Week 4 maternal adaptation during preg Flashcards
1
Q
Uterine grow occurs as a result of ____ and ___
A
Hyperplasia and hypertorphy
2
Q
Late uterine growth is caused by ____
A
stretching of the uterine muscles resulting in hypertrophy
3
Q
early uterine growth is caused by
A
hyperplasia caused by hormones
4
Q
By week ___ the uterus can be palpated
A
12
5
Q
Where can the uterus be palpated at week 12?
A
above the pubis symphysis
6
Q
Where can the uterus be palpated at week 16?
A
Midway between the PS and the umbilicus
7
Q
Where can the uterus be palpated at week 20?
A
the umbilicus
8
Q
In late pregnancy, uterine blood flow reaches up to ____ an minute. This is ___% of maternal blood
A
1200ml
17%
9
Q
What is the most obvious change to the cervix during pregnancy?
A
Changes in color and consistancy
10
Q
What is chadwicks sign?
A
Discoloration of the cervix, vagina, and labia d/t congestion of blood caused by increased estrogen
11
Q
What is Goodell’s sign
A
softening of the cervix
12
Q
How does the cervical plug form and what is its function?
A
It forms as cervical glans proliferate. the tissue becomes honeycomb and excretes mucus rich in immunoglobulins
-its function is to block the ascent of bacteri from the vagina to the uterus
13
Q
How long does the cervical mucus plug remain in place?
A
Until dilation and effacement occurs
14
Q
why are pregnant women at risk for developing UTIs, kidney infections, and candida albicans during pregnancy
A
-because glycogen increases in the vagina and creates an acidic environment. This inhibits many bacteria but the rich glycogen favors the growth of Candida albicans and can cause yeast infections and uti’s
15
Q
How long after conception does the corpus luteum continue to produce hormones befor the placenta takes over?
A
6-7 weeks
16
Q
What is the main function of progesterone during pregnancy?
A
to suppress contractions of the uterus and prevent fetal rejection
17
Q
How do estrogen and pregesteron affect breast development during pregnancy?
A
estrogen stimulates growth of ducts
progesterone promotes growth of lobes, lobules, and alveoli
18
Q
Colostrum can be secreted as early as ____ weeks gestation
A
16
19
Q
How does the heart change during pregnancy?
A
- Enlarges 10-15% in first tri
- Pushed up and to the left as uterus elevates during third tri
- Locations for ausculatation are shifted during late preg
20
Q
When can maternal heart sound changes be detected?`
A
between 12-20 weeks
21
Q
What are the two most common maternal heart changes?
A
- Splitting of the first heart sound
- Systolic murmur
22
Q
Where is a systolic murmur best heard?
A
PMI
mitral/apical
23
Q
___ women have a third heart sound during pregnancy
A
90%
24
Q
Why does blood volume increase during pregnancy>
A
- Increased transport needs
- Increased tissue needs
- Protections from blood loss
25
Why do maternal Hgb and Hct values decline despite the increased RBC volume?
What is the phenomenon called?
The increase in platelets is much higher and causes dilution
| -Physiologic anemia
26
A mother is considered iron deficency anemic when her hgb is less than ____ in the ____ trimester(s) and less than ____ in the ___ trimester(s)
11g/dl first and third
| 10.5g/dl second
27
The dilution of RBC's by plasma may have a protective function. Why is that?
-It decreased blood viscosity and may counter the increased risk for clots from increased fibrinogen
28
Why does maternal CO increase during pregnancy?
| When is CO highest? When is CO lowest?
It increases as a result of increased stroke volume
- It is highest when the woman is on her side
- Lowest when standing or laying supine
29
What happens to systemic vascular resistance during pregnancy?
It lowers
30
Why does systemic vascular resistance lower during pregnancy?
- Progesterone and Prostaglandins cause vaso dilation
| - Endothelial prostacyclin and endothelial-derived relaxant factors such as nitric oxide
31
What happens to maternal blood pressure during pregnancy?
-Minimal changes because of decreased vasc. resistanced and increased blood volume balancing each other
32
How does progesterone affect BP? when does this begin to occur?
It decreases diastolic BP slightly begins around 6 weeks and is most noticable begining in third tri
33
What is supine hypotension?
