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Maternal physiologyMaternal physiology
during pregnancyduring pregnancy
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Reproductive tract (1)Reproductive tract (1)
UterusUterus: from 50g: from 50g--1100g1100g
from
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BraxtonHickscontraction:BraxtonHickscontraction:
sporadic, irregular, asymmetrical, andsporadic, irregular, asymmetrical, and
painless, low pressure, lasting < 30painless, low pressure, lasting < 30
secsec
Reproductive tract (2)Reproductive tract (2)
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Characteristics of True andCharacteristics of True and
False LaborFalse Labor Regular ContractionsRegular Contractions
Stronger, longer, closerStronger, longer, closertogethertogether
Bloodyshow oftenBloodyshow oftenpresentpresent
Cervix effaced andCervix effaced anddilateddilated
Head is fixed betweenHead is fixed betweencontractionscontractions
Sedation does notstopSedation does notstoptrue labortrue labor
IrregularIrregular
No change inNo change incontractioncontractioncharacteristicscharacteristics
No showNo show
No cervical changeNo cervical change
Head may be ballotableHead may be ballotable
Sedation stops falseSedation stops falselaborlabor
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CervixandvulvaCervixandvulva ChadwickssignChadwickssign
congestion of the pelvic vasculature, cause bluish orcongestion of the pelvic vasculature, cause bluish or
purplish discoloration of the cervix and vulvapurplish discoloration of the cervix and vulva
Leukorrhea:Leukorrhea: increase in vaginal discharge, rich inincrease in vaginal discharge, rich in
glucose, lactic acid, low vaginal pHglucose, lactic acid, low vaginal pH
Ovary:Ovary: slightly enlarged, corpus luteum regressesslightly enlarged, corpus luteum regresses
after 10 weeksgestationafter 10 weeksgestation
Reproductive tract (2)Reproductive tract (2)
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Breasts:Breasts: increase in circulationincrease in circulation
EngorgementandvenousprominenceEngorgementandvenousprominence
Mastodynia (breastternderness):Mastodynia (breastternderness): tinglingtingling
to frank pain caused by hormonal responses ofto frank pain caused by hormonal responses of
the mammary ducts and alveolar systemthe mammary ducts and alveolar system
Montgomerystubercles:Montgomerystubercles: enlargement ofenlargement of
circumlacteal sebaceous glands of the areolacircumlacteal sebaceous glands of the areola
Colostrumsecretion:Colostrumsecretion:
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Cardiovascular changes (1)Cardiovascular changes (1)
Position and size of heartPosition and size of heart
ECG changesECG changes
Increased heart rate (+15%)Increased heart rate (+15%)
1515--degree left axis deviationdegree left axis deviation
Inverted TInverted T--waves in lead IIIwaves in lead III
Q in lead III and AVFQ in lead III and AVF
Unspecific ST changesUnspecific ST changes
Appear larger on roentgenogramAppear larger on roentgenogram
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Cardiovascular changesCardiovascular changes
(2)(2) Heart rhythms and murmurs: soft ,Heart rhythms and murmurs: soft ,
transienttransient
Caution: How to interpret these murmursCaution: How to interpret these murmurs
Inferiorvenacavasyndrome:Inferiorvenacavasyndrome:
In the supine position, the inferior vena cava iscompressed by the enlarged uterus, resulting in
decreased cardiac output. Some women may have
symptoms that include dizziness, light-headedness, and
syncope.
