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Women's Health > Book - Chapter 11 and 12 > Flashcards

Book - Chapter 11 and 12 Flashcards

1
Q

The time period of pregnancy is divided into ______ trimester which are how long?

A

3 trimesters, each is 13 weeks long

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2
Q

What are the three categories of signs and symptoms of pregnancy?

A

1) presumptive
2) probable
3) positive

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3
Q

What are the only signs that can with 100% accuracy determine pregnancy? what is the least reliable category of signs?

A

positive signs = 100%

presumptive/subjective = least reliable

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4
Q

What is the basic definition of presumptive signs?

A

the signs that the mother can perceive (subjective)

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5
Q

What’s the most obvious presumptive sign?

A

absence of menstruation

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6
Q

While absence of menstruation on its own is not necessarily a sign of pregnancy, what symptoms would make it more likely a sign of pregnancy?

A

consistent nausea, fatigue, breast tenderness, and urinary frequency

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7
Q

What’s the basic definition of probable signs?

A

signs that can be detected on physical examination (objective)

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8
Q

Name all the probable signs, describe what they are, and state their time of occurence

A
  1. Braxton Hicks contractions (16-28 weeks): irregular, painless contractions beginning during 1st trimester
  2. Positive pregnancy test (4-12 weeks)
  3. Abdominal enlargement (14 weeks)
  4. Ballottement (16-28 weeks): examiner pushes against woman’s cervix during pelvix exam and feels rebound from floating fetus
  5. Goodell’s sign (5 weeks): softening of the cervix due to vasocongestion
  6. Chadwick’s sign (6-8 weeks): bluish-purple coloration of the vaginal mucous and cervix caused by vascularization
  7. Hegar’s sign (6-12 weeks): softening of the lower uterine segment or isthmus
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9
Q

What are the three types of pregnancy tests? Name specimen sampled by test and examples

A
  1. Agglutination inhibition tests: tests urine (Pregnosticon, Gravindex)
  2. Immunoradiometric assay: tests blood serum (Neocept, Pregnosis)
  3. enzyme-linked immunosorbent assay (ELISA): tests blood serum or urine (OTC
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10
Q

What’s the most precise pregnancy test to use? Why?

A

ELISA, reliable 4 days after implantation and 99% accurate

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11
Q

What are the time frames/accuracy rates for agglutination ihibition and immunoradiometric pregnancy tests?

A

agglutination: 14-21 days after conception, 95% accurate
immuno: 6-8 days after conception, 99% accurate

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12
Q

Why is the 99% accuracy on pregnancy tests misleading?

A
  • has no bearing on test to detect early pregnancy as only 5% of clients have detectable hCG 8 days after conception
    (basically the book’s being confusing)
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13
Q

hCG is a _______protein

A

glyco

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14
Q

When does hCG peak?

A

60-70 days after fertilization

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15
Q

What is the doubling time of hCG? How do clinicians use this?

A

doubling time: 48-72 hours

  • used as a marker to differentiate between normal and abnormal gestations where low levels of hCG = ectopic pregnancy and high levels of hCG = possible molar pregnancy or multiple gestational pregnancies
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16
Q

what does the elevation of hCG correspond to?

A

the morning sickness period between 6-12 weeks during early pregnancy

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17
Q

What are the positive signs of pregnancy and what’s their time of occurence?

A

1) ultrasound verification of embryo or fetus (4-6 weeks)
2) fetal movement felt by experienced clinician (20 weeks)
3) auscultation of fetal heart tones via Doppler (10-12 weeks)

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18
Q

Which hormone stimulates uterine growth in the first few months of pregnancy?

A

estrogen

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19
Q

What are the measurements for uterine growth during pregnancy?

A

weight: 70g to 1100/1200g
capacity: from 10 to 5000 mL
- uterine wall thins to 1.5 cm or less

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20
Q

Uterine growth results from an initial ________ of the myometrium then progresses to __________. Which one causes more growth?

