Repro - 1-4 Pregnancy Physiology I

Front 1

Length of pregnancy

Back 1

280 days or 40 weeks from last menstrual period. But within this there is an extra 2 weeks because conception really occurred at ovulation.

Front 2

What is considered at term?

Back 2

37-42 weeks

Front 3

Naugele's rule

Back 3

date of confinement =estimated date of deliv = add 1 week to last menstual period and count back 3 months.

Front 4

Earliest dx of pregnancy

Back 4

Measurement of beta subunit of hCG

This is detectable before missed menses about 9-11 days after conception.

Urine is the most common way because it is accurate and cheap. Serum can also be done.

Front 5

Landmarks of ID of fetal heart action

Back 5

Real time sonar - 6-8 weeks
Doppler sonar - 10-12 weeks
Auscultation - 17-20 weeks.

At 8 weeks you can see fetal heart transvaginally

At 10-12 weeks you can hear fetal heart.

Front 6

When would you want to know really early on if a pregnancy is going ok?

Back 6

Pt had ectopic pregnancy before, if they are spending lots of money (IVF), or had miscarriages before.

Front 7

Sonographic recog of fetus - transabdominal
Landmarks

Back 7

5-6 weeks - white gestational ring
7-8 weeks - fetal echoes in the sac, fetal heart activity.

Front 8

Sonographic recog of fetus - transvaginal
Landmarks

Back 8

4 weeks and 1-3 days - gestational sac (B-hCG is 1500)

5 weeks - yolk sac

6 weeks - fetal heart activity (B-hCG is 17000)

8 weeks - can see fetal heart.

Front 9

When can you first use X-ray?

Back 9

Not preferred to do this, but 16 weeks.

Front 10

Weight gain in pregnancy

Back 10

25-30 pounds total

5-10 pounds in first 20 weeks, then 1 lb / week in the second 20 weeks of pregnancy

Front 11

Landmark of uterus at 20 weeks

Back 11

Will reach the umbilicus.

This is useful in the ER because you can assess if preg or not by putting hand on abd and feeling for level of fetus.

Front 12

Uterus in pregnancy

Back 12

Huge increase in size by hypertrophy and stretching of existing muscle cells.
Estrogen is the trigger for this.

Shape change - flat pear to spherical (12 weeks) and ovoid thereafter.

Dextrorotation (CW rotation)

Front 13

Will there be enlarged uterus with ectopic pregnancy?

Back 13

Yes! Because estrogen is increased.

Front 14

Cervical changes

Back 14

Softening (Hegar's sign) and cyanosis (Chadwick's sign)

Glandular proliferation.

Plug of tenacious mucus in the cervix.

Front 15

Hegar's sign

Back 15

Softening of the cervix

Front 16

Chadwick's sign

Back 16

Cyanosis of the cervix (it will look blue)

Front 17

Function of the corpus luteum

Back 17

This secretes estradiol and progesterone and is imp in first 4-5 weeks after conception only.

Develops from a developing ovarian follicle.

Front 18

Ovulation ____ during pregnancy

Back 18

ceases

Front 19

Luteomas

Back 19

Benign ovarian tumor that may be virilizing (development of sex differences)

Front 20

Abdominal changes in pregnancy

Back 20

Striae (1/2 of women get it)

Diastasis recti - midline separation

Hyperpigmentation - increase melanocyte stim hormone and increased sex steroids
linea nigra - happy trail to the belly button
facial melasma

Vascular spiders and palmar erythema - due to hyperestrogenemia.

Front 21

Breast changes

Back 21

Tenderness, tingling.
Size, nodularity, vascularity, nipple size all increases.
Colostrum (milk) often is present in latter half of pregnancy.

Front 22

Heme changes

Back 22

Blood volume increases (relatively more plasma --> physiologic anemia)
Hence iron supp

Hemoglobin is decreased (around 12.1 vs. 13.3)

More iron abs from intestine.

Front 23

Pattern of increased blood vol

Back 23

Begins in 1st trimester, most rapid in second, plateaus in the third.

Front 24

Blood loss in preg

Back 24

Avg. 500mL during and after deliv.
1000mL if twins or C-section.

Front 25

Definition of post-partum hemorrhage

Back 25

500mL - doesn't make sense though bc avg is 500 mL.

Front 26

Leukocyte change

Back 26

Increase

Front 27

Platelets

Back 27

Slight decrease

Front 28

Coag factors

Back 28

Fibrinogen, VII, VIII, IX, X all increase.

Therefore preg complications can cause coagulation abnormalities.

