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22 Cards in this Set
- Front
- Back
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Uterus
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Total volume 10 ml to 5-10l
Weight 70 -1100gm Stretching and hypertrophy of existing muscle cells Stimulated by estrogen and progesterone for first 3 MO then more mechanical distension Growth stimulated by increasing synthesis of polyamines Muscle cell arrangement: “Figure of Eight” -Ligature dextrorotation -due to sigmoid Contractions- Braxton Hicks Blood flow at term- 500cc/min |
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Cervix
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Softening and cyanosis- two of the earliest signs of pregnancy
Hypertrophy and hyperplasia of cervical glands- mucous plug Erosion or eversion of endocervical glands "Velvety red" spotting/bleeding |
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Ovaries
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Corpus luteum- progesterone production maximal during first 6-7 weeks
Relaxin-by placenta, relaxes uterus and efficacy of cervix Luteoma- Ovarian enlargement, produces androgens, will regress. |
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Baldder
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Increased frequency (mechanical/progest)
Urine- increased glucose and amino acids excretion predisposes to urinary tract infections (shortened uretha too) should not see an increased protein loss in normal pregnancy |
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Renal
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Anatomical changes:
kidneys enlarge approx. 1 cm dilation of ureters and renal pelves (progest) Will hold residual urine (200cc) Functional changes: renal plasma flow increase by 75% GFR increases by 50% Filtration fraction decreases creatinine clearance increases Uterus is dexarotated, can compress right ureter. BUN and Creatinine both decrease Uric acid decreases ( except in preeclamptics) Plasma osmolality decreases (leads to Edema) Sodium balance Renin and angiotensin increase (does not cause vaso constriction) |
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Respiratory System
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Upper Respiratory Tract
mucosa becomes hyperemic and edematous with hypersecretions of mucous -Congestion, nose bleeds, bleeding gums. Pulmonary Function Reduction of airway resistance in pregnancy Minute ventilation increases 30-40% (Increased tidal volume) 02 consumption increases 15-20% Decreases in PaCO2 facilitates CO2 transfer from fetus to mother. Respiratory alkalosis (Kidneys will excrete more bicarb) |
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Cardiovascular System
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Heart enlarges, up to 6L by 1st T. Positions superior and left causing a left axis devistion on EKG.
Cardiac Output increases 30-50% maximal by 10 weeks gestation Secondary to increase in HR (70-90) and Stroke volume (50-60) Decreased when supine Blood Pressure Arterial- peripheral vascular resistance decreases causing BP to decrease slightly in 2nd trimester, returning to normal levels by term Blood Pressure Venous- increases in lower extremities no change in upper extremities or CVP Effects in labor and the immediate puerperium increased CO and work- each contraction squeezes out 300-500cc 10-20% increase in CO immediately puerperium associated with reflex bradycardia |
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Hematological changes
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Maternal plasma volume increases 50%
RBC mass increases 18-30% WBC’s increases Platelets decrease but remain above 150K (<150K = gestational Thrombocytopenia) “Hypercoagulable state” fibrinogen, factors Vll-X increase prothrombin ( factor ll ), bleeding time and clotting time remain the same platelets, factors Xl and Xlll decreases Relative risks of thromboembolism non-pregnant 1.0 pregnant 1.8 puerperium 5.5 Iron Absorption- normal 10% pregnant 20% Fe deficient and pregnant 40% Total Requirement during pregnancy 1000mg 60mg elemental Fe/ day Actively transported to fetus by placenta Maternal Fe deficiency does not appear to lead to reduced stores in the fetus |
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Alimentary
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Appetite
increases from start RDA- add 300 kcal/day during pregnancy Mouth Ptyalism-excess salavation Gums- edematous/soft epulis gravidarum (pyogenic granuloma) |
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Stomach
Small Bowel Liver |
Stomach
Tone/motility decreased Slow emptying Decreased gastroesophageal sphincter tone (progest) Increased gastric mucous secretions (to protect from slowed emptying. Small Bowel- decreased motility with slowed transit time. Liver- changes may mimic liver disease: Increased Alk Phos (from Placenta- Heat stable, AST and ALT normal, Increased Lipid Profile. |
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Colon
Gallbladder |
Colon
constipation- mechanical obstruction, decreased motility, increased water absorption ( 50% increase with pregnancy) leads to constipation. Increased portal venous pressure esophageal varices hemorrhoids Gallbladder slower emptying, increased volume and change in bile consumption Stone and sludge formation. If surgery is required, 2nd T is best time. |
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Skin
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Vascular spiders, palmer erythema
Striae gravidarum (50% of women) Stretch marks have hereditary component due to collagen types. Increase in estrogen, progesterone and melanocyte stimulating hormone Hyperpigmentation of nipples, areola, umbilicus, axilla, perineum and linea nigra “Mask of pregnancy” - chloasma (melasma) changes in nevi Hair loss postpartum (May need to check thyroid if continuous) |
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Breasts
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Enlargement
vascular engorgement and ductal growth alveolar hypertrophy increases 3-4 pounds Nipples/ areolas enlarge, more mobile increased pigmentation Montgomery's glands more prominent colostrum Lactation stimulated by drop in E2/Progest. |
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Musculoskeletal
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Lordosis - low back pain (can be severe in multiparious.
