Maternal Physiology Flashcards by joseph dizon

Uterus of pregnant woman

Thin walled muscular organ
5L to 20 L
500-1000x greater than non pregnant
1100g weight

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Uterus

There is increase in myocytes size and accumulation of fibrous tissue at

External muscle layer

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Uterine hypertrophy early in pregnancy is stimulated by the action of

Estrogen and progesterone

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Myocyte arrangement

Archers over the fundus and extends into the various ligaments

Outer hood like layer

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Myocyte arrangement

Dense network of muscle fibers perforated in all directions by blood vessels

Middle layer

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Middle layer form a figure of

Allow the. Muscle fibers to constrict and penetrate blood vessel

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Myocyte arrangement

With sphincter like fibers around the Fallopian tube orifices and internal cervical os

Internal layer

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Height of fundus

First few weeks

Maintain original piriform or pear shape

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Height of fundus

12 weeks

Corpus and fundus - globular or spherical

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Height of fundus

End of 12 week

Can be palpated in the abdominal cavity

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Uterine contractility

Irregular contractions that are normally painless

Braxton hicks contractions

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Braxton hicks intensities

5-25 mmHg

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Uterine contractility

Number of contractions increase in the last week or two

10-20 minutes with rhythmicity

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Utero placental blood flow

500-750 ml/min

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Utero placental blood flow

Placental perfusion is dependent on

Total uterine blood flow

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Utero placental blood flow

Uterine blood flow is proportional to

Contraction intensity

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Utero placental blood flow regulation

Maternal placental BF progressively increases during

Gestation by vasodilation

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Utero placental blood flow regulation

Doubled by 20 weeks to accommodate the size of the uterus. This is also consequence of estrogen stimulation

Uterine artery

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Utero placental blood flow regulation

Regulates blood flow

Estradiol
Progestin
Relaxin

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Utero placental blood flow regulation

Make blood vessel contract

Norepinephrine

Angiotensin 2

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Cervix maintenance of pregnancy

1 month after conception, the cervix begins to undergo pronounced softening and cyanosis. Because of

Edema of the entire cervix

Hyperplasia of cervical glands

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Cervix maintenance of pregnancy

Necessary to permit functions as diverse as maintenance of a pregnancy to term,and repair following parturition

Rearrangement of collagen rich

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Cervix maintenance of pregnancy

Metabolism have a role in all these changes

Estrogen

Progesterone

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Cervix maintenance of pregnancy

These normal pregnancy induced changes represent an extension or eversion of the

Proliferating columnar endocervical glands

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rich in immunoglobulins and cytokines and may act as an immunological barrier to protect the uterine contents against infection

Mucus plug

Cervical mucus consistency changes as a result of progesterone

Beading

Beading When cervical mucus is spread and dried on a glass slide it is characterized by

Poor crystallization

Arborization of crystals observed as a result of amniotic fluid leakage

Ferning

Pregnancy is associated with both endocervical gland hyperplasia and hyper secretory appearance

Arias Stella reaction

This protein hormone is secreted by corpus luteum as well as the decidua and the placenta

Relaxin

Secretion of relaxin has many maternal physiological adaptations

Remodeling of reproductive tract Initiation of augmented renal hemodynamics Decreased serum osmolality Increase uterine artery compliance

Benign ovarian lesions result from exaggerated physiological follicle stimulation

Theca lutein cysts

Ovaries

Ovulation cease during pregnancy | Maturation of new follicle is suspend

Fallopian tube During pregnancy

Undergoes little hypertrophy

Fallopian tube Decidual cells may develop in the stroma of the

Endosalpinx

Fallopian tube May result to Fallopian tube torsion

Increase size of gravid uterus | Para tubal ovarian cysts

Vagina and perineum Common size of bartholins gland cysts

1cm

Vagina and perineum Increased vascularity prominently affects the vagina and result in the violet color characteristics

Chadwick sign

Vagina and perineum Papillae of the vaginal epithelium undergo hypertrophy to create a fine

Hobnailed appearance

Breast Increase in size and delicate veins become visible just beneath the skin.

>2 months

Breast First few months can be expressed from the nipples by fluently palpation

Colostrum A thick yellow fluid

Breast Glands of Montgomery

Small elevations scattered through the areola | Hypertrophic sebaceous gland

Breast Increase size of gland Montgomery may develop

Gigantomastia which need surgery

Reddish, slightly depressed streaks commonly develop in the abdominal skin and sometimes in the skin over the breast and thighs

Striae gravidarum

Rectus muscle separate at the midline d/t abdominal wall tension

Diastasis recti

Linea alba takes on dark brown or black pigmentation

Lines Nigra

Irregular, brownish patches of varying size on the face and neck, So called mask of pregnancy

Chloasma | Melasma gravidarum

Angiomas , develops 2/3 of white women and 10% of black women

Vascular spiders

Vascular spiders common in the

Face Neck Upper chest Arms

2/3 of white women and 1/3 of black women | Most likely d/t hyoerestrogenemia

Palmar erythema

Metabolic changes 3rd trimester, maternal basal metabolic rate is increasedby

10-20%

Total pregnancy energy demands

1st T: 77,000kcal or 85kcal /day 2nd T: 285kcal/day 3rd T: 475 kcal /day

Metabolic changes Metabolic alterations that increase accumulation of cellular water, fat and protein

Maternal reserves

Water content of the fetus, placenta and amniotic fluid

3.5 L

Accumulates from increase in maternal BV and in the size of uterus and breast

So extra water in normal pregnancy

6.5L

Maternal body water, rather than fat, contributes more significantly to

Infant birth weight

Protein metabolism Product of conception rich rather than carbo and fat

Protein

Protein metabolism Fetus placenta weigh about 4kg and contain

500g of protein

Protein metabolism 500g is added to the uterus as

Contractile protein

Protein metabolism Breast in the glands and yo maternal blood as

Hemoglobin and plasma proteins

Carbohydrate metabolism

Mild fasting hypoglycemia Postprandial hyperglycemia Hyperinsulinemia

Carbohydrate metabolism Pregnancy induced state of peripheral insulin resistance d/t sustained

Postprandial supply of glucose to the fetus

Carbohydrate metabolism Insulin sensitivity in late pregnancy

45-70% lower than in nonpregnat state

Calcium

Decline Follows lowered plasma albumin Serum ionized calcium is unchanged 3rdT 80% 30 g of calcium

Magnesium

Serum level decline Phosphate level lie within the non pregnant range Elevated rebel phosphate

Sodium and potassium

``` 1000mEq Na 300mEq K Glomerular filtration increased Excretion is unchanged Total is decreased slightly d/t expanded plasma volume ```

Iodine

Req increase T4 thyroxine increase Fetal thyroid increase during 2nd half of pregnancy Iodide GFR increase by 30-50%

Blood volume begin to increase

1st T

Plasma volume expands by approximately 15% compared with that of pregnancy

12 menstrual week

Maternal BC expands more rapidly by

2nd T

Slower rate of BV

3rd T

Blood volume Plateau

Last several weeks

Blood volume Expansion results from increase in both

Plasma | Erythrocytes

Blood volume Elevated maternal plasma erythropoietin level that peaks at

3rd T and corresponds maximal erythrocyte production.

Meron pa yung Last part. Aralin mo pa

Hindi nkasama dito sa BS

Uterus of non pregnant women

79g | Almost solid

Maternal Physiology Flashcards

(77 cards)