A

starts of with hyperplasia then hypertrophies, hypertrophy cause for most growth

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21
Q

what’s the function of Braxton Hicks contractions in the last onth of pregnancy?

A

to thin out or efface the cervix before birth

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22
Q

What’s the name of the lower part of the uterus? What structural changes does it undergo during pregnancy? what sign is this responsible for?

A

isthmus: doesn’t undergo hypertrophy and becomes increasingly thin; during first 6-8 weeks causes a positive Hegar’s sign

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23
Q

Why does urinary frequency often accompany pregnancy especially after 3 months?

A

after 3 months, uterus acends into abdoment and its growth presses on urinary bladder

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24
Q

What’s a worry during the last trimester related to the size/placement of the uterus?

A

supine hypotensive syndrome: uterus can fall back against the vena cava in supine position and compress it and cause orthostatic hypotension

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25
Q

What technique is used to date a pregnancy?

A
  • a monthly measurement of the height of the fundus (top of the uterus) as it corresponds to gestational age
    ex: 20cm wide fundus usually by 20 weeks gestation
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26
Q

When can fundal height ost accurately be correlated with gestational weeks?

A

between 18 and 32 weeks

sidenote: obesity, hydramnios and uterine fibroids

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27
Q

When and where does the fundus reach its highest level?

A

at about 36 weeks at the xiphoid process

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28
Q

What is lightening?

A

occurs at about 40 weeks when fetal head begins to descend and engage in the pelvis, breathing becomes easier as it doesn’t push against diaphragm but urinary frequency occurs again (important b/c usually occurs 2 weeks before labor in women who are having their first child; otherwise occurs before onset of labor)

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29
Q

What hormones aid in cervical changes in preparation for labor?

A

oxytocin, relaxin, nitric oxide, and prostaglandins

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30
Q

what happens to vaginal secretions during pregnancy? if itching and irritation occured with this discharge, what would you suspect?

A

becomes more acidic, thick, and white (leukorrhea)

- suspect Candida albicans, if transported to child during birth will cause thrush in neonate

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31
Q

what are tubercles of Montgomery?

A

the sebaceous glands of the breasts that become prominent during pregnancy (keep nipples lubricated for breast-feeding)

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32
Q

what is colostrum?

A

creamy, yellowish breast fluid that can be expressed by third trimester, provides newborn nourishment for first few days of life

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33
Q

What happens to the gums during pregnancy?

A

more prone to bleed due to effects of estrogen, more prone to gingivitis/plaque (50-75% of pregnant women experience gingivitis)

34
Q

What is ptyalism

A

excessive salivation, occurs in pregnant woman along with having more acidic salivations

35
Q

what effect does progesterone have on the GI tract of the pregnant mom? what do we need to be careful of

A

smooth muscle relxation and decreased peristalsis = more water reabsorbed, slow digestion; be weary of low-fiber foods, reduced fluid intake, use of iron supplements etc = constipation = hemorrhoids

36
Q

what’s a universal GI problem for pregnant women?

A

acid indigestion or heartburn (pyrosis)

37
Q

in what percent of women does morning sickness occur? when is this the worst usually?

A

in 80%, between 6-12 weeks

38
Q

what can changes in the gallbladder cause in pregnant women?

A

hypercholesterolemia as gall bladder emptying slows which can lead to gallstone formation

39
Q

When does the placenta take over producing progesterone from the ovaries?

A

around 6-7 weeks

40
Q

What does the increase in vaginal secretions during pregnancy help with?

A

infection prevention

41
Q

What change does progesterone cause in the cervix? What’s the function of this change?

A
  • causes formation of a mucus plug which blocks the cervical os and protects the developing fetus from bacterial invasion
42
Q

What’s the biggest cardiovascular change in the pregnant mom?

A
  • increase in blood volume (by about 1500mL or 50% greater than normal by 30th week)
43
Q

What does blood volume directly correlate with?

A

fetal weight

44
Q

What happens to BP during pregnancy?

