Maternal Physiology

What is hegar sign?

The softening & compressibility of the LOWER UT SEGMENT @ 6wks

• this is how you can check pregnancy

• Uterine sign, not cervical.

• HAND required.

Braxton Hicks definition

Changes in contractility

• aids in in increased blood flow, irregular, and painless contractions of the uterine muscle

• Blood flow becomes stronger by the end of pregnancy

Fetal changes in utero

• Ballottement

• Quickening

Ballottement definition

When the examine taps/pushes the uterus/cervix area, and the fetus floats upwards and rebound back/ bounces.

• Occurs because fetus is floating in amniotic fluid & baby’s head isn’t engaged in the pelvis

Quickening definition

First baby movement

• occurs @ 16-18 weeks

• if the baby is 3 months but the mother does not feel the kicking, this is normal because hasn’t reached 16-18 weeks yet

Cervix definition

Connective tissue that remains CLOSED and firm to prevent baby from getting out

• Softens and dilates during labor; opens 2cm (+sign)

Gooddell sign

Softening of the CERVIX due to increased blood, size, cells

• pregnancy caused increased blood flow and tissue/cell changes in the cervix

What is operculum

“Mucus plug”

• cervical mucus that protects fetus from bacteria and infection

• Forms during pregnancy as the cervix produces thick mucus

During the reproductive stages, what are the changes that occur in the ovaries?

• No ovulation; amenorrhea (no menstrual cycle)
  Estrogen & progesterone SUPPRESS FSH & LH

Description of normal vaginal discharge in pregnancy?

• Increased amount of leukorrhea due to hormones preparing for labor

  • (cervix stimulation

• Mild to no odor, nonirritating

• Increased blood flow to pelvis

• Decreased pH to protect baby

• Vulval edema & varicosities; relaxed blood vessels, enlarged uterus

Chadwick sign definition

Bluish discoloration of mucosa of the cervix, vagina, and vulva

• due to increased blood flow supply/vascularity during pregnancy

Breast characteristics in pregnancy

• Feelings full, heavy, tingling; should NOT be painful

• Nipple & areola pigments; nipples erectile to prepare for lactation

• Sebaceous glands secrete substance to lubricate and protect nipples

• Striae gravidarum visible (stretch marks)

• Prolactin stimulates production of colostrum (prepares breast for lactation

Cardiovascular changes during pregnancy

Should NOT go over 140/90 in pregnancy

• Blood volume increases by 40-50% (1200-1600mL) peaks ~32 wks, decreases @ term (protective mechanism

• Cardiac output (increases 30-50%), peaks 25-30wks, decreases @ term

• Stroke volume increases due to increased demand for O2 in tissues

• Blood pressure- normal or slight drop.

• Decreased system vascular resistance due to vasodilation of effects of hormones

• BP-SBP normal as pre-pregnancy levels, DBP decreased during the 1st trimester up to 2nd-3rd trimesters, then returns to pre-pregnancy levels @ term

  • Systolic; slight to no decrease from pre pregnancy levels

  • Diastolic; slight decrease to mid pregnancy (24-32wks) and gradual return to prepreganncy levels by end of pregnancy

• HR increases 10-20 beasts/min

• Compression of vena cava- supine hypotensive syndrome/vena cava syndrome

• Compression of pelvic blood vessels- edema, varicosities, hemorrhoids, VTE

Supine hypotensive syndrome

When a pregnant person lies flat on their back and the heavy uterus compresses the inferior vena cava → decreases blood return to the heart

• Enlarged uterus compresses the vena cava/uterus pressure on blood vessel -→ closes blood supply/ less blood returns to heart → decreased CO → decreased BP → fainting

Compression of pelvic blood vessels during pregnancy leads to?

Edema, varicosities, hemorrhoids, VTE (venous thromboembolism)

• blood return from lower body slows → blood pools → swelling/varicose veins/hemorrhoids

Neurological changes during pregnancy

Headaches, fainting spells, postural hypotension occur w/ uncertain causes

• Ocular changes: increased fluid & thickening of cornea, decreased intraocular pressure

• Carpal tunnel syndrome: seen in 3rd trimester due to edema on peripheral nerves

Endocrine changes during pregnancy

• Increased thyroid levels, increased size of pituitary gland

• Increased prolactin levels

• Increased insulin levels during 3rd trimester

  • 3rd trimester: placental hormones cause insulin resistance, so maternal insulin levels increase to compensate.

KEY hormone to test for pregnancy

HCG!!!!

• through urine/serum

• Quantitative Serum Testing; most reliable

Ways to diagnose pregnancy

• Presumptive; subjective (complaints)

• Probable; objective (observed by provider)

• Positive; objective (indicates proof of pregnancy)

What hormone maintains the corpus lute production of estrogen and progesterone until the placenta takes over the function?

Human choronic gonadotropin (hCG)

What causes physiologic anemia during pregnancy?

When red blood cells increase, the plasma volume increases way more

• this causes hemodilution, then causes ..

During pregnancy, anemia is diagnosed if

Hemoglobin is

• <11g/dL during the 1st or 3rd trimester

• <10.5g/dL during the 2nd.

  • 10.5 is FINE

GI structure effects during pregnancy

• N/V; possibly due to high levels of hCG

• Presents ~4-6 wks, resolves @ the end of the first trimester

• Pica: non-traditional

• Gums swell + bleed due to increased estrogen

• Ptyalism (increased salivation)

• Stomach: tone, motility of smooth muscles decrease, reflux, heartburn (all become slow due to progesterone relaxation (so that you don’t go into labor)

• Hiatal hernia (widening of hiatus of diaphragm)

• Intestines slow down; reduced peristalsis → causes constipation

• Gall bladder: walls are relaxed, emptying time increases, and high risk for gallstones

• Liver size is normal

• Appendicitis loves to come during pregnancy, so check McBurney’s Point; uterus expands upwards as pregnancy continues, so appendix shifts up

Renal functions during pregnancy

• Kidneys increase in size

  • ureters become dilated and are released

  • Increased amount of urine in pelves & ureters/slow flow of urine

  • Lag time to when urine is formed when it reaches bladder

    • UTI is easy to occur during pregnant women; can lead to pyelonephritis (presents w. flank pain, fever, increased HR. Manage this with fluids, antibiotics)

  • bladder irritability, nocturne, urgency, & frequency= all common in 1st & 3rd trimesters

• Increased GFR, increased excretion of protein & albumin, tubular reabsorption of glucose is impaired; causes spillage in urine because there is so much glucose being filtered

• Kidneys manage metabolic and circulatory demands of both the woman & waste products from the fetus

• lateral recumbent position to increase urine output and decrease edema

Skin changes during pregnancy

• Hyperpigmentation (released from anterior pituitary hormone melanotropin)

• Chloasma (mask of pregnancy; hyperpigmentation over cheeks, nose, forehead)

• Linea nigra (pigmented line from symphysis pubis to fundus)

• Striae gravidarum (stretch marks on stomach)

• Pruritus gravidarum (abdominal itching; moisturize this)

Musculoskeletal effects of pregnancy

• Risk for falls r/t gravid uterus, impaired balance, joint laxity

• Lordosis: increased lumbosacral curvature

• Symphysis pubis widens; pain if separation occurs

• waddling gait is present

• stretching of abdominal muscles; diastasis recti abdominis if separated

• leg cramps