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49 Cards in this Set
- Front
- Back
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Changes in the Uterus
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-pre-pregnancy 7.5 X 5 X 2.5cm (weight 60g or 2oz)
-End of pregnancy 28 X 24 X 21 cm (weight 1100g or 2.5lb) -Enlargement is result of an increase in size (hypertrophy) of the preexisting myometrial cells -Only a limited increase in cell number (hyperplasia) occurs -Uterine wall becomes thicker during the first few months of pregnancy; then, the musculature begins to distend, resulting in a thinning of the muscle wall -Circulatory requirements increase as the uterus enlarges and the fetus and placenta develop -Size and number of blood and lymphatic vessels increase; by the end of pregnancy, one sixth of the total maternal blood volume is contained within the vasculature system of the uterus |
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Braxton Hicks Contractions
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-Intermittent painless contractions of the uterus that may occur every 10 to 20 minutes. They occur more frequently toward the end of pregnancy and are sometimes mistaken for true labor signs
-May be palpated bimanually beginning about 4th month -Help stimulate the movement of blood through the intervillous spaces of the placenta |
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Changes of the Cervix
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-Estrogen stimulates increase in cell numbers and becomes hyperactive
-Cells create a mucus plus that seals the endocervical canal and prevents the ascent of bacteria and other substances into the uterus; it is then expelled when cervical dilation begins -Goodell's sign -Chadwick's sign |
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Goodell's sign
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-Softening of the cervix that occurs during the second month of pregnancy
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Chadwick's Sign
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-Violet bluish color of the vaginal mucous membrane caused by increased vascularity, visible from about the fourth week of pregnancy
-Changes are estrogen induced |
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Changes of the Ovaries
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-Cease ovum production during pregnancy
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Changes of the Vagina
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-Cells undergo hypertrophy, increased vascularization, and hyperplasia during pregnancy
-Changes are Estrogen induced -Secretes a thick, white, acidic (pH 3.5-6) mucus to prevent infections (does favor yeast growth and results in moniliasis) -Chadwick's sign |
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Changes of the Breasts
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-Induced by estrogen and progesterone
-Increase in size and nodularity caused by hyperplasia and hypertrophy in preparation for lactation -End of 2nd month- superficial veins are prominent, nipples are more erectible, and pigmentation of the areola is obvious |
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Colostrum
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-An antibody-rich, yellow secretion, may be expressed manually by the 12th week and may leak from the breasts during the last trimester
-Gradually converts to mature milk during the first few days after birth |
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Changes of the Respiratory System
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-Pregnancy induces small degree of hyperventilation as the tidal (amount of air breathed with ordinary respirations)
-Oxygen consumption increases 15%-20% -Vital capacity increases while compliance and pulmonary diffusion remain constant -Overall, pulmonary function is not impaired by pregnancy |
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Changes of the Cardiovascular System
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-Heart is pushed upward and to the left and rotated forward
-Systolic murmur can be heard in 90% of pregnancy women -Fifth and third beats are louder -Blood volume increases by pressures remain constant -Cardiac output increases -Pulse rate increases -Blood pressure decreases slightly until 3rd trimester when it increases -Increased tendency toward stagnation of the blood in the lower extremities, with a resulting dependent edema and tendency toward varicose vein formation in the legs, vulva, and rectum -Prone to postural hypotension -Risk for DVT |
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Supine hypotensive syndrome (vena caval syndrome, aortocaval compression)
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-A condition that can develope during pregnancy when the enlarging uterus puts pressure on the vena cava when the woman is supine. This pressure interferes with returning blood flow and produces a marked decrease in blood pressure with accompanying dizziness, pallor, and clamminess, which can be corrected by having the woman lie on her left side
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Physiologic anemia of pregnancy
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-Apparent anemia that results because during pregnancy the plasma volume increases more than the erythrocytes increase
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Changes of the Gastrointestinal System
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-Nausea and vomiting in 1st trimester related to hCG and change in carbohydrate metabolism
-Peculiarities of taste and smell are common -Gum tissue becomes soft and bleeds -Saliva secretions may increase or become excessive (ptyalism) -Heartburn (pyrosis) -Gastric emptying time and intestinal motility are delayed -Hemorrhoids frequently develop |
