[7] PRELIMS | NORMAL CHANGES IN PREGNANCY Flashcards
(115 cards)
1
Q
PSYCHOLOGICAL RESPONSES TO PREGNANCY
- Is common initially, even if pregnancy is planned.
- Mother may have concerns about her career, her relationship with her partner, financial implications, and role change.
- She may make comments such as, “I thought I wanted a baby, but now I’m not sure.”
A
AMBIVALENCE
2
Q
PSYCHOLOGICAL RESPONSES TO PREGNANCY
- The woman shows a high degree of tolerance for the discomforts she may experience in the first trimester.
- In the second trimester, she begins to wear maternity clothes
- She begins to perceive movement at about 17-20 weeks. She may make comments such as, “Feeling the baby move makes it all seem real” or “It’s finally sinking in that I’m going to be a mother.”
A
ACCEPTANCE OF PREGNANCY
3
Q
PSYCHOLOGICAL RESPONSES TO PREGNANCY
- The expectant woman typically becomes more inwardly focused, less interested in outside activities.
- She is using this time to plan and adjust
- Her partner may see this as excluding him. She may say, “I never used to like to be alone, but now I like having time to myself just to think and plant.”
A
INTROVERSION
4
Q
PSYCHOLOGICAL RESPONSES TO PREGNANCY
- Sudden shifts of emotions from joy to sadness are common and difficult for the woman and her family.
- The woman often feels a great need for love and affection, but her partner, confused by her emotional changes, may react by withdrawing. She may say, “I’m not usually so emotional, but lately any little thing can set me off.”
A
MOOD SWINGS
5
Q
PSYCHOLOGICAL RESPONSES TO PREGNANCY
- The woman tends to feel somewhat negative about her body as pregnancy progresses.
- Her increasing abdomen coupled with the waddling gait of pregnancy may cause a woman to feel ungainly and unattractive. She may say, “I can’t even see my feet anymore” or “I feel as big as a house.”
A
CHANGES IN BODY IMAGE
6
Q
PSYCHOLOGIC TASKS OF THE MOTHER
To meet this task, she seeks competent prenatal care, practices, good health behaviors and self-care activities, reads about childbirth, and gathers information.
A
ENSURING SAFE PASSAGE THROUGH PREGNANCY, LABOR, AND BIRTH
7
Q
PSYCHOLOGIC TASKS OF THE MOTHER
The expectant woman seeks to gain support for the coming child from her partner and family. She will also work to help her other children accept the coming baby.
A
SEEKING ACCEPTANCE OF THIS CHILD BY OTHERS
8
Q
PSYCHOLOGIC TASKS OF THE MOTHER
After she perceives fetal movement (quickening) the mother begins to form bonds of attachment to the child, and the child becomes more real. The woman may talk about the child as a separate person: “The baby was so active today! I don’t think he (or she) appreciated the pizza last night.”
A
SEEKING COMMITMENT & ACCEPTANCE OF SELF AS MOTHER TO THE INFANT (BINDING IN)
9
Q
PSYCHOLOGIC TASKS OF THE MOTHER
The woman begins to develop patterns of self-denial and delayed personal gratification to meet the needs of her child. She may, for example, give up smoking or alcohol and make plans to adjust her personal schedule to spend more time with her child.
