Chapter 13 - A&P of Pregnancy

What hormones stimulate uterine growth?

High levels of estrogen & progesterone

When may a woman begin “showing”?

After the 14th week

Lightening

• When the fetus begins descending into the pelvis

  • Nullipara - 2 wks b4 labor

  • Multipara - at the start of labor

Hegar Sign

Softening & compression of lower uterine segment that causes urinary frequency

How may Braxton Hicks contractions be ceased/alleviated?

With walking or excercise

Uterine Souffle

Bruit heard/blowing sound of maternal blood flow thru uterine arteries

Funic Souffle

Synchronous with FHR due to fetal blood running thru umbilical cord

Ballottement

Palpation of a floating fetus by bouncing it gently and feeling for a rebound

Quickening

1st feeling of fetal recogniton via fetal movements/flutters

The week quickening occurs gives a clue to

Gestation duration

Goodell Sign

Softening cervical tip from increased vascularity

Friability

• how sensitive the tissue begins

  • Women may bleed after vaginal examination or deep penetration

Operculum

Mucus plug that fills the endocervical canal

***rich in immunoglobulin & acts as a barrier

Chadwick Sign

Violet/blue color of the vaginal mucosa and cervix from increased vascularity

Leukorrhea

White/gray vaginal discharge

Since pregnant women are more vulnerable to infections…

Vaginal pH drops to prevent ascending bacterial infections

What may be seen due to increased vaginal vascularity?

• High sexual interest (2nd trimester)

• Edema/varicosities of vulva

What may explain why BP remains the same or even drops slightly in pregnant woman?

Progesterone has vasodilatory effects = decreased SRV

Supine Hypotensions/Vena Cava Syndrome

When a woman lays on her back she has reflex brady → reduced CO

Cardiac Structural Adaptations

• Cardiac hypertrophy

• PMI shifted upward

• Splitting of S1 & S2

• S3 may be heard from rapid diastolic filling

• Systolic ejection murmur in 96%

Physiologic Anemia of Pregnancy

• Plasma increase > RBC production

  • ⬇ hgb & hct levels

  • Hemodilution!!!

Respiratory Adaptations

• Uterus has upward pressure on the diaphragm

• Chest > abdominal breathing

• Dyspnea

• Voice change

• Impaired hearing

Why are pregnant women in a state of respiratory alkalosis?

Constant hyperventilation with reduced CO₂

Effect on gums from increased estrogen levels?

• Swollen

  • Bleed easily

Epulis

Red, raised nodule on gums (may enlarge)

Ptyalism

• Excess salivation

  • Amplified when nauseated, due to decreased in swallowing

Upper GI Effects

• Increased progesterone

  • Decreases tone (heartburn)

  • Reduces peristalsis (constipation)

Pica

Nonfood cravings

Gallbladder Adaptations

• Increased progesterone

  • Distended/hypercholest/gallstones

  • Cholestasis → itching/jaundice

Liver Adaptations

• Hemodilution → ⬇ albumin//protein

• ALK phos. levels increase

Although the kidneys enlarge during pregnancy

• Urinary stasis → slow urine flow rate

  • ⬆ UTI risk

Best position to preserve renal function during pregnancy?

• Side-lying position increases

  • renal perfusion

  • urine output

  • ⬇ edema

Some women may feel thirsty

Early in the pregnancy

Why may glucosuria be seen?

Impaired tubular reabsorption of glucose

What should we look out for in women on diuretics?

• Hypovolemia

• Reduced placental perfusion

Melasma

Hyperpigmentation

What has been shown to reduce stretch mark redness?

Pulsed laser therapy

Why may women experience palmar erythema?

From the high estrogen levels

MSK Adaptations

• Lordosis

• Waddling gait

• Leg cramps

• RLS

Headaches may indicate

Pre-eclampsia

Why is carpal tunnel seen in pregnant women>

The edema compresses peripheral nerves

Human Chorionic Gonadotropin (hCG)

• Maintains production of estrogen/progesterone until placenta can take over

  • ⬆ lvls: DS/multiple gest.

  • ⬇ lvls: miscarriage/ectopic

• > 25 = 🤰🏻

Estrogen interferes with _________ metabolism

Folic acid

Cortisol stimulates

production of insulin during pregnancy

Home preggo test should be done with

First voided morning speciment

Anticonvulsants/tranquilizers can cause

False (+) results

Diuretics/promethazine can cause

False (-) results