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ppn301 > week 2 anatomy and physiology of pregnancy chapter 10 > Flashcards

week 2 anatomy and physiology of pregnancy chapter 10 Flashcards

1
Q

gravida

A

—A person who is pregnant

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2
Q

Gravidity

A

—Pregnancy

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3
Q

Nulligravida

A

—A person who has never been pregnant and is not currently pregnant

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4
Q

Primigravida

A

—A person who is pregnant for the first time

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5
Q

Multigravida

A

—A person who has had two or more pregnancies

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6
Q

Parity

A

—The number of pregnancies in which the fetus or fetuses have reached 20 weeks of gestation, not the number of fetuses (e.g., twins) born. Parity is not affected by whether the fetus is born alive or is stillborn (i.e., showing no signs of life at birth).

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7
Q

Nullipara

A

—A person who has not completed a pregnancy with a fetus or fetuses beyond 20 weeks of gestation

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8
Q

Primipara

A

—A person who has completed one pregnancy with a fetus or fetuses who have reached 20 weeks of gestation

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9
Q

Multipara

A

—A person who has completed two or more pregnancies to 20 weeks of gestation or more

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10
Q

Viability

A

—Capacity to live outside the uterus; there are no clear limits of gestational age or weight. Infants born at 22 to 25 weeks of gestation are considered to be on the threshold of viability.

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11
Q

Preterm

A

—A pregnancy between 20 weeks and 36 weeks 6 days of gestation

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12
Q

Late Preterm

A

—A pregnancy that has reached between 34 weeks 0 days and 36 weeks 6 days of gestation

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13
Q

Term

A

—A pregnancy from the beginning of week 37 of gestation to the end of week 40 plus 6 days of gestation

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14
Q

Early Term

A

—A pregnancy between 37 weeks and 38 weeks 6 days

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15
Q

Full Term

A

—A pregnancy between 39 weeks and 40 weeks 6 days

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16
Q

Late Term

A

—A pregnancy in the 41st week

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17
Q

Post Term

A

—A pregnancy after 42 weeks

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18
Q

what is the acronym GTPAL stand for?

A

gravidity, term, preterm, abortions, living children

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19
Q

what is the earliest biological marker for pregnancy?

A

Human chorionic gonadotropin (hCG)

Pregnancy tests are based on the recognition of hCG or a beta (β) subunit of hCG. Production of β-hCG begins as early as the day of implantation and can be detected as early as 8 to 10 days after fertilization
The concentration of hCG in blood rises rapidly during early pregnancy, peaks at 9 to 10 weeks, and subsequently declines to a stable level after approximately 20 weeks

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20
Q

what does reduced levels of hCG could indicate?

A

Reduced levels of hCG may indicate miscarriage or abnormal gestation (e.g., fetus with Down syndrome).

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21
Q

what do high hCG levels indicate?

A

Higher than normal levels of hCG may indicate molar pregnancy or multiple gestation

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22
Q

Enzyme-linked immunosorbent assay (ELISA)

A

Enzyme-linked immunosorbent assay (ELISA) testing is the most popular method of testing urine for pregnancy. It uses a specific monoclonal antibody (anti-hCG) with enzymes that bond with hCG in urine. ELISA technology is the basis for most over-the-counter home pregnancy tests.

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23
Q

The most common error in performing home pregnancy tests is-

A

-doing the test too early in pregnancy before a significant rise in hCG level; this can cause a false-negative result

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24
Q

reading a pregnancy test

A

the type of pregnancy test and its degree of sensitivity (the ability to detect low levels of a substance) and specificity (the ability to discern the absence of a substance) must be considered in conjunction with the patient’s history. This includes the date of their last normal menstrual period, their usual cycle length, and results of previous pregnancy tests. It is important to know if the patient is taking any medications or has a substance use disorder. Medications such as anticonvulsants and tranquilizers can cause false-positive results, whereas diuretics and promethazine can cause false-negative results

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25
Q

what are the 3 commonly used categories of signs/symptoms of pregnancy?

A
  • Presumptive—Subjective changes reported by the patient (e.g., amenorrhea, fatigue, breast changes). These can be caused by conditions other than pregnancy.
    *Probable— Objective changes assessed by an examiner (e.g., Hegar sign, ballottement, pregnancy tests). When combined with the presumptive signs and symptoms, these changes strongly suggest pregnancy.
    *Positive— Objective signs assessed by an examiner that can be attributed only to the presence of the fetus (e.g., hearing fetal heart tones, visualizing the fetus, palpating fetal movements). These are definitive signs that confirm pregnancy.
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26
Q

amenorrhea commonly happens at what week in pregnancy?

