Antepartum (Physiological changes in Pregnancy)

Question 1

What does increased vascularity of the vagina and other pelvic viscera result in?

Answer 1

This leads to edema and increased sensitivity (this increased sensitivity may result in increased sexual interest during the 2dn trimester)

Question 2

What happens to the PH in the vagina during pregnancy?

Answer 2

It lowers to a range of 3.5 - 6.0

Question 3

What is the third trimester?

Answer 3

28 weeks through 40 completed weeks

Question 4

What is commonly measured to estimate the duration of a pregnancy?

Answer 4

The Fundus

Question 5

What are the 3 factors that decrease blood flow to the uterus?

Answer 5

1.) Low arterial pressure
2.) Contractions of the uterus
3.) Supine position

Question 6

What is the shape of the uterus in the second trimester?

Answer 6

As the muscular walls strengthen and become more elastic, the uterus becomes “spherical or globular”

Question 7

What happens at 28 weeks with Braxton Hicks? What elivates them?

Answer 7

They become more definite and are alleviated with walking or exercise

Question 8

What hormone increases blood flow to the uterus?

Answer 8

Estrogen

Question 9

What happens to our circulation and coagulation “system” during pregnacy?

Answer 9

Pregnancy is considered a hypercoagulable state in which patients are at at a 5 - 6 times increased risk for thromboembolic disease/

(Circulation time decreases slightly by week 32 but returns to near normal by term)

Question 10

What is the first trimester?

Answer 10

First day of LMP through 12 completed weeks

Question 11

What do Montgomery Tubercles do?

Answer 11

They are bumps on that develop on the areolas that secrete substances to lubricate and provide anti-infective agents to protect breasts during breastfeeding

Question 12

What neuro symptoms occur during pregnancy? (7)

Answer 12

1.) Compression of pelvic nerves may cause leg sensations to change

2.) Edema involving peripheral nerves may lead to carpal tunnel syndrome during last trimester

3.) Stooped shoulder may compress nerves in arm leading to hand numbness

4.) Tension headaches

5.) Light-headedness and syncope may happen in 1st trimester

6.) Hypocalcemia may lead to muscle cramps

7.) Corneal thickening and decreased intraocular pressure can occur but resolves shortly after pregnancy

Question 13

What do Braxton Hicks Contraction facilitate?

Answer 13

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

Question 14

What can ultrasound measure? What at risk conditions is it especially used for?

Answer 14

Ultrasound can measure the bloodflow and is used for pregnancies at risk due to:
1.) HTN
2.) Intrauterine growth restriction
3.) DM
4.) Multiple gestation

Question 15

When/how is renal function most efficient during pregnancy? When is it least efficient? Why?

Answer 15

Renal function most efficient when Pt lays on side or is in a lateral recumbent position and is least effective when the patient assumes a supine position

A side-lying position increases renal perfusion, which increases urine output and decreases edema.

Question 16

What are the 3 categories of changes in pregnancy?

Answer 16

Presumptive – subjective changes reported by Pt

Probable – objective changes assed by an examiner. When combined with presumptive, they strongly suggest pregnancy

Positive – signs assessed by examiner can only be attributed to presence of fetus

Question 17

What happens to blood flow to the kidneys if a pregnant patient is lying in a supine position.

Answer 17

If patient is lying supine, the heavy uterus compresses the vena cava and aorta, which reduces cardiac output. As a result blood flow to the kindeys is reduced so that it may go to the brain and heart.

Question 18

At 3 months gestation what is the Fundus starting to put pressure on? What does it cause?

Answer 18

The finds starts to put pressure on the bladder causing increased urinary frequency

Question 19

What happens to the GI system during pregnancy? (10 of them)

Answer 19

1.) Morning sickness (70-80% experience) - NVP can occur which typically goes away after first trimester

2.) By end of second semester appetitive increases in response to increasing metabolic needs

3.) Patients may have changes in their taste lading to cravings - this can lead to “pica”

4.) Gums may swell and bleed

5.) Excessive salivation (ptyalism)

6.) Pyrosis (heartburn)

7.) Consitpation (this can be caused by the increase in water absorption from the colon or diet, ecxersise, etc)

8.) Decerase in gut biodome diversity

9.) Develpoemnt of gllstones

10.) Inta-abdominal discomfort (from shifting of internal organs)

Question 20

What happens/occurs to the breasts during pregnancy? (5 things)

Answer 20

1.) Fulness and heightened sensitivity due to estrogen and progesterone increases (this sensitivity could be mild tingling to sharp pain)

2.) Pigmented nipples and areolas

3.) Pronounced Montgomery Tubercles (bumps on areolas)

4.) Visible veins

5.) Enlargement of breast from mammary glands in 3rd trimester (results in tissue becoming softer and looser)

Question 21

What is the increase in total body water during pregnancy? WHat must the body due to “componsate” for this increase?

Answer 21

6.5 - 8.5L - To stay balanced the body must maintain more sodium

Question 22

During pregnancy, what does the microbiome prevent?