A
LEARNING TO GIVE OF ONE’S SELF ON BEHALF OF ONE’S CHILD
10
Q
SIGNS OF PREGNANCY
- ____
- ____
- ____
A
- Presumptive (Subjective)
- Probable (Objective)
- Positive (Diagnostic)
11
Q
- Symptoms the woman experiences and reports
- May have causes other than pregnancy
A
Subjective (Presumptive) Changes
12
Q
PRESUMPTIVE SIGNS OF PREGNANCY
- ____
- ____
- ____
- ____
- ____
- ____
- ____
- ____
- ____
- ____
A
- Amenorrhea
- Excessive Fatigue
- Nausea & Vomiting
- Frequency of Voiding
- Uterine Enlargement
- Linea nigra
- Melasma / Chloasma
- Striae Gravidarum
- Changes in breasts
- Quickening
13
Q
PRESUMPTIVE SIGNS OF PREGNANCY
The absence of menses, is the earliest symptom of pregnancy. The missing of more than one menstrual period, especially in a woman whose cycle is ordinarily regular, is an especially useful diagnostic clue
A
Amenorrhea
14
Q
PRESUMPTIVE SIGNS OF PREGNANCY
Occur frequently during the first trimester. Because these symptoms often occur in the early part of the day, they are commonly referred to as morning sickness
A
Nausea and Vomiting in Pregnancy (NVP)
15
Q
PRESUMPTIVE SIGNS OF PREGNANCY
Research suggests that women who experience NVP often have a ____ than those who do not
A
more favorable pregnancy outcome
16
Q
PRESUMPTIVE SIGNS OF PREGNANCY
May be noted within a few weeks after first missed menstrual period and may persist throughout the first trimester
A
Excessive Fatigue
17
Q
PRESUMPTIVE SIGNS OF PREGNANCY
Is experienced during the first trimester as the enlarging uterus presses on the bladder
A
Urinary Frequency
18
Q
PRESUMPTIVE SIGNS OF PREGNANCY
Line of dark pigment forms on the abdomen
A
Linea Nigra
19
Q
PRESUMPTIVE SIGNS OF PREGNANCY
Dark pigment forms on face
A
Melasma
20
Q
PRESUMPTIVE SIGNS OF PREGNANCY
Stretch marks form on abdomen
A
Striae Gravidarum
21
Q
PRESUMPTIVE SIGNS OF PREGNANCY
Are frequently noted in early pregnancy. These changes include tenderness and tingling sensations, increased pigmentation of the areola and nipple, and changes in Montgomery’s glands. The veins also become more visible and form a bluish pattern beneath the skin.
A
Changes in the breasts
22
Q
PRESUMPTIVE SIGNS OF PREGNANCY
The mother’s perception of fetal movement, occurs about 18 to 20 weeks after the last menstrual period in a woman pregnant for the first time by may occur as early as 16 weeks in a woman who has been pregnant before
A
Quickening
23
Q
PRESUMPTIVE SIGNS OF PREGNANCY
Is a fluttering sensation in the abdomen that gradually increases in intensity and frequency.
A
Quickening
24
Q
An examiner can perceive the objective changes that occur in pregnancy. Because these changes can also have other causes, they do not confirm pregnancy
A
Objective (Probable) Changes
25
# PROBABLE SIGNS OF PREGNANCY
* ____
* ____
* ____
* ____
* ____
* ____
* ____
* ____
* ____
* ____
* **Abdominal enlargement**
* **McDonald’s Sign**
* **Uterine souffle**
* **Braxton Hicks Contractions**
* **Ballottement**
* **Hegar's Sign (uterus)**
* **Goodell's Sign (cervix)**
* **Chadwick's Sign (vagina)**
* **Fetal Outline**
* **Positive Pregnancy Test**
26
# PROBABLE SIGNS OF PREGNANCY
Changes in the pelvic organs – the only physical changes detectable during the **(1)** ____ of pregnancy – are caused by increased **(2)** ____
(1) **first 3 months**
(2) **vascular congestion**
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# PROBABLE SIGNS OF PREGNANCY
Softening of the cervix
Goodell's Sign
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# PROBABLE SIGNS OF PREGNANCY
A bluish, purple, or deep red discoloration of the mucous membranes of the cervix, vagina, and vulva (some sources consider this a presumptive sign).
Chadwick's Sign
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# PROBABLE SIGNS OF PREGNANCY
A softening of the isthmus of the uterus, the area between the cervix and the body of the uterus
Hegar's Sign
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# PROBABLE SIGNS OF PREGNANCY
Is an ease in flexing the body of the uterus against the cervix.
Mcdonald's Sign
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# PROBABLE SIGNS OF PREGNANCY
General enlargement and softening of the body of the uterus can be noted after the **(1)** ____ of pregnancy. The fundus of the uterus is palpable just above the symphysis pubis at about **(2)** ____
(1) **8th week**
(2) **10 to 12 weeks’ gestation**
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# PROBABLE SIGNS OF PREGNANCY
____ during the childbearing years is usually regarded as evidence of pregnancy, especially of it is continuous and accompanied by amenorrhea
**Enlargement of the abdomen**
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# PROBABLE SIGNS OF PREGNANCY
Can be palpated most commonly after 28 weeks. As the woman approaches the end of pregnancy, these contractions may become uncomfortable. They are often called false labor.