A

BP especially diastolic declines b/c of periph vasodilation caused by progesterone (lowest during second trimester)

45
Q

do hematocrit/hemoglobin values decrease or increase during pregnancy?

A

while RBC production increases, the plasma increase exceeds the RBC increase causing a lower hematocrit/hemoglobin value (***this state of hemodilution referred to as physiologic anemia of pregnancy)

46
Q

which hormones stimulate a rise in erythropoietin in the last two trimesters?

A

progesterone, prolactin, and hPL

47
Q

do iron demands increase or decrease during pregnancy?

A

increase, fetal tissue biggest user of iron, most women enter pregnancy with deficient iron stores

48
Q

What happens to clotting factors like fibrin/fibrinogen during pregnancy? What does this mean?

A
  • clotting factors increase making pregnancy a hypercoagulable state (higher risk for DVT)
49
Q

what happens to the lungs/breathing during pregnancy?

A

shift upward 4cm from pressure on diaphragm, chest circumference increases allowing for higher tidal volume (hyperventilation, hypocapnia and breathing more diaphragmatic)

50
Q

what are the predominant structural changse in the renal system during pregnancy? What 3 things cause changes in renal structure?

A

predominant: dilation of the renal pelvis and uterus as well as enlargement of kidneys

1) estrogen and progesterone
2) pressure from enlarging uterus
3) increase in maternal blood volume

51
Q

What’s an expected lab value change in a pregnant woman related to the renal system?

A

higher GFR (glomerular filtration rate)

52
Q

Kidney activity usually increases when a person lies down, this is especially true in pregnant woman. What complication could this cause? (think higher GFR so therefore…..)

A

urination frequency while sleeping

53
Q

During pregnancy the sacroiliac/pelivc joints loosen, why? What hormone affects this?

A

to increase the size of the pelvic cavity to make delivery easier, relaxin (and some progesterone)

54
Q

What happens to a pregnant woman’s skin due to hormonal changes?

A

hyperpigmentation from estrogen, progesterone, and melanocyte-stimulating hormone,, usually seen on areola, perineum, axilla, but can also be on face (“mask of pregnancy”)

55
Q

what is another name for the hyperpigmentation of the face called the “mask of pregnancy”

A

facial melasm or chloasma

56
Q

what is the pigmented line that can form in the middle of the abdomen?

A

the linea nigra

57
Q

What sort of fetal abnormalities would we expect to see in a mother with hypothyroidism or inadequate iodine development?

A

neurologic developmental abnormalities

58
Q

are FSH and LH decreased or increased during pregnancy?

A

decreased, secretion inhibited by hCG

59
Q

what hormones are thought to cause morning sickness?

A

elevated hCG and decreased TSH

60
Q

is GH decreased or increased?

A

decreased thought to be b/c of hPL

61
Q

what’s important to know about progesterone and prolactin during pregnancy?

A

prolactine is secreted during pregnancy 10 fold to promote breast development and laction but progesterone secreted by placenta inhibits direct influence on breast suppressing lactogenesis until baby/placenta is delivered

62
Q

what three hormones cause skin pigmentation changes?

A

estrogen (possibly progesterone) and MSH

63
Q

does oxytocin or progesterone stimulate contractions?

A

oxytocin, progesterone suppresses contractions

64
Q

what is oxytocin responsible for other than uterine contractions?

A

milk ejection during breast-feeding

65
Q

does maternal insulin cross the placenta?

A

no, fetus produces own

66
Q

after the first trimester, what acts as antagonists to insulin?

A

steroids (cortisol) from mother’s adrenal glands and placental hPL

67
Q

List all the placental hormones and a description

A

1) hCG (human chorionic gonadotropin): maintains maternal corpus lutuem (secrete prog and est), basis for early preg tests
2) hPL or hCSl: prep of mammory glands, insulin antagonist
3) relaxin: secreted by corpluteum and placenta, w/ progest maintains preg, increased flexibility of pubic symphysis, dilation of cervix
4) progesterone: “hormone of pregnancy” b/c support endometrium of uterus, initially causes uterine thickening then maintains, inhibits contractility, aids breast development
5) estrogen: promotes enlargement of genitals, uterus, breasts; increased vasodilation, relaxation of pelvic ligaments/joints, hyperpigmentation, ductal systems of breasts

68
Q

why does the mother’s innate immune system increase but adaptive immune system decrease during pregnancy?

