2 - Maternal Adaptations in Pregnancy

Fundus

Enlargement from stretching and hypertrophy in uterus is most marked at which area?

• Outer hoodlike layer

• Middle layer of muscles

• Inner sphincter-like fibers

Layers of the uterus

Rotates to the RIGHT(dextrorotation)

The uterus rotates to which direction? This is caused by the rectosigmoid on the left side of the pelvis

Braxton-Hicks contractions

accounts for "false labor"; irregular, unpredictable, sporadic contractions which rises in number in the last two weeks of gestation

nitric oxide (a potent vasodilator)

Uteroplacental blood flow is mediated by which small molecule?

soluble FMS-like tyrosine kinase 1

(sFlt-1)

VEGF and PlGF are attenuated in response to the excess of which hormone?

Angiotensin II

Normal pregnancy has vascular refractoriness to which blood pressure mediator?

Bluish

Increased vascularity and edema causes the cervix to turn to which color?

Cervical ripening

This process involves lowering collagen and proteoglycan concentrations and raises water content (compared with nonpregnant cervix

Mucus plug

Copious amounts of mucus rich in Ig and cytokines produced by endocervical glands causes the formation of this structure. This is expelled at the onset of labor (bloody show)

Beading

Characteristic pattern of cervical mucus seen when it is spread and dried on a glass slide; caused by progesterone causes poor crystallization

Ferning

Characteristic pattern of cervical mucus seen when amniotic fluid violates the cervical canal. It is caused by estrogen and salts leading to crystallization

Placenta

Organ that produces hCG which maintains the corpus luteum

Corpus luteum (CL)

This ovarian structure produces progesterone which maintains the endometrium. It functions maximally until 7 weeks of pregnancy.

Arias-Stella reaction

Loss of polarity, pleiomorphism, intraluminal budding in cervical cells during pregnancy

Eversion

Marked proliferation of cervical glands leads to the outward displacement of the os.

Relaxin

This hormone is produced by the CL, the decidua, and the placenta. It aids in remodeling of reproductive tract connective tissue to accommodate labor.

Theca lutein cysts

Benign ovarian lesions reflecting physiological follicle stimulation (hyperreaction luteinalis); linked to markedly elevated serum hCG levels (e.g. GTD, multifetal gestation)

Chadwick sign

Violet discoloration of the vagina and cervix resulting from increased vascularity

Colostrum

Thick, yellowish fluid expressed from the nipples by gentle massage

Striae gravidarum

Reddish, slightly depressed skin; in multiparas, glistening, silvery lines from previous striae

Diastasis recti

Rectus muscles separating in the midline when abdominal walls do not withstand the tension of the expanding pregnancy

Hyperpigmentation

Develops in 90% of women, usually more accentuated in those with darker complexion; may be due to the melanocyte-stimulating effects of estrogen and progesterone

Linea nigra

Brown-black pigmentation in the midline of the anterior abdominal wall

Chloasma

Irregular brownish patches of varying sizes appearing on the face and neck

Estrogen (hyperestrogenemia)

Vascular changes - likely due to which hormone

Vascular spiders/angiomas

Common on the face, neck, upper chest, and arms; minute, red skin papules with radicles branching out from a central lesion

Palmary erythema

Increased cutaneous blood flow serves to dissipate excess heat generated by augmented metabolism

• Periods of hair growth (anagen)

• Apoptosis-driven involution (catagen)

• Resting period (telogen)

Phases of hair cyclic activity

Telogen effluvium

Excessive hair loss in the puerperium

20%

Metabolic rate increase in 3rdtrimester

10%

Additional metabolic rate increase with twin gestation

12.5 kg (27.5 lbs)

Average weight gain during pregnancy

6.5 L

water content of the fetus, placenta, and AF (~3.5 L) + expanded maternal blood volume and from uterus and breast growth (3.0 L)

Total extra water during pregnancy

Mild fasting hypoglycemia, postprandial hyperglycemia, hyperinsulinemia

Carbohydrate metabolism characteristics during pregnancy

Leptin

Secreted by adipose tissue in non-pregnant humans; important for implantation, cell proliferation, and angiogenesis

Adiponectin

Produced in maternal fat, not in the placenta

• Inversely correlated with adiposity

• Insulin sensitizer

• Reduced in patients with GDM

Ghrelin

Secreted by the stomach and placenta in response to hunger

Visfatin

Elevated levels of this hormone, along with leptin, impair uterine contractility

Physiologic anemia of pregnancy

This refers to the decrease in hemoglobin concentration due to plasma expansion during pregnancy

Factors XI and XIII

All clotting factors increase except

Left axis deviation

Most common ECG change during pregnancy

Supine hypotensive syndrome

Refers to a syndrome caused by compression of the great vessels by the uterus in the supine position

Progesterone

Refractoriness to angiotensin II is probably due to this hormone

• Functional residual capacity (FRC)

• Total lung capacity

Pulmonary volumes that decrease during pregnancy

• Inspiratory capacity (IC)

• Tidal volume (TV) (May be unchanged or

decreased )

Pulmonary volumes that increase during pregnancy

• Inspiratory capacity (IC)

• Tidal volume (TV) (May be unchanged or decreased )

Pulmonary volumes that do not change during pregnancy

• Enhanced respiratory drive due to PROGESTERONE

• Low expiratory reserve volume

• Compensated respiratory alkalosis

Causes of elevated minute ventilation in pregnancy

GFR increases by 25%,

Renal blood flow increases by 80%

GFR and renal blood flow changes during pregnancy

Progesterone inhibits CCK-mediated smooth muscles stimulation → impairs GB contraction →impaired emptying, stasis→cholesterol gallstones in pregnancy

Pathophysiology of increased risk of cholesterol gallstones in pregnancy

Hemorrhoids

Constipation and elevated rectal vessels below the level of the enlarged uterus increases the risk for which GI tract abnormality?

Prolactin

Hormone that ensures lactation in early pregnancy

Thyroid-binding globulin

This carrier protein increases due to estrogen stimulation --> increases TOTAL T4 and T3 BUT do not affect free T4, T3

T4

The fetus relies heavily on maternal production of which thyroid hormone?

Progressive lordosis + anterior neck flexion + shoulder girdle slumping → traction on the ulnar and median nerves

Pathophysiology of upper extremity weakness, numbness during pregnancy

Krukenberg spindles

Brownish-red opacities in the posterior surface of the cornea; often observed in pregnancy