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19 Cards in this Set

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Uterine changes during 1st trimester:
The nonpregnant uterus weight about 70 g with a 10 ml cavity
1st trimester: uterus at 6 wks is soft, globular and asymmetric (Piskacek's sign) @ 12 wks it is 8-10 cm and is rising out of the pelvis.
Uterine changes during early 2nd trimester:
@ 14 wks the uterus is 1/4 of the way to umbilicus
@ 16 wks it is half way to the umbilicus
@ 20 wks it is the fundus is approximately at the umbilicus.
@ 14 wks the uterus is 1/4 of the way to umbilicus
@ 16 wks it is half way to the umbilicus
@ 20 wks it is the fundus is approximately at the umbilicus.
Uterine changes after 20 wks:
The number of cm with the tape measure equals number of weeks of gestation within 2 cm.
By term the uterus weights about 110g with a 5 liter volume
Cervical changes in pregnancy:
Develops increase vascularity
Hegar's sign is softening of the isthmus
Chawick's sign is bluish color of the cervix
Goodell's sign is softening of the cervix
A thick mucous plug forms secondary to gladular proliferation
Ovarian changes during pregnancy:
Anovulation secondary to hormonal interruption of the feedback loop
Corpus luteum persists under the influence of the hormone hCG until about 12 wks.
Corpus luteum is responsible for the secretion of progesterone to maintain the endometrium and pregnancy until the placenta take over production
Ovaries also thought responsible for production of relaxin.
Vaginal changes during pregnancy:
Chadwick's sign-bluish color
thickening of vaginal mucosa
increase in vaginal secretions
some loosening of connective tissue in preparation of birth
Breast changes in pregnancy:
Increase in size secondary to mammary hyperplasia
Areola becomes more deeply pigmented and increase in size
Colostrum may be expressed after the first several months
Montgomery's follicles
Vascularity increases.
Pelvis- four types:
Most common to least common:
1. Gynecoid - 41-42% - Good prognosis for birth
2. Antropoid - 23.5% of white females & 50% of
nonwhite women - Good prognosis for birth
3. Android - 32.5% of white women and 15.7% of
nonwhite women - Heavy heart shaped pelvis leads
to increase posterior positions, dystocia, and
operative births
4. Playpelloid - < 3% RARE pelvic type - Prognosis of
vaginal delivery poor secondary to short AP diameter.
**Remember GAAP**
Gastrointestinal Changes in pregnancy:
Mouth and pharynx:
1. Gingivitis is common and may result in bleeding of gums
2. Increased salivation
3. Epulis (a focal swelling of gums) may develop and resolves after the birth
4. Pregnancy DOES NOT increase tooth decay.
Esophagus
1. Decreased lower espohageal sphincter pressure and tone.
2. Widening of hiatus with decreased tone
3. Heartburn is common
Stomach
1. Decreased gastric emptying time
2. Incompetence of pyloric sphincter
3. Decreased gastric acidity and histamine output.
Large & small intestines
1. Decreased tone & motility
2. Altered enzymatic transport across villi resulting in increased absorption of vitamins
3. Displacement of intestines, cecum, and appendix by the enlarging uterus
Gallbladder
1. Decreased tone & motility
Liver
1. Altered production of liver enzymes
2. Altered production of plasma proteins and serum lipids.
Gentiourinary/renal changes in pregnancy:
1. Dilation of renal calyces, pelvis, and ureters resulting in increased risk of urinary tract infection.
2. Decreased bladder tone
3. Renal blood flow increases 35-60%
4. Decreased renal threshold for glucose, protein, water soluble vitamins, calcium, and hydrogen ions.
5. Glomerular filtration rate increases 40-50%
6. All components of the renal-angiotensin-aldosterone system increase, resulting in retention of water, resistance of pressor effect of agniotensin II, and maintenance of normal blood pressure.
Muscoloskeletal changes in pregnancy:
1. Relaxin and progesterone affect cartilage and connective tissue. This results in loosening of the sacroiliac joint and symphysis pubis. It also encourages the development of the characteristic gait of pregnancy.
