Random Pregnancy Flashcards
How is BP affected in pregnancy?
BP decreases beginning at 8 weeks gestation until a low point is reached mid pregnancy. The diastolic pressure gradually rises to prepregnany levels by term
Back pain may be related to what psychologic processes during pregnancy?
lax ligaments
weight gain
hyperlordosis
anterior tilt of the pelvis
What is the cause of epigastric pain in pregnancy?
pressure from the gravid uterus
What is the cause of round ligament pain during pregnancy?
stretching of the ligaments caused by the enlarging uterus
How is the HR affected in pregnancy?
HR gradually increases throughout pregnancy until it is 10-30% higher at term
How can the onset of htn be measured during pregnancy?
measure BP consistently in the right arm in the sitting position or left lateral recumbent position AFTER 10 minutes rest
What is gestational htn?
BP reading greater than or equal to 140/90
What percentage of pts develop gestational htn?
5-10%
What is a sign of preeclampsia?
BP of 160/110 or greater
What percentage of patients with depression during pregnancy will have postpartum depression?
39%
What is the percentage of postpartum psychosis?
0.1%-0.2%
What are the RF of postpartum depression?
h/o depression
prior postpartum depression
poor social support
When should pregnant pts be screened for depression?
during pregnancy
postpartum
routine well child visits
What screening can be used for depression in pregnancy?
PHQ-2
Edinburgh Postnatal Depression scale
The growing fetus is responsible for how much weight gained in pregnancy?
6-8lbs
How much does the increase in fluid volume account for weight gain in pregnancy?
2-3 lbs
How much does the increase in blood volume?
3-4lbs
How much does the increase in breast enlargement?
1-2lbs
How much does the increase in uterine enlargement?
2 lbs
How much does the increase in amniotic fluid?
2 lbs
How much does the increase in maternal fat and protein stores?
4-6lbs
What accounts for the majority of weight gain during first and second trimesters?
maternal tissue growth
What accounts for the majority of weight gain during the third trimester?
fetal growth
When does postpartum weight loss occur?
the first 6 months after both, with most occurring 3 months after delivery
How much should patients with a prepregnancy BMI of 19.8 to 26 gain over the entire pregnancy?
25-35 lbs
Underweight patients with a BMI less than 19.8 should gain how much over the entire pregnancy?
28-40lbs
Overweight pts with a BMI of 26.1-29 should gain how much weight?
15-25 lbs
Obese patients with a BMI of >29 should gain no more than how much weight?
11-20lbs
Obese patients are at risk of developing what complications?
gestational htn preeclampsia gestational DM cesarean devilery failure to initiate breast feeding
What processes assist in dissipating the excess heat caused by increased metabolism during pregnancy?
peripheral dilation and increased number of capillaries in the hands and feet
acceleration of sweat and sebaceous gland activity
What happens to the skin in pregnancy?
skin thickens and fat is deposited in the sib dermal layers.
some degree of increased pigmentation
new nevi may appear
What are striae agravidarum and when do they appear?
stretch marks- second trimester
When do telangiectasias appear?
2-5th month of pregnancy and resolve after delivery
What is pigmentation of the linea alba called?
linea nigra
What is melasma?
“mask of pregnancy”
What is a diffuse redness covering the entire palmar surface or the thenar and hypothenar eminences likely related to estrogen.
palamar erythema
What is telogen effluvium?
2-6 months after delivery when increased hair shedding occurs
When will regrowth of hair occur?
