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Flashcards in Antepartal Period Deck (55)
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31

Gastrointestinal System

1. Hyperplasia (overgrow) of gums due to estrogen
-Soften, bleed

2. Ptyalism ( excessive salivation)

3. Decreased gastric activity
- Less gastric acid & pepsin
4. Stomach has less peristalsis & tone
- Due to elevated progesterone

32

Gastrointestinal System

1. Decreased cardiac sphincter tone = reflux of stomach acid = heartburn
2. Remedies: avoid lying down too soon after meals, small meals frequently, avoid greasy &
spicy foods, milk/yogurt/dairy products, Tums, papaya (fresh, tablets)
spicy foods, milk/yogurt/dairy products, Tums, papaya (fresh, tablets)
3. Late pregnancy, enlarged uterus displaces stomach & intestines upward, causing more
feelings of fullness & heartburn

33

Gastrointestinal System

1. Intestines hypotonic, with less peristalsis
Due to progesterone
 - Constipation + hemorrhoids
2. Increase in gallbladder disease
- Due to low peristalsis (progesterone) & higher cholesterol levels
3. Liver produces less albumin
Less osmotic activity of blood
 Edema occurs - massive ( preeclampsia - high BP ) ; small - normal 

34

Urinary System

1. Changes begin early on
2. Progesterone dilates renal pelves & ureters + causes slowed peristalsis - hold more urine - UTI
3. After 3rd month, enlarging uterus may compress ureter; dilation above site
4. Increased susceptibility to UTIs
5. Rise in GFR (glomerular filtration rate)
Blood flow to kidneys increased
Kidneys filter more plasma
Increased clearance of urea & creatinine fall
Low renal threshold for glucose - glucosuria 

35

Integumentary System

1, Increased blood flow to skin
- Accounts for increased cardiac output
- Aids in thermoregulation of heat from fetus & placenta
2. “spider angiomas”: dilated skin arterioles
Due to elevated estrogen
Darkening of nevi
Palmar erythema
Boggy mucosa
- Stuffy nose
  - Swollen labia

36

Integumentary System

1. Melanin activity increases (due to estrogen & progesterone)
- Areolas darken
- Linea alba becomes linea nigra
- Chloasma (“mask of pregnancy”) Avoid sun !!!

2. Hair growth

- testosterone & other masculinizing hormones (estrogen & progesterone by-products)
-Hair follicles live longer - blood flow to skin
3. Striae (stretch marks)
- Estrogen causes softening of fibrous tissues
- Obesity & genetic tendency favor development

 

37

Musculoskeletal System

1. Estrogen causes softening of joint capsules, connective tissue & ligaments
2. Pelvic joints become more mobile
- Waddling gait
3. Interosseous ligaments soften
- Flat feet & back pain result
- Bigger shoe size

4. Rectus abdominus separates
- Diastasis rectus occurs ( do stomach crunch - feel ) 

5.Ligaments supporting reproductive organs under tension & stretched

6. Postural changes -Growing uterus- Increased breast size- Change in center of gravity

38

Endocrine System

 Pregnancy impossible without ES
1. Anterior pituitary: FSH & LH (Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) 
- Pituitary prolongs corpus luteal phase of ovary ( after the egg is released)  - Maintains endometrium
2. Posterior pituitary secretes oxytocin
Promotes uterine contractility

39

Endocrine System

1. Thyroid gland enlarges & capacity to bind thyroxine is greater
Estrogen responsible
BMR increased by 25% by late pregnancy
2. Adrenal gland cortex enlarges
Estrogen responsible
Cortisol levels rise; regulate carbohydrate & protein metabolism
3. Aldosterone increases by 2nd TM
Protective response to higher Na+ excretion?
4. Pancreas secretes more insulin
- To meet maternal needs
-Islets of Langerhans are stressed  - Gestational  diabetes 

40

Placental Hormones

1. hCG: secreted by trophoblast; Basis of pregnancy tests
- Stimulates corpus luteum to produce estrogen & progesterone until placenta developed
enough
2. Estrogen: uterine development & ductal system of breasts
3. Progesterone: glandular tissue in breasts
Progesterone plays greatest role in maintaining pregnancy
- Maintains endometrium
- Stops uterine contractility
2/4/11, FDA approved Makena (hydroxyprogesterone caproate) to ↓ preterm birth

41

Placental Hormones

1. HPL, human placental lactogen
- Insulin antagonist
- Increases amount of free fatty acids
- Maternal metabolic needs
- Decreases maternal metabolism of glucose
- Favors fetal growth
2. Relaxin
- Inhibits uterine contractility, decreases strength of contractions, softens cervix, remodels
collagen

42

Reproductive System

1. Uterine myometrial cells enlarge
- Estrogen + distention from growing fetus
2. Uterus strong & elastic
- Fibrous tissue between muscle bands increases
3. 1/6 of maternal blood volume within uterine vascular system by EDC

