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75 Cards in this Set
- Front
- Back
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What are some basic Anatomic adaptations to growing fetus?
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Rib cage flares; diaphragm elevates
Cardiovascular blood flow increases |
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What are some basic Physiologic adaptations to altered hormonal milieu?
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Slowed GI motility
Metabolic changes Placental hormones |
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What happens to the heart when fetus grows?
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Heart pushed up and rotated anteriorly 15 degrees to left
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What happens to maternal blood volume?
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*Increases up to 50%
*Most rapid rise during 2nd trimester *Peaks at 30-34 weeks, then plateaus |
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What happens to the Plasma volume and RBC mass during pregnancy?
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*Plasma volume increase > RBC mass increase
*Result: Hemodilution , decreased Hgb/Hct *Most noticeable 2nd trimester |
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What 3 things happen to Cardiac Output during pregnancy?
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*Increases 30%-50% by 32 weeks,
*Pulse rate increases 10-15 bpm *Stroke volume increases |
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When does the cardiac output begin to increase and when is the greatest increase?
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begins at 10-12 weeks;
greatest increase 18-32 weeks |
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What happens to Cardiac Output during labor?
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There is an additional 25% increase
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What happens to the S1 sound in pregnancy?
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Both components louder
Splitting may be heard |
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What happens to the S2 sound in pregnancy?
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Becomes louder during 3rd trimester
May have persistent expiratory split |
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What happens to the S3 sound in pregnancy?
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*Audible in 90% women after midpregnancy
*Becomes louder if S3 preexisting |
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What type of murmur is commonly heard in pregnant women?
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Systolic ejection murmur
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How often to SEM occur and what types?
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Grade I-II/VI SEM occurs in 60-90% pregnant women
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When should a pregnant woman with a SEM be referred?
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*> or equal to Grade III/VI
*Diastolic *Murmur associated with heave or thrill |
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What happens to BP in early pregnancy?
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Decrease in systolic & diastolic B/P early in pregnancy
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what is the cause of a decreased bp?
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decrease in peripheral vascular resistance
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When does BP return to normal?
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Return to prepregnant levels in 3rd trimester
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What are 3 causes of gastrointestinal changes?
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Estrogen, hCG, & progesterone
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What effect does estrogen have on the GI system?
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increase vascularity
Connective tissue proliferation Salivary production increases; pH decreases |
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What happens with the increased salivary production and decrease in ph?
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increased propensity for tooth decay
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What effect does hCG have on GI system?
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increased sensitivity to taste & smells
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What are 3 main organs in the GI system affected by progesterone?
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Stomach, Gall bladder, & intestines
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What effect does progesterone have on the stomach?
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Cardiac sphincter relaxation
Delayed emptying time increased reflux into lower esophagus |
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What effect does progesterone have on the gall bladder?
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decreased bile flow, increased bile stones
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What effect does progesterone have on the intestines?
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*decreased motility = increased reabsorption of water that results in constipation
* decreased sphincter tone |
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What in carbohydrate metabolism is increased during pregnancy?
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*glucose demand
*insulin production *insulin response to glucose load |
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During carbohydrate metabolism, what are the increased insulin antagonists?
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*hPL
*hCG *hCS |
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During carbohydrate metabolism, what is actually decreased?
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FBS lower in pregnancy
(Exaggerated fasting) |
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What are 3 Renal Anatomic changes that happen?
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*Ureters elongated, distended, displaced
*Dilation results in stagnation of urine *Right ureter more compressed by uterus |
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What happens when the right ureter is compressed by uterus?
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increased risk infection of right kidney
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What are 4 renal physiologic changes?
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*Glomerular filtration rate increase 50%
*Sodium reabsorption increases *Glucosuria (25%) *Proteinuria does not normally occur |
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When does the GFR begin to increase?
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Occurs by 2nd trimester; persists to term
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What happens if Sodium is restricted?
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If Na+ restricted, body conserves Na+
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What causes the Glucosuria?
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Due to impaired tubular glucose reabsorption
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What are 3 Endocrine changes to the thyroid?
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Elevated BMR
Changes in thyroid Lab values Euthyroid of pregnancy |
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What are happens to thyroid lab values in pregnancy?
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TSH normal
Total T4 increase; free T4 normal T3 uptake decrease |
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What is Euthyroid of Pregnancy?
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Diffuse, nontender enlargement
Size: < twice expected Asymptomatic for disease |
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What are 3 cervical changes caused by endocrine system?
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*Marked proliferation of cervical mucous.