A

4 wk

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27
Q

nausea, vomiting happens at what week during pregnancy?

A

4-14wk

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28
Q

urinary frequency happens at what week during pregnancy?

A

6-12 wk

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29
Q

quickening happens at what week during pregnancy?

A

16-20 wk

30
Q

Goodell sign happens at what week during pregnancy?

A

5-6 wk

31
Q

Chadwick sign happens at what week during pregnancy?

A

6-8 wk

32
Q

hegar sign happens at what week during pregnancy?

A

6-12 wk

At approximately 6 weeks of gestation, softening and compressibility of the lower uterine segment (uterine isthmus) occurs (Hegar sign)

This results in exaggerated uterine anteflexion during the first 3 months of pregnancy. In this position, the uterine fundus presses on the urinary bladder, causing the patient to have urinary frequency.

33
Q

uterus

A

High levels of estrogen and progesterone stimulate phenomenal uterine growth in the first trimester.
-Early uterine enlargement results from increased vascularity and dilation of blood vessels, hyperplasia (production of new muscle fibres and fibroelastic tissue) and hypertrophy (enlargement of pre-existing muscle fibres and fibroelastic tissue)

34
Q

uterus sizing (7, 10, 12 weeks)

A

By 7 weeks of gestation the uterus is the size of a large hen’s egg; by 10 weeks it is the size of an orange (twice its nonpregnant size); and by 12 weeks it is the size of a grapefruit. After the third month, uterine enlargement is primarily the result of mechanical pressure of the growing fetus.

As the uterus enlarges, it also changes in shape and position. At conception the uterus is shaped like an upside-down pear.
During the second trimester, as the muscular walls strengthen and become more elastic, the uterus becomes spherical or globular. Later, as the fetus lengthens, the uterus becomes larger and more ovoid and rises out of the pelvis into the abdominal cavity.

The pregnancy may “show” after the fourteenth week, although this may depend on the person’s height and weight.

The uterus rises gradually to the level of the umbilicus at 20 to 22 weeks of gestation and nearly reaches the xiphoid process at term. Between weeks 38 and 40, fundal height decreases as the fetus begins to descend and engage in the pelvis (lightening).

Generally, lightening occurs in the nullipara anytime in the last 4 weeks before the onset of labour and in the multipara at the start of labour.

as the uterus elevates, it rotates to the right- d/t the colon being on the left side

35
Q

fundal heigh

A

determines uterine enlargement
-used to estimate the duration of pregnancy

36
Q

what are Braxton Hicks contraction/ prelabour contractions

A

Soon after the fourth month of pregnancy, uterine contractions can be felt through the abdominal wall. These contractions, referred to as prelabour contractions (or Braxton Hicks contractions)

These contractions facilitate uterine blood flow through the intervillous spaces of the placenta and promote oxygen delivery to the fetus.

After the twenty-eighth week, these contractions become more definite, but they usually cease with walking or exercise

they are painless but annoying

commonly mistaken for true labour

37
Q

what are the 3 factors known to decrease uterine blood flow in a pregnancy patient?

A
  1. low arterial pressure,
  2. contractions of the uterus,
  3. and supine position
38
Q

how can you measure the uterine blood flow

A

Doppler ultrasound examination can be used to measure uterine blood flow velocity, especially in pregnancies at risk due to conditions associated with decreased placental perfusion, such as hypertension, intrauterine growth restriction, diabetes mellitus, and multiple gestation

Using an ultrasound device or a fetal stethoscope, the examiner may hear the uterine souffle or bruit, a rushing or blowing sound of maternal blood flowing through uterine arteries to the placenta that is synchronous with the maternal pulse.

39
Q

funic souffle

A

which is synchronous with the fetal heart rate and is caused by fetal blood coursing through the umbilical cord, may also be heard, as well as the actual heartbeat of the fetus

40
Q

cervical changes in pregnancy

A

The cervix consists primarily of collagen-rich connective tissue and is responsive to hormonal changes of pregnancy. This results in the cervix being a firm, nondistensible, closed structure that maintains the pregnancy and changing to a soft, highly elastic tissue that dilates and becomes almost indistinguishable during labour in preparation for birth.

In a normal, unscarred cervix, a softening of the cervical tip may be observed about the beginning of the sixth week. This probable sign of pregnancy, Goodell sign, is brought about by increased vascularity, slight hypertrophy, and hyperplasia (increase in number of cells).

