Anatomy and Physiology of Pregnancy
Anatomy and Physiology of Pregnancy NURB 331
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This 13 page Class Notes was uploaded by Kelsey Forbeck on Tuesday September 6, 2016. The Class Notes belongs to NURB 331 at University of Indianapolis taught by Professor Rairdon in Fall 2016. Since its upload, it has received 7 views. For similar materials see Lifespan 1 in NURSING at University of Indianapolis.
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Date Created: 09/06/16
NURB 331: Lifespan 1 Unit 2: Pregnancy Anatomy and Physiology of Pregnancy GTPAL- detailed information about a woman’s obstetric history o G- gravida or number of pregnancies o T- number of babies that reach term (37 weeks completed) o P- number of preterm pregnancies (have reached at least 20 weeks but have not reached 37 weeks) o A- number of pregnancies ending in spontaneous or therapeutic abortions o L- number of children that are currently living Definitions to know: o Gravida- a woman who is pregnant o Gravidity- pregnancy o Nulligravida- A woman who has never been pregnant and is currently not pregnant o Primigravida- A woman who is pregnant for the first time o Multigravida- A woman who has had two or more pregnancies o Parity- Number of pregnancies where the fetus(es) have reached 20 weeks gestation, not the number of fetuses born (twins). Parity counts whether the child was born alive or not. o Nullipara- A woman who has not completed a pregnancy with a fetus beyond 20 weeks gestation o Primipara- A woman who has completed one pregnancy with a fetus who have reached 20 weeks gestation o Multipara- A woman who has completed two or more pregnancies to 20 weeks of gestation or more o Preterm- pregnancy that has reached 20 weeks but end before 37 weeks Pregnancy Tests o The hormone detected in a pregnancy test which is the earliest biological marker of pregnancy is hCG. During pregnancy you want hCG to continue to rise. o If hCG doesn’t rise it can result in miscarriage o Production of hCG starts on the day of implantation Detected 7-10 days after conception o False negatives: If the pregnancy test is taken 16-18 week gestation, there could be a false negative because hCG levels drop as the placenta kicks in and starts producing hormones. There could also be a false negative read if the woman is on certain medications o Dilatin is given for those who experience seizures and can interfere with pregnancy test readings. The Three P’s o Presumptive- Changes in the body only felt by the woman carrying the child EX: Fatigue, breast changes, or amenorrhea o Probable- Changes observed by an examiner EX: Hegar sign, ballottement, pregnancy tests o Positive- Signs only due to the presence of the fetus EX: fetal heart tones, visualizing the fetus, palpating fetal movement Presumptive signs of pregnancy o Subjective- felt by the woman Amenorrhea- no periods Nausea/vomiting- morning sickness Fatigue Urinary frequency o During first trimester because the embryo is putting pressure on the bladder o During third trimester because the fetus is outside the pelvis and is putting direct pressure on the mom’s bladder Breast changes- occur within few weeks of pregnancy Quickening- perception of movement internally but cannot be felt externally o May be perceived as gas Probable signs of pregnancy o Objective- observed by examiner during exam Enlargement of the abdomen (uterus) o Is NOT a positive sign because it could be a tumor Goodell’s sign o The cervix will have a velvety appearance o Occurs around 6 weeks’ gestation Chadwick’s sign o Violet-blue vaginal mucosa o Can be seen as early as 6 weeks into the pregnancy Hegar’s sign o Isthmus of the cervix becomes really softened due to hormones o Occurs at 6 weeks’ gestation Ballottement o Examiner does a vaginal exam and with their fingertip pushes up against the cervix. This causes the baby to bump up against the top of the uterus. It then comes down onto the finger of the examiner. Pregnancy tests (serum 4-23 weeks and urine 6-12 weeks) Braxton-Hick’s contraction (16 weeks) o Annoying but not painful contractions Uterine soufflé o Swishing sound as blood goes through the placenta o Can also be caused by something other than pregnancy Positive signs of pregnancy o FHR (fetal heart rate) distinct from mother’s o Identification of embryo or fetus on an ultrasound o Fetal movements visible in late pregnancy when baby is increase in size Reproductive system and the breasts o Uterus: Undergoes most obvious changes during pregnancy Before pregnancy it is small, pear shaped pelvic organs The growth of the uterus is primarily through hyperplasia. Stretching of the cells. Not the increase of size Cardinal placement of the fundus o At 12-14 weeks’ gestation? Symphysis Pubis o At 22-24 weeks’ gestation? Umbilicus o Cervix: Cervix becomes more oval in horizontal plane and external appears as transverse slit after childbirth Endocervical glands of cervical mucosa increase in number and activity Prepares for uterine effacement and cervical dilation when baby is born o Effacement is the stretching and pulling the cervix into the side walls of the uterus when the woman is dilating Increased cervical discharge of thick, tenacious mucous leads to formation of the mucous plug o Purpose of mucous