Physiology of Pregnancy

Question 1

3 changes to uterus during pregnancy

Answer 1

-increased size (20x)/strength/distensibility
-increased contractile proteins and number of mitochondria
-softening of uterine isthums

Question 2

what sign is associated w. softening of the uterine isthmus during pregnancy

Answer 2

hegar’s sign

Question 3

3 changes to cervix during pregnancy

Answer 3

-formation of mucus plug -> seals endocervical canal
-increased vascularity -> purple/blue color
-softening - esp in third trimester

Question 4

what sign is associated w. cervical softening during pregnancy

Answer 4

goodell’s sign

Question 5

what does the placenta secrete (4)

Answer 5

estrogen
progesterone
relaxin
hCG

Question 6

3 changes to the vagina during pregnancy

Answer 6

-increased vascularity -> purple/blue color
-loosening of CT -> distensibility
-leukorrhea -> antibiotic properties

Question 7

pH of the vagina during pregnancy

Answer 7

3.5-6.0

Question 8

5 changes to the breasts during pregnancy

Answer 8

-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

Question 9

when does colostrum secretion begin

Answer 9

16 weeks

Question 10

7 cardiovascular changes during pregnancy

Answer 10

-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

Question 11

what causes decreased BP in pregnancy despite increased CP

Answer 11

progesterone induced vasodilation

Question 12

3 consequences of decreased venous return of LE veins during pregnancy

Answer 12

-dependent edema
-varicose veins
-hemorrhoid

Question 13

what causes supine hypotensive syndrome during pregnancy

Answer 13

uterus pushing on IVC

Question 14

4 hematologic changes during pregnancy

Answer 14

-increased blood volume
-increased total RBC
-increased WBC
-increased clotting factors

Question 15

5 respiratory changes during pregnancy

Answer 15

-increased O2 consumption
-increased subcostal angle/AP diameter/tidal volume
-upward pressure on diaphragm -> elevates 4 cm
-hyperventilation -> mild respiratory alkalosis
-nasal congestion/epistaxis

Question 16

maternal blood pH

Answer 16

7.40 - 7.45

Question 17

what causes nasal congestion during pregnancy

Answer 17

estrogen induced edema

Question 18

5 GI changes associated w. pregnancy

Answer 18

-bleeding/friable gums
-delayted peristalsis/gastric emptying
-n/v/heartburn/GERD
-cholestasis -> increased risk of cholelithiasis
-increased saliva (ptyalism)

Question 19

urinary/bladder changes associated w. first trimester of pregnancy

Answer 19

-increased pressure on bladder -> increased frequency/nocturia/stress incontinence

Question 20

urinary/bladder changes associated w. second trimester of pregnancy

Answer 20

-uterus occupies abd space -> decreased urinary frequency

Question 21

urinary/bladder changes associated w. third trimester of pregnancy

Answer 21

-presenting part descends into pelvis -> increased urinary frequency/notcuria/stress incontinence

Question 22

3 renal changes associated w. pregnancy

Answer 22

-increased GFR/urinary output
-increased kidney size
-hydronephrosis

Question 23

2 UA findings during pregnancy

Answer 23

-glycosuria
-proteinuria

Question 24

4 integumentary changes associated w. pregnancy

Answer 24

-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

Question 25

5 MSK changes associated w. pregnancy

Answer 25

-abd distension -> lordosis
-enlarging uterus -> diastasis recti
-increased progesterone/relaxin -> increased joint mobility/waddling gait
-widening of symphysis pubis
-high bone turnover

Question 26

6 endocrine changes associated w. pregnancy

Answer 26

-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

Question 27

how are FSH/LH affected by pregnancy

Answer 27

suppressed due to feedback from estrogen/progesterone/inhibin

Question 28

describe oxytocin levels during pregnancy/labor

Answer 28

-throughout pregnancy: decreased
-labor onset: increased
-second stage of labor: very increased

Question 29

calorie/wt gain recommendations during pregnancy

Answer 29

calorie: extra 300/day
wt gain: 25-35 lb

Question 30

5 where does wt gain come from in pregnancy

Answer 30

-placenta/amniotic fluids/fetus
-uterus hypertrophy
-increased blood volume
-increased breast tissue
-maternal reserves

Question 31

folic acid needs during pregnancy

Answer 31

600 mcg qd

Question 32

3 functions of folic acid in pregnancy

Answer 32

-RBC synthesis
-placental/fetal growth
-decreased risk of neural tube defects

Question 33

Ca needs during pregnancy

Answer 33

1,000 - 1,300 qd

Question 34

iron needs during pregnancy

Answer 34

27 mg qd

Question 35

what is sheehan’s syndrome

Answer 35

increased intrasella pressure from enlarged pituitary gland during pregnancy -> postpartum hemorrhage/infarction