Braxton Hicks Contractions
34
# PROBABLE SIGNS OF PREGNANCY
May be heard when the examiner auscultates the abdomen over the uterus. It is a soft, blowing sound that occurs at the same rate as the maternal pulse and is caused by the increased uterine blood flow and blood pulsating through the placenta
Uterine Soufflé
35
# PROBABLE SIGNS OF PREGNANCY
A soft, blowing sound of blood pulsating though the umbilical cord. It occurs at the same rate as the fetal heart rate
Funic Soufflé
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# PROBABLE SIGNS OF PREGNANCY
During the **(1)** ____ week of pregnancy, when the fetus is still small in relation to the amount of amniotic fluid present, **(2)** ____ may be demonstrated
(1) **16th to 20th**
(2) **ballottement** (*from the French word balloter, meaning to “to toss about”* )
37
# PROBABLE SIGNS OF PREGNANCY
On bimanual examination, if the **(1)** ____ is tapped sharply by the lower hand, the fetus can be felt to **(2)** ____ against the top examining hand
(1) **lower uterine segment**
(2) **bounce or rise in the amniotic fluid up**
38
# PROBABLE SIGNS OF PREGNANCY
Although the ballottement phenomenon is interesting, it also may be simulated by a ____, and therefore it is no more than a probable sign of pregnancy
**uterine tumor**
39
# PROBABLE SIGNS OF PREGNANCY
May be identified by palpation in many pregnant women after 24 weeks’ gestation
Fetal Outline
40
# PROBABLE SIGNS OF PREGNANCY
Pregnancy tests detect the presence of **(1)** ____ in the maternal blood or urine. These are not considered a positive sign of pregnancy because **(2)** ____
(1) **hCG**
(2) **other conditions can cause elevated hCG levels**
41
# POSITIVE SIGNS OF PREGNANCY
* ____
* ____
* ____
* **Fetal Heartbeat**
* **Fetal Movement**
* **Visualization of Fetus or Gestational Sac (via ultrasound)**
42
# POSITIVE SIGNS OF PREGNANCY
* Fetal Heartbeat (____)
* Fetal Movement (____)
* Visualization of fetus (parts & movement at ____) or gestational sac (____)
by ultrasound
* Fetal Heartbeat (**10-12 weeks**)
* Fetal Movement (**20th week**)
* Visualization of fetus (parts & movement at **8 wks**) or gestational sac (**4-5 weeks gestation or 2-3 weeks after conception**)
by ultrasound
43
# PHYSIOLOGIC CHANGES IN PREGNANCY
Some of the most dramatic changes of pregnancy occur in the ____
**reproductive organs involving the uterus, ovaries, vagina, and breasts**
44
# PHYSIOLOGIC CHANGES IN PREGNANCY
**UTERUS**
* Length increases from approximately ____
* Depth increases from ____
* Width expands from ____
* Weight increases from ____
* Length increases from approximately **6.5 to 32 cm**
* Depth increases from **2.5 to 22 cm**
* Width expands from **4 to 24 cm**
* Weight increases from **50 to 1000 g**
45
By the end of the ____, the uterus is large enough to be palpated as a firm globe under the ____, just above the ____
By the end of the **12th week**, the uterus is large enough to be palpated as a firm globe under the **abdominal wall**, just above the **symphysis pubis**
46
By the ____ of pregnancy, the uterus should reach the level of the ____
By the **20th or 22nd week** of pregnancy, the uterus should reach the level of the **umbilicus**
47
By the ____, it should touch the ____ and can make breathing difficult
By the **36th week**, it should touch the **xiphoid process** and can make breathing difficult
48
A woman in her first pregnancy
Primigravida
49
In ____ for a primigravida, the fetal head settles into the ____ to prepare for birth, and the uterus returns to the it was at ____. This happens about ____
In **Ligthening** for a primigravida, the fetal head settles into the **pelvis** to prepare for birth, and the uterus returns to the it was at **36 weeks**. This happens about **2 weeks before the term (the 38th week)**
50
The ____ of the uterus usually remains in the ____ during pregnancy, although it may be pushed slightly to the right side because of the larger bulk of the ____ on the left.
