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44 Cards in this Set

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What are the 5 primary hormones effected by pregnancy
HCG
Estrogen
Progesterone
HPL
Relaxin
What are the cases/effects of Estrogen during pregnancy
Secreted: Corpus luteum (placenta @ 7wks)
Effects:stimulates breast developement and ducts in breast tissue. Pigmentation of skin (linea nigra), diffuse fluid retention.
What are the cases/effects of Progesterone during pregnancy
Secreted: Corpus luteum (placenta @ 10-12wks)
Effects: decrease ctx, stim developement of breast acini and lobules. Slow GI tract, chnages in CHO metab.
What are the cases/effects of HPL during pregnancy
Secreted: by syncytiotrophoblats
Effects: Mat. meta; increased free fatty acids, decreased glucose (promote fetal growth). Changes in CHO metab may lead to gest.dm
What are the cases/effects of HCG during pregnancy
Secreted: trophoblasts
Effects: stimulates CL to produce estrogen and progesterone. N/V preg +preg test
What are the cases/effects of Relaxin during pregnancy
Secreted: by CL
Effects: decreased uterine axtivity, remodels collagen, soften p.joints/abdomen (make room for fetus). Striae of breasts, gait changes
Changes in uterus duing pregnancy
-Increased size (hypertropy/hyperplasia)-
*Cause: Increased estrogen, later due to grwth of fetus

-Myometrical hypertrophy (later thinning)-
*Causes: estrogen
*Result: Fetus palpable
Changes in cervix during pregnancy
(1)Inc production of cervical mucus
*Causes: estrogen stimulates glands to increase production
*Result: seals of uterine cavity

(2)Goodall's(softening)
*Causes: increased vascularization, engorgement of BVs

(3)Chadwick's (cyanosis)
*Causes: increased vascularization, engorgement of BVs
Changes to vagina during pregnancy
(1)Increased vascularity and distendability
(2)Estrogen causes thickening of mucosa
(3)Increase vaginal pH (yeast infect)
Results and effects of increased uterine size during pregnancy.
(1)Increased femoral venous pressure: edema below uterus

(2)C-V: displacement of heart up and to the left

(3)Resp: increase O2 consumption (15-20%), TV, diaphram up, ribs out, SOB

(4)GI: Heartburn

(5)UT: pressure on bladder
Effects of Pregnancy on CV system
(1)Blood volume: increase by 45% by end, nurished fetus and placenta. Can result in anemia, decreased systemic vasc. & pulm. resistance and increased CO.

(2)CO increases 30-50% by 26 wks

(3)RBC(by 30%), WBC (@5-12k) production. Increase O2 delivery, protect infection.

(4)Fibrin/Fibrinogen: inc by 40-50%. Prevent hemorrhage @ del, inc risk of clot.

(5)Increased bllod flow to uterus and kidney.

(6)HR increase 10-15bpm
Effects of pregnancy on the urinary tract
Increased tubular reabsorption (partly compensates for GFR)

Urinary: increased RPF & GFR. Alt norm level of

Ureters and Pelvis dilate b/c hormones and pressure on uterus and kidneys
What are the PRESUMPTIVE(subjective)signs and symptoms of pregnancy.
-absense of menses
-N&V
-Urinary freq
-Breast tenderness, discoloration, discharge
-"quickening"
-Pigmentation of the skin (mask and belly line)
What are the PROBABLE(Possible, objective) signs and symptoms of pregnancy.
-Enlargement of abdomen
-Changes in size, shape, consistency of uterus
-Fetal outlines distinguished by abdominal palp
-Braxton hicks contractions
+Pregnancy test
+Goodell's (soft cervix)
+Hegar's (soft isthmus)
+Chadwick's (cyanosis)
What are the POSITIVES(diagnostic)signs and symptoms of pregnancy.
-Fetal heart sounds
-Doppler 10-14 wks
-Fetoscope 18-20 wks
-Fetal movement felt by examiner
-Ultrasound
Define
(a) abortion
(b) Gravida
(c) Partity
(d) Nulligravida/nullipara
(e) Primigravida/Primipara
(f) Multigravida/Multipara
(g) Term
(h) Post/term
(i) Viability
(a) <20 wks or <500g

(b) # of preganancies

(c) # of preg carried past 20wks

(d) never been pregnant/ never carried to viable age

(e) 1st preg/ 1st preg to 20wks

(f) 2+ pregnancy, 2+ viable pregnancy

(g) 38-42 wks

(h) +42 wks

(i)Ability to survivr outside the uterus
What are Macdonald's measurements (on the back)
-12wks: fundus @ symphysis
-16wks: 1/2 b/t symphysis & unbilicus
-20wks: @ umbilicus
-22-24wks: dist cm from syphysis and fundus.
Psychological changes during pregnancy
-1st trimester: acceptance of preg, incorp to part of self, ambilvalence normal.

-2nd trimester: acceptance of preg/fetus by self/others. Relationship w/mother/fam.

-3rd trimester: separation fetus-self, prep for birth, fam change.

