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NURS 501 > Exam 3 - Maternal Adaptations of Pregnancy > Flashcards

Exam 3 - Maternal Adaptations of Pregnancy Flashcards

1
Q

How long is the human gestation period?

A

266 days (38 weeks) since ovulation

  • 10 lunar months, 9 calendar months
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2
Q

Musculoligamentous changes to the woman during pregnancy

A
  • Lordosis and accentuated lumbosacral spinal curve
  • Change in posture from center of gravity
    • Kyphosis
    • Altered gait
    • Pubis symphysis widens
    • Pelvis tilts anteriorly
  • Separation of rectus abdominis due to pressure from enlarged uterus –> diastasis recti
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3
Q

Integumentary changes to pregnant women

A

Estrogen and progesterone + melanocyte stimulating hormone induces melanocytes to deposit pigments in skin

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4
Q

What causes striae gravidarum during pregnancy?

A

From thinning of elastin fibers and collagen in connective tissue

  • Stretching and softening in epidermal junction under skin
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5
Q

Nail changes to pregnant women

A
  • Transverse grooving
  • Softening
  • Increased brittleness
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6
Q

Hair changes to pregnant women

A
  • Increase in number of hairs in growth phase
  • Decrease in number of hairs in resting phase
    • Longer and thicker hair

Will reverse postpartum - hair loss 2-4 months after delivery

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7
Q

Cardiovascular changes in pregnant women

A
  • HR increases in first month and peaks at 32 weeks
  • Ventricular muscle mass increases
  • Heart displaced upward, forward, to left
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8
Q

Can murmurs be heard during pregnancy?

A

Systolic murmur heard between 12-20 weeks

  • S1, S2 split can happen and/or S3
  • Murmurs louder than 2 out of 6, or any diastolic murmur, requires eval
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9
Q

Does blood volume increase during pregnancy?

A

Increases as early as 6 weeks and peaks at 32 weeks

  • Due to increased plasma volume and red cell mass (RBC volume)
  • Hemodilution –> decrease in hemoglobin
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10
Q

Why is there an increase in blood volume during pregnancy?

A
  • Maintains adequate blood flow to uterus, fetus, maternal tissues
  • Maintains BP and regulates temperature
  • Prepares for blood loss during delivery
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11
Q

What cardiovascular changes occur during the second and third trimester of pregnancy?

A
  • Hemoglobin and hematocrit levels drop in late pregnancy
    • Due to fetal uptake which maternal reserves cannot replace
  • Iron absorption improved in pregnancy but not enough to account for difference so mothers reserves are depleted
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12
Q

How does blood pressure change during pregnancy?

A

Decreases from pre-pregnancy levels and reaches low in second trimester –> returns to baseline in third trimester

  • Can decrease in left lateral position
  • Due to hormonal effects of vasodilation and decreased SVR
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13
Q

True/false: Pregnancy is considered a hypercoagulable state

A

True - increased clotting factors, decreased fibrinolysis, decreased anticoagulant activity

  • Protective changes to prevent hemorrhage at birth
  • Increases risk for VTE and coagulopathies during pregnancy and immediate postpartum period
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14
Q

Is there increased leukocyte production in pregnancy?

A

Yes, may rise to 6,000-17,000 in third trimester without infection

  • Normal: 4,000-12,000
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15
Q

What are the anatomic changes to the respiratory organs during pregnancy?

A
  • Diaphragm rises from upward uterine pressure
  • Lung chamber expands AP diameter to compensate and improve lung capacity

Allows for sufficient gas exchange to meet maternal and fetal metabolic needs

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16
Q

How does respiration change during pregnancy?

A
  • Tidal volume increases
  • Minute ventilation and CO increase
  • RR unchanged
    • Tachypnea sign of possible respiratory compromise
17
Q

What is the overall effect of hyperventilation on the pregnant woman?

A

State of compensated respiratory alkalosis –> improves carbon dioxide transfer from fetus to mother

18
Q

What are renal system changes that occur due to hematologic changes?

A

Increased CO and arterial vasodilation –> renal blood flow increases in first and second trimester

  • Increased urine flow and output
19
Q

Is the reabsorption of glucose and proteins good during pregnancy?

A

Reabsorption of glucose and protein not efficient in pregnancy –> occasional glycosuria or proteinuria

  • Serum glucose levels should be monitored
  • 24 hour urine >300 mg of protein signals issue
20
Q

What influence does progesterone have on the renal system?

A

Causes dilation of ureters, urethra, bladder –> urinary stasis

  • Increased risk of UTI
21
Q

What GI changes can occur during the second month of pregnancy?

A
  • Gingival edema
  • Hyperemia
  • Bleeding gums

Due to increased vascularity and blood flow, connective tissue changes, inflammatory mediators

22
Q

Does the lower esophageal sphincter tone increase or decrease during pregnancy?

A

Lower esophageal sphincter tone decreases due to progesterone effects

  • Enlarging uterus pushes stomach and intestines up, moving them into thorax
    • Heartburn and reflux
23
Q

What hormones have been associated with N/V during pregnancy?

A

Estrogen and hCG

  • Cause/mechanism unclear
24
Q

Changes to the uterus during pregnancy

A
  • Grows from pear shaped organ weighing 60 g to elongated globular cylinder shape weighing 800-1200 g
  • Myometrium for contractility and elasticity –> allows for lengthening, shortening, and ability to stretch creating forces of labor
25
Q

What happens to the uterus during third trimester?

A

Uterine muscle wall thins allowing for easier palpation of growing fetus

26
Q

What is the role of mucus plugs?

A

Cervical glands produce mucus plug to prevent bacteria from entering uterine cavity

27
Q

When is the mucus plug expelled?

A

Mucus plug expelled prior to onset of labor or in conjunction with onset of labor

  • Can be confused with vaginal leaking of fluid or bloody show
28
Q

What hormones cause weakening of the cervix?

A

Before labor, collagen becomes disorganized on cervix

  • Low progesterone and high estrogen cause mechanical weakening

Prostaglandin activity also helps with cervical dilation

29
Q

Changes related to the ovaries during pregnancy

A
  • Ovulation stops
  • Corpus luteum continues secreting progesterone for 10-12 weeks to maintain endometrium until placenta can assume the production and secretion of hormones
30
Q

What vaginal adaptations occur to the vagina during pregnancy?

A
  • Increased vascularization, hypertrophy, hyperplasia
  • Connective tissue loosens
  • Mucosa produces vaginal secretions (prevent infection)
  • Vaginal walls and perineal body become relaxed –> stretch and accomodate birth

NURS 501 (66 decks)

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