BLEEDING TIME AND CLOTTING TIME ARE UNCHANGED BUT RISK OF THROMBOEMBOLISM (ESP POSTPARTUM) IS GRAVE.

Front 29

CV system changes

Back 29

BV increases
CO increases (the pulse and SV both inc)
Systolic murmurs are common
BP and vasc resistance decrease.
Antecubital venous pressure is unchanged.
Femoral venous pressure steadily rises.
Leg blood flow is retarded.

Front 30

3rd trimester women in supine position?

Back 30

No! elevate one side because the enlarged uterus can compress the IVC which will reduce venous return and thus CO.

Front 31

Resp system changes

Back 31

RR no change.
Diaph moves up, ribs move out.
Increased tidal vol, decreased RV (breathing at a lower lung volume and moving more air per breath)
Resp alkalosis (low pCO2 and decreased bicarb via kidneys to compensate)
Dyspnea
Chronic cold

Front 32

Progesterone effects on resp center

Back 32

Stimulates direct resp center and increases sensitivity of the resp center to CO2

Front 33

Some urinary system changes

Back 33

Hydronephrosis (a backup -swelling of kidneys) and hydroureter (distention of ureter due to blockage)
This is more common on the right.

Inc susc to UTIs

Front 34

Bladder changes

Back 34

Capacity decreases (urinary freq)
Loss of urinary control due to enlarging fetus.

Front 35

Func/lab urinary changes in pregnancy

Back 35

Inc renal plasma flow and GFR (decreased BUN and creatinine)

Glucosuria can happen, but protinuria is not normal.

Slight decrease in plasma osmolality

Front 36

Changes in RAA

Back 36

Reduced sensitivity to the hypertensive effects of angiotensin

Front 37

Serum amylase in a preg woman

Back 37

not reliable.

Front 38

Some GI system signs

Back 38

Diseases present differently (e.g. appendix is higher)

Gastric emptying time and intestinal transit time are delay. Labor/pain meds delay this further.

Pyrosis (heartburn) - inc gastric pressure, slowed emptying, less esoph pressure, less esoph sphincter tone.

N/V

Increased appetite, cravings, aversions.

Constipation
Hemorrhoids (elev venous pressure in the veins below uterus)

More gallstones

Front 39

Hyperemesis gravidarum

Back 39

Very dramatic N/V, weight loss, dehydration, ketonemia, electrolyte imbalance.

Front 40

Liver

Back 40

Liver disease signs are common
Proteins prod by liver are inc in response to estrogen
Inc serum alk phos from placenta.
Cholesterol and other lipids 2X higher.

Front 41

Pituitary

Back 41

Slightly enlarged.

More prolactin and oxytocin

Front 42

Thyroid

Back 42

Still euthyroid.

Total thyroxin is high but the free/effective amt (T3 and T4) is normal.

Front 43

Adrenal

Back 43

Cortisol, aldosterone, DOC increases, DHEAS and DHEA (dehydroepiandosterone) decreased.

Front 44

Pancreas

Back 44

Hypertropy/plasia of beta cells.

Front 45

Carbs in pregnancy

Back 45

Mild fasting hypoglycemia, postprandial hyper.
Hyperinsuloinemia
Tissue resistance to insulin (due to human placental lactogen - so baby can get more)

FFAs are increased to provide alternate energy source for the mother.

Front 46

Fat in pregnancy

Back 46

Early in preg it is stored, plasma lipids increase in the latter half, and late the fetal nutrit demands increase and fat is utilized.

Front 47

Postural cahnges

Back 47

Lumbar lordosis and relaxation of pelvic joints.

Front 48

Concern abt anesthesia for pregnant woemn

Back 48

assume they have a full stomach because of slowed gastric emptying.

Front 49

Fetal nourishment

Back 49

First from interstit fluid from endometrium, Then from maternal blood-filled lacunae and their chorionic villi.

Front 50

Transfer of solute from mom to baby depends on...

Back 50

[] gradients, size, lipid solubility.

Front 51

Stimullus that releases FFAs from adipose tissue to meet mother's energy needs

Back 51

human placental lactogen.

Front 52

How does gluc, amino acids cross placenta?

Back 52

Gluc - facil diff. - it is the main fuel source for the fetus.

AAs - diffusion and active transport. -used for prot synth and energy

Front 53

FFAs for fetus?

Back 53

Used for tissue synth

Front 54

Causes of intrauterine growth restriction

Back 54

Malnutrition, fetal abnormalities, fetal infections, HTN (poor blood flow), maternal illness.

Front 55

Everest in utero

Back 55

Umb artery and vein PO2 is much lower than adult.

