A&P of Pregnancy

when does the heart fully develop for a fetus

end of week 3

when can a heartbeat be heard on ultrasound

week 6

how many days away from last period to the delivery date

280 days

how many days away from conception to the delivery date

266 days

duration of first trimester

0 to 13 weeks 6 days

duration of second trimester

14 weeks to 27 weeks 6 days

duration of third trimester

28 weeks to 40 weeks 6 days

uterus changes

size, shape, position, fundal height, uteroplacental blood flow, cervical, contractility, vagina/vulva, ballottement, quickening

what size is the uterus at the begining of pregnancy

size of fist

position change of the uterus

moved upperwards

when can you hear FHR with a doppler

12 weeks

fundal height changes at 12 weeks

above pubic bone

fundal height changes at 36-38 weeks

right up under the sternum

fundal height changes at 40 weeks

drops below 38 week level

uteroplacental blood flow changes of the uterus

placenta will take over blood flow for baby

ballottement

passive movement of the unengaged fetus, feels like a waterballoon

when is ballottement found

16-18 weeks

quickening

first flutters of baby moving

mutlipearus

pt who carried more than one pregnancy past 20 weeks

nullipearus

pt has never carried pregnancy to 20 weeks

when does a multipearus feel quickening

14-16 weeks

when does a nullipearus pt feel quickening

18-20 weeks

what hormonal changes does the breasts have during pregnancy

increase levels of estrogen and progesterone

what does increase levels of estrogen and progesterone do to the breasts

fullness, heighten sensitivity, tingling, heaviness

nipples and areolae changes

more pigmented, erected nipples, areolae enlargement

increase blood supply in the breasts appearance

vessels are dilated, more visible

striae gravidarum on breast

stretchmarks

prolactin colostrum changes in the breast

first part of breast milk

cardiac changes to heart sounds and vitals

maternal heart rate increases 10-20 bpm, cardiac output increases 30-50%, blood pressure decreases, blood volume increases 40-45%

structure adaptations to heart

cardiac hypertrophy, placement

cardiac hypertrophy

heart enlargement

heart placement

moves up and to the left which makes it vulnerable

pregnant hemoglobin

11-13

pregnant hematocrit

greater than 33

pregnant WBC

5000-15000

pregnant platelets

stays the same

ECG labs for the heart

important to get in high risk pregnancies

structural adaptations to respiratory changes

pushed up, breathing is not good in last trimester, ribs are pushed out, chest breathing replaces abdominal breathing

hormonal regulation respiratory changes

capillary engorgement and pulmonary function

what does capillary engorgement cause

edema and hypermia in the upper respiratory tract

how does edema make the mom feel

congested and gets nose bleeds, change in voice

the edema from capillary engorgement can cause what

upper respiratory infection

change in pulmonary function

maternal oxygen consumption increases steadily

respiratory assessment during pregnancy

vitals, lung sounds, upper repiratory tract

what the change in RR

unchange or slightly increased

lab test for respiratory changes in pregnancy

check x ray

mouth changes in pregnancy

gums become hyperemic

hyperemic

spongy, swollen, bleed easily gums

esophagus and stomach changes

increase progesterone causes everything to slow down

what happens when the GI slows down

constipation and reflux occurs

how to prevent constipation

high fiber diet, stool softener, walk around, increase fluids

how to prevent reflux

eat smaller meals, no greasy food, don’t recline after meals, TUMs

gallbladder and liver changes during pregnancy

distended due to decrease muscle tone, abdominal discomfort, increase emptying time and bile thickening

what can occur with an increase emptying time and thickening bile

gallstones

abdominal assessment during pregnancy

pelvic heaviness or pressure, rounded ligament tension, flatulence, distention and bowel cramping, uterine contraction

anatomic changes to urinary tract

fluid and electrolyte imbalance

physical examination of the urinary tract

UOP, frequency/urgency, edema

urinary edema changes

usually in the 3rd trimester but if sever in 1st and 2nd trimester it is preeclampsia

labs for urinary changes

urine culture, urine analysis, BUN, creatinine and clearance, electrolytes, total protein excretion

integumentary changes

cholasthma, hyperpigmentation, palmar erythema, striae gravidarum, pruritic urticarial papules and plaques of pregnancy, angiomata

palmar erythema

red palms

pruritic urticarial papules and plaques of pregnancy

severe itchiness

angiomata

common and normal, red spot with lines coming out, on face and breast

musculoskeletal changes

lordosis, loss of balance, abdominal muscle tone decrease, stoop shoulder, increase lumbosacral curve, lossen ligaments, abdominal recti

abdominal recti

abdominal muscles split given room for baby

why do pregnant women have an increase of falls

shifting center of gravity, impaired balance, joint laxity

neuro changes

endema, dorsolumbar lordosis, tension headache, hypocalcemia, syncope, acroesthesia

the neuro edema most likely causes

carpal tunnel which is worse in dominant hand

acroesthesia

pins and needles, numbness in hands and fett

treatment for acroesthesia

likely to go away if not then surgery