The **fundus** of the uterus usually remains in the **middle** during pregnancy, although it may be pushed slightly to the right side because of the larger bulk of the **sigmoid colon** on the left.
51
As the uterus increases in size, it pushes the ____ to the sides of the abdomen, elevates the ____, compresses the ____, and puts pressure on the ____.
As the uterus increases in size, it pushes the **intestines** to the sides of the abdomen, elevates the **diaphragm and the liver**, compresses the **stomach**, and puts pressure on the **bladder**.
52
____ begin early in pregnancy, at least by the ____, and are present throughout the rest of pregnancy.
**Uterine contractions** begin early in pregnancy, at least by the **12th week**, and are present throughout the rest of pregnancy.
53
False labor can be differentiated from true labor contractions on internal examination because they ____.
False labor can be differentiated from true labor contractions on internal examination because they **do not cause cervical dilatation**.
54
Physiologic Changes in the Uterus (4)
1. Hegar’s Sign
2. Ballottement
3. Braxton Hicks Contractions
4. Amenorrhea
55
Physiologic Changes in the Cervix (3)
1. Goodell's Sign
2. More vascular and edematous
3. Operculum
## Footnote
*edematous - affected with edema
56
Mucus plug that acts to seal out bacteria
Operculum
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Physiologic Change in the Ovaries
Stop producing ova
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Physiologic Changes in the Vagina (3)
1. Thickening of the secretions - **increase** in lactic acid content
2. Supportive connective tissue loosens
3. Chadwick's sign
59
Physiologic Changes in the Breasts
1. Noticeable changes on **6th week**
2. **Montgomery’s tubercles** enlarge
3. **Areola** darkens, **nipple** erectile
4. **Colostrum** (**16th week**)
5. Prominent superficial veins
60
**Ovulation** stops with pregnancy because of the ____ mechanism of ____ produced by the ____ early in pregnancy and by the ____ later in pregnancy.
**Ovulation** stops with pregnancy because of the **active feedback** mechanism of **estrogen and progesterone** produced by the **corpus luteum** early in pregnancy and by the **placenta** later in pregnancy.
61
The active positive feedback causes the ____ to halt production of ____
The **active positive feedback** causes the **pituitary gland** to halt production of **FSH and luteinizing hormone (LH)**
62
Vaginal secretions during pregnancy fall from a pH of ____ to ____. This occurs because of the action of the ____ bacteria
Vaginal secretions during pregnancy fall from a pH of **greater than 7 (an alkaline pH)** to **4 or 5 (an acid pH)**. This occurs because of the action of the **Lactobacillus acidophilus** bacteria.
63
As the pregnancy progresses, breast size increases because of ____.
As the pregnancy progresses, breast size increases **because of hyperplasia of the mammary alveoli and fat deposits**.
64
The thin watery, high protein fluid that is the precursor of breast milk; an anitbody-rich yellow secretion
Colostrums
65
By the ____, colostrums can be expelled from the nipples
By the **16th week**, colostrums can be expelled from the nipples
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Montgomery’s follicles (____ glands) enlarge, and ____ (reddish stretch marks that slowly turn silver after childbirth) may develop
Montgomery’s follicles (**sebaceous glands**) enlarge, and **striae** (reddish stretch marks that slowly turn silver after childbirth) may develop
67
Physiologic Changes in the Integumentary System (11)
1. Linea Nigra
2. Facial Chloasma/Melasma
3. Hyperpigmentation
4. Hyperactive sweat and sebaceous glands
5. Palmar erythema
6. Striae Gravidum
7. Diastasis
8. Umbilicus stretched
9. Vascular spider/telangiectases
10. Hair growth increases/decreases
11. After birth, increase in hair shedding (1-4 months) and is replaced by 6-12 months
68
"Mask of Pregnancy"; darkened areas of the face, particularly on the cheeks and across the nose caused by the Melanocyte-Stimulating Hormone
Melasma
69
Pink or reddish streaks caused by the rupture and atrophy of small segments of the connective layer of the skin
Striae Gravidarum
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Separation of the rectus muscle that results from the acommodation of the growing fetus
Diastasis
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The umbilicus is stretched by pregnancy to such an extent that by the ____, its depression caused by diastatsis becomes ____ because it has been pushed so far ____.