4. Braxton-Hicks contractions
- Irregular, painless (help cervix get ready for labor)
- Occur throughout pregnancy; more aware of in 4th month
5. Hegar’s sign: softening of uterine isthmus
6. McDonald’s sign: ease of flexion of uterine body against cervix

43

Reproductive System

1. Glandular tissue of cervix stimulated by estrogen
cell # increases (hyperactive)
2. Endocervical glands secrete thick, sticky mucus plug
Seals off endocervical canal
Protects against bacterial infections
3. Goodell’s sign: cervix soft
- Feels like lower lip (usually feels like tip of your nose)
4. Chadwick’s sign: cervix cyanotic
Due to increased blood flow

44

Reproductive System

1. Ovaries do not produce ova during pregnancy
- Corpus luteum produces hormones
- Placenta takes over by 10-12 weeks
2. Vagina: affected by estrogen
- Thickening of mucosa
- Loosening of connective tissue
- Increased vaginal secretions
Thick, white, acidic
- Yeast infections rise
- Bacterial infections decrease

45

Uterine Size

Bimanual Exam before 12 weeks 

46

Fundal Height: # of Weeks

After 12 weeks 

1. Palpable above pubic symphysis: 12
2. Midway between pubic bone & umbilicus: 16
3. At umbilicus: 20
- Quickening ( baby is moving on the daily basis) 
- Fetoscope ( hear heart beat) 
Decreases at end of pregnancy ( baby dropping to pelvis) 

47

McDonald Method

From top of the symphysis pubis to the top of the fundus - roughly equal to the week of pregnancy ( +/- 2 sm ) 

Consistent Measurements Needed!

Too big - gestational diabetes; dates off; caring more than one baby

Too small - dates off; mom is starving herself; not groving properly 

48

Fetoscope

Don’t Date Pregnancy by First FHT by Ultrasound Doppler!

18-20 Weeks - hear heart beat !!!

49

Tests Done by MD/CNM/NP

1. UA/UC (dipstick, too)
- Dipstick for glucose, protein (preeclampsia), ketones (not eaten recently) 
2. R/O UTI - asymptomatic
3. Pap Smear
- R/O cervical cancer
4. Gonorrhea culture/Chlamydia culture/genital culture
- R/O STDs
5. Bacterial vaginosis AKA “BV” (nonspecific vaginitis)
(strong odor after intercoarse; frothy gray discharge; weaken bag of water - break too soon )
6. Non-lab test: clinical pelvimetry - feel bones in vagina to see if she can deliver vaginaly) 

50

Routine Maternal Laboratory Tests

1. Complete Blood Count (CBC)
- Anemia
- Infection
- Abnormal platelet count - less than 100000 - Danger !!!
2. Blood type, Rh, abnormal antibodies
- Erythroblastosis fetalis - Rh disease - M (-) and B (+) - M destroys Bs RBC - B anemic 
- Hyperbilirubinemia
- Some antibodies carry risks to fetus
3. Serology (VDRL/RPR)
- Syphilis ( after 16 weeks can cross placenta - congenital syphilis) 
4. HbSAg (Hepatitis B Surface Antigen)
Risk of hepatitis B transmission ( tells if someone has been exposed to Hepatitis B)

51

Routine Lab Tests

1. Rubella titer
- Immunity to “German measles” ( Positive is immune; negative - need immunization after baby is born)
2. Sickle cell screening (prn) - positive 
-Diagnostic test = Hgb Electrophoresis ( disease or trait) - African american, Mediterian sea, India)
3. HIV testing
4. MSAFP (maternal serum alpha fetoprotein)
-15-20 weeks, optional screening test
- AKA “quad screen” or “quad check”
↑ suggests neural tube defects - spina bifida

↓ suggests Down Syndrome - amniocentesis 

52

Routine Lab Tests

1. Down Syndrome Screening
- Bloodwork at 9-13 weeks (1st trimester)
- Ultrasound 11-14 weeks: nuchal translucency ( 2nd ) - collection of fluid on the back of babies neck - suggestive - more testing  
2. Serum glucose (GCT) - glucose challenge testing 
24-28 weeks’ gestation
3. GBS: group B strep - baby risk - meningitis, pneumonia 
35-37 weeks’ gestation
Vaginal/rectal/UC culture
Treat in labor if positive - antibiotic ( Ampicillin) 2 doses 4 hours prior to delivery. Baby - 48 hours, vitals Q4

53

Chorionic Villus Sampling (CVS)

10-13 weeks, removal of chorionic villi

Transcervical or transabdominal route
Chromosomes, paternity
Results in 1-2 weeks
98-99% accurate
1% risk of miscarriage

54

Amniocentesis

14-20 weeks (11) - enough amniotic fluid 

Chromosomes, paternity, lung status (late preg.)
Results days-4 weeks
98-99% accurate
1/400 miscarriage risk

55