Uncomplicated and Healthy Pregnancy: Anatomy, Physiology, and Prenatal Care

A comprehensive set of 60 review flashcards covering maternal anatomy and physiology, endocrine roles, presumptive/probable/positive signs of pregnancy, GTPAL, and trimester-specific clinical care.

How does the uterine smooth muscle adapt to accommodate fetal growth during pregnancy?

The smooth muscle of the uterine wall undergoes hypertrophic and hyperplastic changes.

What hormone is thought to play a key role in uterine spiral artery remodeling during pregnancy?

Estrogen.

What changes do estrogen and progesterone induce in breast tissue during pregnancy?

They cause breast tissue to differentiate and create additional milk ducts to prepare for milk production.

By what percentage does maternal blood volume increase during pregnancy?

$$30\%\text{ to }50\%$$

What are the two primary purposes of the $30\%\text{ to }50\%$ increase in maternal blood volume?

To meet the oxygen demands of the fetus and to compensate for blood loss at delivery.

How do maternal cardiac output, stroke volume, and heart rate change during pregnancy?

Maternal cardiac output and stroke volume increase, and maternal heart rate becomes elevated.

What causes the decrease in peripheral vascular resistance and maternal blood pressure during pregnancy?

Elevated estrogen levels.

What is the physiological effect of lower hematocrit values in pregnancy?

They decrease blood viscosity and lower resistance for blood to reach the uteroplacental circulation.

By how much does the elevation of clotting factors increase the risk of blood clots during pregnancy?

By nearly five times ($5\times$).

What causes an increase in lower extremity venous pressure and varicosities during pregnancy?

The gravid uterus exerting pressure on the pelvic and femoral vessels.

Why does maternal respiratory rate increase during pregnancy?

To accommodate increased maternal and fetal oxygen demands.

Why is total lung volume expansion decreased during pregnancy?

Due to upward pressure exerted by the growing uterus on the diaphragm.

What term refers to the fetus settling deeper into the pelvis near the end of pregnancy, relieving diaphragm pressure?

Lightening.

What causes pregnant clients to feel full faster and experience acid reflux?

Upward displacement of the stomach and intestines by the expanding uterus.

What gastrointestinal manifestations result from delayed gastric emptying caused by hormonal changes?

Heartburn, nausea, and vomiting.

What gastrointestinal issue is caused by decreased intestinal motility during pregnancy?

Constipation.

By approximately what percentage do maternal kidneys increase in size during pregnancy?

Approximately $30\%$.

By approximately what percentage does the glomerular filtration rate (GFR) increase above prepregnancy baseline values?

Approximately $50\%$.

What causes urinary frequency early in pregnancy compared to late in pregnancy?

Early pregnancy frequency is caused by increased progesterone and human chorionic gonadotropin (hCG); later frequency is caused by mechanical pressure from the growing uterus.

Which two urinary findings are considered expected variations during pregnancy but must still be monitored?

Glycosuria and proteinuria.

Why is the maternal basal metabolic rate increased throughout pregnancy?

Due to increased maternal and fetal energy usage.

During the first and second trimesters, what stimulates increased fat storage for later use?

Placental hormones and growth factors.

What hormone forms the basis of pregnancy testing and what initially produces it?

Human chorionic gonadotropin (hCG); it is initially produced by the trophoblast cells surrounding the embryo until the placenta takes over.

What are four key physiological roles of progesterone during pregnancy?

Establishes the placenta, maintains the health of the uterine wall, supports blood vessel growth, and prevents uterine contractions.

What are the primary physiological roles of estrogen during pregnancy?

Promotes blood vessel growth, maintains the uterine lining, and aids in fetal organ development.

What is the primary role of prolactin during pregnancy?

Stimulates breast growth and breastmilk production.

What are three actions of relaxin during pregnancy?

Promotes uterine relaxation, cervical softening, and maternal vasodilation.

What are the two primary physiological functions of oxytocin?

Stimulates uterine contractions and the release of prostaglandins.

How do relaxin and progesterone affect maternal musculoskeletal joints?

They cause joints to become more flexible to accommodate pregnancy changes.

What postural adjustments occur to compensate for the forward shift in the center of gravity caused by the gravid uterus?

Lumbar lordosis and anterior pelvic tilt (leading to low back pain).

What musculoskeletal condition involves the separation of the abdominal muscles and thinning of the linea alba?

Diastasis recti.

What peripheral nerve condition can develop during pregnancy due to hormone-induced fluid and tissue changes?

Carpal tunnel syndrome.

What are striae gravidarum?

Purple or pink bands (stretch marks) that develop on the skin as it stretches to accommodate the growing uterus.

