top of the uterus
the white vaginal discharge with pregnancy
Tubercles of Montgomery
sebaceous glands responsible for nipple lubrication during breast feeding
involuntary constriction and relaxation of the muscles of the intestines; creates a “wave-like” motion that pushes contents of bowel forward
high levels of cholesterol in the blood
product of heart rate or the number of heartbeats per minute, and the stroke volume
the volume of blood pumped from the ventricle per heartbeat
What is a normal adult cardiac output?
4.7 L blood per minute
the volume of air inhaled
the study of structure or how something is made
a normal red blood cell has an area of pallor in its center
three 13 week intervals of pregnancy
Signs and Symptoms of Pregnancy
fatigue breast tenderness nausea and vomiting amenorrhea urinary frequency hyperpigmentation of the skin fetal movement uterine enlargement breast enlargement
Hyperpigmentation of the skin occurs when?
Fetal movement (quickening)
Braxton Hicks contractions
16-28 weeks function is to efface or thin the cervix in the last month of pregnancy
When will you see a positive pregnancy test?
around 14 weeks
the examiner pushes against the cervix during pelvic exam and feels a rebound from the floating uterus
softening of the cervix
vaginal mucosa and cervix take on a bluish color
softening of the lower uterine segment
When can an ultra sound verify the embryo?
When can the physician feel fetal movement?
Auscultation of the fetal heart tones via doppler occurs when?
the earliest biochemical marker for pregnancy
-usually detectable 5-8 days after conception, but definitely by day 11
hCG levels in pregnancy
usually double every 48-72 hours until they peak 60-70 days after fertilization
What do physicians use to help differentiate between a normal and abnormal pregnancy?
hCG doubling time
Lower levels of hCG may cause?
Higher levels of hCG may cause?
molar pregnancy or multiple-gestational pregnancies
What are four other causes of hCG elevation?
a fast growing cancer that grows in the uterus
-abnormal cells start in the tissue that would become the placenta
a noncancerous tumor that develops in the uterus as a result of a nonviable pregnancy
Supine Hypotensive Syndrome
the heavy/gravid uterus can fall back against the inferior vena cava in the supine position, resulting in vena cava compression
Symptoms of Supine Hypotensive Syndrome
reduced venous return
decreased cardiac output and blood pressure
increased orthostatic stress
weakness, light headedness, nausea, dizziness, and syncope
When a patient is experiencing Symptoms of Supine Hypotensive Syndrome what should you have them do?
instruct them to lie on her left side, which displaces the uterus and pressure is removed from the vena cava
What causes Goodell’s sign to happen?
the cervix begins to soften due to vasocongestion and the influence of estrogen
What will happen along with the cervix softening?
- endo-cervical glands enlarge and increase in number creating more cervical mucous
- progesterone causes a thick mucous plug to form
- Chadwick’s sign
What does the cervical mucous plug do?
blocks the cervical os and protects against bacterial invasion
How much will the weight of the uterus increase at term?
70 g to 1100-1200
How will the capacity of the uterus increase at term?
from 10 mL to 5000 mL or greater
As pregnancy progresses how much of the uterine blood flow will go to the placenta?
How long will the uterus remain in the pelvic cavity before ascending into the abdomen?
the first 3 months
How long are the ovaries enlarged because of increased blood supply?
until approximately 14-16 weeks
Why does ovulation stop during pregnancy?
because of elevated levels of estrogen and progesterone
When do the ovaries stop becoming active in hormone production for pregnancy?
about weeks 6-7 when the placenta takes over the production of progesterone
What happens to the breast during pregnancy?
- begin to grow larger and increase in fullness
- become more vascular
- nipples and areolas become deeply pigmented
- tubercles of Montgomery become prominent
When can colostrum be expressed by the breasts?
by the third trimester
creamy, yellowish breast fluid that provides nourishment for the breast feeding newborn during the first few days of life
Where does the gastrointestinal system begin and end?
begins in the oral cavity and ends in the rectum
What happens to the gums during pregnancy?
