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EXAM #1 - FAMILY
Pregnancy Adaptations
| Question | Answer |
|---|---|
| Uterus Adaptation in Pregnancy | Size increases to 20 times of nonpregnant size, with capacity increasing 2,000 times. Weight increases from 2 oz to approximately 2 lb at term. Uterine growth occurs as a result of hyperplasia and hypertrophy of the myometrial cells. Increased strength and elasticity allows uterus to contract and expel fetus during birth |
| Cervix Adaptation in Pregnancy | Increases in mass, water content, and vascularization. Changes from a rigid to a soft, distensible structure allowing fetus to be expelled. Under influence of progesterone, a thick mucus plug is formed, which blocks the cervical and protects the developing fetus from bacteria |
| Vagina Adaptation in Pregnancy | Increased vascularity because of estrogen influences. Results in pelvic congestion and hypertrophy. Increased thickness of mucosa, along with an increase in vaginal secretions, to help prevent bacterial infections |
| Ovaries Adaptation in Pregnancy | Increased blood supply causes them to enlarge until approximately the 12th to 14th week of gestation. They actively produce hormones to support pregnancy until weeks 6-7 and then the placenta takes over the production of progesterone |
| Breasts Adaptation in Pregnancy | Begin soon after conception. Increase in size, and pigmentation. Tubercles of Montgomery enlarge and become more prominent, and nipples are more erect. Blood vessels become more prominent, and blood flow doubles |
| GI System Adaptations in Pregnancy | Gums become hyperemic, swollen, and friable and bleed easily. Saliva production increases. Decreases esophageal sphincter pressure and tone, increasing the risk of heartburn. Decreased tone and mobility, with delayed gastric emptying time, increasing risk of gastroesophageal reflux and vomiting. Decreased gastric acidity and histamine output, which improves symptoms of peptic ulcer disease. Decreased tone and mobility of gallbladder, which increases risk of gallstones |
| Cardiovascular Adaptations in Pregnancy | Plasma increase (50%), and RBCs (25-33%) causing hemodilution, results in lower hematocrit and hemoglobin. CO increases from 30-50% by the 32nd week. Increased CO is associated with increased venous return and greater right ventricular output. HR increased by 10-14 bpm, between 14 and 20 weeks gestation. BP decreases 10-15 mm Hg, with the lowest around mid-pregnancy. Both fibrin and plasma fibrinogen levels increase along with various blood-clotting factors. Make pregnancy a hypercoagulable state. |
| Respiratory System Adaptations in Pregnancy | Enlargement of the uterus shifts the diaphragm up to 4 cm above usual. Muscles and cartilage in the thoracic region relax, and chest broadens, with conversion from abdominal breathing to thoracic breathing. Leads to 50% increase in air volume per minute. Tidal volume, or volume of air inhaled, increasing gradually by 30-40% (from 500 mL to 700 mL) as pregnancy progresses |
| Renal/Urinary Adaptations in Pregnancy | Renal pelvis becomes dilated. Ureters (especially the right) elongate, widen, and become more curved above pelvic rim. Bladder tone decreases and bladder capacity doubles by term. GFR increases 40-60% during pregnancy. Blood flow to the kidneys increases by 50-80% due to the increase in cardiac output |
| Musculoskeletal Adaptations in Pregnancy | Distention of abdomen with growth of fetus tilts the pelvis forward, shifting center of gravity. Compensated by developing and increased curvature (lordosis) of the spine. Relaxation and increased mobility of joints occur because of the hormones progesterone and relaxin, which leads to the waddle gait |
| Integumentary Adaptations in Pregnancy | Hyperpigmentation of the skin, most commonly on the areola, genital skin, axilla, inner aspects of thighs, and a line on the middle of abdomen (linea nigra). Striae gravidarum (Stretch marks). Melasma (mask of pregnancy) occurs in about 70% of women. Characterized by irregular, blotchy areas of pigmentation on the face, most commonly on the cheeks, chin, and nose. |
