normal pregnancy and premature birth 12/21 Flashcards
(31 cards)
CV changes
earliest and most dramatic
anatomic changes of CV
displaced upward and left
more horizontal
hypertrophy
functional changes
increase CO 30-50%
decrease blood flow to splanchnic and skeletal muscles
At term,20% of CO to uterus
first 1/2 of pregnancy=increase SV
second half=increase HR
BP
decrease through 2 trimester then normalizes towards end
resting HR increase
CV physical findings
increased second heart sound split with inspiration
distended neck veins
low grade systolic ejection murmur
Resp. changes
mediated by progesterone
elevation of diaphragm
increased chest diameter and circumference
elevated diaphargm results in
decreased RV
decreased fRV
decreased total lung volume
consequence of increased TV
increased expiratory capacity(minute ventilation)–> increase RR/decrease PCO2–> resp. alkalosis–> compensated by increased excretion of bicarb from kidney–> normal maternal arterial pH
hematologic
increased plasma volume
increased RBC volume
increased coagulation factors
increased total oxygen carrying capacity
Phys EX.:see edema
increase in plasma volume is more than increase in RBC volume–> normal anemia associated with pregnancy
changes in other systems
increase WBC
hypercoagulable state
enlarged kidney
dilation of ureters
renal plasma flow increase–> decrease BUN,Cr
GI,breast and skin changes
decrease in tone and motility of stomach
increased GERD
increased constipation
increased risk of gallstones
enlargement of breast due to vascular engorgement–> later due to increased mass
hirsu,striae,linea nigra,melasma
prevention and tx of preterm premature rupture of membranes
prevention:17 OH-progesterone
Tx:steroids,AB,neuroprotection
preterm labor
prevention with 17 OH-progesterone
Tx with steroids,AB,tocolysis and neuroprotection
chorioamniotis
maternal fever,maternal or fever tachycardia +/- fundal tenderness
RF:young age,low socio,nulliparity,extended labor and ruptured membranes,multiple vaginal examinations,preexisting infx of low tract
ascending infx:bacteroides,prevotella,E.coli,anaerobes,GBS
endomyometritis
diagnosed post delivery within 36 hours
fever,tachy,malaise,fundal tenderness
polymicrobial ascending infx
placental abruption
trauma,cocaine,HTN
see couvelaire uterus:blood from ruptured placenta in myometrium
gestational HTN
after 20 weeks of gestation
>140/90 on two seperate occasions,at least 6 hours apart
resolves by 6 weeks postpartum
seen in third trimester
diagnosis of pregnancy
chadwick’s sign=bluish discoloration of vagina and cervix
Hegar’s sign=softening of cervix
fetal heart sounds detectable at 12 weeks by doppler
Naegle’s rule for EDD
LMP+7 days-3 month=estimated delivery date EDD
fundal height
1cm/week gestation after 20 weeks
HPL
human placental lactogen produced by placenta
decreases glucose uptake and acts as anti-insulin
Braxton-Hick’s
contractions perceived as labor but not associated with cervical changes
false labor
shorter and less intense than true labor
normal stages of labor
stage1: between onset of labor and full cervical dilation (10 cm)
stage2: complete cervical dilation to delivery of infant
stage3: from delivery of infant to delivery of placenta
stage4: immediate post-partum period
fetal blood circulation
