MTP Term Test 1

When does the first trimester of pregnancy span from?

conception - 13 weeks

When does the second trimester of pregnancy span from?

14-27 weeks

When does the third trimester of pregnancy span from?

28-40 weeks

What event happens during the second trimester of pregnancy that makes it easier for the mother to accept the baby?

Quickening (the mother can first start to feel the fetus move)

What hormone is detected in maternal blood shortly after implantation and is the basis for pregnancy testing?

Human chorionic gonadotropin

What is human chorionic gonadotropin produced by?

Chorionic villi

What effect does human chorionic gonadotropin have on a male fetus?

causes testes to produce testosterone

What is the purpose of human chorionic gonadotropin?

• keeps the corpus luteum from shrinking back so it can produce estrogen and progesterone

• surpasses mother’s immune response

Which hormones are originally produced by the corpus luteum and later by the placenta?

Estrogen, progesterone, and relaxin

What is the purpose of estrogen?

• promotes fertilization

• causes growth/changes in the breast, uterus and cervix

• creates changes in metabolism

What is the purpose of progesterone?

• maintainence of endometrial lining

• prevents uterus from contracting

• relaxes all smooth muscle

• stimulates development of the lobes of the breast

What is placental lactogen aka?

Human placental lactogen, chorionic somatomammotropin

Where is placental lactogen produced?

Chorionic villi in the 6th week

What is the main hormone for stimulating fetal growth?

Placental lactogen

What is the purpose of placental lactogen?

• stimulates alveoli in the breast to develop and prepare for lactation

• alters metabolism to increase availability of glucose to the fetus

What is the purpose of relaxin?

• inhibits uterine activity

• increases flexibility of the pubic symphasis, ligaments of the Si jt, and sacarococcygeal jt’s and ligaments

• relaxes soft tissue

How much does the uterus weight before pregnancy?

60g (2 oz.)

How much does the uterus weight at the end of a pregnancy?

1000g (2.2lb)

What two physiological changes does the uterus go through during pregnancy?

Hypertrophy and hyperplasia

How much does the size of the uterus increase by during pregnancy?

500-1000x

What happen to muscle and collagen fibres in the uterus during pregnancy?

• muscle fibres increase in length and width

• collagen fibres develop between muscle fibres to add elasticity and strength to the uterine wall

What happen to blood vessels during pregnancy?

• increase in diameter and length

• blood vessels in the pelvic region enlarge in order to act as a reservoir (to keep blood supply to the fetus constant)

What is the size / location of the uterus at:

12 weeks?

20-22 weeks?

36 weeks?

• 12 weeks: grapefruit

• 20-22 weeks: level of umbilicus

• 36 weeks: level of xiphoid

What happens to the uterine wall at 24 weeks?

It becomes thinned to the point that the fetal outline can be palpated

Why does the cervix soften during pregnancy?

due to increased number of blood vessels and volume of interstitial fluid

What is the mucous plug? (operculum)

a plug that seals the cervical opening soon after fertilization to seal out bacteria and prevent infection in utero

What structure goes through one of the 1st physiological changes during pregnancy?

Breasts

What happens to the breasts in the 1st trimester?

growth of new ducts and early formation of new lobules

What happens to the breasts in the 2nd trimester?

• conversion of alveolar epithelium to secretory cells

• colostrum appears in the alveoli

• increased connective tissue and fat depostition

What happens to the breasts in the 3rd trimester?

continued glandular cell number and production of colostrum

What is colostrum?

A precursor to milk

What hormones stimulate growth of the lobes, alveoli and ductal system?

estrogen and prgesterone

What is prolactin?

a hormone that stimulates milk production during pregnancy, \

what is prolactin secreted by?

the anterior pituitary gland

What happens to prolactin after birth?

estrogen and progesterone levels increase, leading to a significant increase in prolactin levels and in increase in milk production

What are stretch marks aka?

striae gravidarum

What are stretch marks caused by?

rupture and breakdown of elastic tissue in the deeper layers of skin

What is increased pigmentation during pregnancy caused by?

hormonal changes

Where is increased pigmentation often found?

Face, neck, nipples, and midline of abdomen

What are vascular spiders?

dilated capillaries that spread from a central point

How much does blood volume increase during pregnancy?

30-50%

• in order to compensate for blood loss at delivery and supply adequate oxygen to the placenta

How much does cardiac output increase by during prgnancy?

25-50%

What happens to blood pressure during pregnancy?

Doesn’t change or decreases in the 2nd trimester

What happens to blood flow in the lower extremities during the 3rd trimester

it decreases due to the pressure the uterus places on the veins and arteries

What is the cause of supine hypotension syndrome?

The weight of the uterus pressing the vena cava against the vertebrae

• can obstruct blood flow from the legs to the heart

• can also result in fetal hypoxia due to decreased blood flow to the placenta

What can happen when the expanding uterus puts pressure on the diaphragm?

Dyspnea/SOB

What happens to the ribcage/intercostals during pregnancy?

The ribcage expands laterally causing intercostal spaces to widen

• intercostals can become restricted and trigger points can develop

By week 24, what happens due to the pressure of the uterus on the diaphragm?

breathing can occur more in the chest than in the abdomen

What does the uterus push on in the GI system?

the stomach and intestines laterally and posteriorly

What can lead to heartburn during pregnancy?