6-12 months
How are autoimmune illnesses affected in pregnancy?
can lead to temporary remission of the pregnant individuals autoimmune/inflammatory diseases
Before the second trimester the pregnant pt is the source of thyroid hormone for the fetus, therefore what is important to maintain?
adequate iodine intake
The diagnosis of hyperthyroidism in pregnancy is difficult but what is highly suggestive?
weight loss
tachycardia
bruit over the thyroid
How can you confirm hyperthyroidism in a pregnant patient?
measure TSH and free T4
What is the result of the eyes undergoing physiologic and hormonal adaptation in pregnancy?
hypersensitive and change the refractory power of the eye
blurred vision for contact wears
diabetic retinopathy may worsen
mild corneal edema and thickening
intraocular pressure falls by latter half of pregnancy
What are the symptoms indicative of pregnancy induced hypertension (PIH)?
diplopia
scotomata
blurred vision
amaurosis fagax
What is seen on retinal examination with PIH?
segmental arteriolar narrowing with a wet, glistening appearance indicative of edema. (different compared to long stand htn with vascular tortuosity, angiosclerosis, hemorrhage and exudates)
Why should cycloplegia and mydratic agents be avoided unless there is a need to evaluate for retinal disease?
bc of systemic absroption
What is the result of increased estrogen levels and increased vascularity in the upper respiratory tract?
nasal stuffiness decreased sense of smell epistaxis fullness in the ears impaired hearing
What is the result of increased estrogen levels and increased vascularity in the connective tissue of the gums?
hormone induced laryngeal changes may lead to hoarseness, deepening or cracking of voice, vocal changes or persistent cough
How does pregnancy affect anatomic changes in the chest?
as the lower ribs flare- an increase in the lateral diameter of about 2cm and an increase in the circumference of 5-7cm
How does the costal angle change in later pregnancy?
increases from about 68.5 degrees to 103.5 degrees
How is the diaphragm affected during pregnancy?
the diaphragm is 4cm above its usual position but its movement increases so that most breathing is done by the diaphragm
How are minute ventilation and respiratory rate affected during pregnancy?
minute ventilation increases due to increased tidal volume
respiratory rate is unchanged
How is asthma affected in pregnancy?
varied course-may get worse better or unaffected
In pregnant pts, what % increase is there in blood volume?
40-50% increase over prepregnancy level
Why does blood volume increase in pregnant pts?
As a result of the increase in plasma volume which begins in first trimester and reaches a max in the 30th week
How much does plasma volume increase in pregnancy ?
increases 50% with single and as much as 70% with twin pregnancy
The heart works harder to accommodate the increased ____ ____ and ___ ____ required for the expanded blood volume.
heart rate and stroke volume
How is the left ventricle affected in pregnancy?
increases in both wall thickness and mass
When does blood volume return to pre pregnancy state?
within 3-4 weeks after delivery
How is the apical pulse shifted during pregnancy?
upward and more lateral by 1-1.5cm
How might the heart sounds change after 20 weeks gestation?
more audible splitting of S1 and S2 and S3 may be readily heard. However a fourth heart sound is abnormal
Where will systolic ejection murmurs be heard in pregnant pts?
over the pulmonic area in 90% of pregnant pts.
intensified during inspiration or expiration but not not louder than grade 2
How is the EKG affected in pregnancy?
its NOT!
What might suggest an abnormality in the cardiac exam?
cyanosis
clubbing
persistent neck vein distended
development of a diastolic murmur
Should JVP change in pregnancy?
NO
During pregnancy how was the systemic vascular resistance change?
systemic vascular resistance decreases and peripheral vasodilation occurs resulting in palmar erythema and spider telaniectasias
How was systolic and diastolic pressure change?
systolic BP decreases slightly but there is a greater decrease in diastolic BP
Lower BP can be noted when pt is supine in third trimester, why?
secondary to venous compression of the vena cava and impaired venous return
What may cause an increase in dependent edema, variscosities of legs and vulva and hemorrhoids?
compression of the pelvic veins and interior vena cava from the enlarged uterus. Blood pools in the lower extremities
What position does the blood not pool in the lateral extremities?
when in the lateral recumbent position
What happens in the abdomen to the muscles in pregnancy?
as the uterus enlarges the abdominal wall stretches and loses tone
What happens during the third trimester in the abdomen?
the rectus abdominis muscle may separate, allowing abdominal contents to protrude at the midline
How is the umbilicus affected during pregnancy?
it flattens or protrudes
When does the abdominal counter change in pregnancy?
when listening occurs about 2 weeks before term in nullipara and the fetal presenting part descends into the true pelvis
What forms on the abdomen as the skin is stretched?
striae
Why is heartburn a common concern in pregnancy?
during the second trimester the lower esophageal sphincter pressure decreases and peristaltic wave velocity also decreases.