The umbilicus is stretched by pregnancy to such an extent that by the **28th week**, its depression caused by diastasis becomes **obliterated and smooth** because it has been pushed so far **outward**.
72
A local change that often occurs in the respiratory system is marked ____ of the nasopharynx, a response to increased ____ levels.
A local change that often occurs in the respiratory system is marked **congestion, or “stuffiness”** of the nasopharynx, a response to increased **estrogen** levels.
73
The anteroposterior diameter ____, and the chest circumference expands by as much as ____; as a result, there is ____ of intrathoracic volume
The anteroposterior diameter **increases**, and the chest circumference expands by as much as **6 cm**; as a result, there is **no significant loss** of intrathoracic volume
74
Breathing changes from abdominal to ____ as pregnancy progresses, and descent of the diaphragm on inspiration becomes ____.
Breathing changes from abdominal to **thoracic** as pregnancy progresses, and descent of the diaphragm on inspiration becomes **less possible**.
75
Even with all this crowding, a woman’s vital capacity ____ during pregnancy because, although the lungs are crowded in the vertical dimension, they can ____.
Even with all this crowding, a woman’s vital capacity **does not decrease** during pregnancy because, although the lungs are crowded in the vertical dimension, they can **expand horizontally**.
76
* Residual volume is ____ by the pressure of the diaphragm.
* Tidal volume is ____ as a woman draws in extra volume to increase effectiveness of air exchange.
* Total oxygen consumption ____
* Residual volume is **decreased up to 20%** by the pressure of the diaphragm.
* Tidal volume is **increased up to 40%** as a woman draws in extra volume to increase effectiveness of air exchange.
* Total oxygen consumption **increases by as much as 20%**
77
* The cumulative effect of these respiratory changes is often experienced by a woman as ____
* The total respiratory changes and the compensating mechanisms that occur in the respiratory system can be described as a ____ fully compensated by a ____
* The cumulative effect of these respiratory changes is often experienced by a woman as **chronic shortness of breath**
* The total respiratory changes and the compensating mechanisms that occur in the respiratory system can be described as a **chronic respiratory alkalosis** fully compensated by a **chronic metabolic acidosis**
78
At least 50% of some women experience some ____ early in pregnancy. This is one of the first sensations a woman may experience with pregnancy which is most apparent ____, ____, or ____
At least 50% of some women experience some **nausea and vomiting** early in pregnancy. This is one of the first sensations a woman may experience with pregnancy which is most apparent **early in the morning**, **on rising**, or **if a woman becomes fatigued during the day**
79
**Heartburn** during pregnancy is caused by:
* ____ displacement of the stomach by the uterus
* a relaxed ____ caused by the action of relaxin
* **upward** displacement of the stomach by the uterus
* a relaxed **cardioesophageal sphincter** caused by the action of relaxin
80
* The total circulatory blood volume of a woman’s body increases by at least ____ (and possibly as much as ____) during pregnancy.
* Blood loss at a normal vagina is about ____
* Blood loss from a caesarean birth can be as high as ____
* The total circulatory blood volume of a woman’s body increases by at least **30%** (and possibly as much as **50%**) during pregnancy.
* Blood loss at a normal vagina is about **300 to 400 mL**
* Blood loss from a caesarean birth can be as high as **800 to 1000 mL**
81
The fetus requires a total of about ____ of iron to grow. The increases in the mother’s circulatory red blood cell mass require an ____ of iron.
The fetus requires a total of about **350 to 400 mg** of iron to grow. The increases in the mother’s circulatory red blood cell mass require an **additional 400 mg** of iron.
82
Either a haemoglobin concentration of ____ or a hematocrit value ____ in the **1st or 3rd trimester** of pregnancy or a haemoglobin concentration of ____ in the **2nd trimester** is considered ____, for which ____ is advocated.
Either a haemoglobin concentration of **less than 11g/100 mL** or a hematocrit value **below 33%** in the **1st or 3rd trimester** of pregnancy or a haemoglobin concentration of **less than 10.5 g/dL** (hematocrit <32%) in the **2nd trimester** is considered **true anemia**, for which **iron therapy above normal supplementation** is advocated.
83
If the intake of folic acid is not great enough, ____ (large non-functioning red blood cells) will result. Inadequate folic acid levels have also been linked to an increased risk for ____ in fetuses.