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Changes of the Urinary Tract
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-Urinary frequency until 2nd trimester
-Near term, pressure is exerted on the bladder which can impair drainage of blood and lymph from the hyperemic bladder, rendering it mor susceptible to infection and trauma -Presence of AAs and Glu in urine -Increased risk of UTI -GFR and RPF (renal plasma flow) increase -Decreased BUM and creatinine |
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Changes of the Skin
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-Caused by increased estrogen, progesterone, and alpha-melanocyte-stimulating hormone levels
-Pigmentation increases in areolae, nipples, vulva, perianal area, and linea alba -Cholasma -Straie, or stretch marks, are reddish, wavy, depressed streaks that may occur over the abdomen, breasts, and thighs as pregnancy progresses |
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Cholasma (melasma gravidarum)
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-Brownish pigmentation over the bridge of the nose and the cheeks during pregnancy and in some women who are taking oral contraceptives
-AKA mask of pregnancy |
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Vascular spider nevi
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-Small, bright-red elevations of the skin radiating from a central body may develop on the chest, neck, face, arms, and legs
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Changes of the Hair
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-Rate of hair growth may decrease during pregnancy
-Rate increases significantly for 1 - 4 months after birth -Sweat and sebaceous glands are frequently hyperactive during pregnancy |
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Changes of the Musculoskeletal System
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-Teeth are not changed
-Sacroiliac, sacrococcygeal, and pubic joints relax causing a waddling gait -Lumbodorsal spinal curve is accentuated causing aches in the neck, shoulders, and upper extremities -Paresthesias due to pressure on peripheral nerves |
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Changes of the Eyes
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-Intraocular pressure decreases due to increased vitreous outflow
-Slight thickening of the cornea due to fluid retention |
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Changes of the Central Nervous System
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-Decreased attention, concentration, and memory
-Sleep problems: difficulty falling asleep, frequent awakenings, fewer hours of sleep, and reduced sleep efficiency |
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Weight Gain
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-Recommended total weight gain during pregnancy for a woman of normal weight before pregnancy is 11.5 to 16 kg (25 to 35lb)
-For women who were overweight 6.8 to 11.5kb (15 to 25lb) -Obese women are advised to limit weight gain to 5 to 9kg (11 to 20lb) -Underweight women are advised to gain 12.7 to 18.1kg (28 to 40lb) |
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Water Metabolism
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-Increased water retention
-Extra water is needed for the products of conception: the fetus, placenta, and amniotic fluid; and the mother's increased blood volume, interstitial fluids, and enlarged organs |
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Nutrient Metabolism
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-Increased protein retention
-Fats are more completely absorbed causing cholesterols to rise and decrease elimination of the bowel -Glycosuria -Demand for iron -Progressive absorption and retention of calcium |
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Changes of the Thyroid
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-Increase in size
-Total serum thyroxine (t4) increases in early pregnancy and TSH decreases -BMR increases by as much as 20% to 25% |
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Changes of the Parathyroid
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-Concentration of the parathyroid hormone and the size of the glands increase, paralleling the fetal calcium requirements
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Changes of the Pituitary Gland
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-Enlarges somewhat
-Anterior pituitary hormones: FSH (stimulates follicle growth within the ovary) and LH (effects ovulation) -Thyrotopin and adrenotropin - alter maternal metabolism to support the pregnancy -Prolactin - responsible for initiation of lactation -Oxytocin - promotion of uterine contractility and the stimulation of milk ejection from the breasts -Vasopressin - causes vasoconstriction which increases BP and has an antidiuretic effect to regulate water balance |
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Changes of the Adrenal Gland
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-Estrogen induced increases in the levels of circulating cortisol result primarily from lowed renal execretion
-Secrete increased levels of aldosterone by the early part of the 2nd trimester which may be the body's protective response to the increased sodium excretion associated with progesterone |
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Changes of the Pancreas
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-The pregnancy woman has increased insulin demands and the islets of Langerhans are stressed to meet this increased demand
-A latent deficiency may become apparent during pregnancy, producing symptoms of gestation diabetes |
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Human Chorionic Gonatotropin
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-Secreted by the trophoblast in early pregnancy