Front 56

How to overcome everest in utero

Back 56

Fetus has high CO bc of high HR and low periph resistance.

O2 carrying capacity of fetus is enhanced by higher hemoglobin [] and fetal hemoglobin.

Materal CO is increased (this is why hemorrhage can be so bad)

Front 57

Amniotic fluid vol

Back 57

50cc at 12 weeks, 200 at 20, 1 L at 36

Front 58

Failure of swallowing of fetus results in...

Back 58

Polyhydramnios (too much fluid)
e.g. esophageal atresia

Front 59

Renal agenesis/ureteral obstruction can lead to...

Back 59

Oligohydramnios or too little fluid.
This can lead to pulmonary hypoplasia (death) because lung fluid maintain lung function and facilitate pulm growth.

Front 60

Source of amniotic fluid

Back 60

Early - transudate from maternal plasma
16 weeks and further - fetal production (lung liquid and urine) and resorption (swallowing and flow across membranes to fetal/maternal circ)

Front 61

Protective function of amniotic fluid

Back 61

Decline in volume leads to cramped quarters, umb cord compression, morbidity in post-term pregnancies

Front 62

Tests of amniotic fluid

Back 62

Cytogenetics
delta OD 450
fetal lung maturity tests
amniotic fluid index (volume)

Front 63

Stillbirth

Back 63

baby died before

Front 64

dry-birth

Back 64

slang - feels like fluid leaked out.

Front 65

When is a baby viable?

Back 65

at 24 weeks. fetus can survive outside uterus at this point.

Front 66

SEs of preg (from pt example) - early on in the going

Back 66

vag discharge, acne, vivid dreams due to progesterone, extra folic acid, ca++, iron, constipation, avoid NSAIDs, bleeding, contractions with orgasm (avoid sex if you have this so you don't get premature labor).

Front 67

tests to get once preggo

Back 67

carrier for hep b, syphilis, aneuploidy screening (blood, not invasive), glucose testing (if diabetic)

Front 68

3rd trimester sx of pregnancy (pt example)

Back 68

pelvic pain, check proteins for pre-eclampsia, use sunscreen, high interest in sex (opposed to before), appts weekly at this point, risk of group B strep infection of the baby.

Front 69

Birth definition

Back 69

Complete expulsion of a fetus

Front 70

Birth rate

Back 70

# births/1000 population

Front 71

Live birth

Back 71

Infant breathes spont or shows some sign of life.

Front 72

Neunatal death

Back 72

death in first 28 days of life

early neonatal death is in first 7 dyas of life, late is 8-28 days of life.

Front 73

Perinatal mortality rate

Back 73

Very bad in the USA

Number of stillbirths (this is fetal deaths past 20 weeks) and neonatal deaths (1st 28 days) per 1000 births.

Front 74

Maternal mortality rate

Back 74

Number of maternal deaths that occur as result of reprod process per 100000 live births.

Front 75

Leading causes of maternal death

Back 75

1. severe bleeding
2. sepsis
3. unsafe abortion

Front 76

Hemorrhage causes of maternal death

Back 76

placenta previa, placental abruption, PPH (postpartum hemorrhage), uterine rupture, ectopic pregnancy

Front 77

HTN causes of maternal death

Back 77

pre-eclampsia

Front 78

infectious causes of maternal death

Back 78

H1N1, puerperal sepsis, pneumonia, pyelonephritis, chorioamnionitis

Front 79

thromboembolic phenomenon causes of maternal death

Back 79

pulm emboli, amniotic fluid emboli.

Front 80

Other random causes of maternal death

Back 80

obstructed labor, complications of illegal abortion.

Front 81

Most common reason for perinatal mortalit

Back 81

prematurity leading to low birth weight.

a distant second is congenital malformations.

Front 82

Most spontaneous abortions are during...

Back 82

1st 8 weeks.

But by definition, spont. abortion can be in the first 20 weeks.

Front 83

Types of early pregnancy loss

Back 83

spontaneous abortion
ectopic pregnancy (usually in fallopian tube)
gestational trophoblastic disease (very rare - molar preg is one type (an abnormality of the placenta))

Front 84

Types of late pregnancy loss
(past 20 weeks)

Back 84

Still birth - intrauterine fetal demise

Front 85

Incidence of dizygotic (fraternal) twins increasing with...

Back 85

assisted reproductive technique.

Front 86

Multiple gestation puts you at increased risk for..

Back 86

intrauterine fetal demise, prematurity, congenital abnormalities, hyperemesis, preeclampsia, gestational diabetes, intrauterine growth restriction.