Maternity: Physio Adaptations & Pregnancy Discomforts

Maternal Adaptations in pregnancy

Front: Is a WBC count of 13,000 at 40 weeks of gestation normal or abnormal?

: Normal (N). White blood cells (WBCs) increase near term.

Front: Is a Hemoglobin (Hgb) of 11.0 g/dl at 28 weeks of gestation normal or abnormal?

: Normal (N). Anemia in pregnancy is defined as Hgb ≤ 10-10.5 g/dl. Since 11.0 g/dl is above this threshold, it is not considered anemic according to the source.

Front: Is a Hematocrit (Hct) of 33% at 12 weeks of gestation normal or abnormal?

: Abnormal (A). Anemia in pregnancy is defined as Hct ≤ 32-35%. A value of 33% falls within the anemic range.

Front: Is a pulse rate of 100 bpm in pregnancy normal or abnormal?

: Normal (N). Between 14-20 weeks, heart rate increases 10-15 bpm. Given this increase from a non-pregnant baseline, a pulse of 100 bpm can be within a normal physiological range for a pregnant individual.

Front: Is a Blood Pressure (BP) of 130/94 in the 2nd trimester normal or abnormal?

: Abnormal (A). In the 2nd trimester, BP normally decreases 5-10 mmHg systolic & diastolic from pre-pregnant levels. A BP of 130/94, particularly the diastolic value of 94, is generally considered elevated and does not align with the expected decrease or normal baseline for pregnancy.

Front: Are respirations of 22 breaths/min in pregnancy normal or abnormal?

: Normal (N). The rate of breathing increases 1-2 breaths/min during pregnancy. Therefore, a respiratory rate of 22 breaths/min is within the expected normal range given this increase.

Front: What is leukorrhea and what are a normal and a pathologic cause?

: Leukorrhea is a vaginal change during pregnancy. * Normal cause: Increased vascularity, hypertrophy, and lengthening of the vagina due to estrogen effect. * Pathologic cause: Candida albicans, leading to vaginitis, which is common.

Front: List 4 breast and nipple changes that occur in pregnancy.

: 1. Breasts grow throughout pregnancy due to the effect of estrogen. 2. Increased fullness, tenderness, and tingling sensations. 3. Blood flow to the breasts doubles, and veins become visible. 4. Nipples become larger, darker, and more erect. 5. Tubercles of Montgomery become prominent. 6. Colostrum may be expressed by the third trimester.

Front: List 4 normal changes that occur in the cardiac system during pregnancy.

: 1. Increase in blood volume by 40-50% above non-pregnant levels. 2. Cardiac output increases by 30-50%. 3. Heart rate increases 10-15 bpm between 14-20 weeks of gestation. 4. A soft systolic murmur may occur. 5. Possible palpitations may occur.

Front: What is physiologic anemia of pregnancy and what causes it?

: Physiologic anemia of pregnancy is the result when the increase in plasma volume exceeds the increase in red blood cells (RBCs). * Cause: Blood volume increases by 40-50% and RBCs also increase by 25-33% higher than pre-pregnant levels. However, the increase in plasma volume is disproportionately greater than the increase in RBCs. * Definition of anemia: Hgb ≤ 10-10.5 g/dl and Hct ≤ 32-35%.

Front: What should you do first if a pregnant woman complains of dizziness while supine, and what is the probable cause?

: * First action: Get the woman off her back. * Probable cause: Supine Hypotension, also referred to as "Venal caval syndrome," which occurs especially in the third trimester, when the heavy uterus falls back against the inferior vena cava, compressing it and reducing blood flow back to the heart.

Front: What is epitaxis and what causes it in pregnancy?

: Epitaxis (also commonly spelled "epistaxis") is a condition caused by the increased vascularity of the respiratory tract during pregnancy. This increased blood flow and fragility of blood vessels in the nasal passages can lead to nosebleeds.

Front: Name 2 changes to the mouth and gums caused by pregnancy.

: 1. The gums become hyperemic, swollen, and friable due to the effect of estrogen. 2. Ptyalism, or excessive salivation, can occur due to estrogen.

Front: What is the risk of periodontal disease in pregnancy?

: Peridontal diseases are linked with preterm birth.

Front: What causes nausea and vomiting in pregnancy, and what are some comfort measures?

: * Cause: Nausea and vomiting are primarily due to hCG (human chorionic gonadotropin). This typically occurs between 6-12 weeks gestation for most women. * Comfort measures: Eating small, frequent meals; having a bland snack before rising in the morning; avoiding strong smells; avoiding fatty, greasy, spicy, or acidic foods; drinking fluids in between meals; and finding that cold foods are sometimes better tolerated. * Non-pharmacologic options: Sea bands, acupuncture, ginger, and hypnosis.

Front: What causes heartburn (pyrosis, reflux) in pregnancy, and what would you counsel a mother to do for it?

: * Cause: Heartburn (pyrosis or reflux) is caused by the relaxation of the esophageal sphincter. * Counseling/Comfort measures: Avoid acidic foods (e.g., tomato sauce, citrus juices) and other food triggers (commonly fried, fatty, or spicy foods); avoid alcohol & tobacco; eat small meals; drink in between meals; remain upright after eating; and elevate the head of the bed.

Front: Name 3 causes for urinary frequency in pregnancy (both physiologic and pathologic).