Pelvic joint ligaments soften Unsteady gait (prone to falls) |
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Endocrine
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Pituitary
increases in oxytocin and prolactin decreased growth hormone Thyroid 25% increase in size increase in bound thyroxine( T4, T3); free portion stays the same increased uptake of iodine(T3 resin uptake decreases) increase in warmth and sweating (also releasing fetal heat.) Parathyroid increased PTH (increases Ca uptake in the gut and kidney) Calcitonin protects maternal bones Adrenal increases in: cortisol, aldosterone, renin, angiotensin, deoxycorticosterone (DOC), testosterone and androstenedione Decrease in DHEAS (Male hormones broken down in placenta) Pancreas Hypertrophy and hyperplasia of beta cells (increased insulin) Accelerated starvation in fasting state Diabetogenic effect of pregnancy: peripheral resistance to the action of insulin (upto 80%) secondary to hPL, progesterone, and estrogen Maternal insulin and glucagon don’t cross placenta Possible signs of gestational diabetes. |
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Metabolic changes
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Weight gain (28lbs)
Water 3.5L- fetus, placenta, and amniotic fluid 3.0L- maternal blood volume, uterus, and breasts Edema secondary to venous decompensation or preeclampsia Protein 500 gm to infant 500 gm to uterus, breasts, hemoglobin and plasma proteins Albumin and immunoglobulins decrease ( IgG only one to cross placenta) Fibrinogen increases Acid-base Equilibrium Respiratory alkalosis (hyperventilation) partially compensated for by decreased plasma bicarbonate (Functions in fetal transfer of CO2) Fats Increase in total lipids Storage of fat in midpregnancy, used to supply fetus in late pregnancy Progesterone may reset “lipostat” in hypothalamus =Increased cholesterol |
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Fetal
Growth and Metabolism |
Caloric requirements
Metabolism: energy necessary to maintain existing organism Synthesis and accretion of new tissues O2 consumption 8cc/kg/min of total O2 consumed 80% to maintain existing tissues total calories at term 290kcal/day (Mom +300) Glucose: Derived all from placenta; no endogenous prod. Transfer across placenta carrier-mediated or facilitated major nutrient of the fetus placenta lactogen (hPL) blocks peripheral uptake and utilization by mother while promoting mobilization and utilization of FFA (for mother) Fetal insulin very important for fetal growth fetal insulin detectable at 12 weeks gestation Amino Acids & Lipids Diffusion and active transport Fetal uptake dependent on concentrating capacity of placenta Used not only for synthesis of proteins but also for metabolism with production of urea and CO2 Lipids transferred across placenta at low rates synthesized from glucose |
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Circulation and Cardiovascular changes
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In Utero= vessels parallel
At birth= vessels in series A. 1. Umbilical vein and ductus venoses (ligamentum teres and venosum) 2. Foramen ovale 3. Ductus Arteriosus 4. Hypogastric arteries (umbilical ligaments) B. 1. At term umbilical blood flow 300cc/min 2. Only 10-30% of blood goes through lungs C. Fetal hear Rate decreases during last half of pregnancy 1. FHR variability caused by opposing influences of sympathetic and parasympathetic stimuli and brain stem 2. Effect of maternal acidosis, hypoxia and fetal cord compression D. FHR patterns in Labor Early Decel=head compression Variable decel=cord compression/nucal cord Late decel=Utero-placental insufficeny. |
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Respiratory System
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A. Respiratory epithelium and bronchioles don’t really develop until 20 weeks
Alveolar buds off bronchioles 24 weeks B. Respiratory movements by 11 weeks gestation By 4th month sufficient to move amniotic fluid in and out C. Surfactant 1. Type II pneumocytes 2. Reduces surface tension to prevent Hyaline membrane disease 3. Derived from Lecithin and Phosphatidylglycerol 4. Regulated by PAPase 5. Stimulated by cortisol, glucocorticoids, prolactin, estrogen and thyroxine -Selestrone=Glucocorticoid used to stimulate fetal lung development. D. Lung maturity 1. Lecithin/Sphingomyelin ratio ( L/S ratio ) 2. Phosphatidylglycerol level ( PG ) L/S>2 + PG = Good Lung |
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Fetal Blood
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A. Hematopoesis (Yolk Sac-Liver- Bone Marrow)
B. Fetopacental Blood Volume at term - 125 cc/kg of fetus Hgb F 1. 2 alpha chains and 2 gamma chains 2. Increased affinity for O2 3. Average fetal Hgb = 18 gm/dl 4. At term 70% Hgb F, 30% Hgb A Fetal EPO made in liver. Mom may have persistent HbF, can test with Klienhower-Becky test (KB). |
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Fetal Renal
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A. Kidney Function in-utero not vital for fetal survival but is important for amniotic fluid balance
B. Fetal urine hypotonic C. Fetal kidney can reabsorb glucose better than adult |
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Fetal GI
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A. No net uptake of nutrients by fetal intestines
B. Meconium (mostly Post term) c. Swallowing 1. At term fetus can swallow nearly 450cc/24hrs 2. If obstructed can lead to polyhydramnios (More fluid around baby) |
