[09.19] Maternal Changes_ Reproductive System, Breast, and Skin V2

70 g to 1,100 g at term

What is the weight of the uterus from pre-pregnancy to at term?

10 ml to 5-20 L at term

What is the capacity of the uterus from pre-pregnancy to at term?

Fundus

Where is uterine enlargement most marked?

Week 20

When does the myometrium surrounding the placental site grow more rapidly?

Umbilicus

By week 20, where is the fetus seen at the level of?

Fundus

What part of the uterus is the most contractile?

Outer hood-like layer, middle layer, and internal layer

What are the layers of the uterine musculature?

Arches over the fundus and extends into various ligaments

What does the outer hood-like layer do?

Dense network of muscle fibers perforated in all directions by blood vessels

What mainly comprises the middle layer of the uterine wall?

Figure eight

What figure is formed by the interlacing of any two cells in the middle layer of the uterine wall?

Ligate the blood vessels during a contraction

What is the function of the interlacing fibers in the middle layer of the uterine wall?

Uterine atony

What condition occurs when the uterus does not contract adequately/properly, causing blood vessels to continue to bleed?

Oxytocin

What medication is given to contract the uterus and reduce bleeding?

Fallopian tube orifices and the internal os of the cervix

What areas have sphincter-like fibers around them in the internal layer of the uterine musculature?

Piriform/pear-shaped (early 1st trimester) → globular & spherical (12 weeks) → ovoid (late 2nd trimester to term)

How does the shape of the uterus change during pregnancy?

Dextrorotation

What is the rotation of the uterus to the right called?

Rectosigmoid

What pushes the left side of the uterus towards the right?

Constipation

What can compression of the rectosigmoid cause during the 2nd-3rd trimester?

Round ligament

During dextrorotation, which ligament is most affected?

Labia majora

Where is the round ligament attached to?

Hydroureter

What can compression of the ureter during dextrorotation cause?

Laterally and superiorly

How are the intestines displaced as the uterus grows?

False labor

What is another name for Braxton Hicks contractions?

Unpredictable, sporadic, and non-rhythmic

What kind of contractions are Braxton Hicks contractions?

5 - 25 mmHg

What is the intensity of Braxton Hicks contractions?

Anterior trunk of the internal iliac artery

Where do the uterine arteries come from?

Vasodilation

What is maternal-placental blood flow increase mainly due to?

Estrogen, progesterone, relaxin, and nitric oxide

What hormones/substances cause vasodilation and reduced uterine vascular resistance?

Preeclampsia or hypertensive pregnancies and fetal growth restriction

What can reduced nitric oxide (NO) lead to?

Internal iliac artery

Where should one trace to locate the uterine artery?

Ovarian artery

What artery supplies the fallopian tube?

Aorta

Where does the ovarian artery come from?

Increased risk for pitting edema

What risk increases during pregnancy in relation to circulation?

Softening (Goodell sign) and bluish tone (Chadwick sign)

What changes occur in the cervix during pregnancy?

Increased vascularity and edema and changes in collagen network

What causes the softening and bluish tone of the cervix?

Lip-like consistency

What consistency does the cervix have with Goodell sign?

Nose-like consistency

What consistency does the cervix have when not pregnant?

Goodell sign

What sign indicates that a patient is likely to be pregnant if their cervix is soft upon palpation?

Chadwick sign

What sign indicates that the cervix is blue due to increased vascularity?

Retention of pregnancy until term, dilatation to aid delivery, and postpartum repair & reconstitution

What does the rearrangement of collagen-rich connective tissue aid the cervix in?

Proliferation

What do cervical glands undergo during pregnancy?

Immunoglobulin A (IgA) and cytokines

What is cervical mucus rich in?

Protects the fetus from the potentially harmful polymicrobial environment of the vagina by controlling the population of bacteria

What is the immunological barrier function of cervical mucus?

Mucus plug

What does cervical mucus serve as?

Bloody show

What results at the onset of labor due to cervical mucus?

Leukorrhea

What is the mucus discharge with no odor called?

Bacterial Vaginosis

What is the mucus discharge with foul or fishy odor called?

Imbalance of the bacterial flora in the vagina

What causes bacterial vaginosis?

Lactobacilli

What controls the population of bad bacteria in the vagina?

Beading

What patterns resembling bubbles are seen in cervical/vaginal discharge indicating pregnancy?

