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Flashcards in Maternal Adaptations to Pregnancy Deck (19)
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1

Human placental lactogen (HPL)

- polypeptide, similar to GH and Prl
- rises steadily throughout pregnancy
- can also be positive with bronchogenic carcinoma, hepatoma, lymphoma and
pheochromocytoma
- functions include lipolysis, inhibition of glu uptake, anti-insulin
- not required for successful pregnancy

2

Human Chorionic Gonadotropin (hCG)

- glycoprotein, 2 subunits, alpha is similar to FSH/LH/TSH, beta is specific
- increases with multiple gestations, erythroblastosis, hydatidiform mole,
choriocarcinoma
- actions: prolongs life of corpus luteum, inc. steroid production; used as a dx test for pregnancy

3

The placental hormones

HPL, hCG, LHRH, TRH, E, P

4

Cervical changes during pregnancy

• Softening and cyanosis
• Increased vascularity
• Edema
• Hypertrophy and hyperplasia of glands
• Erosions
• Cervical mucus
• Histology
• Connective tissue

5

Chadwick's sign

Violet blue color of the vaginal mucosa ⇒ presumptive sign of pregnancy

6

Uterine changes during pregnancy

• Weight - ~1,000g heavier
• Volume
• Type of uterine muscular growth - wall thins from ~10 to 5.5mm
• Stimulus for growth
• Uterine position changes
• Uterine contractions
• Uterine blood flow - inc. from about 100 to 600 ml/min
• Cervical changes

7

Ovaries/oviduct changes during pregnancy

The ovaries:
• Ovulation
• Corpus luteum
• Relaxin
• Luteoma
• Decidual reaction
• Engorgement of ovarian veins
The oviducts:
• Flattened epithelium
• Decidual cells but no continuous decidual reaction

8

Maternal endocrine changes during pregnancy

- RAAS is much more active
- increased PTH, Vit D, Ca absorption; dec. total but normal ionized Ca, normal calcitonin
- thyroid enlarged but TSH/function normal, inc. TBG capacity, normal T3/T4, inc. BMR
- pituitary enlargement, GH is low around delivery and remains low; Prl inc. in preg, drops after delivery; oxytocin inc. with gestational age
- adrenal hormones increase throughout preganancy

9

Fetal endocrine changes during pregnancy

- PTH at 12-13wks, low till term; Ca falls postpartum, calcitonin normal, 25(OH)D normal, 1,25(OH)2D low at term, inc. first 48 hrs
- TSH normal at term, thyroid functions at 12-16wks; TBG capacity, T3/rT3 inc. at term, free T4 normal at term, T3 normal by 1st week

10

Metabolic changes in pregnancy

• Weight gain
• Protein metabolism - aa's increase in fetus
• Carbohydrate metabolism - insulin resistance in mom
• Fat metabolism - fat consumed whenever possible, inc. FFAs
*Average weight gain is 11kg (24lbs) accounted for by the fetal tissues and increased maternal tissues (uterus, breast, blood, EVF, and fat)

11

Urinary tract changes during pregnancy

- kidneys increase in size by 1.5cm, inc. GFR, RBF, cre clearance, dec. BUN; glucosuria, proteinuria
- ureter dilates, elongates, dec. urine flow
- bladder inc. in size and blood vessel tortuosity, elevation of trigone, inc. pressure from uterus

12

CV, respiratory changes during pregnancy

- diaphragm is elevated at term, decreasing TLC/VC
- Heart displaced/rotated laterally, widely split S1 (85% with S3; 90% soft, mid-systolic flow murmur), atrial/ventricular extrasystoles
- CO inc. 4.5-->6L/min because of inc. SV, dec. TPR; theory = the fetus itself is like an AV fistula, inc. plasma volume, and hormonal changes

13

CV changes at delivery

- during labor: 30% increase in CO at first stage, then more in second stage; with anesthesia (pain relief) CO will dec.
- inc. in CO comes from inc. SV when pressure on IVC is relieved, and uterine contraction/autotransfusion

14

Hemodynamic changes during pregnancy

- dec. RBC life span, dec. O2 affinity
- increased reticulocytes, RCV, EPO; erythroid hyperplasia of BM-->requires more iron
- plasma volume inc. 45% (rapidly in 2nd trimester); Hct dec. 5-6%
- Hgb may dec but

15

Liver, Gallbladder, and Esophagus changes during pregnancy

Liver:
• Alkaline phosphatase doubles
• ↓ plasma albumin
• ↓ cholinesterase activity
• No change hepatic blood flow, bilirubin, or morphology
Gall bladder:
• Distension
• Hypotonic
• Thickening of bile
Esophagus:
• pressure ~15mmHg until week 36 (~3mmHg), then peaks postpartum (~25mmHg)

16

Breast changes during pregnancy

• Tenderness
• Increased size, nipple size
• Nodularity
• Clostrum
• Areolar changes
• Montgomery glands

17

Musculoskeletal changes during pregnancy

• Lordosis
• Increased joint mobility
• Low back pain
• Postural changes
• Weight gain
• Pressure on joints
• Weakening of ligamentous supports

18

Skin changes during pregnancy

Blood vessels: Vascular spiders, venous varicosities, palmar erythema
Hyperpigmentation:
• Nevi
• Chlosma ⇒ mask of pregnancy
Hair:
• Anagen (growth) normally lasts 2 – 6 years
• Telogen (resting phase): 15 – 20% usually; falls to 10% late pregnancy (2nd and 3rd trimesters); increases to 30% postpartum ⇒ most hair lost 2 – 4 months postpartum

19

Abdominal wall changes during pregnancy

Striae gravidarium:
• Reddish slightly depressed skin streaks
• 50% pregnant women
• Silver streaks
• Unrelated to degree of skin stretching alone - requires striae factor

Diastasis recti - separation of rectus muscles in midline
• Linea nigra
• Midline, darkened skin line