plug- It filters out bacteria and keeps mom from getting infected o Vagina and Vulva: Secretions increase pH becomes more acidic The hormone estrogen prepares the vagina for passage of newborn and causes thickening of mucosa and a loosening of connective o Ovaries: Purpose of corpus luteum- Produces progesterone o If it fails, then mom will lose the baby Cease to produce ova during pregnancy o Breasts: Areola darkens in color Nipple darkens in color Grows in size Cardiovascular system: Diaphragm pushes up and then pushes the heart up as well and over There may be slight cardiac enlargement probably secondary to increased blood volume and cardiac output Between 14-20 weeks’ heart rate increases about 10-15 bpm *Due to the increase in thoracic pressure, palpations may occur* *Orthostatic hypotension is common* Blood pressure will show no significant change, but if the patient is hypotensive there is a problem There will be a decreased systemic vascular resistance in pregnancy which will cause a drop in blood pressure The hormone that relaxes smooth muscles causing vessels to dilate is progesterone. Blood volume increases 40%-45% The hormone that causes tone of vasculature to relax and enables body to accommodate massive increase in blood flow is progesterone Physiological anemia (a.k.a. Pseudo anemia) o Plasma increases and dilutes the RBC’s o If the hemoglobin is anything less than 11 then the patient has actual anemia o Anything 11 or above is pseudo anemia o Leukocytes The lab value should be the same or slightly higher If there is an increase it is because if there is an infection the body will fight it faster Estrogen causes and increase in WBCs o Cardiac output Defined: amount of blood leaving the heart CO=HR X stroke volume HR increases up to 10-15 beats per minute as pregnancy progresses (around 14-15 weeks) Stroke volume returns to pre pregnant state as pregnancy progresses o Vena Cava Syndrome Defined: Supine hypotension caused by heavy uterus resting on vena cava when the woman lies on her back flat Signs and Symptoms: dizziness, clammy, pale These signs and symptoms come about because there is not enough venous blood return to the heart so the blood cannot be sent through to the arterial system Relief? If you turn the woman on her side or raise the head of the bed o Blood coagulation Protective functions of blood coagulation A complication known as deep vein thrombosis may occur This incident occurs most often in post-partum period Respiratory System o Changes: During pregnancy there will be a change in mechanical function The required amount of oxygen will increase during pregnancy Increase in tidal volume Decrease in blood PCO2 The hormone progesterone causes a decrease in airway resistance by relaxation of smooth muscles The respiratory rate will not change much or may slightly increase The tidal volume (how much air is in the lungs) increases 30%-40% Residual capacity decreases 20% because of the elevation of the diaphragm o Rhinitis of Pregnancy Defined: Nasal stuffiness/congestion during pregnancy (Common) Epistaxis or nose bleeds may occur as well Estrogen induces edema and vascular congestion pf the nasal mucosa * If it’s vascular changes then it’s caused by estrogen* Metabolism o The functions of metabolism accelerate o The recommended weight gain is around 25-35 pounds o You never want pregnant women to go on a diet Urinary System o The kidneys have to work very hard as the glomerular filtration rate increases o Renal tubules increase absorption so the female will not be urinating as much o The water is needed for increased blood volume and for dissolving nutrients for fetus so the water is retained This could result in a UTI or even kidney damage o The right ureter will be effected the most due to the weight of the uterus. This will cause common discomfort and pain in the female Integumentary system o Sweat and sebaceous glands become more active o Palms and hands will become a deeper red o Pruritic urticarial papules and plaques of pregnancy (PUPPP) also known as the rash of pregnancy may occur as well Looks as if the patient has poison ivy Goes away at the end of pregnancy o Abdominal Striae (stretch marks) Caused by changes in adrenal glands Will not disappear completely after birth o Skin pigmentation changes Linea nigra is a line that is seen vertically down the abdomen Caused by adrenal gland and will disappear Chloasma Gravidarum is a brownish colored “pregnancy mask” Also caused by adrenal gland and will disappear after pregnancy GI system o As the uterus increases in size, it displaces the stomach and intestines toward the back and sides of the abdomen o Acidity of gastric secretions is decreased o The emptying of the stomach and motility of the intestines slows down Mouth and Esophagus o Gums might bleed due to increase in tenderness (estrogen causes this change) o Pyrosis or heartburn is a common complaint due to the relaxation of the cardiac sphincter of the stomach which permits reflux Gall bladder o Gallstones become more common during pregnancy o Progesterone causes a decrease in tone and motility of the gall bladder Pancreas o The demand for insulin increases for pregnant women o Gestational diabetes symptoms may appear due to lack of insulin
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