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Cardiovascular changesCardiovascular changes
(3)(3) Stroke volume +30%Stroke volume +30%
Heart rate +15%Heart rate +15%
Cardiac output +40%Cardiac output +40%
Oxygen consumption +20%Oxygen consumption +20%
SVRSVR(systemic vascular resistance)(systemic vascular resistance) --5%5%
Systolic BPSystolic BP --10mmHg10mmHg Diastolic BPDiastolic BP --15mmHg15mmHg
Mean BPMean BP --15mmHg15mmHg
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Blood volume +30%Blood volume +30%
Plasma volume +40%Plasma volume +40%
Red blood cell volume +20%Red blood cell volume +20%
Dilutional anemiaDilutional anemia
Increase cardiac outputIncrease cardiac output
Decrease blood viscosityDecrease blood viscosity
VasodilatationVasodilatation
Rightshift oxyhemoglobin dissociation curve
Rightshift oxyhemoglobin dissociation curve
Cardiovascular changesCardiovascular changes
(4)(4)
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Venouspressure:Venouspressure:
1.1. unchanged in the upper bodyunchanged in the upper body2.2. Significantly increases in the lowerSignificantly increases in the lower
extremities, esp. during supine, sitting orextremities, esp. during supine, sitting or
standing position, returns to near normalstanding position, returns to near normalin lateral recumbent positionin lateral recumbent position
Cardiovascular changes(5)Cardiovascular changes(5)
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Hematologic system (1)Hematologic system (1)
Blood volumeBlood volume (polymorphonuclear)(polymorphonuclear) +40%+40%
Dilutional anemia Hb 110 g/LDilutional anemia Hb 110 g/L Leukocytosis 15,000/Leukocytosis 15,000/QQll
Platelet not changePlatelet not change
Sedimentation rate increase, 100m/hSedimentation rate increase, 100m/h
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Hematologic system (2)Hematologic system (2)
Clotting factors:hypercoagulable,Clotting factors:hypercoagulable,
throboembolismthroboembolism
Fibrinogen (factor I) +50% (4.5 vs 3 g/L)Fibrinogen (factor I) +50% (4.5 vs 3 g/L)Factor VIII increaseFactor VIII increase
Factors VII, IX, X and XII increaseFactors VII, IX, X and XII increase
Prothrombin time, PT shortenedProthrombin time, PT shortened
ATPP activated partial thromoplastin time shortenedATPP activated partial thromoplastin time shortened
Fibrinolytic activity decreaseFibrinolytic activity decrease
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Hematologic system (3)Hematologic system (3)
Iron : active transplacental transferIron : active transplacental transfer
Requirement 1000mgRequirement 1000mg
increase maternal red cell mass 500mgincrease maternal red cell mass 500mg
fetal development 300mgfetal development 300mg
compensate for normal iron loss 200mgcompensate for normal iron loss 200mg
To supply, 300 mg of ferroussulfate is needed, andTo supply, 300 mg of ferroussulfate is needed, and
twice the dose for anemic patients.twice the dose for anemic patients.
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Renal changes (1)Renal changes (1)
Kidney slightly enlargedKidney slightly enlarged
Renal plasma flow +35%Renal plasma flow +35%
Glomerular filtration rate +50%Glomerular filtration rate +50%
Serum creatinine, uric acidSerum creatinine, uric acid
and urea nitrogenand urea nitrogen
Renin, angiotensin I and IIRenin, angiotensin I and IIRenin substrateRenin substrate
Glucosuria (50%) +Glucosuria (50%) +
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Renal changes (2)Renal changes (2)
renal pelves dilatedrenal pelves dilated
Ureters (esp. rightside) dilatedUreters (esp. rightside) dilated
Bladder tone reducedBladder tone reduced
Bladder capacity reducedBladder capacity reduced
Residual volume increased
Residual volume increased
Chance of pyelonephritis increaasedChance of pyelonephritis increaased
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Pulmonary changesPulmonary changes
Mucosal hyperemiaMucosal hyperemia
Subcostal angleSubcostal angle
Chest circumference and diameterChest circumference and diameter
Diaphragmatic excursionDiaphragmatic excursion
Tidal volume +30Tidal volume +30--40%40%
POPO22 is increased, PCOis increased, PCO22 is decreased.is decreased.