Progesterone and poor crystallization during pregnancy

What causes cervical mucus beading?

Ferning

What is the arborization of ice-like crystals in cervical mucus called?

Amniotic fluid leakage

What does ferning indicate?

Arias-Stella Reaction

What is the endocervical gland hyperplasia and hypersecretory appearance during pregnancy called?

Mistaken as an abnormal or pathological cervical finding such as cancer

What can Arias-Stella Reaction be mistaken as?

Theca Lutein cysts

What benign ovarian lesions reflect exaggerated physiological follicle stimulation?

Hyperreactio luteinalis

What is the term for exaggerated physiological follicle stimulation?

Bilateral cystic ovaries

What is the typical presentation of Theca Lutein cysts?

hCG

Theca Lutein cysts are associated with markedly elevated serum levels of what?

Gestational Trophoblastic Disease (GTD)

What condition are Theca Lutein cysts frequently found with?

Massively elevated levels of androstenedione and testosterone

Maternal virilization, temporal balding, hirsutism, and clitoromegaly are associated with what?

Little hypertrophy

How much hypertrophy does the musculature of the fallopian tubes undergo?

Somewhat flattened

How does the epithelium of tubal mucosa become?

Decidual cells

What cells may develop in the stroma of the endosalpinx?

Greater vascularity and hyperemia

What develops in the skin and muscles of the perineum and vulva during pregnancy?

Violet-colored appearance

What color does the vagina and cervix turn due to augmented vascularity?

Epithelial thickening, thickening and loosening of connective tissue, and smooth muscle cell hypertrophy

What changes occur in the vaginal wall in preparation for labor and delivery?

3.5 to 6

What is the pH of vaginal discharge during pregnancy?

Increased production of lactic acid by the action of Lactobacillus acidophilus

What causes the acidic pH of vaginal discharge?

Breast Tenderness and Paresthesia

What occurs in the early weeks of pregnancy in the breasts?

Increase in size with delicate veins visible

What changes occur in the breasts after the 2nd month of pregnancy?

Thick, yellowish fluid

What is the characteristic of colostrum?

3rd trimester or week 30

When can colostrum be expressed from the nipples?

Becomes broader and more deeply pigmented

How does the areola change during pregnancy?

Hypertrophic sebaceous glands

What are the Glands of Montgomery?

Scattered throughout the areolae

Where are the Glands of Montgomery located?

Produces a thin film of secretions on the areola to moisten it during breastfeeding

What is the function of the Glands of Montgomery?

Produces a scent that the baby can smell in order to locate the nipple

What is another function of the Glands of Montgomery?

Latch on a regular basis (every 2 hours or less)

What is more important than pre-pregnancy breast size for milk production?

Striae gravidarum

What is the medical term for stretch marks?

Reddish, slightly depressed streaks

What is the initial appearance of striae gravidarum?

Abdominal skin, skin over the breasts, and thighs

Where do striae gravidarum commonly develop?

Marks thin and become silvery white

How do stretch marks change after pregnancy?

Prepregnancy weight and weight gain during pregnancy, younger maternal age, and family history

What are the risk factors for striae gravidarum?

Separation of rectus abdominis at the midline

What is diastasis recti?

Prolonged stretching during pregnancy

What causes diastasis recti?

Core exercises (6 months after delivery) and binder

What is advised for patients with diastasis recti?

Abdominal hernia

What can diastasis recti cause?

Elevated levels of melanocyte-stimulating hormone

What causes hyperpigmentation during pregnancy?

Armpits, nape, inguinal area, areola, and nipples

Where can darkening extend to due to hyperpigmentation?

Linea Nigra

What is the linea alba called when it takes on a dark brown-black pigmentation during pregnancy?

Chloasma (Melasma Gravidarum)

What is the mask of pregnancy called?

Irregular brownish patches of varying size on face and neck

What is the appearance of Chloasma?

Legs, palms, and breasts

Where may varicosities appear during pregnancy?

Increased cutaneous blood flow

What serves to dissipate excess heat by the augmented metabolism?

Vascular spiders or angiomas

What are minute, red skin elevations with radicles branching out from a central lesion called?

Face, neck upper chest and arms

Where are vascular spiders or angiomas common?

Palmar erythema

What is the likely consequence of hyperestrogenemia?

Fundus

Where does uterine muscle hypertrophy occur mostly?

Rectosigmoid

What causes the uterus to rotate to the right?