41
Q

what is ballottement

A

Passive movement of the unengaged fetus is called ballottement and can be identified generally between the sixteenth and eighteenth week. Ballottement is a technique of palpating a floating structure by bouncing it gently and feeling it rebound. To palpate the fetus, the examiner places a finger within the vagina and taps gently upward, causing the fetus to rise. The fetus then sinks, and a gentle tap is felt on the finger

42
Q

what is quickening

A

the first recognition of fetal movements, or “feeling life.”
It can be detected as early as the fourteenth week in the multiparous patient. The nulliparous patient may not notice these sensations until between the sixteenth and twentieth week.
-can be difficult to distinguish from peristalsis

The week in which quickening occurs provides a tentative clue in dating the duration of gestation.

43
Q

what is Chadwick sign?

A

Increased vascularity results in a violet-bluish colour of the vaginal mucosa and cervix. The deepened colour, termed

Chadwick sign, is note noted by the eighth week of pregnancy in primigravidas

44
Q

what is Leukorrhea

A

Leukorrhea is a white or slightly grey mucoid discharge with a faint musty odour.
-vaginal discharge should never be pruritic or blood stained

45
Q

Prolactin

A

produced by the anterior pituitary gland, stimulates production of colostrum by the end of the first trimester. During the second trimester, human placental lactogen stimulates secretion of colostrum
-by 16 wks the breast are prepared for full lactation

46
Q

cardiovascular system in pregnancy

A

Slight cardiac hypertrophy (enlargement) is probably secondary to increased blood volume and cardiac output that occurs in pregnancy. The heart returns to its normal size within 6 months after childbirth.
As the diaphragm is displaced upward by the enlarging uterus, the heart is elevated upward and rotated forward to the left

47
Q

heart rate in pregnancy

A

The patient’s heart rate begins to increase at about 5 weeks of gestation, reaching a peak of 15 to 20 beats/minute over the prepregnancy baseline by 32 weeks and persisting until term. This represents an increase of approximately 17% over the prepregnancy heart rate

48
Q

blood pressure in pregnancy

A

Blood pressure is influenced by two major factors: cardiac output (CO) and systemic vascular resistance (SVR). Although CO increases significantly during pregnancy, blood pressure remains the same or decreases slightly. This is due to reduced SVR caused primarily by the vasodilatory effects of progesterone, prostaglandins, and relaxin.

SVR is lowest at 16 to 34 weeks and increases gradually, approximating nonpregnant values by term. During the first trimester, systolic blood pressure usually remains the same as the prepregnancy level but can decrease slightly as pregnancy advances. Diastolic blood pressure begins to decrease in the first trimester, continues to drop until 28 weeks, and gradually increases, returning to prepregnancy levels by term

49
Q

what are the factors that affect a blood pressure reading in a pregnant person?

A

SVR is lowest at 16 to 34 weeks and increases gradually, approximating nonpregnant values by term. During the first trimester, systolic blood pressure usually remains the same as the prepregnancy level but can decrease slightly as pregnancy advances. Diastolic blood pressure begins to decrease in the first trimester, continues to drop until 28 weeks, and gradually increases, returning to prepregnancy levels by term

50
Q

what happens if you measure a bp with a cuff that is too small?

A

A cuff that is too small yields a falsely high reading;

51
Q

what happens if you measure a bp with a cuff that is too big?

A

a cuff that is too large yields a falsely low reading.

52
Q

measurement of the right cuff size for a b/p reading?

A

An appropriately sized cuff (i.e., length 1.5 times the circumference of the arm) should be used.

53
Q

how to correctly take a b/p reading?

A

Blood pressure should be measured with the patient in the sitting position with their arm at the level of the heart. The arm used and position of the patient should be documented.

-If possible, allow a period of quiet rest before measuring the blood pressure.
*If blood pressure is consistently higher in one arm, the arm with the higher values should be used for all blood pressure measurements

54
Q

positions of b/p readings and outcomes

A

Brachial blood pressure is highest when the patient is sitting, lowest when they are lying in the lateral recumbent position, and intermediate when they are supine, except for some patients who experience supine hypotension.

55
Q

what is supine hypotension?

A

Supine hypotension can occur when the patient lies on their back and the weight of the abdominal contents compresses the vena cava and aorta, causing a decrease in BP and a feeling of faintness

56
Q

s/s of supine hypotension

A

Pallor
Dizziness, faintness, breathlessness
Tachycardia
Nausea
Clammy (damp, cool) skin; sweating
A drop of 30 mm Hg in their systolic pressure

57
Q

intervention of supine hypotension?