Total lung capacity decreaseTotal lung capacity decrease --15%15%
Minute ventilation +30Minute ventilation +30--40%40%
Mild respiratory alkalosisMild respiratory alkalosis
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Gastrointestinal changeGastrointestinal change
Morning sicknessMorning sickness
hyperremesisgravidarumhyperremesisgravidarum (weight loss,(weight loss,
ketonemia and electrolyte imbalance)ketonemia and electrolyte imbalance)
Dietary craving: picaDietary craving: pica
Decreased gastrointestinal motility: reflux andDecreased gastrointestinal motility: reflux and
heartburnheartburn
Gallbladder function, cholestasisGallbladder function, cholestasis
Hyperemia and softening of the gums (epulis)Hyperemia and softening of the gums (epulis)
HemorrhoidHemorrhoid
Appendix displacedAppendix displaced
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Skin changesSkin changes
Vascular spidersVascular spiders
Striae gravidarumStriae gravidarum
Hyperpigmentation (estrogen and melanocyteHyperpigmentation (estrogen and melanocyte--
stimulating hormone)stimulating hormone)
Linea albaLinea albalinea nigralinea nigra
ChloasmaChloasma
Skin neviSkin nevi
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MetabolismMetabolism
Basal metabolism rate, BMR +15Basal metabolism rate, BMR +15--20%20%
Weight gain 12.5Weight gain 12.5
Fetus 3400gFetus 3400gPlacenta 650Placenta 650
Amniotic Amniotic
Uterus 960Uterus 960
Plasma, red cells 1450Plasma, red cells 1450Mammary glands 405Mammary glands 405
Extracellular, extravascular water 1480Extracellular, extravascular water 1480
Deposition of fat and protein 3345Deposition of fat and protein 3345
Insulin resistanceInsulin resistance
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A quizA quiz
DefinitionsDefinitions
1. fetus1. fetus
2. hyperemesis gravidarus2. hyperemesis gravidarus
3. Morula3. Morula
4. Inferior vena cava syndrome4. Inferior vena cava syndrome
5. Chadwickssign5. Chadwickssign6. Capacitation6. Capacitation
7. Lower segment of uterus7. Lower segment of uterus
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1. Fetal membrane is composed of ______and______.1. Fetal membrane is composed of ______and______.
2. The prerequisites for successful implantation2. The prerequisites for successful implantation
are________, _______ and ___________.are________, _______ and ___________.
3. Placenta is composed of _______, _________and3. Placenta is composed of _______, _________and
___________.___________.
4. Maternal4. Maternal--fetalfetal--placenta unit is a concept usuallyplacenta unit is a concept usuallyused to describe the production of ________andused to describe the production of ________and
can be used to evaluate the placental function.can be used to evaluate the placental function.
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True or falseTrue or false
1. Supplement of iron during pregnancy is primarily to1. Supplement of iron during pregnancy is primarily to
prevent fetal anemia.prevent fetal anemia.
2. Because of the frequent incidence of glucosuria2. Because of the frequent incidence of glucosuria
among pregnant patients, quantitative urineamong pregnant patients, quantitative urine
glucose measurements are not clinically useful inglucose measurements are not clinically useful in
managing patients with diabetes, because they domanaging patients with diabetes, because they do
not reflect blood glucose levels.not reflect blood glucose levels.
3. The left pyelonephritis has a higher incidence in3. The left pyelonephritis has a higher incidence in
pregnant women.pregnant women.
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4.On chest x4.On chest x--ray, the heart appears toray, the heart appears to
demonstrate cardiomegaly duringdemonstrate cardiomegaly during
pregnancy.pregnancy.
5. In the fetus, the blood circulating in the IVC5. In the fetus, the blood circulating in the IVC
enters the right atrium and mix well withenters the right atrium and mix well with
the deoxygenated blood from SVC and thenthe deoxygenated blood from SVC and thengoes to the left atrium and supplies thegoes to the left atrium and supplies the
head, etc.head, etc.
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1. In a normal singleton pregnancy,maternal blood volume
A. increases by 10-15%
B. increases by 45%
C. decreases by 10-15%
D. decreases by 45%
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2. Which of the following is not characteristic of a2. Which of the following is not characteristic of a
normal pregnancy?normal pregnancy?
A. cardiac volume increases by 10%A. cardiac volume increases by 10%B. the ECG shows deviation to the leftB. the ECG shows deviation to the left
C. the rest pulse rate increases by approximately 10C. the rest pulse rate increases by approximately 10--
15% beats per min15% beats per min
D. arterial blood pressure and vascular resistanceD. arterial blood pressure and vascular resistance
increasesincreases
E. The heart is displaced upward and to the leftE. The heart is displaced upward and to the left
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3. Epulis is a pregnancy3. Epulis is a pregnancy--related vascularrelated vascularswelling of theswelling of the
A. GumsA. Gums
B. NailbedB. Nailbed
C. LarynxC. Larynx
D. NaresD. Nares
E. EpiglottisE. Epiglottis
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