MCN module 4

• Ovulation


  Stops with pregnancy due to feedback mechanism of estrogen and progesterone
• Corpus luteum


  Increases in size until 16th week, then placenta takes over production of progesterone and estrogen
• Vagina


  Epithelium and tissue become hypertrophic, increased vascularity changes color to deep violet, pH becomes acidic
• Cervix


  Becomes more vascular and edematous, softens in consistency, mucous plug forms
• Uterus


  Increases dramatically in size to accommodate growing fetus, undergoes changes in length, depth, width, weight, wall thickness, and volume
• Breasts


  Increase in size, areola darkens and enlarges, Montgomery's tubercles enlarge, produce colostrum
• Respiratory system


  Nasal congestion is common
• Montgomery's tubercles


  Sebaceous glands of the areola that enlarge and become protuberant during pregnancy
• Colostrum


  Yellowish secretion from the nipples during pregnancy, precursor of breastmilk, high in protein and antibodies
• Respiratory system changes in pregnancy

  • Marked congestion or "stuffiness" of the nasopharynx
  • Diaphragm displaced upward by 4 cm
  • Vital capacity does not decrease
  • Residual volume decreased up to 20%
  • Tidal volume increased up to 40%
  • Total oxygen consumption increases by up to 20%
  • Increased ventilation (mild hyperventilation) to blow off excess CO2
  • Total ventilation capacity may rise by up to 40%
  • Respiratory alkalosis compensated by kidneys excreting plasma bicarbonate
• Cardiovascular system changes in pregnancy


  • Cardiac output increases 25-50%
  • Heart shifts to more transverse position
  • Functional heart murmurs may occur
  • Palpitations in early and late pregnancy
  • Pulmonary and peripheral vascular resistance decreases, lowering blood pressure in first/second trimesters
  • Blood pressure rises again in third trimester
  • Impaired blood flow to lower extremities
  • Supine hypotensive syndrome from uterus compressing vena cava
  • Blood volume increases, peaking 28-32 weeks
  • Pseudoanemia early in pregnancy
• Renal system changes in pregnancy

  • Urinary frequency in first trimester, relieved in second, returns in third
  • Urinary output increases 60-80%
  • Specific gravity of urine decreases
  • Glomerular filtration rate and renal plasma flow increase 30-50% by second trimester
• Integumentary system changes in pregnancy

  • Striae gravidarum (stretch marks)
  • Diastasis (separation of rectus muscles)
  • Umbilicus protrudes
  • Linea nigra (dark line on abdomen)
  • Melasma (darkening of face)
  • Vascular spiders or telangiectases
  • Increased sweating
  • Palmar erythema
  • Increased scalp hair growth
• Musculoskeletal system changes in pregnancy

  • Relaxation of pelvic joints causes "waddling" gait
  • Physiologic lordosis (increased lumbar curve)
  • Softening of pelvic ligaments and joints
  • Symphysis pubis separation up to 3-4 mm
• Few neurologic changes with a typical pregnancy, except possible pressure on sciatic nerve
• Gastrointestinal system changes in pregnancy

  • Relaxation of GI muscles, slowed gastric emptying
  • Nausea and vomiting (morning sickness) in first trimester
  • Increased appetite after first trimester
  • Heartburn from reflux
  • Constipation and flatulence
  • Increased tendency for gallstones
  • Hemorrhoids
  • Gum hypertrophy and bleeding
  • Increased saliva production
• Endocrine system changes in pregnancy

  • Decreased FSH and LH
  • Increased growth hormone and melanocyte-stimulating hormone
  • Thyroid gland enlarges, basal metabolic rate increases
  • Parathyroid glands enlarge
  • Adrenal gland activity increases, producing more corticosteroids and aldosterone
  • Pancreas increases insulin production
• Psychosocial change in first trimester

  Accepting the pregnancy
• Gravida


  Number of times pregnant, regardless of duration, including the present pregnancy
• Primagravida


  Pregnant for the first time
• Multigravida


  Pregnant for second or subsequent time
• Para


  Number of pregnancies that lasted more than 20 weeks, regardless of outcome
• Nullipara


  A woman who has not given birth to a baby beyond 20 weeks' gestation
• Primipara


  A woman who has given birth to one baby more than 20 weeks' gestation
• Multipara


  Woman who has had two or more births at more than 20 weeks' gestation
• TPAL M


  Para subdivided: Term, Premature births, Abortions, and Living children, Multiple pregnancy
• Term


  38 - 42 weeks
• Postdate / Post term

  More than 42 weeks
• Preterm


  21 to 37 weeks
• Abortion


  Less than 20 weeks
• Presumptive (Subjective) signs of pregnancy

  Least indicative of pregnancy, experienced by the woman but cannot be documented by an examiner
• Probable (Objective) signs of pregnancy

  More reliable than presumptive signs, can be documented by an examiner but are not positive or true diagnostic findings
• Positive signs of pregnancy

  Only 3: Demonstration of a fetal heart separate from the mother's, Fetal movements felt by an examiner, Visualization of the fetus by ultrasound
• Fetal heart can be shown on ultrasound

  As early as 6-7 weeks, audible by stethoscope at 18-20 weeks
• Fetal movements felt by woman

  As early as 16-20 weeks, felt by examiner at 20-24 weeks
• Fetus visualized by ultrasound

  Gestational sac seen at 4-6 weeks, fetal outline at 8 weeks
• Purposes of prenatal care

  • Establish baseline health
  • Determine gestational age
  • Monitor fetal development and maternal well-being
  • Identify high-risk women
  • Minimize risk of complications
  • Provide education
• Conduct of initial prenatal visit

  1. Extensive health history collection

  2. Complete physical exam including pelvic exam

  3. Blood and urine tests
• Fundal height measurement


  Uterus palpable at 12-14 weeks, reaches umbilicus at 20-22 weeks, xiphoid at 36 weeks, then descends at 40 weeks

  
• Plotting uterine growth can help detect unusual variation in fetal growth