A

Position patient on their side until their signs and symptoms subside and vital signs stabilize within normal limits.

Abdominal inspection is followed by measurement of the height of the fundus

58
Q

what is psychological anemia?

A

During pregnancy, there is an accelerated production of RBCs (nonpregnant, 4.2 to 5.4 × 1012/L). The RBC mass increases by 250 to 450 mL, or approximately 20 to 30% over prepregnancy values
-The percentage of increase depends on the amount of iron available. Because the plasma increase is greater than the increase in RBC production, there is a decrease in normal hemoglobin and hematocrit values
-The decrease is more noticeable during the second trimester, when rapid expansion of blood volume occurs faster than RBC production.
-If the hemoglobin value drops to 110 g/L or less or if the hematocrit decreases to 0.32 or less, the patient is considered anemic

59
Q

diuretics during pregnancy

A

As efficient as the renal system is, it can be overstressed by excessive dietary sodium intake or restriction or by use of diuretics. Severe hypovolemia and reduced placental perfusion are two consequences of using diuretics during pregnancy.

60
Q

what is linea nigra

A

is a pigmented line extending from the symphysis pubis to the top of the fundus in the midline. This line is known as the linea alba before hormone-induced pigmentation. In primigravidas the extension of the linea nigra, beginning in the third month, keeps pace with the rising height of the fundus; in multigravidas the entire line often appears earlier than the third month.

61
Q

what is Striae gravidarum

A

Striae gravidarum, or stretch marks (seen over the lower abdomen in Figure 10.12), appear in 50 to 90% of pregnant patients during the second half of pregnancy. Striae reflect separation within the underlying connective (collagen) tissue of the skin. These slightly depressed streaks tend to occur over areas of maximum stretch (the abdomen, thighs, and breasts). The stretching sometimes causes a sensation that resembles itching. The tendency to develop striae may be familial. After birth they usually fade, although they never disappear completely. No topical therapy has been shown to affect the course of striae, although pulsed laser therapy can reduce redness of early lesions

62
Q

what are angiomatas

A

Angiomatas, commonly known as vascular spiders, are tiny, star-shaped or branched, slightly raised, and pulsating end-arterioles usually found on the neck, thorax, face, and arms. Angiomatas appear during the second to fifth month of pregnancy as a result of increased blood flow to the skin due to rising estrogen levels during pregnancy and usually disappear within the first 3 months postpartum

63
Q

skin colour and pregnancy

A

Integumentary system changes vary greatly among individuals of different ethnic backgrounds. Therefore, when performing physical assessments, the colour of a person’s skin should be noted along with any changes that may be attributed to pregnancy.

64
Q

falling risk in pregnancy

A

Pregnant individuals are at increased risk for falling because of the shifting centre of gravity, impaired balance, and joint laxity.

65
Q

carpal tunnel syndrome in pregnancy

A

Edema involving the peripheral nerves may result in carpal tunnel syndrome during the last trimester. The syndrome is characterized by paresthesia (abnormal sensation such as burning or tingling) and pain in the hand, radiating to the elbow. The sensations are caused by edema that compresses the median nerve beneath the carpal ligament of the wrist. Smoking and alcohol consumption can impair the microcirculation and may worsen the symptoms. The dominant hand is usually affected most, although many patients report symptoms in both hands. Symptoms usually regress after pregnancy. In some cases, surgical treatment is necessary.

66
Q

Oxytocin

A

Stimulates uterine contractions; stimulates milk ejection from breasts

67
Q

Human chorionic gonadotropin

A

Maintains corpus luteum production of estrogen and progesterone until placenta takes over the function

68
Q

Progesterone

A

Suppresses secretion of FSH and LH by the anterior pituitary; maintains pregnancy by relaxing smooth muscles, decreasing uterine contractility; causes fat to deposit in subcutaneous tissues over the maternal abdomen, back, and upper thighs; decreases person’s ability to use insulin

69
Q

Estrogen

A

Suppresses secretion of FSH and LH by the anterior pituitary; causes fat to deposit in subcutaneous tissues over the maternal abdomen, back, and upper thighs; promotes enlargement of genitals, uterus, and breasts; increases vascularity; relaxes pelvic ligaments and joints; interferes with folic acid metabolism; increases level of total body proteins; promotes retention of sodium and water; decreases secretion of hydrochloric acid and pepsin; decreases mother’s ability to use insulin

70
Q

Human placental lactogen (previously called chorionic somatomammotropin)

A

Acts as a growth hormone; contributes to breast development; decreases maternal metabolism of glucose; increases amount of fatty acids for metabolic needs

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