Part 2 - TNB: Mother Baby

Question 1

• Stretch marks (abdomen, breasts, hips, etc.)
• May cause itching

Answer 1

Striae gravidarum

Question 2

Brownish hyperpigmentation of the skin (cheeks, nose & forehead)

Answer 2

Chloasma “mask of pregnancy”

Question 3

Red, mottled, blotchy appearance of the hands

Answer 3

Palmar Erythema

Question 4

Linea nigra

Answer 4

• Means “black line”
• Presents as vertical line on belly
during pregnancy

Question 5

Montgomery Glands/Tubercles

Answer 5

• Small rough / nodular / pimple-like
appearance of the areola (nipple)

Question 6

Integumentary Pregnancy Physiology Changes

Answer 6

• Striae gravidarum
• Chloasma
• Palmar erythema
• Linea nigra
• Montgomery
• Increased hair & nail growth

Question 7

Center of gravity shifts forward leading to an inward curve of the spine

Answer 7

Lordosis

Question 8

Edema causes pressure on the peripheral nerves

Answer 8

Carpal Tunnel Syndrome

Question 9

The growing uterus causes stretching of the abdominal wall

Answer 9

Diastasis recti abdominis

Question 10

Musculoskeletal Pregnancy Physiology Changes

Answer 10

• Lordosis
• Low back pain
• Carpal tunnel syndrome
• Calf cramps
• Diastasis recti abdominis

Question 11

Renal Pregnancy Physiology Changes

Answer 11

• Increased GFR from increased plasma volume
• Smooth muscle relaxation of bladder and renal pelvis
• Increased risk for UTIs
• Increased urgency, frequency & nocturia
• Increased progesterone = decreased tone of bladder, ureter & urethra

Question 12

Hematological Pregnancy Physiology Changes

Answer 12

• Decreased hemoglobin & hematocrit
• Increased fibrinogen

Question 13

Why is there a decrease of hemoglobin & hematocrit during pregnancy?

Answer 13

This is due to HEMODILUTION - increased blood volume is diluting Hgb & Hct.

Plasma volume is greater than the amount of red blood cells (RBCs) = hemodilution

This results to PHYSIOLOGICAL ANEMIA.

Question 14

What is the effect of INCREASED FIBRINOGEN?

Answer 14

Pregnant women are hypercoagulable which increases the risk for DVTs

Question 15

Fibrinogen normal level for non-pregnant women

Answer 15

200-400 mg/dL

Question 16

Fibrinogen level pregnant women

Answer 16

Up to 600 mg/dL

Question 17

This hormone relaxes smooth muscle during pregnancy.

Answer 17

Relaxin & Progesterone

Question 18

This hormone aids in growth of the uterus, the placenta, growth of new blood vessels, etc.

Answer 18

Estrogen

Question 19

hCG meaning

Answer 19

Human Chorionic Gonadotropin

Question 20

What produces hCG during pregnancy and what does it do?

Answer 20

The placenta produces hCG during
pregnancy & it prevents menstruation

Question 21

Cardiovascular Pregnancy Physiologic Changes

Answer 21

• Increased cardiac output
• Blood pressure may stay the same or have a slight decrease
• Increase in blood volume
• Heart enlarges
• Cardiac rhythm: May experience palpitations and cardiac dysrhythmias
• Hypercoagulable: Increase risk for DVTs

Question 22

Increased in blood volume may cause…

Answer 22

Edema

Question 23

Respiratory Pregnancy Physiology Changes

Answer 23

• Increased basal metabolic rate (BMR)
• Increased O2 needs
• Mild respiratory alkalosis
• Chest increases in size to allow for fetal growth and lung expansion
• Increased vascularity of URT

Question 24

Gastrointestinal Physiology Pregnancy Changes

Answer 24

• Nausea & vomiting
• Pyrosis (heartburn)
• Constipation
• Hemorrhoids
• Pica (craving substances that are not considered food)
• Swollen mouth & gums

Question 25

When is "morning sickness" most common?

Answer 25

First trimester

Question 26

What happens when there is increased progesterone?

Answer 26

Lower esophageal sphincter relaxes Decreased gut motality

Question 27

These are drugs that can cause birth defects in the developing fetus.

Answer 27

Teratogenic Drugs

Question 28

What are TERATOGENIC DRUGS?

Answer 28

"TERA-TOWAS" T- Thalidomide E- epileptic medications (valproic acid, phenytoin) R - retinoid (vit A) A - Ace inhibitors, ARBs T - Third element (lithium) O - oral contraceptives W - warfarin (coumadin) A - Alcohol S - sulfonamides & sulfones

Question 29

What are considered as TORCH infections (infections that can cross the placenta, harm pregnant women and the developing fetus)?

Answer 29

T - Toxoplasmosis O - Other infections R - Rubella C - Cytomegalovirus (CMV) H - Herpes simplex virus (HSV)

Question 30

The poor intake of this increases fetal risk for neural tube defects (NTDs)

Answer 30

Folic Acid

Question 31

How much folic acid should be consumed daily?

Answer 31

600-800 mcg/day

Question 32

* Needed for tissue growth * Great sources of protein: lean meats, eggs, cheese, milk, nuts, legumes

Answer 32

Protein

Question 33

* DHA intake (300 mcg/day) * Needed for brain development for the growing fetus

Answer 33

Omega-3 fatty acids

Question 34

How much should you gain in the first trimester?

Answer 34

About 2.2-4.4 lbs (1-2 kg)

Question 35

How much should you gain in 2nd and 3rd trimester?

Answer 35

0.5-1 lb per week

Question 36

* Iron intake (25–30 mg/day) * ↑ risk for iron defi ciency due to ↑ iron requirements during pregnancy * Adequate intake is needed to supply the fetus with iron

Answer 36

Iron

Question 37

* Same intake as non-pregnant (1,000 mg/day)

Answer 37

Calcium

Question 38

How many calories should be increased in first trimester?

Answer 38

No increase

Question 39

How many calories should be increased in second & third trimester?

Answer 39

Additional 300-400 calories per day

Question 40

Foods to avoid during pregnancy

Answer 40

✘ Unpasteurized milk ✘ Unwashed fruits & vegetables ✘ Deli meat ✘ Liver ✘ Raw fi sh/raw meat ✘ Fish high in mercury (shark, tilefi sh, swordfi sh, etc.) ✘ Alcohol

Question 41

Excess amount of caffeine intake contribute to what?

Answer 41

Intrauterine Growth Restriction (IUGR)