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OB > Week 4 maternal adaptation during preg > Flashcards

Week 4 maternal adaptation during preg Flashcards

1
Q

Uterine grow occurs as a result of ____ and ___

A

Hyperplasia and hypertorphy

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2
Q

Late uterine growth is caused by ____

A

stretching of the uterine muscles resulting in hypertrophy

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3
Q

early uterine growth is caused by

A

hyperplasia caused by hormones

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4
Q

By week ___ the uterus can be palpated

A

12

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5
Q

Where can the uterus be palpated at week 12?

A

above the pubis symphysis

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6
Q

Where can the uterus be palpated at week 16?

A

Midway between the PS and the umbilicus

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7
Q

Where can the uterus be palpated at week 20?

A

the umbilicus

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8
Q

In late pregnancy, uterine blood flow reaches up to ____ an minute. This is ___% of maternal blood

A

1200ml

17%

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9
Q

What is the most obvious change to the cervix during pregnancy?

A

Changes in color and consistancy

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10
Q

What is chadwicks sign?

A

Discoloration of the cervix, vagina, and labia d/t congestion of blood caused by increased estrogen

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11
Q

What is Goodell’s sign

A

softening of the cervix

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12
Q

How does the cervical plug form and what is its function?

A

It forms as cervical glans proliferate. the tissue becomes honeycomb and excretes mucus rich in immunoglobulins
-its function is to block the ascent of bacteri from the vagina to the uterus

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13
Q

How long does the cervical mucus plug remain in place?

A

Until dilation and effacement occurs

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14
Q

why are pregnant women at risk for developing UTIs, kidney infections, and candida albicans during pregnancy

A

-because glycogen increases in the vagina and creates an acidic environment. This inhibits many bacteria but the rich glycogen favors the growth of Candida albicans and can cause yeast infections and uti’s

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15
Q

How long after conception does the corpus luteum continue to produce hormones befor the placenta takes over?

A

6-7 weeks

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16
Q

What is the main function of progesterone during pregnancy?

A

to suppress contractions of the uterus and prevent fetal rejection

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17
Q

How do estrogen and pregesteron affect breast development during pregnancy?

A

estrogen stimulates growth of ducts

progesterone promotes growth of lobes, lobules, and alveoli

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18
Q

Colostrum can be secreted as early as ____ weeks gestation

A

16

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19
Q

How does the heart change during pregnancy?

A
  • Enlarges 10-15% in first tri
  • Pushed up and to the left as uterus elevates during third tri
  • Locations for ausculatation are shifted during late preg
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20
Q

When can maternal heart sound changes be detected?`

A

between 12-20 weeks

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21
Q

What are the two most common maternal heart changes?

A
  • Splitting of the first heart sound

- Systolic murmur

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22
Q

Where is a systolic murmur best heard?

A

PMI

mitral/apical

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23
Q

___ women have a third heart sound during pregnancy

A

90%

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24
Q

Why does blood volume increase during pregnancy>

A
  • Increased transport needs
  • Increased tissue needs
  • Protections from blood loss
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25
Q

Why do maternal Hgb and Hct values decline despite the increased RBC volume?
What is the phenomenon called?

A

The increase in platelets is much higher and causes dilution

-Physiologic anemia

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26
Q

A mother is considered iron deficency anemic when her hgb is less than ____ in the ____ trimester(s) and less than ____ in the ___ trimester(s)

A

11g/dl first and third

10.5g/dl second

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27
Q

The dilution of RBC’s by plasma may have a protective function. Why is that?

A

-It decreased blood viscosity and may counter the increased risk for clots from increased fibrinogen

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28
Q

Why does maternal CO increase during pregnancy?

When is CO highest? When is CO lowest?

A

It increases as a result of increased stroke volume

  • It is highest when the woman is on her side
  • Lowest when standing or laying supine
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29
Q

What happens to systemic vascular resistance during pregnancy?

A

It lowers

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30
Q

Why does systemic vascular resistance lower during pregnancy?

A
  • Progesterone and Prostaglandins cause vaso dilation

- Endothelial prostacyclin and endothelial-derived relaxant factors such as nitric oxide

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31
Q

What happens to maternal blood pressure during pregnancy?

A

-Minimal changes because of decreased vasc. resistanced and increased blood volume balancing each other

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32
Q

How does progesterone affect BP? when does this begin to occur?

A

It decreases diastolic BP slightly begins around 6 weeks and is most noticable begining in third tri

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33
Q

What is supine hypotension?

