93 terms

Normal Pregnancy

What CV changes occur in normal pregnancy?
- Left upward shift of heart
- PMI shifts laterally
- Heart increases size secondary to increase in mass and volume
- Hypertrophy of smooth muscle vasculature and reduction in collagen content
How does blood change during pregnancy?
- Blood volume expansion in 1st trimester (plateaus 30th week)
What hormones participate in the volume expansion?
- RAAS (increased levels of aldosterone)
- Progesterone
- Human chorionic sumatomammotropin
What is the significance of blood increase?
- To compensate for maternal blood loss at delivery
- 500 - 600 mL lost in vaginal delivery
- 1000 mL lost in cesarean
How does cardiac output change during pregnancy?
- Increases 40%
- @ 20-24 weeks
How does stroke volume change during pregnancy?
- Increases 25-30%
- @ 12-24 weeks
How much does the heart rate increase during pregnancy?
- 15 beats/min
What can happen to the vena cava in the 3rd trimester?
- Supine position can reduce CO and arterial pressure caused by compression from uterus
- Hypotension, bradycardia and syncope can result
- Women should lie on side
Does venous pressure increase or decrease in LE?
- Increase
- Causes edema and variscosities
- Compression of inferior vena cava by gravid
Does venous pressure increase or decrease in UE?
- Unchanged
What is the purpose of increased blood flow?
- Helps dissipate heat produced by metabolism of mom and fetus
What kind of heart murmurs can pregnant women develop?
- Systolic ejection murmurs
What changes occur to the pulmonary system?
- Diaphragm elevated as much as 4cm
- Rib cage displaced upward
What hormones plays a role in the hyperventilzation phase of pregnancy?
- Progesterone
Can pregnant women secrete protein in their urine?
- Yes
- Up to 300mg over 24hrs is normal
What happens to the bladder during pregnancy?
- Urinary bladder is displaced upward and flattened in anteroposterior diameter
- Urinary frequency one of earliest signs of preg (Due to hormones)
What happens to the esophageal sphincter during pregnancy?
- Blunted response and decreased pressure
Is it important to make sure women is not anemic?
- Yes
- Due to blood expansion anemia is common
- Many women on Fe supp
What changes do WBCs go through during pregnancy?
- WBC can increase (up to 16,000 in 3rd trimester and 25,000 during labor)
- Chemotaxis can be impaired - more susceptible to infection
What skin changes can occur in pregnancy?
- Linea negra
- Hyperpigmentation
- Striae gravidarum
- Spider angiomas
- Palmar erythema
- Variscosities in legs, anus and vulva
What changes can nail and hair go through?
- Nails become brittle and have horizontal grooves (Beau's lines)
- Hair thickens
What is the average weight gain during pregnancy?
- 27.5 pounds
- Uterus, breast tissue, blood volume and water volume contribute
What is the average weight gain?
- 27.5 lbs
What is the connective tissue of the umbilical cord called?
- Wharton's jelly
What term is used in the 1st 8 weeks to describe the developing organism?
- Embryo
What does the umbilical vein carry?
- Oxygenated blood from the placenta to the fetus
Where does blood flow increase during pregnancy?
- Hands and feet
- Skin
- Uterus
- Kidneys
- Skin
- Breasts
What type of heart murmur occurs in 90% or more gravidas?
- Systolic
What happens to the diaphragm during pregnancy?
- Gets elevated as much as 4cm
- Elevation does not impair its function
- Abdominal muscles have less tone and fxn therefore, diaphragm respiration is very important
How is the bladder displaced in pregnancy?
- Upward and flattened in the anteroposterior diameter
What is one of the earliest signs of pregnancy?
- Urinary frequency
- May be related to pregnancy hormones
What esophageal/stomach disorder is common with pregnacy?
- Reflux symptoms
- Preg. associated with > production of gastrin
- Most cases reported in 1st trimester
- Related to hormone-mediated relaxation of the LES
- Rate of emptying is slower
How are clotting factors affected during pregnancy?
- Coagulation factors increase during preg
- Fibrinolytic activity is depressed during preg
What causes/provokes melasma development?
- Hyperpigmentation of the skin
- Exaccerbatred by sun exposure
- Centro-malar area
- Due to elevated [] of melanocyte-stimulating hormone/ estrogen
What are striae gravidarum?
- Stretch marks
- Appear in 2nd trimester on abdomen, breasts, thighs and buttocks
- Genetic predisposition
What are other common cutaneous changes?
- Spider angiomas
- Palmar erythema
- Cutis marmorata (mottled appearance of skin secondary to vasomotor instability)
- Variscosities
- Compression of vena cava leading to increased venous pressures --> hemorrhoids
What are Beau's lines?
- Horizontal grooves in the nails (nails become more brittle too)
What happens to hair during pregnancy?
- Thickens by increased number of follicles in anagen (growth) phase
What is the pathways for almost all of the blood from the SVC?
- Tricuspid valve into R ventricle --> pulmonary trunk --> DEoxygenated blood passes thru ductus arteriosus to the descending aorta and onto placenta
What is the pathway for almost all of the blood from the IVC?
- OXygenated umbilical venous blood passes thru the foramen ovale into the L atrium and L ventricle to be ejected into ascending aorta
What happens when placental transfer of oxygen is inadequate?