If the intake of folic acid is not great enough, **megalohemoglobinemia** (large non-functioning red blood cells) will result. Inadequate folic acid levels have also been linked to an increased risk for **neural tube disorders** in fetuses.
84
A woman’s cardiac output increases significantly, by ____; the heart rate increases by ____
A woman’s cardiac output increases significantly, by **25% to 50%**; the heart rate increases by **10 beats per minute**
85
Despite the hypervolemia of pregnancy, the ____ does not normally rise because the increased heart action takes care of the greater amount of circulating blood
Despite the hypervolemia of pregnancy, the **blood pressure** does not normally rise because the increased heart action takes care of the greater amount of circulating blood
85
In most women, blood pressure actually ____ during the second trimester because the ____ is lowered as the placenta expands rapidly. During the 3rd trimester, the blood pressure ____ to first semester levels
In most women, blood pressure actually **decreases slightly** during the second trimester because the **peripheral resistance to circulation** is lowered as the placenta expands rapidly. During the 3rd trimester, the blood pressure **rises again** to first semester levels
85
When a pregnant woman lies supine, the weight of the growing uterus presses the vena cava against the vertebrae, obstructing blood flow from the lower extremities. This causes a decrease in blood return to the heart and, consequently, decreased cardiac output and hypotension
Supine Hypotension Syndrome
86
# SUPINE HYPOTENSTION SYNDROME
When a pregnant woman lies supine, the weight of the growing uterus presses the ____ against the vertebrae, obstructing blood flow from the ____. This causes a ____ to the heart and, consequently, ____
When a pregnant woman lies supine, the weight of the growing uterus presses the **vena cava** against the vertebrae, obstructing blood flow from the **lower extremities**. This causes a **decrease in blood return** to the heart and, consequently, **decreased cardiac output and hypotension**
87
# SUPINE HYPOTENSTION SYNDROME
A woman experiences this hypotension as ____. The condition potentially dangerous because it can cause ____
A woman experiences this hypotension as **lightheadedness, faintness, and palpitations**. The condition potentially dangerous because it can cause **fetal hypoxia**
88
# SUPINE HYPOTENSTION SYNDROME
Supine hypotension syndrome can easily be corrected by having a woman ____, so that blood flow through the vena cava increases again
Supine hypotension syndrome can easily be corrected by having a woman **turn onto her side (preferably the left side)**, so that blood flow through the vena cava increases again
89
# BLOOD CONSTITUTION
The level of circulating fibrinogen, a constituent of the blood that is necessary for clotting, increases as much as ____ during pregnancy, probably because of the increased level of ____. Other clotting factors such as factors ____ and the ____ count also increase
The level of circulating fibrinogen, a constituent of the blood that is necessary for clotting, increases as much as **50%** during pregnancy, probably because of the increased level of **estrogen**. Other clotting factors such as factors **VII, VIII, IX, & X**, and the **platelet count** also increase
90
# BLOOD CONSTITUTION
Total ____ rises slightly, both as a protective mechanism and as a reflection of a woman’s increased total blood volume (up to about ____).
Total **white blood cell count** rises slightly, both as a protective mechanism and as a reflection of a woman’s increased total blood volume (up to about **20,000 cells/mm3**).
91
# BLOOD CONSTITUTION
The ____ of blood decreases, perhaps indicating the amount of ____ being used by fetus. Because the circulating system has a ____ and ____, fluid readily leaves the blood for institial tissue vessels to equalize osmotic and hydrostatic pressure. This causes the ____ of pregnancy (not to be confused with ____, which is a symptom of pregnancy induced ____).
The **total protein level** of blood decreases, perhaps indicating the amount of **protein** being used by fetus. Because the circulating system has a **lower total protein load & hypervolemia**, fluid readily leaves the blood for institial tissue vessels to equalize osmotic and hydrostatic pressure. This causes the **common ankle and foot edema** of pregnancy (not to be confused with **nondependent or generalized edema**, which is a symptom of **pregnancy induced hypertension**).