-Occlusion of the vena cava lowers venous return from LE's and reduces cardiac return
34
Pregnant women are in a ____ state because of increased clotting factors and decreased clot inhibiting factors
Hypercoagulable state
35
What clotting factors rise during pregnancy?
Fibrinogen(1), 7, 8, 9,and 10
36
What factor that normally inhibits clots is decreased during pregnancy?
Fibrinolytic activity
37
How does the maternal respiratory system change during pregnancy?
-O2 consumption is increased r/t fetal needs and increased metabolic needs of mom
38
How does progesteron affect breathing?
It caused mom to hyperventilate slightly because of deeper breaths not increased RR
39
What two states facilitate transfer of CO2 from the fetus to the mother?
Hyperventilation and resp. Alkalosis
40
What is the major cause of maternal respiratory changes during pregnancy?
increased oxygen consumption, hormonal factors, and physical effects of the enlarging uterus
41
What is the physiology behing progesterones effect on a respirations?
- It decreases airway resistance and increases the sensitivity of the breathing center
- This causes a heightened awareness of the need to breath and the feeling of SOB
42
Why are pregnant women at high risk of Gastric reflux?
Relaxation of the LES
43
How is gastric motility affected by pregnancy? What are some SE's of this?
Emptying time decreases to allow more time for nutrient absorption
-May cause bloating and constipation and decreased B-vitamin absorption
44
What are the two main factors that affect the liver during pregnancy?
- Progesterone and Estrogen cause functional changes
| - Uterus changes the livers position and affects its function
45
Why are pregnant woment at higher risk of gall stones?
- Gallbladder becomes hypotonic and has decreased function
- Bile becomes thicker
- Bile retention (causes itching)
46
How does pregnancy affect Liver labs?
- Alk. Phos increases x2-4
| - Hemodilution causes decreased albumin and total protein
47
How does progesterone affect the bladder?
Decreased tone
48
Why do pregnant women have nocturia?
- Water and sodium retention during the day and release at night.
- Edema from decreased blood drainage (from uterine pressure)
- (uterine pressure)
49
Why do pregnant women have a higher risk for bacteriuria/pyelonephritis?
Obstructed urinary flow in the ureters causes urinary stasis
50
How does pregnancy effect the function of the kidneys?
- Increased plasma flow
- Increased GFR d/t increased CO
- Increased glucose excretion
- Mild proteinuria is common
51
Oxytocin is inhibited by ___
progesterone
52
Why does the thyroid gland increase in size during pregnancy?
-Hyperplasis and increased vascularity
53
Why is it important to monitor thyroid funtion in pregnant women?
- T4 and T3 cross the placenta.
| - The fetus does not make its own until 10-12 weeks and is needed for early neurological function development
54
How do pregnant blood glucose levels compare to pre-preg levels?
10-20% lower
55
During pregnancy, when does insulin sensitivity decline? Why?
second half.
Because of HGS, prolactin, estrogen, progesterone, and cortisol.
Basically, the body needs more GB for metabolism so it decreased sensitivity to raise bg
56
Why is maternal fasting GB low?
Because excess blood glucose goes to the fetus
57
Why is post partem blood glucose higher?
Because of the left over insulin resistance
58
What is gestational DM?
When the pregnant mothers pancreas doesn't increase insulin production to an adequate level to make up for the increased resistance. Causing hyperglycemia
59
Why does cortisol increase during pregnancy? Its function?
- As a result of estrogen and decreased metabolism
| - It stimulates gluconeogenesis to insure appropriate GB levels
60
Why does aldosterone increase during pregnancy?
-to overcome salt-wasting effects of progesterone
61
What is the primary function of HCG
To prevent deterioration of the corpus luteum until the placenta takes over
62
What are some functions of estrogen during pregnancy?
- Suppression of FSH and LH
- Stimulation of uterine growth
- Increased blood supply to uterine vessels
- Added deposit of maternal fat stores
- Increased uterine contraction near term
- Development of the glands and ductal system in the breasts
- Hyperpigmentation
- Stimulation of vascular changes in the skin, breasts, upper resp tract and bladder
- Antagonist to insulin
63
What are some functions of progesterone during pregnancy?