- Anaerobic glycolysis leads to accumulation of excessive amounts of lactic acid
Blood from the umbilical vein reflects...
- Uteroplacental status and is influenced by mom
Blood from the umbilical arteries reflects...
- Uteroplacental status PLUS fetal status
- Fetal blood samples are more accurate than Apgar scores in determining fetal status
What two events occur at birth that alter fetal hemodynamics?
1. Ligation of umbilical cord causes abrupt rise in arterial pressure
2. Rise in plasma CO2 and fall in PO2 initiates regular breathing
What happens if the ductus arteriosus remains open?
- Machinery murmur: Systolic crescendo murmur
When does obliteration of the foramen ovale usually occur?
- 6-8 weeks
What is the time frame for an embryo?
- Fertilization to 8th week of pregnancy
What is the time frame for a fetus?
- 8th week to delivery
What is duration of a pregnancy termed?
- Gestational age
- Age of fetus calculated from 1st day of LMP
- Expressed in weeks
What is the difference between gestational age and developmental age?
- Developmental age (fetal age) is the age of the offspring calculated from the day of IMPLANTATION
What does gravid mean?
- Pregnant
What does gravidity mean?
- Total number of pregnancies
What is parity mean?
- State of having given birth to an infant or infants >500g ALIVE OR DEAD
- In the absence of wt., an estimated duration of gestation of 20+
- A multiple birth (twins) is considered 1 parous experience
Who is the hottest man alive?
- Andrew MackNair
When is a fetus considered viable?
- 23-24 weeks
- 500-600g+ (over 1.1 lbs)
What is an infant?
- Live-borne individual from birth to 1 year of life
What is preterm infant?
- Born prior to 37th week of gestation
What is an abortion?
- Expulsion or extraction of all (complete) or any part (incomplete) of the placenta or membranes, without an identifiable fetus or with a fetus weighing <500g
- In absence of known wt, an estimated duration of gestation under 20 weeks
What is an immature infant?
- Weighs 500-1000g
- 20-28 weeks gestation
What is a premature infant?
- 1000-2500g
- Gestation of 28-37 weeks
What is a low-birthweight infant?
- Live born infant weighing less than or 2500g (5.5 lbs)
What is an undergrown or small-for-gestational-age infant?
- Significantly undersized (<2 SD for period of gestation)
What is a mature infant?
- 37 weeks of gestation
- Weighs more than 2500 lbs
What is a postmature infant?
- One that has completed 42 weeks or more of gestation
It is common to offer induction to women __ days after their due date.
What is the neonatal interval?
- Birth until 28 days of life
What is the perinatal period?
- Time from 28 weeks of completed gestation to first 7 days of life
When is amenorrhea a reliable sign of pregnancy?
- In women with regular menstrual cycles
What can occur at the time of implantation?
- Spotting
When does N/V usually occur during pregnancy?
- 2 - 12 weeks gestation
What is the trx for N/V?
- Light, dry foods
- Frequent meals
- Emotional support
- High-dose vitamin B6
What most likely is the cause of N/V?
- Rapidly rising levels of hCG
What changes happen to the breast?
- Mastodynia
- Enlargement of circumlacteal sebaceous glands of areola (Montgomery tubercles)
- Colostrum secretion
- Secondary breasts
What is quickening?
- Initial movement of the fetus
- 18-20 weeks in primigravidas
- 14-16 weeks in multigravidas
What are urinary signs of preg?
- Bladder irritability, frequency, nocturia
- UTI (associated with miscarriage, preterm birth and intrauterine fetal demise)
What are other changes/symptoms of pregnancy?
- Increased basal body temp
- Cholasma: darkening of skin over forehead, bridge of nose, cheekbones (at ~16 weeks and intensified by sun)
- Linea negra: Darkening of nipples and linea alba
- Striae of breast and abdomen
- Spider telangiectases
What is Chadwick's sign?
- Congestion of pelvic vasculature causes bluish or purplish discoloration of vagina and cervix
What is Hegar's sign?
- Widening of the softened area of the isthmus
- Occurs at 6-8 weeks
What joint relaxes during pregnancy most?
- Pubic symphysis
What is the normal fetal heart rate?
- 120-160 bpm
When can fetal heart rate be heard?
- 10 weeks gestation with doppler
When can the fetus be palpated?
- 18 weeks
- After 22 weeks, the fetal outline can be palpated through ab. wall
When is cardiac activity discernible?
- 5-6 weeks...or somewhere else it said 10
When can hCG be detected in serum?
- One week after conception
What is the most widely used technique for determination of gestational age?
- U/S
When can fetal crown to rump length be measured?
- 5-13 weeks
- Most accurate means to determine age
When is the uterus palpable at the pubic symphysis?
- 8 weeks
When is the uterus an abdominal organ?
- 12 weeks
When is the uterus at the midpoint between pubic symphysis and umbilicus?
- 16 weeks
When is the uterus palpable at the umbilicus?
- 20 weeks
What is fundal height measured from?
- Distance in cm from pubic symphysis to curvature of the fundus
- Correlates roughly with the estimated gestation age at 26-34 weeks
- After 36 weeks fundal height may decrease
When can first fetal movements usually be felt?
- 17 weeks about for multipara
- 18 weeks in average primipara
When does a fetus have its best chance at survival?
- 37 to 41 weeks