A

to reduce the risk of rejecting the fetus

69
Q

Basically, use this card as an overview to study, I put a number with the system and in parentheses a part of that system is denoted…at the end of the number I summarize the main problems

General Overview of Body System Changes

A

1) GI: (mouth) gums swell and tear easily, increased saliva; (esophagus) lower esophageal sphincter pressure/tone so GERD (stomach) delayed emptying so GERD vomitting, decreased pH/histamine so peptic ulcers; (intestines) decreased motility so constipation + flatulence; (gallbladder): decreased tone/motility so risk of gallstone formation
GI PROBLEMS: gum bleeding/saliva; GERD; vomitting; peptic ulcer; constipation; flatulence; gallstone formation

2) Cardiovascular: (blood volume) 50% increase + hemodilation so low Hct/Hgb; (CO + HR): CO increases so increased venous return especially in left lateral position, HR increased 10-15bpm; (BP) diastolic decreases 10-15 at mid-preg. blood components increase
* * RBCs fibrin and plasma fibrinogen clotting factors all increase (PREGNANCY = HYPERCOAGUABLE STATE)

3) RESP: enlargement of uterus shifts diaphragm up 4cm; chest broadens with conversion from ab to thoracic breathing; 50% increase in air volume
4) RENAL: pelvis dilates, ureters elongate, bladder tone decreases and bladder capacity doubles by term, GFR increases 40-60%, blood flow to kidneys increases
5) Musculoskeletal: distention of abdomen tilts pelvis forward shifting center of gravity -> compensates with increased curvature (lordosis) of spine; proges/relaxin relax joints causing waddle gait
6) Integumentary: hyperpigmentation (areola, genitals, axilla, inner thighs, linea nigra in middle ob abdomen); striae gravidarum or stretch marks; melasma or mask of pregnancy in 45-70% of women
7) Immune: up innate immunity and down adaptive helps prevent fetal rejection

70
Q

What are two of the most essential nutrients for pregnant moms? What are recommended intakes?

A

iron: 40mg/day

folic acid: 400-800 mcg/day

71
Q

what are good food sources of folic acid?

A

dark green veggies like broccoli; romaine lettuce; spinach; baked beans, black-eyed peas; citrus fruits; peanuts; liver

72
Q

why should women avoid eating certain types of fish?

A

they could be high in mercury and expose the fetus

73
Q

what’s a big culprit in fetal death from eating contaminated foods?

A

Listeria

74
Q

What are the different recommended weight gains based on BMI category?

A

1) underweight (BMI

75
Q

How do you calculate BMI

A

convert height to metric (1 inch = 2.54 cm), square the height
then convert the weight into kg and divide by the squared height
so if the person weighs 80 kg and is 2 m tall, the BMI is 20

76
Q

What’s normal BMI?

A

18.5-24.9`

77
Q

What are findings you wan to see when tracking weight gain during pregnancy?

A

underweight: at least 5lbs in 1st trimester then > 1lb/week
normal: 3.5-5lbs in 1st trimester then 1lb/week
overweight: 2 lbs in 1st trimester then 2/3 lbs/week

78
Q

what is pica

A

compulsive ingestion of nonfood substances

79
Q

what are the maternal psychosocial responses to pregnancy as listed by our book?

A

1) ambivalence: feeling opposite emotions at same time usually due to strained external factors, often evolves to acceptance by 2nd trimester
2) introversion: “focusing on oneself”, common during early preg, withdrawal,
3) acceptance: 2nd trimester or when ultrasound done
4) mood swings
5) body image changes

80
Q

what is the time period of greatest environmental sensitivity for the developing embryo?

A

days 17-56 after conception

Women's Health (9 decks)

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