Maternal Adaptations to Pregnancy
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Questions and Answers

Why is the left lateral recumbent position recommended for pregnant women?

  • It increases blood flow returning to the heart.
  • It decreases the risk of dependent edema.
  • It reduces pressure on the inferior vena cava. (correct)
  • It prevents the development of varicose veins.
  • What is the primary cause of hemodilution during pregnancy?

  • Reduced iron absorption leading to anemia.
  • Disproportionate increase in plasma volume compared to red blood cell production. (correct)
  • Decreased red blood cell production.
  • Increased red blood cell destruction.
  • What is a significant respiratory change during pregnancy, and what causes it?

  • Increased chest expansion due to relaxed ligaments and displaced diaphragm. (correct)
  • Increased threshold for carbon dioxide due to hormonal changes.
  • Decreased oxygen requirements due to changes in metabolism.
  • Decreased chest expansion due to abdominal pressure.
  • What renal change is typically observed during pregnancy?

    <p>Increased glomerular filtration rate (GFR). (A)</p> Signup and view all the answers

    Which integumentary system change is caused by increased melanocyte-stimulating hormone (MSH) during pregnancy?

    <p>Darkening of the areola and nipples. (D)</p> Signup and view all the answers

    What musculoskeletal change contributes to balance issues in pregnant women?

    <p>Anterior shift in the center of gravity. (C)</p> Signup and view all the answers

    What gastrointestinal change is primarily attributed to the effects of progesterone during pregnancy?

    <p>Bloating and constipation. (D)</p> Signup and view all the answers

    Which hematological change increases the risk of thrombosis during pregnancy?

    <p>Increased levels of clotting factors VII, VIII, IX, and X. (B)</p> Signup and view all the answers

    What does 'Gravida' refer to in obstetric history?

    <p>Total number of times a client has been pregnant, regardless of outcome or duration. (A)</p> Signup and view all the answers

    A client is currently pregnant. She had one previous pregnancy that resulted in a delivery at 39 weeks and another that ended in miscarriage at 10 weeks. What is her GTPAL?

    <p>G3 P1011 (C)</p> Signup and view all the answers

    What is indicated when a client is referred to as 'Primigravida'?

    <p>The client is experiencing her first pregnancy. (D)</p> Signup and view all the answers

    A woman is in her second pregnancy. Her first pregnancy ended at 35 weeks with the birth of a healthy baby. How would you classify her in terms of 'gravida' and 'para'?

    <p>Gravida 2, Para 1 (D)</p> Signup and view all the answers

    What is the correct interpreation of 'P' in the TPAL acronym?

    <p>Number of pregnancies that have reached 20 weeks gestation or more. (B)</p> Signup and view all the answers

    Which pregnancy is defined as a 'Term' delivery within the TPAL acronym?

    <p>Infants born after 38-42 weeks gestation. (C)</p> Signup and view all the answers

    A patient's obstetric history is documented as G4 P1112. What does this indicate about her pregnancies?

    <p>She has had 4 pregnancies, 1 term birth, 1 preterm birth, 1 abortion, and 2 living children. (C)</p> Signup and view all the answers

    What is the correct definition of a 'Multigravida' client?

    <p>A client who has been pregnant more than once. (A)</p> Signup and view all the answers

    Which of the following signs can ONLY be attributed to the presence of a fetus?

    <p>Fetal heartbeat (C)</p> Signup and view all the answers

    What physiological change occurs in the uterus during pregnancy?

    <p>Hypertrophy and hyperplasia of myometrial cells (B)</p> Signup and view all the answers

    What is the role of the corpus luteum during early pregnancy?

    <p>To secrete estrogen and progesterone (C)</p> Signup and view all the answers

    What change occurs in blood pressure during the first and second trimesters of pregnancy?

    <p>It decreases due to systemic vascular resistance (C)</p> Signup and view all the answers

    What condition can result from the gravid uterus compressing the vena cava when a woman is supine?