92
# BLOOD CONSTITUTION
Blood lipids increase by ____, and the cholesterol serum level increases by ____. These increases provide a ready supply of ____ for the fetus
Blood lipids increase by **one third**, and the cholesterol serum level increases by **90% to 100%**. These increases provide a ready supply of **available energy** for the fetus
93
Changes in the urinary system during pregnancy result from: (4)
* Effects of high estrogen and progesterone levels
* Compression of the bladder and uterus by the growing uterus
* Increased blood volume
* Postural influences
94
Water is retained during pregnancy to ____ and to ____.
Water is retained during pregnancy to **aid the increase in blood volume** and to **serve as a ready source of fluid for the fetus**.
95
* During pregnancy, urinary output gradually increases (____)
* By the 2nd trimester, both the GFR and the renal plasma flow have increased by ____, and they remain at these levels for the ____
* During pregnancy, urinary output gradually increases (**by about 60%-80%**)
* By the 2nd trimester, both the GFR and the renal plasma flow have increased by **30%-50%**, and they remain at these levels for the **duration of the pregnancy**
96
A pregnant woman may notice an increase in urinary frequency during the ____, until the uterus rises out of the pelvis and relieves pressure on the bladder.
A pregnant woman may notice an increase in urinary frequency **during the first 3 months of pregnancy**, until the uterus rises out of the pelvis and relieves pressure on the bladder.
97
* Because of the increased level of progesterone during pregnancy, the ____ increase in diameter and the bladder capacity increases to about ____.
* The uterus tends to rise on the ____ of the abdomen because it is pushed slightly in that direction by the greater bulk of the ____
* Because of the increased level of progesterone during pregnancy, the **uterus** increase in diameter and the bladder capacity increases to about **1500 mL**.
* The uterus tends to rise on the **right side** of the abdomen because it is pushed slightly in that direction by the greater bulk of the **sigmoid colon**
98
**Pride of Pregnancy**:
* shoulders ____
* abdomen ____
* creates a ____ (forward curve of the lumbar spine), which may lead to ____
**Pride of Pregnancy**:
* shoulders **back**
* abdomen **forward**
* creates a **lordosis** (forward curve of the lumbar spine), which may lead to **backache**
99
* The softening of the woman's pelvic ligaments is probably caused by ____.
* A wide separation of the symphysis pubis, as much as ____ by ____ weeks of pregnancy, may occur.
* The softening of the woman's pelvic ligaments is probably caused by the **influence of both the ovarian hormone relaxin and placental progesterone**.
* A wide separation of the symphysis pubis, as much as **3-4 mm by 32 weeks** of pregnancy, may occur.
100
During pregnancy, intraocular pressure ____, probably because of the ____, and the cornea ____ because of fluid retention
During pregnancy, intraocular pressure **decreases**, probably because of the **increased vitreous outflow**, and the cornea **thickens slightly** because of fluid retention
101
The recommended weight gain for women of normal weight before pregnancy is ____, whereas for women who were overweight, the recommended gain is ____
The recommended weight gain for women of normal weight before pregnancy is **25 to 35 lbs (11.4 to 15.9 kg)** whereas for women who were overweight, the recommended gain is **15 to 25 lbs (6.8 to 11.4 kg)**
102
Factors causing increased water retention: (3)
* The increased level of steroid sex hormones
* The lowered serum protein
* increased intracapillary pressure and permeability
103
The fetus makes its greatest protein and fat demands during the ____, doubling in weight during the ____.
The fetus makes its greatest protein and fat demands during the **second half of pregnancy**, doubling in weight during the **last 6 to 8 weeks**.
104
* Protein must be stored during pregnancy to ____ and to avoid ____.
* Carbohydrate needs also increase, especially during the ____.
* Fats are more completely absorbed during pregnancy, and the level of free fatty acids increases in response to human ____.
* Protein must be stored during pregnancy to **maintain a constant level within the breast milk** and to avoid **depletion of maternal tissues**.
* Carbohydrate needs also increase, especially during the **second and third trimesters**.
* Fats are more completely absorbed during pregnancy, and the level of free fatty acids increases in response to human **placental lactogen (hpl)**.
105
* The thyroid glands enlarges in ____ in such an extent that the basal metabolic rate increases by about ____.
* These thyroid changes, along with emotional lability, tachycardia, palpitations, and increased perspiration, may lead to a mistaken diagnosis of ____ if pregnancy has not been determined.
* Because calcium is important for fetal growth, the hypertrophy of the ____ is probably necessary to satisfy the increased requirement of this.
