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OB CH9
Changes in pregnancy
| Question | Answer |
|---|---|
| Uterine Changes | Pre- Pregnancy it is 7.5*5*2.5cm weights about 60g(2oz) At the end of Pregnancy it is 28*24*21cm weights about 1100g(2.5lbs) and its capacity goes from about 10-5000ml |
| Braxton-Hicks Contractions | Irregular painless contractions starting around the 4th month of pregnancy |
| Cervix | Estrogen stimulates the glandular tissue of the cervix, which increases increases in cell #. |
| Mucus Plug | Created by the endocervical glands secrete a sticky mucus which seals endocervical canal. |
| Ovaries | They stop pruducing ova but the corpus luteum produces hormones until wk 6-8. They secrete progesterone until about the 7th wk when the placenta takes over |
| Vagina | Estrogen causes a thickening of the vaginal mucosa, a loosening of connective tissue and a increase in vaginal secretions which are thick, white and acidic to prevent infection but favors yeast infections |
| Goodell's Sign | Is a softening of the Cervix |
| Chadwick's Sign | Is a Bluish discoloration |
| Breasts | Estrogen and Progesterone cause changes. they become more nodular, increase in size and number in preperation for lactaction. |
| Breast II | The superficial viens become more prominent,nipple erect, and areolas darkens. Montgommery's follicles enlarge and striae may develope |
| Resiratory System | The volume per minute increases by about 30-40%.Progesterone decrease airway resistance acounting for %15-20 |
| Subcostal Angle | The uterus pushes up on the diaphram and the subcostal angle increases so the rib cage flares causing the chest circumfrance to increase by as much as 6cm. Brathing switches from belly to thoracic |
| Cardio Vascular | An increase blood flow to uterus causes a 30-50% blood flow increase that peaks around 25-30 wks. pulses may increase by 10-15 bpm |
| Uterus and Cardiovascular | Enlarged uterus may put pressure on the vena cava and cause swelling of the lower exremities, hemmoriods late in pregnancy this could also cause postural hypotension |
| Blood volume | It increases rapidy until about 30-34wks where volume is up 40-50%, this is caused by erythrocytes and plasma |
| Erythrocyte increases | Erythrocytes Increase by about %30 in women who take Iron supplements and only %18 percent in women who don't |
| Hg and Hct (Physiologic amenia of Pregnancy | Hct will be up and Hg will be down because Plasma volume increases %50 and Erythrocyte only increases %30 |
| Leukocyte Production | Increases throughout pregnancy to between 5000-12000/mm3 and may reach 20000-30000/mm3 during labor and early postpartum period so WBC should not be used as a sign of infection |
| Fibrin and Plasma Fibrinogen levels | Factors VII,VIII,IX,X increase during pregnancy and can put pt at a increased risk for DVT |
| BP Changes | It goes down in during the2nd trimester and increases to prepregnant level by the end of third trimester |
| GI system | During the 1st trimester elevated HCG levels and changes in carb. metabolism may cause N & V. Gums may soften or bleed easy.Elevated progesterone may cause delayed gastric emptying and consitpation. which can lead to hemorrhoids. |
| Heartburn | Relaxing of the cardiac sphincter also relaxes which can cause pyrosis (heartburn) |
| GI Lab changes | Plasma Albumin concentrations and serum cholinesterase activity decreases with normal pregnancy |
| Urinary | The growing uterus presses on the bladder causing urinary frequency in the 1st trimester |
| GFR | The ureters evongate and dialate above the pelvic brim. GFR increases by as much as 50% by the 2nd trimester, but renal tube reabsorption increases to compensate. Glycosuria may be normal or may indicate gestational diabetes |
| Sabaceous Glands | Are hyperactive and control temp and caridac |
| Memory | Is sometimes short during and shortly after pregnancy |
| Eyes | Decrerased intra ocular pressure. Cornea thickens making in hard to wear contacts, resolves within 6 wks after birth |
| Metabolism | A increase in weight between 25-35lbs is expected; over weight women is 10lbs less. 3-5lbs in 1st tri and 12-15lbs in 2nd and 3rd |
| Water Retention | There is a increase in water retention from estrogen and progesterone. There is also a decrease in serum albumin |
| Protein Intake | Is more greatly required during the 2nd half of pregnancy when the einfant doubles in weight. It is also stored for breast milk. |
| Fat intake | There is a increase in the level of lipids and cholesterol. Fats are more completely absorbed which may cause ketonuria |
| Thyroid | Enlarges slightly due to increased vascularity, estrogen levels, and serum protein-bound iodine. BMR > by 25% |
| Anterior Pituitary | Makes pregnancy possible by hypothalamic stimulation of the anterior pituitary to release FSH, LH and prolong's the corpus luteal phases which maintains the endometrium. It also releases prolactin |
| Posterior Pituitary | Produces Vasopressin (ADH)and oxytocin. Vasopressin causes constriction and increases BP. Oxytocin promotes uterine contractability and stimulates ejection of milk from breasts |
| Adrenals | Cortisol levels (which regulate carbohydrate and protein metabolism) increase in response to increased estrogen levels. They also increase aldosterone levels by 2nd tri to aid in NA+ regulation |
| Pancreas | Increased insulin needs that if not met may lead to gestational biabetes after 28wks |
| Human Choronic Gonadotrpin (HCG) | Stimulates Progesterone and estrogen by corpus luteum until placental takes over |
| Human Placental Lactogen (hPL) | acts as a insulin antagonist, increasing amount of free fatty acids and decreases maternal metabolism of glucose to favor fetal growth |
| Relaxin | Inhibits uterine activity, diminishes strength of uterine contractions and aids in softening the cervix. |
| Subjective Signs of pregnancy | Amenorrhea, Morning sickness in 1st tri only; favorable outcomes,Excessive fatigue 1st tri, urinary frequency,breast changes,quickening at 16-20wks. |
| Objective Signs of pregnancy | Goodell's sign;soft cervix, Hegar's sign;softening of isthmus, Chadwick's;darkening of mucous membranes,Mcdonald's;ease in flexing body of uterus against cervix, Enlarged abd; 8wks, palpable fundus;12 wks, Braxton hicks;28wks, Uterine souffle;blood |
| Objestive signs of pregnancy II | Skin Pigment changes, Fetal outline palpated;24wks, Ballottement;passive fetal movement against cervix,Blood and urine tests for hCG(not a +sign of prenancy) |
| Signs of Pregnancy | Fetal heart beat; Doppler 10-12wks, fetoscope 17-20wks. Fetal movement 20wks. Visualization of the fetus by ultra sound 4-5wks for gesational sac and 8wks for fetal parts |
| Urine tests | Hemagglutination inhibition test, and Latex aggulutination test. Both sould be done in the morning and will be positive 10-14 days after missed period |
| Blood test B-subunit radioimmunassay (RIA) | +few days after implantion but requires several hours to preform |
| Blood Tests Immunoradiometric assay (IRMA) | can detect very low levels of hCG and takes 30m |
| Blood Tests Enzyme-linked immunosorbent assay (ELISA) | Quick to preform and picks up hCG 7-9 days after conception |
| Fluoroimmunoassy (FIA) | takes 2-3h and is extremely sensitive and used to follow concentrations |
| Couvades | The father has developmental symptoms of pregnancy such as weight gain and Nausea |
Created by:
Ryon_Henry