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obstetrics > maternal physiology > Flashcards

maternal physiology Flashcards

1
Q

uterine changes

A 
increase size d/t increase polyamines
pyriform shape at 6wks
globular at end of 2nd month
spherical at end of 3rd month
length>width at 20th wk
term - volume 2-20L; 1100g
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2
Q

fundic height = AOG

A

18-32wks

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3
Q

progressive softening of isthmus

A

hegar’s sign

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4
Q

isthmus changes

A

term - 7-10cm

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5
Q

site for CS incision

A

isthmus

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6
Q

LUS begins to develop

braxton-hicks contraction

A

34 wks

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7
Q

widening of LUS responsible for 2 phenomena

A

upward migration of low lying placenta

stretching nd shearing of placenta implanted in LUS (placenta previa bleeds)

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8
Q

fetal head often descends to or even thru inlet

A

lightening

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9
Q

abdomen undergoes shape change

A

baby dropped

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10
Q

cervix changes

A

softening and cyanosis d/t increased vascularity and edema
hyperplasia & hypertrophy of glands, muscle & CT
dilation to aid delivery & repair ff parturition

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11
Q

marked opening of cervix

A

goodell’s sign

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12
Q

uterine vascular system changes

A

UV - reduce elastin and adrenergic nerve density; dilation

UA - dilation d/t trophoblastic invasion of TM

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13
Q

htn in pregnancy

A

problem in trophoblastic invasion, ballooning doe not happen

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14
Q

ovaries changes

A

corpus luteum - function max in 6-7 weeks; prod. progesterone w/c supports pregnancy; persists until 8wks

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15
Q

vagina changes

A 
hyperplasia & hypertrophy of epithelium
increased vascularity (6wks) and hyperemia
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16
Q

bluish discoloration of vagina

A

chadwick’s sign

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17
Q

pelvic floor changes

A

more vascular
levator ani hypertrophy
less rigid, more distensible

18
Q

pelvic girdle changes

A

relaxation of pelvic joint
thickened edematous joint capsule
increase mobility of pelvic bones

19
Q

breast changes

A

dark nipples
hyperplasia & hypertrophy of glands
areola broader and deeply pigmented

20
Q

skin changes

A

increase pigmentation
melasma
PUPPP

21
Q

abdominal wall changes

A

striae gravidarum (silvery white after delivery)
diastasis (recti separation)
linea nigra

22
Q

vascular changes

A

angioma d/t hyperestrogenemia

23
Q

CVS changes

A

increased CO (30-50% at 25-32 wks)

24
Q

heart changes

A

displace to left and upward

25
Q

ABP changes

A

decreases at 24-26wks then rises thereafter (D>S)
brachial AP lower when sitting
antecubital VP unchange
femoral VP rises from 8 to 24mmHg at term in supine
varicose veins & hemorrhoids & DVT

26
Q

renin, angiotensin II, plasma volume

A

increase d/t augmented estrogen prod.

27
Q

ANP & BNP

A

unchange

28
Q

prostaglandin

A

elevated
PGE2 markedly elevated during late pregnancy (natriuretic);
PGI2 rises during late pregnancy (vasodilation & plt fx);

29
Q

endothelin

A

unchange

vasoconstrictor

30
Q

nitric oxide

A

vasodilator

31
Q

respi changes

A 
dyspnea (upward diaphragm 4cm)
subcostal angle widen
decreased FRC, ERV, RV, TLC
increased IC, TV, RMV
unchanged RR, LC, MBC
increased total hgb mass and O2 consumption
32
Q

GI changes

A 
hyperemic and softened gums
epulis gravidarum (pyogenic granuloma)
pyrosis (heartburn)
emptying time unchanged
hemorrhoids
cholestasis
33
Q

GUT changes

A

increase size of kidney, GFR, renal plasma flow
physiologic hydroureter > bacteriuria > UTI
bladder pushed upward with marked tortuosity of vessel, edema & hyperemia

34
Q

endocrine changes

A 
enlarged pituitary (12mm)
inc. prolactin (150ng/mL), oxytocin, GH, thyroid gland, TBG, T3 & T4, iodine, PTH, calcitonin 
dec. gonadotrophs & somatotroph, GH(36wks)
unchanged corticotrophs & thyrotrophs, AVP
35
Q

placenta changes

A

hCG - syncytiotrophoblast (8-10d); 10-12wks decline; nadir 20wks
HPL - glucose sparer; syncytiotrophoblast; inc. 34-36wks
estrogen - syncytiotrophoblast; inc
progesterone - syncytiotrophoblast & plasma LDL; relaxant

36
Q

adrenal changes

A

inc. cortisol, aldosterone, deoxycorticosterone, androgen

37
Q

hema changes

A

inc. BV, RBC, WBC slight, all BM elements, coag fcators, ferritin
hypervolemia
dec hgb conc.(12.5g/dL; <11 abnormal)
iron req. 1000mg/d (300mg fetus & placenta; 500mg RBC prod; 200mg excreted)

38
Q

skeletal changes

A

lower back pain

lordosis

39
Q

musculoskeletal changes

A

aching, numbness, weakness

40
Q

immunologic changes

A

dec. humoral & cell-mediated
early: pro-inflam (implantation) & anti-inflam (uterine epithelium repair)
mid: anti-inflam
parturition: pro-inflam

41
Q

maternal metab

A

wt gain 12.5kg / 27lbs
inc. H2O(6.5 L: 3.5 fetal, placenta, AF; 1.5 plasma; 1.5 breast and intestinal tissue) and Na metab, glucose, protein(500g fetus) metab, fat (declines at 3rd trim) metab, pH (mild alkalosis 7.42-7.44)

42
Q

CNS changes

A

dec. memory, IOP, corneal sensitivity
krukenberg opacities
difficulty sleeping
PP blues

obstetrics (11 decks)

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