Maternal Physio - Repro Flashcards Preview

OBGYN - 3. OB normal > Maternal Physio - Repro > Flashcards

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
  • Later months of pregnancy

  • 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 (indicate the main portion of the uterine wall)

  • 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

 

Memory aid:

  • Main
  • Middle

A image thumb
13

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

450 to 650 mL/m

 

Summary:

  • More or less half liter

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
    • Due to increased vascularity and edema of cervix
  • Cervical mucus beading
    • Due to progesterone
  • Arias-Stella reaction
    • Endocervical gland hyperplasia and hypersecretory appearance

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
    • 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

 

Memory aid:

  • corProgesterone

25

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

  • Phenomenon
  • Description

  • Phenomenon
    • Decidual reaction
  • Description
    • 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

 

Memory aid:

  • RElaxin
  • REmodelling

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)
  • Bead Buntis Baba NaCl
  • 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

 

Memory aid:

  • Puti Pepet Progesterone

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 presumptive sign)

34

When is Chadwick sign observed?

6th week

 

Note:

  • All of the 3 signs are seen at 6 weeks