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79 Cards in this Set
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first half of pregnancy |
-10% fetal growth during 1st half -increased capacity of mother to deliver blood, oxygen and nutrients to the fetus during 2nd half |
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second half of pregnancy |
-90% fetal growth during 2nd half -energy and nutrient delivery to fetus is heightened |
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most significant change during pregnancy |
blood volume -total vol increases 1250ml -increase vol begins 3rd month of gestation -amount of blood increase depends on the size, number of fetus' and subsequent pregnancies -no correlation between nonpregnant blood vol and amount of vol increase -small increase in plasma leads to still births, low birth weight and miscarriage |
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Plasma |
-plasma increases 50% -plasma vol increases until the 34th week -slight fall in vol towards term, drops 200ml |
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Red Blood Cell Count |
-red blood cell count increases throughout pregnancy -50ml increase first 20 weeks -100ml increase by 30 weeks (150ml) -100ml increase by term (250ml) -with iron supplementation increase is about 400ml |
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plasma volume and red blood cell count volume |
1st trimester- both plasma and red blood cell count increases 2nd trimester- plasma volume increases at faster rate than red blood cell count 3rd trimester- red blood cell count continues to increase, plasma volume decreases |
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what tests for red blood cell volume in percentage, PVC (pack cell volume) |
hematocrit |
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what effects the clinical picture levels of hb (hemoglobin) & hematocrit (RBC pack celled volume) |
hemodilution |
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hemoglobin & hematocrit levels fr 1st, 2nd & 3rd trimester |
hemoglobin / hematocrit 1st- 11.0 33 2nd- 10.5 32 3rd- 11.0 33 |
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hemodilution |
plasma volume increase, makes everything in blood appear diluted |
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Causes of anemia during pregnancy |
-iron deficiency -B12 -Folate -B6 - Vitamin C deficiency -Protein deficiency -blood loss |
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Anemia decreases |
the oxygen carrying capacity of RBC |
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Normal non pregnant serum ferritin levels |
18 micrograms per L (less than 18 is anemic) |
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Normal pregnant serum ferritin levels |
12 micrograms per L (less than 12 is anemic) |
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Should iron be supplemented during pregnancy? |
Yes |
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Anemias Iron (Fe) deficiency What is hypochromic iron anemia? |
less color (lighter color) of the red blood cells |
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Anemias Iron (Fe) deficiency What is Microcytic anemia? |
red blood cells are smaller in size |
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Anemias Folic acid (B12) deficiency What is macrocytic anemia? |
red blood cells are larger in size |
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Anemias Folic acid (B12) deficiency What is megaloblastic anemia? |
red blood cells are irregular in shape |
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What are fasting blood glucose levels like during pregnancy? |
fasting blood glucose levels decrease during pregnancy due to fetal uptake during the 3rd trimester the average is 10-15% lower than during non-pregnancy |
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Diabetes during pregnancy |
-there is a greater resistance to insulin during pregnancy -gestational diabetes creates greater risk for diabetes during subsequent pregnancies and later in life |
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glucose tolerance test is used for what? |
to test for type 2 diabetes |
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normal blood values for a glucose tolerance test of a non-pregnant woman is |
75 grams |
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100 gram glucose 3 hour oral glucose tolerance test is used to test for |
gestational diabetes fasting: 95mg/ milligrams per deciliter 1 hour: less than 180 milligrams per deciliter 2 hours: less than 155 milligrams per deciliter 3 hours: less than 140 milligrams per deciliter |
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Lipids increase in cholesterol used to |
make hormones |
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what cholesterol does not increase as much as other lipids |
LDL AND HDL |
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lipids are carried in the blood while bound to a protein called |
globuin |
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Proteins pregnancy |
<5.5 to 6 grams per 100ml steadies at about 28 weeks gestation due to hemodilution |
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Albumin pregnancy |
2.5 to 3 grams per 100ml |
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what is the glomerular filtration rate? |
50-60% -accumulation of extracellular fluid -accumulation of fluid in hands and feet |
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What are the function of kidneys |
-maintain blood levels or nutrients -waste -maintains blood volume -hormone produced that stimulates red blood cell production -activation of vitamin D -acid/base balance |
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glomerular filtration rate with in the bowmans capsule |
-water, nutrients and waste are pulled into bowmans capsule -proteins and fat soluble vitamins do not go in the urine, held in capillaries with water, retained due to osmotic pressure |
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glomerular filtration rate increases what (infection) |
increased possibility of urinary tract infection |
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Edema-water retention mild and generalized through the body, hands and feet (what happens with hemodilution and estrogen) |
hemodilution: albumin is low and interspacial spaces retain water estrogen: causes retention of water in the connective tissue |
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edema during pregnancy, without what? reflects healthy expansion of plasma volume |
without hypertension reflects healthy expansion of plasma volume |
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the cadiovascular system adapts to |
cope with increase in blood volume and larger body mass |
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during pregnancy the heart does what? (size) |
has slight hypertrophy because of the increase in blood volume and cardic output |
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during pregnancy the heart rate |
increases |
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Arterial blood pressure during first half of pregnancy (systolic and diastolic) |
decrease in systolic and diastolic by 5-10mm Hg (9%) because of vasodialation |
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what is vasodialation? |
blood vessels are more relaxed and dialated because of hormones (progesterone) |
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Why does the tendency of blood to coagulate increase during pregnancy? |
clotting factors in the blood increase and fibrinolysis or dissolution of clot is low in pregnancy |
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because renal tract because dilated what else occurs/ can occur |