They become hyperemic, swollen, and friable causing easy bleeding
What happens to the saliva during pregnancy?
Becomes more acidic
-some complain of excessive salivation-ptyalism
What two dental diseases are common during pregnancy?
Periodontitis and gingivitis
Periodontal disease may cause what?
preeclampsia, low-birthweight, stillbirth, and early onset of neonatal sepsis
What may be the cause of ptyalism?
the decrease in unconscious swallowing by the women when nauseated
GI Side Effects of pregnancy
What are some causes of constipation during pregnancy?
low-fiber food choices reduced fluid intake iron supplements decreased activity level intestinal displacement
What causes heartburn during pregnancy?
slowed gastric emptying combined with relaxation of cardiac sphincter
What can cause hypercholesterolemia?
due to the emptying time of the gallbladder secondary to smooth muscle relaxation caused by increased progesterone
What can hypercholesterolemia put the patient at risk for?
What medication was recently approved by the FDA as the first drug to specifically treat morning sickness?
How much will the moms heart rate increase during pregnancy?
How much will the moms cardiac output increase?
How much will blood volume be increased?
An increase in what can lead to anemia?
increased plasma volume
Why do a lot of women experience physiologic anemia?
because maternal blood volume expansion happens at a larger proportion than the increase in red blood cells
What is the criteria for Physiologic Anemia?
- Hemoglobin of 10g or less
- Red blood cells 3.5 million/mm3
- Normal morphology w/ central pallor
Why is the increase in blood volume necessary?
provides adequate hydration of fetal and maternal tissues, to supply blood flow to perfuse the enlarging uterus, provide a reserve during birth, perfusion of kidneys
Why does the heart increase in size?
to accommodate the increased blood volume and cardiac output
How much will the heart rate increase between 14-20 weeks?
What can happen to a woman with preexisting heart conditions?
She may become symptomatic and begin to show signs of decompensation during the time the blood volume peeks
When should a mom with preexisting heart conditions be monitored more closely?
between 28-35 weeks
What happens to the moms blood pressure during pregnancy?
Declines due to the peripheral vasoconstriction caused by the increased level of progesterone
When will you see the blood pressure reach its lowest point?
Why should any significant rise in blood pressure be investigated?
To make sure the mom has not developed gestational hypertension
a clinical diagnosis defined by new onset of systolic BP of 140 mmHg or higher and/or diastolic of 90 mmHg or higher after 20 weeks gestation
What changes increase a woman’s risk of developing DVT/PE?
- increase in fibrin and fibrinogen levels
- venous stasis secondary to venous pooling
Increase in fibrin and fibrinogen levels along with other clotting factors make pregnancy what kind of state?
What causes the lungs to function differently during pregnancy?
- increased progesterone
- growing uterus pushes lungs up approximately 4 cm above the usual position
What will allow for a larger tidal volume?
- increase in diaphragmatic excursion
- increase in chest circumference
- increase in transverse diameter
How much will the mother’s oxygen consumption increase due to the requirements of the developing fetus?
How does a woman’s breathing change?
she will breathe more deeply and faster
What influences increased vascularity in the respiratory tract and causes congestion?
increased estrogen levels
Rising levels of sex hormones and sensitivity to allergens may influence the nasal mucosa causing women to experience what throughout their pregnancy?
nosebleeds, rhinitis and congestion
What will allow for increase in blood flow to the kidneys during pregnancy?
What are the primary changes in the urinary structure during pregnancy? And why do they occur?
