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2145 Maternal Adaptations to Pregnancy and Labor

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What are some cardiovascular adaptations during pregnancy (5)?
Oxygenation needs an increase so..
1. AR increases 15-20 bpm
2. Blood volume increases ~45%
3. Cardiac Output increases ~40%
4. Healthy pregnancy, no increase in BP b/c of action of estrogen and progesterone (mom vasodilates to compensate for volume & output. if vasoconstricts ↑ BP)
5. heart is pushed upward & toward the left as uterus expands
How much does HR increase during pregnancy?
AR increases 15-20 bpm
How much does blood volume increase during pregnancy?
~45%
How much does cardiac output increase during pregnancy?
~40%
What are some cardiovascular adpations DURING LABOR? (3)
1. Cardiac output increases
- 1st stage cardiac output increases 10-15%
- 2nd stage (pushing) CO increases 30-50%
- 4th stage CO may peak by 80% over pre-pregnancy (a lot of thick extra blood)
2. During contractions BP inceases
- 1st stage systolic 10mmHg
- 2nd stage systolic 30mmHg and Diastolic 25 mmHg
3. Increase in heart rate is possible - depends on pain tolerance
Cardiac output increases how much during 1st stage?
10-15%
Cardiac output increases how much during 2nd stage?
30-50%
Cardiac output increases how much during 4th stage?
80% over pre-pregnancy b/c after delivery a lot of thick extra blood
Blood pressure (systolic) increases how much during 1st stage?
10mm
Blood pressure (systolic & diastolic) increases how much during 2nd stage?
systolic = 30mm
diastolic = 25mm
What are some Hematological Adaptations during Pregnancy (4)?
WBC-5-10000
Hg- 12-14
Hct- 12-14x3
1. In pregnancy, plasma and cellular elements increase, plasma increases faster- so 'dilutional' anemia may occur (volume is ↑ but not RBCs ex. give fluids)
2. WBC increase 5000-12000
3. Clotting factors increase (50%) - hypercoagulable state- increase risk of DVT, DIC (Disseminated intravascular coagulation)
4. Erythrocytes ↑ by 20-30% - usually requires iron supplement
How much does WBC increase during pregnancy & what may WBC increase to during labor?
increase 5000-15000 during pregnancy
Increase to 25,000 during labor
How much do clotting factors increase during pregnancy?
50%
How much do erythrocytes increase during pregnancy?
20-30%
What are some hematological adaptions during labor and birth (4)?
1. WBC may increase +25000 then in early pp may increase to 30000
2. With birth blood loss less than or equal to: vaginal delivery: 500mL, C/S birth: 1000mL
3. Further increase of clotting factors-return to pre-pregnant state 3-4 wks pp
4. Check CBC 1st day post op C/S pt, also Hgb, WBC
What are some respiratory adaptions during pregnancy (3) & during labor (2)?
Pregnancy:
1. increasing O2 consumption b/c of larger uterus & fetus
2. thoracis circumference increases by 2-3 inches, diaphragm elevates
3. increased RR 15% 2-3 breaths/min
Labor:
1. increase in RR and possibly AR, depends on pain level & tolerance
2. hyperventilation = tingling in extremities, dizziness. help them slow breathing & cup hands around mouth
What are 6 renal adaptations during pregnancy?
1. Increased glomerular filtration rate of 40-50% non pregnant state due to increased blood volume
2. Urine output is 25% higher
3. Bladder tone is decreased = infections
4. ability of renal tubules to reabsorb glucose ↓ so may see glucose in urine which is primed for bacteria growth
5. ureters compressed by larger uterus
6. Physiologic hydronephrosis, ureters elongate and become tortuous, upper 1/3 of ureter may dilate →UTI
What are some renal adaptations during labor (5)?
1. Proteinuria of +1 WNL
2. Prolonged straining during 2nd stage may cause injury to bladder
3. Spontaneous voiding may be difficult- even if no edpidural
4. after birth swelling may inhibit urination
5. usually measure 1st 2 urine outputs after birth
What are some integument adaptations during pregnancy (6)?
1. Hyperpigmentation- melasma, linea alba-linea nigra, other areas too
2. Hair- increased growth
3. Striae gravidarum = stretch marks
4. nail growth increases
5. Blood vessels may have increased permeability so edema, palmar erythema, spider nevi
6. Pruritus, acne
What are stretch marks (5)?
1. May start as purple or blueish areas that turn white or silver white after birth
2. Not painful
3. Upsetting to patient
4. CoCoa butter may help
5. usually don't go away
What are some GI adapations during pregnancy (6)?
1. Gums become swollen, soft and have a tendency to bleed, go to dentist b/c ↑ risk of periodontal disease
2. GI tract- progesterone causes smooth muscle relaxation/ decreased peristalsis
3. Constipation
4. Hemorrhoids
5. Heartburn/reflux
6. increase risk for gall stones due to delayed emptying
Gi adaptations during labor (3)?
1. GI motility and absorption decreased b/c blood flow is going to uterus. if you eat -->vomit
2. Stomach emptying time slowed- N/V
3. Diarrhea possible w/ onset of labor (nothing can be in rectum)
What are five endocrine adaptations during pregnancy?
1. Pituitary gland- increased prolactin
2. Thyroid- increased thyroxine & BMR 25% term
3. Pancreas- increased insulin entire pregnancy to compensate for placental hormone insulin antagonism (HPL-human placental lactogen)
4. Ovaries/Placenta- estrogen, progesterone, relaxin
5. Parathyroid = increased parathyroid hormone to help meet fetal demand for Ca & P
What are endocrine adaptations during labor (2)?
1. Decreasing progesterone
2. Increasing estrogen, prostoglandins, oxytocin
Ballottement
near midpregnancy a sudden tap on the cervix during VE may cause fetus to rise and rebound to original position
what four ways can you help minimize varicose veins
1. don't cross legs
2. wear TED hose
3. elevate legs at end of day
4. try not to stand too much
linea nigra
dark line of pigmentation from symphysis to umbilicus
chloasma
brownish patches, forehead, cheeks & bridge of nose
"mask of pregnancy"
Chadwick's sign
Cervix - bluish color, extends to vagina & labia
Goodell's sign
Cervix - softening of the cervix
Hegar's sign
1. 6th week pregnancy
2. lower uterine segment softens and can be compressed
Normal blood loss with vagina birth
500mL
Normal blood loss with C/S
1000mL
Breast changes during pregnancy (5)
1. enlarge due to progesterone & estrogen
2. more vascular, veins often visible
3. stretch marks
4. nipples enlarges & darkens
5. Montgomery glands secrete substances to lubricate nipple
4 major changes in blood flow during pregnancy
1. additional blood flow to perfuse the placenta (↑ cardiac output)
2. more blood to maternal kidneys to filter mom & baby blood
3. woman's skin needs increased circulation to dissipate heat
4. expanding uterus on vena cava lowers perfusion back to the heart
how much does RR increase during pregnancy?
15%, 2-3 breaths/min
How much does the GFR Increase during pregnancy
40-50%
How much increased urine output during pregnancy
25%
Musculoskeletal changes during pregnancy
1. pelvic ligaments & joints soften allowing for passage of fetus. causes a waddles effect
2. mother may lean backward to maintain balance
3. diastasis recti = separation of rectus abdominis muscles