progesterone causes the renal tract to relax, urine tends to stagnate -high concentration can lead to microbial growth -higher risk of urinary tract infection |
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Water in the body |
increases about 7 to 10 L caused by -2/3 increase in blood and increase in size of reproductive organs -1/3 interstitial (cell/tissue) water increase |
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gastrointestinal system (general effects of pregnancy) |
-increased appetite -increased thirst -nausea, vomiting, heart burn and constipation |
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GI Problems constipation |
-decrease in muscle tone -unusual food choices -decrease in fluid intake -increased pressure due to constipation (may cause hemorrhoids/bleeding) -hypoperistalsis |
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what is hypoperistalsis? |
slower movement through the GI due to constipation |
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GI Problems gallstones (why they happen) |
-frequent in pregnancy -decrease in gale bladder emptying (bile remains there longer) -increase in cholesterol bile- cholesterol precipitates out |
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What is pica? |
cravings for non-food materials or foods in mass quantities |
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what production reduction interferes with the absorption of calcium and iron |
acid and pepsin |
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what is the basal metabolic rate? |
involuntary energy requirement |
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what is RMR |
resting metabolic rate -rate taken while sleeping not awake |
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what is REE |
resting energy expenditure |
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basal metabolism increase |
-increases by fourth month -15-20% higher at term -returns to normal rate by 5-6 days postpartum -increased cardiac work -increased body temp |
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immunity is what during pregnancy |
supressed -more susceptible to infections (urinary and reproductive system) |
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Hormones What does progesterone do ? |
-relaxes muscles , uterine blood vessels and gastrointestinal tract -maintains implant -stimulates growth of endometrium -stimulates breast development -induced maternal fat deposition -increases renal sodium excretion |
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Hormones what does estrogen do ? |
-promotes growth of fetus -alters structure of mucopolusaccharides in the connective tissue to hold more water (connective tissue, ligaments more flexible, helps with delivery of baby) -increases the synthesis and storage of lipids and proteins -increases blood flow to the uterus -increases uterine and breast tissue development |
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what does Human Chorionic Gonadotropin (HCG) ? |
-found only during pregnancy -concentrations increase rapidly to 8/10 weeks then remains constant -pregnancy tests test for HCG in urine and blood -produced early on by stimulation corpus luteum -later produced by placenta after 2 months - stimulates endometrium growth |
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What does Human placental lactogen (HPL) ? |
-stimulates growth of mammary glands -inhibits the action of insulin |
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What do Glucocorticoids do? |
-increase blood glucose levels by gloconeogenesis -increase insulin destruction in the placenta |
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weight/ weight gain is a good measurement of |
-health status -dietary adequacy -plasma volume expansion |
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the fetus accounts for how much of maternal weight gain? |
7.5lbs |
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the placenta accounts for how much of maternal weight gain? |
1.5lbs |
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the amniotic fluid accounts for how much of maternal weight gain? |
2.0lbs |
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the uterus & supporting muscle accounts for how much of maternal weight gain? |
2.0lbs |
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the breast tissue accounts for how much of maternal weight gain? |
2.0lbs |
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the increased blood volume accounts for how much of maternal weight gain? |
2.0lbs |
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the maternal fat stores account for how much of maternal weight gain? |
7.0lbs |
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the maternal fluid retention accounts for how much of maternal weight gain? |
4.0lbs |
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total approximate maternal weight gain |
30.0lbs -total differs due to a number of factors including pre-pregnancy weight etc. |
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Pre-pregnancy overweight obesity stats |
-62% of women who could become pregnant were over weight -33% of women who could become pregnant were obese -women should not lose weight during pregnancy but strive for less weight gain, risks poor diet, inadequate nutrient gain and ketosis |
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What risk factors increase due to being overweight or obese pre-pregnancy (for the mother) |
-antenatal complications -gestational diabetes -prolonged labor, complications during pregnancy and delivery -pregnancy induced hypertension -urinary tract infection -C-section -hypertension -postpartum infection -women less likely to initiate and maintain breast feeding |
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what risk factors increase due to being overweight or obese (for the baby) |
-low aspar scale -large for gestational age infants -risk for neural tube defects and other congenital defects -higher perinatal mortality -difficulty regulating Blood glucose levels during the neonatal period -higher fat mass in infants and subsequent overweight in children |
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what are the risk factors due to low pre-prgnancy weight and inadequate weight gain (mother and baby) |
-greater energy needs for mother and infant
-preterm baby -intrauterine growth retardation -risk of perinatal mortality -lower apgar scale score -underweight and smoking greatly increase risks |
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normal pre-pregnancy BMI recommendation |
BMI (kg/m^2) recommended wt gain 18.5 - 24.9 25 - 35lb |
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Normal maternal wt gain per trimester |
1st: some wt gain, 3 - 5 lbs 2nd & 3rd: steady linear wt gain, approx 1lb per week -0.88lb - 1lb per week according to AND position paper - 3 - 4lbs per month according to MyPlate |
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Underweight maternal recommended weight gain |
-less than 0.5lb per week in the second trimester -less than 0.75 per week in the third trimester -without gain there is greater risk of pre term infant and small for gestational age infant |
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overweight maternal recommended weight gain |
-less than 0.5 per week in the third trimester -increased risk of pre term infant |
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gaining more than 1.5 lbs per week in the third trimester causes greater risk for |
weight retention postpartum |
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gaining more than 7lb per month in the second half of pregnancy may be a sign of |
pregnancy induced hypertension or pre-eclampsia |