Dilation of the renal pelvis and the uterus
-result of increased estrogen and progesterone, pressure from enlarging uterus, and dilation of renal pelvis
Why does the glomerular filtration rate (GFR) increase?
because of increased blood flow which leads to increased urine flow
What happens to the ureters?
elongate, widen, and become more curved above the pelvic rim
When does activity of the kidneys increase and decrease?
increase when lying down and decrease with standing
How long can it take after pregnancy for the urinary anatomy to return to normal?
up to 3 months
What will happen to the mom’s ligaments holding the sacroiliac joint and pubis symphysis in place at 10-12 weeks?
begin to soften and stretch and the articulations between the joints widen and become more mobile
What is the purpose of the changes to the sacroiliac joint and pubis symphysis?
increase the size of the pelvic cavity which will make delivery easier
What can cause lower back pain?
postural changes coupled with loosening of the sacroiliac joints
increase in the normal lumbosacral curve
What leads to the “waddle” during pregnancy?
relaxation and increased mobility of joints because of the hormones progesterone and relaxin
-increased weight gain can make it worse
What causes hyperpigmentation?
increased estrogen, progesterone, and melanocyte-stimulating hormone levels
Where do you must commonly see hyperpigmentation?
nipples, areolas, umbilicus, perineum, and axilla
“Mask of pregnancy”
-increased pigmentation on the face
skin in the middle of the abdomen that has developed a pigmented line running from the umbilicus to the pubic area
Where are varicosities most commonly seen?
legs, vulva, perineum
What are varicose veins often the result of?
distention, instability, and poor circulation secondary to prolonged standing or sitting and the heavy gravid uterus placing pressure on the pelvic veins preventing complete venous return
Interventions to reduce varicosities
- elevating both legs
- avoid prolonged sitting or standing-change positions frequently
- resting in left lateral position
- walking daily
- avoid tight clothing and knee high stockings
- TED hose
small blood vessels
- appear on the neck, thorax, face, and arms
- especially obvious in Caucasian women
What is the pinker area on the palmer surface of the hands called?
Hair during pregnancy
hair growth declines followed by subsequent hair loss after delivery
Nails during pregnancy
- typically grow faster, but are more brittle
- whitish discolorations or distal separation of the nailbeds
- transverse grooves
- enlarges and becomes more active
- increases TSH during 1st trimester and tapers off within a few weeks after birth
- essential for proper brain development
will compromise fetal neurologic development
- enlarges during pregnancy
- produces multiple hormones
Why are FSH and LH most likely blocked during pregnancy?
because of the hCG hormone as well as increased levels of prolactin
What is thought to be the reason for morning sickness?
elevated levels of hCG and decreased levels of TSH during the first trimester
What inhibits the direct influence of prolactin on the breasts during pregnancy?
high levels of progesterone secreted by the placenta
When does lactogenesis begin?
at birth after the placenta is expelled and there is a sharp drop in progesterone
Where is prolactin released and what is it in response to?
Released from the anterior pituitary gland in response to suckling by the newborn
responsible for uterine contractions both before and after delivery
What is believed to be the initiator of labor?
decrease in progesterone
What do contractions lead to?
- cervical thinning and dilation
- exert pressure which helps descend fetus into the pelvis
What does oxytocin do for the body after delivery?
causes the myometrium to contract, which decreases blood flow, which decreases the amount of bleeding during and after delivery
an exocrine organ which supplies digestive enzymes and buffers
How many cell types are in the pancreas and which one produces insulin?
4; beta cells produce insulin
How does a women develop gestational diabetes?
she has an inadequate number of beta cells so she may be unable to produce enough insulin and will develop glucose intolerance during pregnancy
What regulates carbohydrate and protein metabolism and is helpful with stress?
During pregnancy Cortisol will:
- helps keep up the level of glucose
- breaks down protein to repair tissues and manufacture enzymes
- has anti-insulin, anti-inflammatory, and anti-allergic actions
- needed for precursors of adrenaline
Immunologic Alterations help prevent what from happening?
the mother’s immune system from rejecting the fetus
Because of immunologic alterations the mother is more at risk for?
infections such as UTI’s and influence the course of chronic disorders such as autoimmune disease
Inadequate nutritional intake can result in what?
preterm birth, low birth weight, and congenital anomalies
Excessive nutritional intake is connected with?
fetal macrosomia leading to difficult birth, neonatal hypoglycemia, and continued obesity for mom and baby, and metabolic syndrome
BMI = 18.5-24.9 total weight gain = 15-25 lbs.