*Endocervical glands take up approximately half of the cervix by third trimester. *Mucous plug - protective. |
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How is the pituitary affected by the endocrine changes during pregnancy?(6)
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*Continued enlargement
*Prolactin quiet until 36 wks then increases *FSH and LH levels remain suppressed *Growth hormone increases *Oxytocin production increases *Melanotrophic hormone increases |
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How is the parathyroid gland affected by the endocrine changes during pregnancy?
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*Hormones remain elevated throughout pregnancy
*Calcium and Phosphorus metabolism increases |
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How are the adrenal glands affected by the endocrine changes during pregnancy?
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*Adrenocorticotropin levels continue to be elevated throughout pregnancy
*Concentration of cortisol rises *Aldosterone continues to be elevated |
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Does secretion of cortisol during pregnancy increase or stay the same?
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stays the same
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What function does the elevated aldosterone serve?
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protects of natriuretic effects of progestrone
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What are 5 musculoskeletal changes that occur during pregnancy?
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*Lordosis
*Shift in center of gravity *Diastasis recti *Relaxation of ligaments *increased joint mobility |
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What are the 3 biggest areas affected by the increase in joint mobility?
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*Pubic
*Sacroiliac *Sacrococcygeal |
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What are 4 integumentary changes that happen during pregnancy?
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*Hyperpigmentation
*Vascular changes *Changes in hair growth *Abdominal wall changes |
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What are some examples of hyperpigmentation?
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*Linea Negra
*Melanocytic Nevi *Cholasma |
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What are some examples of vascular changes?
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Spider angiomas, palmar erythema, capillary hemangiomas, epulis/gingivitis
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What are some examples of changes in hair growth?
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Increased hair growth & mild hirsutism
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What are some examples of abdominal wall changes?
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striae gravidarum & diastasis recti
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What is this an example of ?
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Cholasma
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What are 2 breast changes that occur?
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*Increased sensitivity and size
*Areolae darken |
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How do estrogen, progesterone and hPL help to increase sensitivity and size of a pregnant women's breasts?
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*Estrogen: ducts; overall growth
*Progesterone: alveolar development *hPL: tingling, tenseness, nodularity |
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What happens to areolae at sixteen weeks?
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mottled secondary areolae
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What are Montegomery's Tubercules?
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Marked hyperpigmentation and papules developed on the nipples and areolae
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What is the corpus luteum responsible for producing in early pregnancy?
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*hCG
*Progesterone *Estrogen *Relaxin |
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How long is the Corpus Luteum necessary for?
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Necessary for pregnancy until week 7, when it begins to regress
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What happens to the Uterine isthmus during pregnancy?
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Becomes lower uterine segment during labor
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What happens to the Endometrium?
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decidual reaction, Exaggerated hypertrophy and secretion
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What happens to the myometrium?
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*Hypertrophy; hyperplasia
*Increased collageneous tissue |
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What is the weight of a non pregnant uterus vs. a pregnant one?
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70gm vs 1100gm
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What is the capacity of a non-pregnant uterus vs. a pregnant one?
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10ml vs. greater than or equal to 5000 ml
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What are the dimensions of a nonpregnant uterus vs. a pregnant one?
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7.5 x 5x 2.5 cm vs. 28 x 24 x 21 cm
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What are some presumptive signs of pregnancy?
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*Cessation of menses
*Nausea and vomiting *Frequent urination *Breast tenderness *Quickening *Fatigue *Skin changes |
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What are some probable signs of pregnancy?
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*Enlargement of abdomen
*Pregnancy test (hCG) *Piskacek’s sign *Hegar’s sign *Chadwick’s sign *Goodell’s sign *Braxton-Hicks contractions |
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When is a hCG pregnancy test found to be positive?
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Positive 7-10 days after conception
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What is Piskacek's' sign and when does it occur?
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*Occurs at 4-6 weeks
*Uterine fundus asymmetric, with prominence on side of implantation |
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What is Hegar's sign and when does it occur?
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*Occurs as early as 6 weeks
*Uterine isthmus soft, compressible |
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What is Chadwick's sign and when does it occur?
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*Occurs at 6-8 weeks
*Cyanosis of the vulva, vagina, and cervix |
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What is Goodell's sign and when does it occur?
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*Occurs at 8 weeks
*Softening of the cervix |
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What are Braxton-Hicks contractions and when do they occur?
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*End of first trimester
*Irregular, painless, intermittent |
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What are positive signs of pregnancy?
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*Fetal heart tones
*Visualization of *embryo/fetusPalpation of fetal movement by examiner |
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When can you hear/see FHT?
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*Ultrasound: 4-8 weeks
*Doppler: 10-12 weeks *Fetoscope: 18-20 weeks |
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When can you visualize the embryo/fetus?
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Ultrasound: >5-6 weeks
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When can you palpate fetal movement?
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19+ weeks
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