Pregnancy Flashcards
promotes endometrial growth that supports the early embryo. It appears to stimulate marked enlargement of the pituitary gland (by up to 135%) and increased prolactin output from its anterior lobe, which readies breast tissue for lactation.
-also contributes to the hypercoagulable state that puts pregnant women at four to five times higher risk for thromboembolic events, primarily in the venous system.
Estrogen
-increase throughout pregnancy, leading to increased tidal volume and alveolar minute ventilation, though respiratory rate remains constant; respiratory alkalosis and subjective shortness of breath result from these changes.
- Decreased gastrointestinal motility from progesterone contributes to gastroesophageal reflux, constipation, and biliary diseases in pregnancy (such as cholelithiasis and cholestasis).
-relaxes tone in the ureters and bladder, causing hydronephrosis (in the right ureter more than the left) and an increased risk of bacteriuria
Progesterone level
has five variant subtypes. Two are crucial to maintaining the pregnancy, one produced by the corpus luteum in early pregnancy to stabilize the endometrium and prevent loss of the early embryo.
-The other is produced by the placenta throughout gestation, supporting progesterone synthesis. Serum and urine pregnancy assays test primarily for the two pregnancy-related hCG variants
-the other three isoforms are produced by different cancers and the pituitary gland.
Human chorionic gonadotropin (hCG)
influences fetal growth and the development of preeclampsia.
-Human placental lactogen (related to the placental growth hormone family) and other hormones contribute to insulin resistance during pregnancy and the development of gestational diabetes (GDM), which carries a lifetime risk of progressing to type 2 diabetes of up to 60%.
Placental growth hormone
-changes include an increase in thyroid-binding globulin due to rising levels of estrogen and cross-stimulation of thyroid-stimulating hormone (TSH) receptors by beta-hCG.
-This results in a slight increase, usually in the normal range, in serum concentrations of free T3 and T4, while serum TSH concentrations appropriately decrease. This transient apparent “hyperthyroidism” should be considered physiologic.
-Normal pregnancy is considered a euthyroid state throughout all trimesters.
Thyroid function
…is secreted by the corpus luteum and placenta and is involved in the remodeling of reproductive tract connective tissue to facilitate delivery, increased renal hemodynamics, and increased serum osmolality.
-Despite its name, it does not affect peripheral joint laxity during pregnancy.
Relaxin
increases during pregnancy, which raises erythrocyte mass. Plasma volume increases to a greater extent, causing relative hemodilution and physiologic anemia, which can protect against blood loss during birth.
Erythropoietin
purplish striae gravidarum or “
stretch marks”
a brownish black pigmented vertical stripe along the midline skin, may appear
linea nigra,
As tension on the abdominal wall increases with advancing pregnancy, the rectus abdominis muscles may separate at the midline, called
diastasis recti.
Increased vascularity throughout the pelvis gives the vagina and cervix a bluish color, known as
the Chadwick sign.
Normal vaginal secretions may become thick, white, and more profuse, known as
leukorrhea of pregnancy
refers to the number of times that a woman has been pregnant, a
Gravidity
is the number of times that she has given birth to a fetus to a viable age (≥24 gestational weeks), regardless of whether the child was born alive or was stillborn
parity
Parity is further broken down into term deliveries, preterm deliveries, abortions (spontaneous abortions and terminated pregnancies), and living children, which yields the mnemonic “
TPAL
obstetric visits traditionally follow a set schedule:
monthly until 28 gestational weeks, then biweekly until 36 weeks, then weekly until delivery.
are used to determine the fetal position in the maternal abdomen beginning in the second trimester; accuracy is greatest after 36 weeks’ gestation
Leopold maneuvers
Compression interferes with venous return from the lower extremities and pelvic vessels, causing the patient to feel dizzy and faint, also known as
supine hypotension.
Weight loss due to nausea and vomiting that exceeds 5% of prepregnancy weight is considered excessive, representing …what?, and can lead to adverse pregnancy outcomes.
hyperemesis gravidarum
is systolic blood pressure (SBP) >140 mm Hg or diastolic blood pressure (DBP) >90 mm Hg first documented after 20 weeks, without proteinuria or other evidence of preeclampsia, that resolves by 12 weeks postpartum.