A

-Occlusion of the vena cava lowers venous return from LE’s and reduces cardiac return

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34
Q

Pregnant women are in a ____ state because of increased clotting factors and decreased clot inhibiting factors

A

Hypercoagulable state

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35
Q

What clotting factors rise during pregnancy?

A

Fibrinogen(1), 7, 8, 9,and 10

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36
Q

What factor that normally inhibits clots is decreased during pregnancy?

A

Fibrinolytic activity

37
Q

How does the maternal respiratory system change during pregnancy?

A

-O2 consumption is increased r/t fetal needs and increased metabolic needs of mom

38
Q

How does progesteron affect breathing?

A

It caused mom to hyperventilate slightly because of deeper breaths not increased RR

39
Q

What two states facilitate transfer of CO2 from the fetus to the mother?

A

Hyperventilation and resp. Alkalosis

40
Q

What is the major cause of maternal respiratory changes during pregnancy?

A

increased oxygen consumption, hormonal factors, and physical effects of the enlarging uterus

41
Q

What is the physiology behing progesterones effect on a respirations?

A
  • It decreases airway resistance and increases the sensitivity of the breathing center
  • This causes a heightened awareness of the need to breath and the feeling of SOB
42
Q

Why are pregnant women at high risk of Gastric reflux?

A

Relaxation of the LES

43
Q

How is gastric motility affected by pregnancy? What are some SE’s of this?

A

Emptying time decreases to allow more time for nutrient absorption
-May cause bloating and constipation and decreased B-vitamin absorption

44
Q

What are the two main factors that affect the liver during pregnancy?

A
  • Progesterone and Estrogen cause functional changes

- Uterus changes the livers position and affects its function

45
Q

Why are pregnant woment at higher risk of gall stones?

A
  • Gallbladder becomes hypotonic and has decreased function
  • Bile becomes thicker
  • Bile retention (causes itching)
46
Q

How does pregnancy affect Liver labs?

A
  • Alk. Phos increases x2-4

- Hemodilution causes decreased albumin and total protein

47
Q

How does progesterone affect the bladder?

A

Decreased tone

48
Q

Why do pregnant women have nocturia?

A
  • Water and sodium retention during the day and release at night.
  • Edema from decreased blood drainage (from uterine pressure)
  • (uterine pressure)
49
Q

Why do pregnant women have a higher risk for bacteriuria/pyelonephritis?

A

Obstructed urinary flow in the ureters causes urinary stasis

50
Q

How does pregnancy effect the function of the kidneys?

A
  • Increased plasma flow
  • Increased GFR d/t increased CO
  • Increased glucose excretion
  • Mild proteinuria is common
51
Q

Oxytocin is inhibited by ___

A

progesterone

52
Q

Why does the thyroid gland increase in size during pregnancy?

A

-Hyperplasis and increased vascularity

53
Q

Why is it important to monitor thyroid funtion in pregnant women?

A
  • T4 and T3 cross the placenta.

- The fetus does not make its own until 10-12 weeks and is needed for early neurological function development

54
Q

How do pregnant blood glucose levels compare to pre-preg levels?

A

10-20% lower

55
Q

During pregnancy, when does insulin sensitivity decline? Why?

A

second half.
Because of HGS, prolactin, estrogen, progesterone, and cortisol.
Basically, the body needs more GB for metabolism so it decreased sensitivity to raise bg

56
Q

Why is maternal fasting GB low?

A

Because excess blood glucose goes to the fetus

57
Q

Why is post partem blood glucose higher?

A

Because of the left over insulin resistance

58
Q

What is gestational DM?

A

When the pregnant mothers pancreas doesn’t increase insulin production to an adequate level to make up for the increased resistance. Causing hyperglycemia

59
Q

Why does cortisol increase during pregnancy? Its function?

A
  • As a result of estrogen and decreased metabolism

- It stimulates gluconeogenesis to insure appropriate GB levels

60
Q

Why does aldosterone increase during pregnancy?

A

-to overcome salt-wasting effects of progesterone

61
Q

What is the primary function of HCG

A

To prevent deterioration of the corpus luteum until the placenta takes over

62
Q

What are some functions of estrogen during pregnancy?

A
  • Suppression of FSH and LH
  • Stimulation of uterine growth
  • Increased blood supply to uterine vessels
  • Added deposit of maternal fat stores
  • Increased uterine contraction near term
  • Development of the glands and ductal system in the breasts
  • Hyperpigmentation
  • Stimulation of vascular changes in the skin, breasts, upper resp tract and bladder
  • Antagonist to insulin
63
Q

What are some functions of progesterone during pregnancy?