: 1. Physiologic: Increased Glomerular Filtration Rate (GFR) by 40-60%. 2. Physiologic: Mechanical pressure of the uterus on the bladder and ureters. 3. Pathologic: Urinary Tract Infection (UTI) because progesterone relaxes the urinary tract, leading to incomplete bladder emptying and urinary stasis. This urinary stasis, along with mechanical pressure, increases the risk of infection.

Front: Why are UTIs dangerous in pregnancy?

: * UTIs are more likely to progress to pyelonephritis (kidney infection) in pregnancy. * Both UTIs and pyelonephritis can cause preterm birth.

Front: What happens to the mother’s basal metabolic rate in pregnancy?

: The mother's basal metabolic rate (BMR) is increased by 25% in pregnancy.

Front: What causes hip, back, and pubic symphysis pain in the 2nd and 3rd trimesters?

: The pain is caused by the relaxation and increased mobility of all ligaments and joints, especially the pubic symphysis and sacroiliac joint. This is due to the hormones estrogen and relaxin, which allow for pelvic enlargement at birth.

Front: What are Striae gravidarum, Linea nigra, and Chloasma (melasma) in pregnancy?

: These are all types of increased pigmentation that occur during pregnancy.

Front: What causes mood swings in pregnancy?

: Mood swings are common in pregnancy and are caused by: * Hormonal changes. * Fatigue. * Changes in self-image and body image. * Changes in role, including changes in the relationship.

Front: Why is it important to identify and treat depression in pregnancy, and what are some treatment options?

: * Importance: Untreated depression is associated with negative outcomes such as preterm birth, Intrauterine Growth Restriction (IUGR), and low birth weight. * Treatment options: Research supports a variety of approaches including medication, counseling, support, exercise, meditation, and a combination of two or more therapies. Zoloft (sertraline) is mentioned as an antidepressant considered safest in pregnancy.

Front: Name 3 things that can influence a mother or father’s ability to adapt to pregnancy.

: 1. Social support (physical, emotional, financial). 2. The culture’s response to pregnancy. 3. Their age and emotional readiness. 4. Life circumstances (partner, other children, work, finances).

Front: List 4 conditions that make coitus unsafe in pregnancy.

: 1. Placenta previa. 2. Active bleeding. 3. Preterm labor. 4. ROM (Rupture of Membranes). 5. STI (Sexually Transmitted Infection).

Front: List 3 presumptive signs of pregnancy.

: Fatigue, breast tenderness/enlargement, nausea and vomiting, amenorrhea, urinary frequency, hyperpigmentation of the skin, fetal movements (quickening), uterus enlargement.

Front: List 3 probable signs of pregnancy.

: Positive pregnancy test (urine or serum hCG), abdominal enlargement, Goodell’s sign (softening of the cervix), Chadwick’s sign (bluish purple cervix), Hegar’s sign (softening of lower uterine segment), Ballotment, Braxton Hicks contractions.

Front: List 3 positive signs of pregnancy.

: Ultrasound verification of embryo, fetal movement felt by practitioner, auscultation of fetal heart tones.

Front: How much does the uterus grow during pregnancy and what stimulates its growth?

: The uterus grows up to 20x its non-pregnant size, and its growth is stimulated by estrogen. It rises above the pelvis at 3 months.

Front: What causes amenorrhea in early pregnancy?

: A thickened endometrium is stabilized by progesterone, originally from the corpus luteum.

Front: What happens to the depth of breathing during pregnancy?

: Increased depth (tidal volume) until lungs are crowded by the uterus in the 3rd trimester. The diaphragm is also elevated by up to 4cm, and chest circumference increases by 2-3 cm.

Front: What causes decreased peristalsis in the GI system during pregnancy?

: Smooth muscle relaxation due to progesterone.

Front: What is hyperemesis gravidarum and what are its risks?

: Hyperemesis gravidarum is severe nausea and vomiting in pregnancy, with risks of dehydration, malnutrition, and ketonuria.

Front: Name 3 comfort measures for constipation in pregnancy.

: Increase dietary roughage & fluids, exercise, and use a stool softener. (Additionally, avoid laxatives or enemas as they can cause contractions; iron supplements may worsen constipation).

Front: What happens to renal blood flow during pregnancy?

: Renal blood flow increases by 50-80%.

Front: What happens to the thyroid gland during pregnancy?

: The thyroid gland enlarges and increases T3 & free T4 production, which may mimic a mild hyperthyroid state.

Front: What happens to the pancreatic islets of Langerhans during pregnancy?

: They are stressed to meet the increased insulin needs of pregnancy, potentially leading to Gestational Diabetes Mellitus (GDM) if unable.

Front: What causes leg cramps in pregnancy?

: Imbalance of calcium and pressure of the gravid uterus on nerves supplying the lower extremities.

Front: What is Carpal Tunnel Syndrome in pregnancy and what causes it?

: Carpal Tunnel Syndrome involves hand tingling, numbness, and pain caused by edema putting pressure on the median nerve in the wrist.

Front: Describe maternal emotional reactions in the first trimester.

: Ambivalence, mood swings, and acceptance of the biological fact of pregnancy.

Front: Describe Couvade Syndrome.

: Couvade Syndrome is a sympathetic phenomenon experienced by fathers during pregnancy.