Chapter 13 & 15

Question 1

changes in the reproductive system: uterus

Answer 1

gets bigger, muscle tissue strengthens, gets firmer and muscle tissues gets thicker in upper uterus
purple - vascular increases blood supply
rise of pelvis, close to term can drop back down (lightning)
engagement - drops to level of iscial spine, baby can’t move, is stationed (may or may not happen with lightning)

Question 2

changes in the reproductive system: breast

Answer 2

get larger, alevoli gets darker with dark skin people

Question 3

GI adaptations

Answer 3

decrease peristalsis, more likely to become constipated

Question 4

respiratory adaptations

Answer 4

less expansion of lungs (A-P diameter); relaxent hormone that relaxes the joints and cartilage and allows expansion

Question 5

renal adaptations

Answer 5

dilation of uterus, problems with stasis, higher risk of UTIs

Question 6

other system adaptations

Answer 6

center of gravity changes, lower extremity edema (occurs in later mnths, edema above wast not normal), stai (stretch marks pulling of connective tissues), morning sickness (hormonal changes)

Question 7

endocrine system

Answer 7

Pituitary, thyroid, adrenals and pancreas

Question 8

placental hormones

Answer 8

Human Chorionic Gonadotropin (HCG)
Estrogen/ Progesterone
Human Placental Lactogen (HPL)
Relaxin

Question 9

HCG -

Answer 9

timing is important

Question 10

oxytocin -

Answer 10

from posterior pituitary - stimulates contractions, stimulates nipples to release oxytocin in body, let down reflex

Question 11

prolactin -

Answer 11

stimulates milk production in breast - anterior pituitary

Question 12

thyroxin -

Answer 12

released by thyroid

Question 13

adrenal glands -

Answer 13

aldesterone, rise to retain Na

Question 14

pancreas -

Answer 14

control glucose (carbohydrate metabolism); 
glucose will cross placenta but insulin does not, baby releases its own insulin - why fat baby if mom has high blood glucose
hyperglycemia - 2nd and 3rd trimester when 1st trimester hypoglycemia

Question 15

5-8 wks

Answer 15

urinary frequency

Question 16

9-12 wks

Answer 16

morning sickness, gets better by 12th wk, growing uterus may start to show

Question 17

13-16 wks

Answer 17

may feel fetal movement around 16 wks (quickening) urinary frequency decreases

Question 18

5 months

Answer 18

examiner can feel movement, pigmentation stages, fondus at level of umbilicus

Question 19

6 months

Answer 19

distinct relaxation and dilation of vessels, more likely UTI

Question 20

7 months

Answer 20

rapid growth of uterine size (back pain)

Question 21

8 months

Answer 21

heart burn (bc uterus pressed on stomach), delayed GI emptying, brackstan hicks contractions

Question 22

9-10 months

Answer 22

lightening, SOB, veriscosities, edema more pronounced uterine efaces and dilates, urinary frequency again

Question 23

supine position

Answer 23

compromises blood flow to mom and baby, if have to be on back use wedge

Question 24

confirming pregnancy

Answer 24

The establishment of pregnancy includes both symptoms and complaints related to of pregnancy and signs that are observed by the examiner

Theses signs and symptoms are grouped under three areas-
Presumptive, Probable and Positive

Question 25

presumptive indications (All can be caused by other conditions)

Answer 25

Amenorrhea - no period (problem bc might not have period bc of other reasons) Nausea and vomiting - bc of hormonal changes, more frequently in morning Fatigue - hypoglycemia, possibly dehydration Urinary frequency - pressure on bladder Breast and skin changes- Chloasma, Linea Nigra Fetal movement- Quickening - mom feels it Vaginal and cervical color changes- Chadwick’s Sign

Question 26

probable indications (Can be documented by the examiner, primarily related to changes in reproductive organs)

Answer 26

``` Abdominal enlargement- McDonald’s Technique - measure fondus height in CM (with 22 cm should be 22 mg Cervical softening (bc of increase of vasolarity)- Goodell’s Sign (softening of cervix), Hegar Sign (softening of uterus) Uterine changes- Ballottement (presenting part), Braxton-Hicks Contractions, Palpation of Fetal Outline, Uterine Souffle (when listen when doppler hear a blowing murmur, blood in large uterine vessels, will match mothers pulse) if funic souffle blood rushing through umbilical cord, more rapid than pulse Pregnancy tests- HCG ```

Question 27

positive indications (Nothing can mimic these findings)

Answer 27

Auscultation of fetal heart sounds (pick up 18-20 wks, ultrasound can pick up early, between 110-160 bpm before born, after born 120) Fetal movements by the examiner Visualization of the fetus- by ultrasound