* The thyroid glands enlarges in **early pregnancy** in such an extent that the basal metabolic rate increases by about **20%**.
* These thyroid changes, along with emotional lability, tachycardia, palpitations, and increased perspiration, may lead to a mistaken diagnosis of **hyperthyroidism** if pregnancy has not been determined.
* Because calcium is important for fetal growth, the hypertrophy of the **parathyroid hormone** is probably necessary to satisfy the increased requirement of this.
106
* A woman who is diabetic and taking insulin during pregnancy will need ____ during pregnancy.
* A woman who is prediabetic may develop ____ for the first time during pregnancy
* A woman who is diabetic and taking insulin during pregnancy will need **more insulin** during pregnancy.
* A woman who is prediabetic may develop **overt diabetes** for the first time during pregnancy
107
* The ____ is affected by pregnancy because there is a halt in the production of FSH and LH brought on by the high estrogen and progesterone levels of the placenta.
* There is increased production of ____ and ____.
* Late in pregnancy, the ____ begins to produce oxytocin, which will be needed to ____.
* ____ production is also begun ____, as the breasts prepare for lactation.
* The **pituitary gland** is affected by pregnancy because there is a halt in the production of FSH and LH brought on by the high estrogen and progesterone levels of the placenta.
* There is increased production of **growth hormone** and **melanocyte stimulating hormone**.
* Late in pregnancy, the **posterior pituitary** begins to produce oxytocin, which will be needed to **aid in labor**.
* **Prolactin** production is also begun **late in pregnancy**, as the breasts prepare for lactation.
108
* The ____ pituitary secretes ____ and ____.
* ____ cause vasoconstriction, which results in ____ blood pressure, it also helps regulate water balance.
* ____ promotes uterine contractility and stimulates ejection of milk from the breasts (the ____ reflex) in the postpartum period
* The **posterior** pituitary secretes **vasopressin (antidiuretic hormone)** and **oxytocin**.
* **Vasopressin** causes vasoconstriction, which results in **increased** blood pressure, it also helps regulate water balance.
* **Oxytocin** promotes uterine contractility and stimulates ejection of milk from the breasts (the **Letdown reflex**) in the postpartum period
109
Adrenal gland activity increases in pregnancy as increased levels of corticosteroids and aldosterone are produced which is to: (3)
* aid in suppressing an inflammatory reaction
* help reduce the possibility of a woman’s body rejecting the foreign protein of the fetus
* help to regulate glucose metabolism in a woman
110
The increased level of aldosterone aids in ____ and ____ in the amount of fluid retained
The increased level of aldosterone aids in **promoting sodium reabsorption** and **maintaining osmolarity** in the amount of fluid retained
111
The most striking change in the endocrine system during pregnancy is the addition of the ____ as an endocrine organ that produces large amounts of ____
The most striking change in the endocrine system during pregnancy is the addition of the **placenta** as an endocrine organ that produces large amounts of **estrogen, progesterone, hCG, human placental lactogen (hPL), relaxin, and prostaglandins**
112
* Estrogen causes ____ estrogen levels.
* Progesterone has a major role in ____, ____, and ____.
* Relaxin, secreted primarily by the ____, is responsible for ____ and to ____.
* Estrogen causes **breast and high circulating** estrogen levels.
* Progesterone has a major role in **maintaining the endometrium**, **inhibiting uterine contractility**, and **aiding in the development of the breasts for lactation**.
* Relaxin, secreted primarily by the **corpus luteum**, is responsible for **helping to inhibit uterine activity** and to **soften the cervix and the collagen in joints**.
113
* hCG is secreted by the ____ of the placenta in early pregnancy. It stimulates ____ synthesis in the ovaries until the placenta can assume this role.
* hPL, also known as ____, is also produced by the ____ and serves as an ____ to insulin, making insulin less effective, which allows ____ to become available for fetal growth.
* hCG is secreted by the **trophoblast cells** of the placenta in early pregnancy. It stimulates **progesterone and estrogen** synthesis in the ovaries until the placenta can assume this role.
* hPL, also known as **human placental lactogen**, is also produced by the **placenta** and serves as an **antagonist** to insulin, making insulin less effective, which allows **more glucose** to become available for fetal growth.