    <p>Supine hypotensive syndrome (D)</p> Signup and view all the answers

    What happens to the ovaries during pregnancy?

    <p>They become inactive (C)</p> Signup and view all the answers

    Which statement about cardiovascular changes during pregnancy is true?

    <p>Cardiac output increases by 30-50% (A)</p> Signup and view all the answers

    Which change occurs in the vagina during pregnancy?

    <p>Increased secretion amount and acidity (D)</p> Signup and view all the answers

    Flashcards

    Gravida

    Number of times a person has been pregnant, including the current pregnancy.

    Para

    Number of pregnancies reaching 20 weeks or more, regardless of outcome.

    GTPAL

    A system to document obstetric history: Gravida, Term, Preterm, Abortions, Living.

    Primigravida

    A woman pregnant for the first time.

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    Multigravida

    A woman who has been pregnant more than once.

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    Parity

    Refers to the number of pregnancies that reached at least 20 weeks.

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    Presumptive signs of pregnancy

    Symptoms felt by the woman that suggest pregnancy, like nausea.

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    Probable signs of pregnancy

    Changes observed by a healthcare examiner that suggest pregnancy.

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    Positive signs of pregnancy

    Indicators that can only be attributed to a fetus, such as fetal heartbeat, movements, or ultrasound visualization.

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    Braxton Hicks contractions

    Inactive or practice contractions that can occur during pregnancy, signaling the body’s preparation for labor.

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    Myometrial hypertrophy

    The increase in size and number of muscle cells in the uterus as it expands during pregnancy.

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    Mucous plug

    A protective barrier that forms in the cervix during pregnancy to guard the uterus against infections.

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    Supine hypotensive syndrome

    A condition occurring when the gravid uterus compresses the vena cava while a woman lies flat, reducing blood return to the heart.

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    Changes in blood flow during pregnancy

    Increased blood volume and cardiac output by 30-50% to support maternal and fetal needs.

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    Corpus luteum's role during pregnancy

    The structure that produces progesterone and estrogen until the placenta can take over these functions.

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    Increased vascularity in the vagina

    Expansion of blood vessels in the vagina, leading to increased blood flow, tissue loosening, and secretion changes.

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    Left lateral recumbent position

    A lying position on the left side that reduces pressure on the heart and vessels.

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    Hematological changes in pregnancy

    Increased blood plasma and red blood cell production leading to hemodilution.

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    Increased WBCs

    White blood cells increase during the second trimester and peak in the third trimester.

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    Thrombosis risk

    Increase in fibrin/fibrinogen and clotting factors leading to higher risk of blood clots during pregnancy.

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    Urinary frequency

    Increased need to urinate during the first and third trimesters due to pressure from the uterus.

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    Darkening of skin areas

    Increased melanin stimulating hormone causes darkening of areola and other skin areas.

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    Diastasis recti

    Abdominal muscle separation due to increased pressure and changes in the body during pregnancy.

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    Gastrointestinal changes

    Changes including bloating, constipation, and increased saliva due to hormonal effects during pregnancy.

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    Study Notes

    Maternal Adaptations to Pregnancy

    • Gravida: The number of times a client has been pregnant, including the current pregnancy.
    • Para: The number of pregnancies that have reached 20 weeks gestation, regardless of outcome. Twins/triplets are counted as one.
    • GTPAL: A system used to document obstetric history.
      • G: Gravida
      • T: Term births (38-42 weeks)
      • P: Preterm births (20-38 weeks)
      • A: Abortions (before 20 weeks)
      • L: Living children
    • Example: A woman who has been pregnant three times, had two term births, no preterm births or abortions, and has two living children would be documented as G3 T2 P0 A0 L2.
    • Primigravida: A client pregnant for the first time
    • Multigravida: A client who has been pregnant more than once
    • Primipara: A client who has not delivered a pregnancy past 20 weeks
    • Multipara: A client who has delivered more than one pregnancy past 20 weeks

    Signs of Pregnancy

    • Presumptive Signs: Changes felt by the woman. Examples include amenorrhea, nausea, fatigue.
    • Probable signs: Changes observed by the examiner. Examples include changes in pelvic organs or a positive HCG test
    • Positive Signs: Changes that are definitively linked to the presence of a fetus. Examples include a fetal heartbeat, fetal movements, and ultrasound visualization of a fetus.