| Endocrine Adaptations in Pregnancy | Controls the integrity and duration of gestation by maintaining the corpus luteum via hCG secretion, production of estrogen, progesterone, hPL, and other hormones and growth factors via the placenta. Release of oxytocin (by posterior pituitary gland), prolactin (by the anterior pituitary), and relaxin (by the ovary, uterus, and placenta) |
| Immune System Adaptations in Pregnancy | General enhancement of innate immunity (inflammatory response and phagocytosis) and suppression of adaptive immunity (protective response to specific foreign antigen) take place. These alterations help prevent the mother's immune system from rejecting the fetus, and increase her risk for developing certain infections, and influence the course of chronic disorders such as autoimmune diseases. |
| Hegar's Sign | Softening of the lower uterine segment or isthmus |
| Goodell's Sign | Softening of the cervix |
| Chadwick's Sign | Bluish/purple coloration of the vaginal mucosa and cervix |
| Ballottement | Examiner pushes against the woman's cervix during a pelvic examination and feels the rebound from a floating fetus |
| Inadequate Nutritional Intake | Associated with preterm birth, low birth weight, and congenital anomalies |
| Excessive Nutritional Intake | Connected with fetal macrosomia (heavier than 4,000 g), leading to a difficult birth, neonatal hypoglycemia, and continued obesity in the mother and the potential for childhood obesity with the components of metabolic syndrome. |
| Most important Nutrients in Pregnancy | Iron and folic acid are needed to form new blood cells for the expanded maternal blood volume and prevent anemia. |
| Iron | Essential for fetal growth and brain development of maternal anemia. |
| Folic Acid | Essential for before and during pregnancy to prevent neural tube defects in the fetus. |
| Weight Gain for Woman who are underweight during pregnancy (BMI < 18.5) | Total weight gain range is 28-40 pounds. Should gain slightly more than 1 pound per week in the second and third trimesters. |
| Weight Gain for Woman who are Normal weight during pregnancy (BMI 18.5-24.9) | Total weight gain range is 25-35 pounds, with 3.5-5 lb gained in the first trimester, and 1 lb per week in the second and third trimesters |
| Weight Gain for Woman who are Overweight during pregnancy (BMI 25 - 29.9) | Total weight gain range is 15-25 lb. Should gain about 2 lb in the first trimester, and 2-3 lb per week in the 2nd and 3rd trimesters |
| Weight Gain for Woman who are Obese during pregnancy (BMI 30 or higher) | Total weight gain range is 11-20 lb |
| Common Psychosocial Responses in Pregnancy | Ambivalence, Introversion, Acceptance, Mood Swings, and Changes in Body Image |
| Ambivalence | Having conflicting feelings at the same time. Commonly occurs during the first trimester. |
| Introversion | Focusing on oneself. May be withdrawn, become increasingly preoccupied with themselves and the baby. May participate less with the outside world, and may appear passive about family and friends. This is normal, and heightens during the first and third trimesters. |
| Mood Swings | Emotional lability is common throughout most pregnancies. One moment they feel great joy, and within a short time they feel shock and disbelief. Commonly will cry without any apparent cause. Some refer to it as an emotional roller coaster. |
| Changes in Body Image | Can vary from each individual. Some may feel as if they have never been more beautiful, while others feel overweight and uncomfortable. |
| Presumptive Signs of Pregnancy | Breast Tenderness (3-4 weeks) Amenorrhea (4 weeks) Nausea & Vomiting (4-14 weeks) Breast Enlargement (6 Weeks) Urinary Frequency (6-12 Weeks) Uterine Enlargement (7-12 Weeks) Fatigue (12 weeks) Hyperpigmentation of Skin (16 weeks) Fetal Movement "quickening" (16-20 weeks) |
| Probable Signs of Pregnancy | Positive Pregnancy Test (4-12 Weeks) Goodell Sign (5 weeks) Chadwick Sign (6-8 weeks) Hegar Sign (6-12 weeks) Abdominal Enlargement (14 weeks) Braxton Hicks Contractions (16-28 weeks) Ballottement (16-28 weeks) |
| Positive Signs of Pregnancy | Ultrasound verification of embryo or fetus (4-6 weeks) Auscultation of Fetal Heart Tones Via Doppler (10-12 weeks) Fetal Movement felt by clinician (20 weeks) |
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