Maternal adaptation

Question 1

State which hormone is responsible hypertrophy(1) and hyperplasia of the uterus (1)

Answer 1

Hypertrophy of muscle fibers- estrogen
Hyperplasia of uterine cells - progesterone

Question 2

Describe Goodell’s sign, what causes it and when it is seen

Answer 2

Softening of the cervix due to increased vascularization from hypertrophy and engorgement of blood vessels below uterus
From week 4 and 8 approximately week 6

Question 3

Describe Chadwick’s sign, what causes it and when it is seen

Answer 3

It is a bluish discoloration of the mucous membranes of the cervix, vagina and vulva caused by venous congestion as a result of increased blood flow
4-8 Weeks

Question 4

Describe hegar’s sign, what causes it and when its seen

Answer 4

Compressibility and softening of the cervical isthmus
Caused by increased blood flow, estrogen and progesterone
4-12 weeks

Question 5

Function of progesterone x2

Answer 5

Raise body temperature
Causes smooth muscle relaxation

Question 6

What membrane produces HCG and its function

Answer 6

Produced by syncytiotrophoblast and stimulates corpus luteum to produces progesterone

Question 7

What stimulates the thyroid binding globulin and where is it produced

Answer 7

Stimulated by high estrogen levels and produced by hepatic cells

Question 8

Function of T4 thyroid hormone

Answer 8

Fetal neural development

Question 9

Where is corticotropin releasing hormone produced and its function

Answer 9

By placenta
Potentiates the action of prostaglandins and oxytocin

Question 10

Function of estrogen during labour x2

Answer 10

Softening and ripening the cervix

Question 11

Hormones produced by fetus in utero that help in labour x2

Answer 11

Pituitary produces oxytocin
Adrenal glands produce cortisol which converts progesterone to estrogen which promotes cervical ripening

Question 12

Frequency of vaginal exams during latent and active phase of labour x2

Answer 12

Once every 6 hours in latent and once every 4 hours in active

Question 13

Complications of labour x5

Answer 13

Pain
Perineal tears
Excessive bleeding
Fetal distress
Retained placenta

Question 14

Define uterine inversion

Answer 14

Placenta fails to separate from uterus hence it pulls it inside out as it exits

Question 15

4 changes to the breast

Answer 15

Nipple becomes dark and large
Montgometry glands more prominent
Engorgement and dilation of superficial veins
Secretion by 8 weeks

Question 16

Uterus position at term x2

Answer 16

Dextrorotation
Dextrodeviation

Question 17

3 cervical changes

Answer 17

Softens
Proliferation of glands
Formation of mucus plug

Question 18

Define Jacquemier’s sign and what causes it

Answer 18

Bluish discoloration of the vagina caused by increased blood supply in the venous plexus

Question 19

4 categories of maternal adaptation

Answer 19

1. Increased precursors for hormone production
2. Improved transport capacity
3. Exchange of nutrients and oxygen
4. Removal of additional waste products by peripheral vasodilation

Question 20

What causes the fall in BP x2

Answer 20

Decreased peripheral resistance
Formation of AV shunts in placenta

Question 21

Causes of dyspnea in pregnancy x3

Answer 21

Reduced pCO2
Increased TV
Reduced TLC

Question 22

Effects of bladder pressure from uterus x4

Answer 22

Increased micturition
Urinary stasis
Stress incontinence
Hydronephrosis and hydroureter

Question 23

True or false. Free T3 &T4 levels change during pregnancy

Answer 23

False

Question 24

3 anti insulin hormones

Answer 24

Prolactin, lactogen, cortisol

Question 25

What causes ketoacidosis in pregnancy

Answer 25

Lipolysis since maternal source of energy shifts from glucose to lipids

Question 26

Why is pregnancy a hypercoagulable state x4

Answer 26

Increased clotting factors Decreased fibrinolytic agents Venous stasis Endothelial injury

Question 27

GIT changes x5

Answer 27

Relaxation of GIT muscles Increased transit time Constipation Hemorrhoids Gums- soft and easily bleed

Question 28

Musculoskeletal complications of pregnancy x2

Answer 28

Lumbar lordoisis Carpal tunnel syndrome

Question 29

Effect of relaxin and progesterone on pelvic ligaments x2

Answer 29

Relaxation and pain (pelvic girdle and coccygeal)

Question 30

Effect of estrogen in pregnancy x3

Answer 30

Induce growth of fetal organs Stimulate maternal tissue growth Suppress FSH and LH

Question 31

Why there is plasma volume expansion x4

Answer 31

To meet metabolic demands of fetus and placenta To deliver nutrients and remove waste products To protect from excessive blood loss during birth To protect from effects of impaired venous return when standing up or in supine

Question 32

Function of human placental lactogen x2

Answer 32

Mobilize FFA for mothers needs Diverts glucose to placenta and fetus

Question 33

When does HDL and LDL peak in pregnancy

Answer 33

Week 25 and 26

Question 34

Effect of progesterone on clotting system x2

Answer 34

Blood stasis Venodilation

Question 35

Changes in clotting system x4

Answer 35

Decreased PT APTT Decreased fibrinolysis Increased fibrinogen Increased clotting factors

Question 36

What causes the fall in BP during mid second trimester

Answer 36

Formation of atrioventricular shunts in the placenta

Question 37

How does the ECG change during pregnancy x3

Answer 37

ST changes Inverted T waves on lead lll Large or prominent Q waves on lead lll

Question 38

Cause of physiologic edema

Answer 38

Pressure of gravid uterus on IVC

Question 39

Why the increase in skin perfusion during pregnancy

Answer 39

As a means to lose heat of fetal metabolism via maternal circulation

Question 40

Effect of progesterone on respiratory tract

Answer 40

Increases CO2 sensitivity and facilitates gas exchange

Question 41

Changes in respiratory volumes x2

Answer 41

Increased tidal volume Decreased functional residual capacity

Question 42

Effects of uterus pressure on bladder x5

Answer 42

Stress incontinence Increased micturition Hydronephrosis Hydroureter Urine stasis

Question 43

Git changes during pregnancy x5

Answer 43

Gastrointestinal reflux Gall bladder relaxation Bile tract stasis Hemorrhoids Soft gums

Question 44

Musculoskeletal changes x4

Answer 44

Leg cramps Pelvic tilt Back arch Waddling gait

Question 44

Function of thyroxin

Answer 44

Fetal neural development

Question 45

3 anti insulin hormones and their functions x3

Answer 45

Human placental lactogen, prolactin, cortisol 1. Increase insulin resistance in mother 2. Decrease peripheral uptake of glucose 3. Ensure continuous glucose supply to fetus