-L&D: safe passage for self/babe
What are the common lab tests that are run during pregnancy:
-CBC
-Rubella screen
-Varicella screen
-VDRL: Veneral Disease Research Lab
-GDM: if BMI>30 @16-20wks repeat 26-28wks
-Chlamydia
-Gonorrhea culture
-Pap smear: HPV
-Glucose. Glucola 26-28wks
-Rh factor
-HIV testing
-GBS 36-37wks
Triple/Quad test 15-18 wks
-Alpha-fetoprotein (AFP)testing: High inc risk neural tube defect. Low indicates downs
-HCG
-Inibin A
-Estriol

-Multiple marker test: AFP hCG, estriol; Quad screen: AFP, hCG, estiol plus inhibin A

TORCH: Toxoplasmosis, Other, Rubella, Cytomegalovirus and Herpes
Nutrional needs of pregnant women
FIRST TRIMESTER
-eat what stays down
-may increase CHO
-cut out substances

2nd/3rd TRIMESTER
-quality/quantity
-Protein +30%
-Caloties: +300
-Fe: +100% (30mg)
-Folic acid: 50% (600mcg)4g w/hx
-H2O sol vita 10-20%
Weight gain benchmarks during pregnancy
-25-35 lbs during preg
-1st tri 3-5lbs
-Gain 10lbs in 1st 20wks
-2nd&3rd trimester 1/2-1lbs/wk

Fetus 2x's wt from 32-40wks, 1/2lbs/wk last week.
What the danger signs in each trimester
1st:
-Severe vomitting
-Fever >24hrs/ >101
-Buring in urination
-Ab cramping/bleeding

2nd and 3rd:
-change in fetal movements
-Watery discharge/ROM
-Sudden inc sweat (HTN)
-Pain/bleeding
What is a typical follow-up visit scedule
-Q4 wks <28s
-Q2 wks 28-36wks
-Q week 36-41wks
What are typical lab values for a pregnant women
-HGB: 10-14
-HCT: 32-42
-WBCs 5-15
-Fibrinigen: 400
What are the external structures of the female reproductive system
-Mons pubis
-Labia majora/minora
-Clitoris
-Vestibular glands
-Vaginal vestibule
-Vaginal orifice
-Urethral opening
What are the internal structures of the female reproductive system
-Vagina
-Uterus
-Uterine tubes
-Ovaries
What are the 4 pairs of ligaments that support the uterus
-Cardinal
-Uterosacral
-Round
-Broad
What are the bones of the pelvis
(1) innominate bones (ilium, ischium, pubis)

(2)Sacrum

(3)Coccyx
What is the dividing line between true and false pelvis
The Inlet (false below/true above)
Effects of Estrogen/Progesterone on the breasts
ESTROGEN
-Stimulate growth by inducing fat deposition
-Increase elasticity
-Growth of the ductile system
-Inc vascularization of breast tissue

PROGESTERONE
-Maturation of mammary gland tissue
Identify structures of the breast
mammary glands- lobes- lobules- acini (secrete milk/colostrum)

-Lactiferous sinuses serve as milk reseviors connect to the nipples
Normal timing on mensturation
-Onset: 13 yrs
-Uterine bleeding: 14 days post ovulation
-Length of cycle: 28 days
-Duration of flow: 3-6 days
-Blood loss: 20-80ml
Phases of endometrical cycle
(1)Menstrual phase: shedding of functional 2/3 of endometrium

(2)Proliferation phase: period of rapid grwth (5th day- ovulation). Depends on estrogen stimulation from ovarian follicles. Estrogen peaks

(3)Secretory phase: day of ovulation- 3 days b/f next period. Large amts of progesterone are produced. By the end of this phase endometrial lining fullly formed.

(4)Ischemic phase: if ovulation has not occured blood supply cut off and necrosis occurs.
Timing of Ovulation and implantation
OVULATION: around 14th day of endometrial cycle

IMPLANTATION: 7-10 days after ovulation
Define fertilization, implantation and conception
FERTILIZATION: union of egg and sperm, usually occurring in the ampulla of the fallopian tube.

IMPLANTATION: zona pellucida degenerated, trophoblast attactes to uterine wall (6-10 days post conception) usually in anterior/posterior region of fungus.

CONCEPTION:
Calculating fetal age.
BASIC: 40 weeks (280 days) from the LMP, or 38 weeks (266 days) from the date of fertilization.

Naegele's rule:
LMP + 7days - 3months + 1yr
Define Gametogenesis, Oogenesis, spermatogenesis
GAMETOGENESIS: production of gametes

SERMATOGENESIS: in male production of 4 mature gamates

OOGENESIS: in female the production of one mature ovum and 3 polar bodies
Mitotic vs Meiotic cellular division
MITOSIS: results in 2 dipliod cells

MEIOSIS: results in 4 hapliod cells (gametes)
Define Mendelian inheritance in relation to single-gene and multifactoral inheritance.
Multifactorial inheritance:
combination of genetic and environmental factors

Single-Gene inheritance:
when one gene controls a trait, disorder or defect.
What are the terms used to describe abnormalities of chromosomal number
(1) polyploidy, exact multiple of a chromosomal set

(2) Aneuploidy: not all the chromosomes are duplicate
What does G_P_tpal represent
G- gravida
P- paragravida
t- term
p- premature
a- abortion
l- living children
What are other physiological changes that occur during pregnancy
Neurological: carpal tunnel syndrome (edema to peripheral nerves)

Gallbladder: distend, tockening of bile, slight hypercholesterolemia from increase progesterone.
List five factors affecting progress in labor
(1)Passageway
(2)Passenger
(3)Postition
(4)Power
(5)Psycological response
List 4 pelvic shapes
(1)Gynecoid
(2)Android
(3)Anthropoid
(4)Platypelloid