Maternal Physio - Repro Flashcards Preview

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Flashcards in Maternal Physio - Repro Deck (34):
1

Compare the uterus in nonpregnant and pregnant woman

  • General morphology
  • Weight
  • Capacity
    • Nonpregnant
    • Pregnant

  • General morphology
    • Nonpregnant
      • Almost-solid structure
    • Pregnant
      • Thin-walled muscular organ
  • Weight
    • Nonpregnant
      • 70 g
    • Pregnant
      • 1,100 g
  • Capacity
    • Nonpregnant
      • 10 mL or less
    • Pregnant
      • 5 to 20 L (500 to 1,000X greater)

2

Cause of enlargement of uterus

----

Hypertrophy or hyperplasia

Hypertrophy rather than hyperplasia

3

Uterine hypertrophy early in pregnancy probably is stimulated by:

  • Early in pregnancy – estrogen
  • After 12 weeks – pressure exerted by the expanding products of conception

 

Memory aid:

  • Estrogen
  • Enlarges the uterus

4

T/F. Hypertrophy of early pregnancy occurs entirely due to mechanical distention

False; similar uterine changes are observed with ectopic pregnancy

5

Uterine enlargement is most marked in this portion of the uterus

Fundus

6

The position of the placenta also influences the extent of uterine hypertrophy. Why?

The portion of the uterus surrounding the placental site enlarges more rapidly than does the rest

7

Describe the attachment of the tubes and the ovarian + round ligaments to the fundus

  • Early month of pregnancy
    • only slightly below the apex of the fundus
  • Later months of pregnancy
    • slightly above the middle of the uterus

8

Describe the shape of the uterus as pregnancy progresses

  • Pre-pregnancy – pear shape
  • First few weeks (8-10 weeks) – pear shape
  • 12 weeks – almost spherical
  • Subsequent – ovoid

9

Describe the location of the uterus as pregnancy progresses

  • 12 weeks - too large to remain entirely within the pelvis
  • As uterus enlarges, it:
    • contacts the anterior abdominal wall
    • displaces the intestines laterally
    • superiorly reaches almost to the liver

10

With ascent of the uterus from the pelvis, it usually undergoes what?  This is caused by what? What is the implication?

  • Phenomenon
    • Dextrorotation
  • Cause
    • rectosigmoid on the left side of the pelvis
  • Implication
    • The round ligament must be avoided in lower uterine incision

11

Softening of the uterine isthmus

Hegar sign

12

Arrangement of uterine muscle cells and description

  • Outer hoodlike layer
    • Arches over the fundus and extends into various ligaments
  • Middle layer
    • Main portion of uterine wall
    • Figure of 8 configuration
    • Perforated by blood vessels
  • Internal layer
    • With sphincter-like fibers around the fallopian tube orifices and internal os of the cervix

A image thumb
13

Uteroplacental blood flow increases progressively, with estimates ranging ___ in near term

450 to 650 mL/m

14

Physiologic reason for increase in uterine blood flow

  • Increase in maternal-placental blood flow – vasodilation d/t estrogen action
  • Increase fetal-placental blood flow – a continuing growth of placental vessels

15

Uterine finding on bimanual exam

Uterus feels soft and elastic

16

Fundal height by weeks 12, 15, 20, 28, 32, 36, 40 weeks

  • 12 – barely palpable above pubic symphysis
  • 15 – midpoint between pubic symphysis and umbilicus
  • 20 – at the umbilicus
  • 28 – 6 cm above the umbilicus
  • 32 – 6 cm below the xyphoid process
  • 36 – 2 cm below xyphoid process
  • 40 – 4 cm below xiphoid process

17

Cervical changes and the physiologic mechanism for such change

  • Goodell's sign
  • Cervical mucus beading
  • Arias-Stella reaction

18

What is Goodell's sign?

Cervical softening and cyanosis due to increased vascularity and edema of the entire cervix

19

Cervical mucus beading occurs as a result of ____

Progesterone

20

What is Arias-Stella reaction?

Endocervical gland hyperplasia and hypersecretory appearance

21

Cervix palpation on pregnant versus nonpregnant

  • Nonpregnant
    • feels like the cartilage of the nose
  • Pregnant
    • feels like the lips of the mouth

22

Physiologic mechanism for mucus plug formation

↑ in gland activity leads to the formation of a mucous plug

23

Mucous plug composition and function

Immunoglobulins and cytokines, which act as a barrier to bacteria

24

Corpus luteum

  • Origin
  • When does it maximally function
  • Produces what hormome

  • Origin
    • the remains of the ovarian follicle that has released a mature ovum during a previous ovulation
  • When does it maximally function
    • First 6-7 weeks of pregnancy
  • Produces what hormome
    • Progesterone

25

The set of changes in the endometrium of the uterus that prepare it for implantation of an embryo

Decidual reaction

 

Note: Described as elevated patches of tissue which bleed easily

26

Relaxin

  • Produced by
  • Action

  • Produced by
    • Corpus luteum, deciduas, placenta
  • Action
    • Remodelling of reproductive tract connective tissue to accomodate pregnancy

27

Beading versus ferning

  • Not pregnant – estrogen effect → ↑ NaCl in mucus → crystallization → ferning
  • Pregnant – progesterone effect → ↓ NaCl in mucus → no crystallization → beading

 

Memory aid:

  • Beaded (circle like a pregnant tummy)
  • Pregnant – progesterone

28

Describe the vaginal secretion during pregnancy and the physiology of each

  • thicker with a white color due to influence of progesterone
  • more acidic in nature as a result of ↑ Lactobacillus acidophilus

29

Effect of Lactobacillus acidophilus

Inhibits growth of most pathogens and favors growth of yeasts

30

Vaginal pH during pregnancy

3.5 to 6

31

Description of vaginal discoloration and rationale

Blood flow increases →  vagina appears dark bluish or purplish-red

32

Sign described as bluish discoloration of the vaginal and cervical mucosa

Chadwick’s sign

33

Chadwick sign

----

Presumptive, probable or positive sign?

Presumptive

 

Note: Of the three signs (with Hegar and Goodel, this is the only preseumptive sign)

34

When is Chadwick sign observed?

6th week

 

Note: All of the 3 signs are seen at 6 weeks