- Suppression of fsh and lh
- Maintenance of the endometrial layer for implantation of the fertilized ovum and prevention of menstruation
- Decreased uterine contractility
- Increased fat deposits
- Stimulation of development of the lobes, lobules, and ducts in the breasts
- Relaxation of smooth muscles of the uterus, gastric sphincter, bowel, ureters, bladder
- Increased resp sensitivity to carbon dioxide, stimulation ventilation
- Suppression of the immunologic response, preventing rejection of the fetus
- Antagonist to insulin
- Retention of sodium
64
What is the primary function of HPL and HCS
increase availability of glucose for the fetus
65
Basal metabolic rate increases by _____ by the third trimester
10-20%
66
What are some factors that cause edema during pregnancy?
- Helodilution causes slightly decreases colloid osmotic pressure
- Decreased venous return
67
How are eyes affected during pregnancy?
- corneal edma= contact lens discomfort
| - Decreased IOP= improved glaucoma
68
How are the ears effected during pregnancy?
changes in eustachian tube MM's may cause blocked ears and mild hearing loss
69
How does the immune system change during pregnancy?
it is altered to allow for the fetus to not be rejected
- May cause rh arthritis and multiple sclerosis to improve
- Slight decrease in infection resistance
70
What is a presumptive indication of pregnancy?
most, but not all, indications are subjective and reported by the woman. Least reliable indicators of pregnancy
71
What are the 7 main presumptive indications of pregnancy?
- Amenorrhea (absence of menstration)
- N/V
- Fatigue
- Urinary frequency
- Breast and skin changes
- Vaginal and cervical color change
- Fetal movements
72
What is a probable signs of pregnancy?
Objective findings that can be documented by examiner
73
What are 9 probable signs of pregnancy?
- Abdominal enlargement
- Cervical softening
- Changes in uterine consistancy
- Ballottement (dancing fetus when tap the cervix)
- Braxton-Hicks
- Palpation of fetal outline
- Uterine souffle
- Sound of blood curculating through uterine vessels corrosponding to maternal pulse
- Pregnancy tests
74
what is Uterine soufflé
: soft, blowing sound, may be auscultated over the uterus
75
What hormones do pregnancy tests detect.
| How early can they be positive?
- hCG or B-hCG
| - 3-7 days after conception detectable but depending on the test it can be later
76
What void is the best for a urine preg test
First morning void
77
What is a positive indication of pregnancy?
Positive confirmation
78
What are the only three signs that are positive indications of pregnancy?
- Auscultation of a fetal heart (as early as 6 weeks with doppler and 18-20 with fetoscope)
- Fetal movement detected by examiner
- Visualization of the embryo or fetus (as early as 3-4 weeks vis trans vag u/s)
79
What is the self statement during the first trimester?
I am pregnant
80
What is the self statement during the second trimester?
I am going to have a baby
81
What is the self statement during the third trimester
I am going to be a mother
82
What are the three main paternal developmental responses to pregnancy?
1) grappling with the reality of pregnancy and the new child
2) struggling for recognition as a parent from his family and social network
3) making an effort to be seen as relevant to childbearing
83
What are the AAP & ACOG recommendations for F/U in a healthy pregnancy?
- Conception to 28 weeks – every 4 weeks
- 29-36 weeks – every 2 weeks
- 37 weeks to birth weekly
84
What are the critical signs of a pregnancy complication?
- Vaginal bleeding
- Leaking fluids
- Swelling of fingers or eyes/face
- Continuous H/A
- Visual disturbances
- Seizures
- Severe abdominal or epigastric pain
- Fever/chills
- Painful urination
- Persistant vomiting
- Changes in fetal movement and strength
- s/s of preterm labor
85
What can cause Persistent or severe abdominal or epigastric pain?
Ectopic preg, worsening preeclampsia, placental abruption
86
Persistent vomiting is a symptom of ___
Hyperemesis gravidarum
87
Changes in frequency or strength of fetal movement could indicate___
Fetal compromise or death
88
What are some s/s of preterm labor?
uterine contractions, cramps, constant or irregular low backache, pelvic pressure, watery vaginal discharge