Answer 22

Microbiome prevents ascending bacterial infections (However, during pregnancy the patient is more vulnerable to yeast infections

Question 23

What happens to RBC count, Hemoglobin and hematocrit count, and WBC during pregnancy?

Answer 23

RBC ↑17%
Hemoglobin and hematocrit decrease
WBC increase 2nd and 3rd trimester

Question 24

What happens to the respiratory system during pregnancy?

Answer 24

1.) Increase of 20-40% in O2 consumption

2.) Diaphragm is pushed up thus the ribcage also expands

3.) Tidal volume increased 40% but Resp rate stays the same (or might slightly increase)

Question 25

What is glycosuria? Why does this happen? What is the normal range?

Answer 25

-Happens/occurswhen you pass blood glucose into the urine

The tubular reabsorption of glucose is impared so that glycosuria occurs resulting in 1 - 10g of gluose being excreted via the kidneys per day

Question 26

What is needed to prevent exsessive sodium depletion during an increase in total body water volume during pregnancy? Why?

Answer 26

Additional sodium is needed to expand fluid volume and maintain an isotonic state

Question 27

What happens to the integumentary system during pregnancy? (8 things)

Answer 27

1.) Hyperpigmentation (due to stimulation from anterior pituitary hormone “melanotropin”)

2.) Facial melasma (aka chloasma or mask of pregnancy”

3.) Linea Nigra (pigmented line that extends from symphysis pubis to top of fundis in midline” - dark line on belly)

4.) Striae gravidarum (strech marks) - can be itchy

5.) Accelerated nail and hair growth

6.) Acne - variable, some get it some don’t

7.) Decrese in scalp hair loss rate (makes hair look more full + shiny)

8.) Increased blood supply to skin leading to increased perspiration = feeling hot

Question 28

What is the main known alternation of functioning in neuro system during pregnancy?

Answer 28

*The major known alternation in function of the neuro system during pregnancy is hypothalamic - pituitary neurohormonal changes

Question 29

What kind of chronic respiratory state is the body in during pregnancy?

Answer 29

A mild state of hyperventilation with reduced arterial carbon dioxide (PaCO2) and increased oxygen (PaCO2) over non pregnant levels

Question 30

Although cardiac output increased significantly during pregnacy, What happens to blood pressure? Why?

Answer 30

Blood pressure remains the same or decreases slightly. This is due to reduced SVR (systemic vascular resistance) caused by the vascodilarity effects or progesterone, prostaglandins, and relaxin.

Question 31

What happend to the renal system during pregnacy? What does this cause?

Answer 31

1.) Smooth muscle walls of ureters undergo hyperplasia and hypertrophy and muscle tone relaxation (This causes a larger volume of urine to be held in the pelvis and ureters and also causes a decrease in urine flow rate)

2.) Increased urinary frequency
-This can cause a decrese in bladder tone which increases bladder capacity size to 1500mL

Question 33

What does the term Gestation refer to?

Answer 33

The number of weeks of pregnancy since the first day of the last menstrual period

Question 34

What is the second trimester?

Answer 34

13 weeks through 27 completed weeks

Question 35

What happens to a patient’s blood pressure during pregnancy? What do we need to watch for?

Answer 35

Systolic: Stays the same for 1st trimester and then slowly decreases

Diastolic: Decreases until 28wk and then starts to increase

-Watch for orthostatic hypotension

(Automated machines may not work in Pts with pre-eclampsia)

Question 36

What happens to the MSK system during pregnacy? (4 things)

Answer 36

1.) Persons center of gravity shifts forward changing their posture

2.) Aching, numbness, and weakness of the upper extremities

3.) Separation of the symphysis pubis and instability of sacroiliac joints creating difficulty walking/ waddle gait (this is done to make room of the pelvis for birth) - this can cause pain while walking

4.) Stretching of the abdominal wall causing it to loose some tone (Rectus abdominus muscles may separate and cause protrusion of umbilicus )

Question 37

What can Braxton Hicks be confused for during the late term? What does this cause?

Answer 37

Can be confused with true labor and premature labor contractions, leading to delay in seeking help

Question 38

What does the term Antepartum refer to?

Answer 38

The time between conception and the onset of labour; often used to describe the period during which a women is pregnant; used interchangeably prenatal

Question 39

What happens to the cardiovascular system during pregnacy?

Answer 39

1.) Hypertrophy due to increased volume and cardiac output

2.) Audible splitting of S1 and S2 sounds ( S3 may be heard after 20 weeks of gestation)

3.) Increased heart rate

4.) Changes in blood pressure

5.) Increased in total blood volume consisiting of plasma and red blood cells increases by 40 - 50%

Question 40

What increases to the uterus for pregnancy? Why?

Answer 40

Bloodflow to uterus increases 10x for pregnancy as it provides the O2 to the fetus

Question 41

What are Braxton Hicks contractions? When can they start to be felt?

Answer 41

They are irregular and painless contractions that occur intermittently and can be felt after the fourth month of pregnancy

Question 42

What is the “Goodell Signs”? When does it occur?

Answer 42

It is the softening of the cervical tip that can be observed at the beginning of the 6th week (it is a probable sign of pregnancy)