    Reproductive System Changes

    • Uterus:
      • Hypertrophy and hyperplasia of myometrial cells
      • Moves from being a pelvic organ to an abdominal organ
      • By pregnancy's end, approximately 1/6 of the mother's total body mass.
    • Cervix:
      • Mucous plug forms
      • Increased vascularity (blood vessels) and fragility.
    • Vagina:
      • Increased vascularity.
      • Tissue loosens/vault lengthens.
      • Increased secretions.
    • Ovaries:
      • Stop producing ova.
      • Corpus luteum releases progesterone and estrogen until the placenta takes over.
    • Breasts:
      • Placenta releases estrogen and progesterone, increasing alveoli and ductal systems.
      • Prolactin is needed for milk production, but is inhibited by estrogen & progesterone. Production of milk stops during pregnancy when the placenta produces the required hormones

    Cardiovascular Changes

    • Increased blood flow to the placenta, uterus & breasts
    • Cardiac workload increases (increased cardiac output by 30-50%)
    • Increased heart rate (by 10-15 bpm)
    • Blood pressure may decrease during the first and second trimesters but returns to normal by term.
    • Supine Hypotensive Syndrome: Gravid uterus compresses vena cava (especially when lying flat). Interferes with blood return to the heart—resulting in dependent edema, varicose veins, hemorrhoids, and thrombophlebitis
    • Left lateral recumbent position is considered to be the best position for the expectant mother.

    Hematological Changes

    • Rapid increase in plasma volume (40-45% above non-pregnant levels, peaking at 32-34 weeks).
    • Increased red blood cell production (RBC) (approximately 20-30% more).
    • White blood cell (WBC) count increases in the 2nd trimester, peaking in the 3rd.
    • Fibrin/fibrinogen and clotting factors (VII, VIII, IX, X) increase, increasing risk of thrombosis.

    Respiratory Changes

    • Increased oxygen requirements / lowered threshold for CO2.
    • Ligaments relax, and the diaphragm is displaced, increasing chest expansion.
    • Upper respiratory tract becomes more vascular with edema in the nose, pharynx, trachea and bronchi.

    Renal System Changes

    • Increased pressure from the uterus leads to increased urinary frequency in the first and third trimesters.
    • Glomerular filtration rate (GFR) increases.
    • Possible glycosuria.
    • Proteinuria (trace amounts are normal; > 1 warrants close monitoring)

    Integumentary System Changes

    • Increased skin pigmentation (MSH) due to darkening of areola, nipples, axilla, and perianal area. This affects the complexion and creates chloasma.
    • Linea nigra
    • Striae gravidarum(stretch marks)
    • Vascular spiders
    • Palmar erythema
    • Increased perspiration
    • Gum hypertrophy
    • Increased nail growth
    • Decreased hair loss, and potential hirsutism

    Musculoskeletal Changes

    • Center of gravity shifts forward, leading to balance issues
    • Joint relaxation due to relaxin hormone leads to waddling and back pain.
    • Diastasis recti (separation of abdominal muscles)

    Gastrointestinal Changes

    • hCG and changes in carbohydrate metabolism may cause morning sickness.
    • Progesterone (a smooth muscle relaxer) can lead to constipation, heartburn, and bloating.
    • Gums soften and bleed easily. Saliva production may increase
    • Delayed emptying of the gallbladder and potential stone formation.

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    Description

    This quiz explores key concepts related to maternal adaptations during pregnancy, including gravidity and para classifications. Understanding the GTPAL system and recognizing signs of pregnancy are essential for providing quality prenatal care. Test your knowledge on these important obstetric terms and their implications for maternal health.

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