Gestational hypertension
rregular brownish patches around the forehead, cheeks, nose, and jaw are known as ….what? the “mask of pregnancy,” a normal skin finding during pregnancy.
chloasma or melasma,
Thyroid issues that are abnormal and require investigation during pregnancy
Thyroid enlargement, goiters, and nodules
often found during pregnancy due to increased blood flow through the breast vasculature.
venous hum or a continuous mammary souffle (“a puff of air,” pronounced soo-fuhl)
Definition of Preeclampsia
SBP ≥140 or DBP ≥90 after 20 weeks on two occasions at least 4 hours apart in a woman with previously normal BP or BP ≥160/110 confirmed within minutes and proteinuria ≥300 mg/24 hours, protein to creatinine ratio ≥0.3, or dipstick 1+;
Or
New-onset hypertension without proteinuria and any of the following: thrombocytopenia (platelets <100,000/μL), impaired liver function (liver transaminase levels more than twice normal), new renal insufficiency (creatinine >1.1 mg/dL or doubles in the absence of renal disease), pulmonary edema, or new-onset cerebral or visual symptoms.20
There may be increased splitting of S1 due to increased circulating blood volume and 90% of patients will have an audible
systolic murmur.
what king of murmur is not normal in pregnancy and should be investigated further
A diastolic murmur
a spontaneous mild leakage often accompanied by a cramping sensation in the breast during a hot shower or orgasm in the third trimester.
let down
The maternal sensation of fetal movement is traditionally known as
“quickening.”
when does the examiner can feel movement externally?
-When does mother feel movement?
The examiner can usually feel movements externally after 24 gestational weeks;
-the mother can usually feel these by 18 to 24 weeks.
when is regular uterine contraction are abnormal?
Before 37 weeks, regular uterine contractions with or without pain and bleeding are abnormal, suggesting preterm labor.
when should the fundal height be measured?
Measure the fundal height if gestational age is >20 weeks, when the fundus should reach the umbilicus.
-Though subject to error between 16 and 36 weeks, measurement of the fundal height in centimeters should roughly equal the number of weeks of gestation.
abnormal fetal height measurement
-If fundal height is 4 cm larger than expected, consider multiple gestation, a large fetus, extra amniotic fluid, or uterine leiomyoma.
- If fundal height is 4 cm smaller than expected, consider low-level amniotic fluid, missed abortion, intrauterine growth retardation, or fetal anomaly.
-These conditions should be investigated by ultrasound.
when can fetal heart tone be detected?
fetal heart tones, which is normally audible as early as 10 to 12 weeks’ gestation.
-Detection of fetal heart tones may be slightly delayed in patients who are obese.
Inaudible fetal heart tones may indicate
fewer weeks of gestation than expected, fetal demise, false pregnancy, or observer error; inability to locate the FHR should always be investigated with formal ultrasound
the inner portion of the cervix everts slightly during pregnancy, and appears as a glandular friable darker pink or red area inside the os.
called ectropion
A pink cervix suggests a nonpregnant state.
Cervical erosion, erythema, discharge, or irritation suggests what?
cervicitis, and warrants investigation for STIs.
Investigate abnormal vaginal discharges for?.
for possible candida or bacterial vaginosis, which can affect pregnancy outcom
cervix softening during pregnancy is called
Hegar sign
Cervical opening or shortening (cervical effacement) prior to 37 weeks may indicate
preterm labor.
Cervical opening or shortening
(cervical effacement)
An irregularly shaped uterus suggests
uterine leiomyomata, or fibroids, or a bicornuate uterus, one with two distinct cavities separated by a septum.
are used to determine the fetal position in the maternal abdomen beginning in the second trimester; accuracy is greatest after 36 weeks’ gestation
Leopold maneuvers
zygote
week 1
blastocysts
week 2
embryo
week3-week 8
fetus
week 9-week 38
