreased
-labor onset: increased
-second stage of labor: very increased
calorie/wt gain recommendations during pregnancy
calorie: extra 300/day
wt gain: 25-35 lb
5 where does wt gain come from in pregnancy
-placenta/amniotic fluids/fetus
-uterus hypertrophy
-increased blood volume
-increased breast tissue
-maternal reserves
folic acid needs during pregnancy
600 mcg qd
3 functions of folic acid in pregnancy
-RBC synthesis
-placental/fetal growth
-decreased risk of neural tube defects
Ca needs during pregnancy
1,000 - 1,300 qd
iron needs during pregnancy
27 mg qd
what is sheehan’s syndrome
increased intrasella pressure from enlarged pituitary gland during pregnancy -> postpartum hemorrhage/infarction