2. Lordosis
Respiratory changes in pregnancy:
1. Level of diaphragm rises about 4 cm becaused of the increase in uterine size
2. Thoracic circumference increases by 5-6 cm and residual volume is decreased
3. A mild respiratory alkalosis occurs due to decreased PCO2
4. congestion of nasal tissue occurs
5. Respiratory rate changes very little, but the tidal volume, minute volume ventilatory, and minute oxygen uptake all appreciably increase.
6. Some women experience a physiologic dyspnea, due to the increased tidal volume and lower PCO2
Hematologic changes in pregnancy:
1. Blood volume increases by 30-50%
2. Plasma volume expand which results in a physiologic anemia
3. Hemoglobin averages 12.5g/dL
4. Some require an additional gram of iron in pregnancy
5. Pregnancy can be considered a hypercoaguable state, since fibrinogen (Factor I), and Factors VII-X all increase during pregnancy.
Cardiovascular changes in pregnancy:
1. Cardiac volume increase by about 10% and peaks at about 20 wks
2. Resting pulse increase by 10-15 beats per minute with a peak at 28 wks.
3. Slight cardiac shift (up and to the left) due to enlarging uterus.
4. 90% of pregnant women develop a physiologic systolic heart murmur.
5. May have exaggerated splitting of S1, audible third sound, or soft transient diastolic murmur.
6. Cardiac output is increased
7. Diastolic blood pressure is lower in first two trimesters due to development of new vascular beds and relaxation of peripheral tone by progesterone that results in decreased flow resistance.
Changes in the integumentary system during pregnancy:
Vascular changes:
1. Palmar erythema
2. Spider angiomas
3. Varicose veins and hemorrhoids
4. Hyperpigmentation is believed to be related to estrogens and progesterone which have a melanocyte-stimulating effect.
5. Choasma, feckles, nevi, and recent scars may darken.
6. Linea nigra
7. Increase in sweat/sebaceous activity
8. Changes in connective tissue resulting in striae gravidum.
Hair growth
1. Estrogen increases the length of the anagen (gowth) phase of hair follicles.
2. Mild hirsutism may develop in early pregnancy
Changes in the endocrine system during pregnancy:
Pituitary
1. Prolactin levels are 10 times higher at term than in the non pregnant state
2. Enlarges by over 100%
Thyroid
1. Increases in size by about 13%
2. Normal pregnant women is euthyroid due to estrogen-induced increase in thyroxine binding globulin (TBG)
3. Thyroid stimulating hormone (TSH) does NOT cross the placenta
4. Thyroid stimulating globulines and Thyrotropin-releasing hormones (TRH) DO cross the placenta
Adrenal glands
1. Remain the same size, however, there is an increase in the zona fasciculata that produces glucocorticoid.
2. Twofold increase in serum cortisol.
Pancreas
1. Hypertrophy and hyperplasia of the B cells
2. Insulin resistance as a result of the placental hormones especially hPL
Metabolism
Weight gain during pregnancy:
Based on BMI:
* Underweight/BMI under 18.5-Gain 28-40 lbs total
2nd & 3rd Trimester = 1.0-1.3 lbs per wk
* Normal weight/BMI 18.5 to 24.9-Gain 25-35 lbs total
2nd & 3rd Trimester = 0/8-1.0 lb per wk
* Overweight/BMI 25.0-29-9-Gain 15-25 lbs total
2nd & 3rd Trimester = 0.5=0.7 lbs per wk
* Obese/BMI 30.0 and above-Gain 11-20 lbs total
2nd & 3rd Trimester = 0.4-0.6 lb per wk
Average weight gain in pregnancy:
is 28 lbs
1.5 lbs for placenta
2 lbs for amniotic fluid
2.5 lbs for uterine growth
3 lbs for increased blood volume
1 lb for increased breast tissue
7.5 lbs for fetus
Remainder for maternal fat deposits
How is metabolism of protein & carbohydrates altered during pregnancy?
How is fat deposit and storage altered during pregnancy?
Protein metabolism is increased
Carbohydrate metabolism is altered, the blood glucose levels are 10-20% lower than non pregnant states.
Fat deposit and storage is increased to prepare for breastfeeding.