What causes constipation in pregnancy?
gastric emptying is normal but GI transit time is prolonged in the 2nd and 3rd trimesters
When are gallstones more common in pregnancy and why?
2nd and 3rd trimester as a result of the gallbladder becoming more distended with decreased emptying time and change in tone. the status and The secretion of lithogenic bile increases the formation of cholesterol crystals and the development of gall stones.
How are the kidneys affected in pregnancy?
they enlarge by about 1cm in length and the renal pelvis and ureters dilate from effects of hormones and pressure from the enlarging uterus
Dilation of the ureter is greater on the _____ side because it is affected by displacement of the uterus due to the ovarian vein.
right
The ureters also ____ and form single and double curves or varying sizes and angulation.
elongate
How can the changes in ureters and kidneys affect a pregnant pt?
can lead to urinary statuses and pyelonephritis in gravid women with asymptomatic bacteriuria
What position can renal function be most efficient?
if women lays in lateral recumbent position to help prevent compression the vena cava and aorta
How long will the renal changes last after delivery?
3-4 months
What causes the elevated of the bladder trigone and causes thickening of the posterior margin of the bladder after the 4th month of pregnancy?
increase in uterine size
hyperemia of all pelvic organs
hyperplasia or muscle and connective tissue
What is the result of the deepening and widening of the trigone by the end of pregnancy?
may result in micrthematuria
How is the colon affected during pregnancy?
it is displaces laterally upward and posteriorly
peristaltic activity may decrease
water absorption is increased
What is the result of the colon changes in pregnancy?
bowel sounds are diminished
constipation of flatus are more common
How is the appendix affected in pregnancy?
It is displaced upward and laterally, away from McBurney’s point.
How much time post party does the pelvic floor regain tone?
6-7 weeks postpartum
IF a woman is taking iron during pregnancy how does that affect her stool?
stool may be dark green or black. iron may also contribute to constipation or cause diarrhea
How do increased hormone levels in pregnancy affect MSK?
elasticity of ligaments and softening of the cartilage in pelvis at 12-20 weeks.
Increased mobility of the sacroiliac, sacrococcygeal and symphysis pubis
How is the spine affected in pregnancy?
lordosis occurs in an effort to shift the center of gravity back over the lower extremities.
What contributes to the “waddling” gait of late pregnancy?
increased mobility and instability of the sacroiliac joints and symphysis pubis as the ligaments become less tense
How can you asses for lumbosacral hyperextension?
bend forward at the waist to touch toes. palpate the distance between L4 and S1. If it becomes flixed before the spine is fully extended, the women will be hyperextended when walking
When does most back pain resolve after delivery?
within 6 months after
What causes carpal tunnel syndrome during the last trimester?
the associated fluid retention during pregnancy.
When using a doppler, what is heard as a pulsatile pumping sound?
arterial flow
When suing a doppler was is heard as a sound of rushing wind?
venous flow
What instruments are used for fetal heart rate?
fetoscope, Left scope, stethoscope or Doppler
What has a band that fits against the head of the listener and also has a metal band that aids in bone conduction so that heart tones are heard more easily
fetoscope
What has a weighted end that when places on the abdomen does not need stabilization?
Left scope
When can a fetoscope and Left scope detect fetal heart rate?
17-19 weeks gestation
What is an ultrasound that picks up suffering frequencies from the beating fetal heart?
doppler method
When can the doppler method detect a fetal heart?
10-12 weeks