-Stimulates progesterone and estrogen production by the corpus luteum to maintain the pregnancy until the placenta is developed sufficiently to assume that function |
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Human Placental Lactogen
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-Produced by the syncytiotrophoblast
-Antagonist of insulin; it increases the amount of circulating free fatty acids for maternal metabolic needs and decreases maternal metabolism of glucose to favor fetal growth |
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Estrogen
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-Secreted by the corpus luteum and then at 7th week by the placenta
-Stimulates uterine development to provide a suitable environment for the fetus -Helps develop the ductal system of the breasts in preparation for lactation |
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Progesterone
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-Secreted by the corpus luteum and then the placenta
-Place greatest role in maintaining pregnancy -Maintains the endometrium and also inhibits spontaneous uterine contractility, thus preventing early spontaneous abortion due to uterine activity -Helps develop the acini and lobules of the breasts in preparation for lactation |
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Relaxin
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-Detectable in serum by the time of the first missed menstrual period
-Inhibits uterine activity, diminishes the strength of uterine contractions, aids in the softening of the cervix, and has the longterm effect of remodeling collagen -Primary source is corpus luteum |
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Hegar's Sign
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A softening of the lower uterine segment found upon palpation in the second or third month of pregnancy
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Ladin's Sign
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Soft spot anteriorly in the middle of the uterus near the junction of the body of the uterus and cervix
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McDonald's Sign
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A probably sign of pregnancy characterized by an ease in flexing the body of the uterus against the cervix
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Braun von Fernwald's Sign
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Irregular softening and enlargement at the site of implantation
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Piskacek's Sign
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Tumorlike, asymmetric enlargement of the uterus that occasionally occurs with pregnancy
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Ballottement
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A technique of palpation to detect or examine a floating object in the body. In obstetrics, the fetus, when pushed, floats away and then returns to touch the examiner's fingers
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Hemagglutination-inhibition test
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-Immunoassay
-Based on the fact that no clumping of cells occurs when the urine of a pregnant woman is added to the hCG-sensitized red blood cells of sheep -95% diagnosing pregnancy -98% diagnosing non pregnancy - + 10 to 14 days after first missed period -Specimen used is the first early morning midstream urine because it is adequately concentrated for accuracy |
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Latex Agglutination Test
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-Immunoassay
-Based on the fact that latex particle agglutination is inhibited in the presence of urine containing hCG -95% diagnosing pregnancy -98% diagnosing non pregnancy - + 10 to 14 days after first missed period -Specimen used is the first early morning midstream urine because it is adequately concentrated for accuracy |
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B-Subunity Radioimmunoassay (RIA)
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-Uses an antiserum with specificity for the B-subunit of hCG in plasma
-Very accurate - + few days after implantation -Also used to diagnose ectopic pregnancy and trophoblastic disease -Requires several hours to perform and has only limited sensitivity |
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Immunoradiometric Assay (IRMA)
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-Uses a radioactive antibody to identify the presence of hCG in serum
-Identify very low concentrations of hCG -30 minutes to perform -Requires gamma counter - labs switching to ELISA |
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Enzyme-Linked Immunosorbent Assay (ELISA)
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-Does not use radioisotopes but a substance that results in a color change after binding
-A blue color develops, the intensity of which is related to the amount of hCG present -Urine or blood -Quick and sensitive - + 7 to 9 days after ovulation or 5 days before missed period |
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Fluroimmunoassay (FIA)
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-Uses an antibody tagged with a fluorescent label to detect hCG
-Takes 2 to 3 hours -Extremely sensitive |
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Variables that affect the accuracy of home pregnancy tests
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-Reading level above the 6th grade - instructions may not be understood
-False positive - early pregnancy loss, protein in the urine, or the presence of background hCG production -False negative - test completed too early or too late |
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Fetal Heart Rate
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-120 - 160 bpm
-Detected with fetoscope approx weeks 17 to 20 -Detected with doppler device as early as 10 to 12 weeks |