A shift in stomach position which changes the angle in which the esophagus attaches to the stomach

• the lower esophageal sphincter working less effectively

What is transit time?

The time it takes for food to pass through the GI tract

What causes increased transit time in pregnancy?

• relaxin and progesterone decreasing smooth muscle tone (perstalsis)

• pressure from the uterus

• decreased blood flow to GI tract

How many women experience morning sickness and what are the symptoms?

At least 50%, nausea and vomitting

What are the possible causes of morning sickness

• increased transit time

• poor valve action

• response to hormones

• anxiety

What ligaments soften to allow for passage of the baby at delivery?

The pelvic ligaments

What postural changes occur during pregnancy

• increased lumbar lordosis

• increased shoulder protraction and thoracic curve

What is the definition of antepartum?

before labour / birth (prenatal)

What is the definition of postpartum?

The 6 week period after childbirth

What is the definition of perinatal?

the periods before, during or after the time of birth

What is the definition of nullipara?

a woman who had never given birth to a child

What is the definition of primapara?

A woman who has given birth for the first time

What is the definition of gravida?

A pregnant woman

What is the definition of EDC/EDD?

• estimated date of confinement

• estimated date of delivery

What is the definition of PIH?

pregnancy induced hypertension

What is the definition of SVD

spontaneous vaginal delivery

What is the definition of O/E?

On examination

What is the definition of U/S?

Ultrasound

What is the definition of NICU?

Neonatal intensive care unit

What are varicose veins?

dilated, tortuous veins of the of the lower extremities

What are the two types of varicose veins?

• primary: impaired blood flow in superficial saphenous veins

• secondary: impaired blood flow in deep venous channels

What are the causes of varicose veins?

• deep vein thrombosis (most common cause of secondary)

• congenial venous malformations

• arteriovenous fistulas

• increased pressure on abdominal and pelvix veins caused by pregnancy/tumour

What are the risk factors or varicose veins?

• age after 50

• females more than males

• obesity

• prolonged standing

• pregnancy

• increased intra-abdominal pressure

What is the mechanical cause of varicose veins?

• prolonged increased pressure on veins causes the valves to become incompetent and not close properly

• reflux of venous blood causes the veins to enlarge and move further apart

What techniques can be used for varicose veins?

• elevate limbs to 45 degrees

• circulatory techniques

• with severe vv work proximally only

• contrast foot baths (if no swelling)

• cold foot baths

What are the 8 danger signs of pregnancy?

1. vaginal bleeding

2. persistant vomitting

3. chills and fever

4. escape of vaginal fluid

5. abdominal or chest pain

6. swelling and pain in leg

7. swelling of the face/fingers, severe headache and blurred vision

8. lack of fetal movement

When does vomiting become a danger sign?

more than 2x a day

• can indicate systemic infection

What does escape of vaginal fluid indicate?

membrane rupture and release of amniotic fluid

• may be one of the first signs of labour

What may abdominal or chest pain indicate?

Ectopic pregnancy, separation of placenta or pulmonary embolus

What can swelling and pain in the leg indicate?

Thrombophlebitis

What may swelling of the face/fingers, severe headache and blurred vision indicate?

Preeclampsia

What is high-risk pregnancy?

either the mother or fetus is at risk due to an existing psycho-social or physiological factor

• the pregnant person or infant will need special intervention to prevent illness or death

What are the 3 ways in which a high-risk pregnancy can develop?

1. start in good health and develop a condition (hypertension, diabetes)

2. enter pregnancy with extisting illness or disability (hypertension, thyroid disorder)

3. particular socio-economic, social or previous pregnancy complications

Why is pregnancy under age 18 considered high-risk?

• increased incidence of hypertension, iron deficiency, anemia and premature labour

• cephalopelvic disproportion

• lack of knowledge about infant care

When can RMT’s not preform abdominal massage on a pregnant person?

In the 1st trimester and 6 months after pregnancy

What percentage of pregnancies cause the development of hypertension?

7%

What BP reading shows hypertension?

140/90 or greater

What is gestational hypertension

hypertension with onset after 20 weeks of gestation without any features of preeclampsia

What is pre-existing hypertension?

hypertension with onset before 20 weeks of gestation

• occurs in up to 22% of people of child-bearing age

• 1% of pregnancies have this complication

How is preeclampsia defined?

a hypertension and proteinuria that occurs due to widespread vascular endothelial malfunction

When can preeclampsia occur?

after 20 weeks gestation or as late as 4-6 weeks postpartum

What is eclampsia defined as?

seizures occurring in a woman with preeclampsia

What is the medical treatment for preeclampsia?

Delivery is the only treatment

• px with preeclampsia without severe features is often induced at 37 weeks

What is the medical treatment for gestational hypertension?

Bed rest and restricted activity

What is a thrombus?

a collection of fibrin, blood cells, platelets and granulocytes within a deep vein

What is the danger of a thrombus?

If a portion of the thrombus is dislodged, the danger is a pulmonary embolism

What is venous thrombosis caused by?

• stasis of venous blood from uterine pressure

• hypercoagubility due to increased estrogen

• fetal pressure at delivery

What are the warning signs of venous thrombosis?

Swelling, warmth, redness, leg cramps, tenderness

What is abruptio placenta?

premature separation of the placenta

• often occurs after 20-24 weeks

What are the symptoms of abruptio placenta?

heavy bleeding, sharp stabbing pain in uterus