What is the linea nigra?

A darkened linea alba that runs vertically down the midline of the abdomen.

What is melasma?

Facial hyperpigmentation that can span across the bridge of the nose to the cheeks, forehead, or chin.

What typically happens to hyperpigmented integumentary changes (melasma, linea nigra) post-pregnancy?

All will lighten post-pregnancy.

What are presumptive signs of pregnancy?

Subjective signs felt or experienced by the client, including amenorrhea, breast tenderness, breast enlargement, nausea/vomiting, fatigue, urinary frequency, and skin changes.

What are probable signs of pregnancy?

Objective signs identified by a healthcare provider or laboratory test, such as positive pregnancy tests, Goodell's sign, Hegar's sign, ballottement, and Chadwick's sign.

What constitutes a positive sign of pregnancy?

Direct verification of the fetus via visualization of the fetus and/or detection of fetal heart activity.

What is Goodell's sign?

Cervical softening that occurs during pregnancy.

What is Hegar's sign?

Softening of the lower portion of the uterus.

Which clinical assessment technique is illustrated in the diagram, involving fetal displacement by upward pressure and palpation of its rebound?

Ballottement.

What is Chadwick's sign?

A blue discoloration of the cervix, vagina, and vulva due to increased vascularity.

How is the estimated date of birth (EDB) calculated using Naegele's rule?

Take the first day of the last menstrual period (LMP), subtract $3\text{ months}$, and add $7\text{ days}$.

In the GTPAL obstetrical history acronym, what does 'G' define?

Gravida: the total number of pregnancies, including the current pregnancy.

In the GTPAL obstetrical history acronym, what does 'T' define?

Term: the number of births at $37\text{ weeks}$ of gestation or after.

In the GTPAL obstetrical history acronym, what does 'P' define?

Preterm: the number of births born before $37\text{ weeks}$ of gestation.

In the GTPAL obstetrical history acronym, what does 'A' define?

Abortion: the number of medical, procedural, and/or spontaneous abortions (miscarriages).

In the GTPAL obstetrical history acronym, what does 'L' define?

Living: the number of living children.

What diagnostic tests are included in the routine first-visit prenatal laboratory panel?

CBC, blood type, Rh factor screening, rubella, hepatitis B surface antigen (HBsAg), and human immunodeficiency virus (HIV).

What protein on red blood cells determines whether an individual is Rh-positive or Rh-negative?

Rho D protein (D antigen).

At what gestational window can chorionic villus sampling (CVS) be performed, and what tissue is collected?

Between $10\text{ and }13\text{ weeks}$; a piece of the placenta is sent for genetic testing.

What is the recommended range of total pregnancy weight gain based on prepregnancy weight?

$11\text{ to }40\text{ pounds}$.

What is the expected normal baseline fetal heart rate (FHR) range?

$110\text{ to }160\text{ bpm}$.

Between what gestational weeks is the quad screen or triple screen performed, and what does it assess?

Between $15\text{ and }20\text{ weeks}$; it assesses the risk of chromosomal abnormalities.

When is Rho(D) immune globulin (RhIG / Rhogam) administered to an Rh-negative client?

At $26\text{ to }28\text{ weeks}$ of gestation.

Between what gestational weeks is a routine glucose challenge test performed?

Between $24\text{ and }28\text{ weeks}$.

What anatomical assessments are conducted during the $18\text{--}20\text{ week}$ anatomy ultrasound?

Assessment of the fetal head, skull, brain, nuchal skin folds, face, neck, thorax, heart, abdomen, spine, extremities, genitalia, placental location/proximity to cervical os, and cervical length.

What is the distinction between oligohydramnios and polyhydramnios?

Oligohydramnios is less amniotic fluid volume than typical, whereas polyhydramnios is more amniotic fluid volume than typical.

What is quickening, and during what gestational age window is it typically first felt?

The client's initial perception of fetal movement, typically felt between $16\text{ and }20\text{ weeks}$.

What spinal postural changes across gestation are illustrated in this diagram?

Increased thoracic curve and increased lumbar curve (lumbar lordosis).

When should fetal kick counts begin, and what is the expected threshold of movements?

Initiate at $28\text{ weeks}$; the client should feel $10$ movements over $2\text{ to }3\text{ hours}$.

Between what gestational weeks is screening for Group B Streptococcus (GBS) performed?

Between $35\text{ and }37\text{ weeks}$.

What gestational age range defines postterm pregnancy?

Greater than $42\text{ weeks}$.

According to the fundal height landmarks in the provided image, at approximately what gestational week does the fundus reach the level of the umbilicus?

$20\text{ weeks}$.