maternal physiology

Question 1

uterine changes

Answer 1

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

Question 2

fundic height = AOG

Answer 2

18-32wks

Question 3

progressive softening of isthmus

Answer 3

hegar’s sign

Question 4

isthmus changes

Answer 4

term - 7-10cm

Question 5

site for CS incision

Answer 5

isthmus

Question 6

LUS begins to develop

braxton-hicks contraction

Answer 6

34 wks

Question 7

widening of LUS responsible for 2 phenomena

Answer 7

upward migration of low lying placenta

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

Question 8

fetal head often descends to or even thru inlet

Answer 8

lightening

Question 9

abdomen undergoes shape change

Answer 9

baby dropped

Question 10

cervix changes

Answer 10

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

Question 11

marked opening of cervix

Answer 11

goodell’s sign

Question 12

uterine vascular system changes

Answer 12

UV - reduce elastin and adrenergic nerve density; dilation

UA - dilation d/t trophoblastic invasion of TM

Question 13

htn in pregnancy

Answer 13

problem in trophoblastic invasion, ballooning doe not happen

Question 14

ovaries changes

Answer 14

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

Question 15

vagina changes

Answer 15

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

Question 16

bluish discoloration of vagina

Answer 16

chadwick’s sign

Question 17

pelvic floor changes

Answer 17

more vascular
levator ani hypertrophy
less rigid, more distensible

Question 18

pelvic girdle changes

Answer 18

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

Question 19

breast changes

Answer 19

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

Question 20

skin changes

Answer 20

increase pigmentation
melasma
PUPPP

Question 21

abdominal wall changes

Answer 21

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

Question 22

vascular changes

Answer 22

angioma d/t hyperestrogenemia

Question 23

CVS changes

Answer 23

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

Question 24

heart changes

Answer 24

displace to left and upward

Question 25

ABP changes

Answer 25

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

Question 26

renin, angiotensin II, plasma volume

Answer 26

increase d/t augmented estrogen prod.

Question 27

ANP & BNP

Answer 27

unchange

Question 28

prostaglandin

Answer 28

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

Question 29

endothelin

Answer 29

unchange | vasoconstrictor

Question 30

nitric oxide

Answer 30

vasodilator

Question 31

respi changes

Answer 31

``` 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 ```

Question 32

GI changes

Answer 32

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

Question 33

GUT changes

Answer 33

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

Question 34

endocrine changes

Answer 34

``` 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 ```

Question 35

placenta changes

Answer 35

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

Question 36

adrenal changes

Answer 36

inc. cortisol, aldosterone, deoxycorticosterone, androgen

Question 37

hema changes

Answer 37

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)

Question 38

skeletal changes

Answer 38

lower back pain | lordosis

Question 39

musculoskeletal changes

Answer 39

aching, numbness, weakness

Question 40

immunologic changes

Answer 40

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

Question 41

maternal metab

Answer 41

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)

Question 42

CNS changes

Answer 42

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