A
  • Suppression of fsh and lh
  • Maintenance of the endometrial layer for implantation of the fertilized ovum and prevention of menstruation
  • Decreased uterine contractility
  • Increased fat deposits
  • Stimulation of development of the lobes, lobules, and ducts in the breasts
  • Relaxation of smooth muscles of the uterus, gastric sphincter, bowel, ureters, bladder
  • Increased resp sensitivity to carbon dioxide, stimulation ventilation
  • Suppression of the immunologic response, preventing rejection of the fetus
  • Antagonist to insulin
  • Retention of sodium
64
Q

What is the primary function of HPL and HCS

A

increase availability of glucose for the fetus

65
Q

Basal metabolic rate increases by _____ by the third trimester

A

10-20%

66
Q

What are some factors that cause edema during pregnancy?

A
  • Helodilution causes slightly decreases colloid osmotic pressure
  • Decreased venous return
67
Q

How are eyes affected during pregnancy?

A
  • corneal edma= contact lens discomfort

- Decreased IOP= improved glaucoma

68
Q

How are the ears effected during pregnancy?

A

changes in eustachian tube MM’s may cause blocked ears and mild hearing loss

69
Q

How does the immune system change during pregnancy?

A

it is altered to allow for the fetus to not be rejected

  • May cause rh arthritis and multiple sclerosis to improve
  • Slight decrease in infection resistance
70
Q

What is a presumptive indication of pregnancy?

A

most, but not all, indications are subjective and reported by the woman. Least reliable indicators of pregnancy

71
Q

What are the 7 main presumptive indications of pregnancy?

A
  • Amenorrhea (absence of menstration)
  • N/V
  • Fatigue
  • Urinary frequency
  • Breast and skin changes
  • Vaginal and cervical color change
  • Fetal movements
72
Q

What is a probable signs of pregnancy?

A

Objective findings that can be documented by examiner

73
Q

What are 9 probable signs of pregnancy?

A
  • Abdominal enlargement
  • Cervical softening
  • Changes in uterine consistancy
  • Ballottement (dancing fetus when tap the cervix)
  • Braxton-Hicks
  • Palpation of fetal outline
  • Uterine souffle
  • Sound of blood curculating through uterine vessels corrosponding to maternal pulse
  • Pregnancy tests
74
Q

what is Uterine soufflé

A

: soft, blowing sound, may be auscultated over the uterus

75
Q

What hormones do pregnancy tests detect.

How early can they be positive?

A
  • hCG or B-hCG

- 3-7 days after conception detectable but depending on the test it can be later

76
Q

What void is the best for a urine preg test

A

First morning void

77
Q

What is a positive indication of pregnancy?

A

Positive confirmation

78
Q

What are the only three signs that are positive indications of pregnancy?

A
  • Auscultation of a fetal heart (as early as 6 weeks with doppler and 18-20 with fetoscope)
  • Fetal movement detected by examiner
  • Visualization of the embryo or fetus (as early as 3-4 weeks vis trans vag u/s)
79
Q

What is the self statement during the first trimester?

A

I am pregnant

80
Q

What is the self statement during the second trimester?

A

I am going to have a baby

81
Q

What is the self statement during the third trimester

A

I am going to be a mother

82
Q

What are the three main paternal developmental responses to pregnancy?

A

1) grappling with the reality of pregnancy and the new child
2) struggling for recognition as a parent from his family and social network
3) making an effort to be seen as relevant to childbearing

83
Q

What are the AAP & ACOG recommendations for F/U in a healthy pregnancy?

A
  • Conception to 28 weeks – every 4 weeks
  • 29-36 weeks – every 2 weeks
  • 37 weeks to birth weekly
84
Q

What are the critical signs of a pregnancy complication?

A
  • Vaginal bleeding
  • Leaking fluids
  • Swelling of fingers or eyes/face
  • Continuous H/A
  • Visual disturbances
  • Seizures
  • Severe abdominal or epigastric pain
  • Fever/chills
  • Painful urination
  • Persistant vomiting
  • Changes in fetal movement and strength
  • s/s of preterm labor
85
Q

What can cause Persistent or severe abdominal or epigastric pain?

A

Ectopic preg, worsening preeclampsia, placental abruption

86
Q

Persistent vomiting is a symptom of ___

A

Hyperemesis gravidarum

87
Q

Changes in frequency or strength of fetal movement could indicate___

A

Fetal compromise or death

88
Q

What are some s/s of preterm labor?

A

uterine contractions, cramps, constant or irregular low backache, pelvic pressure, watery vaginal discharge

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