Pregnancy Student Past Paper PDF

Pathophysiology 1 & Pharmacotherape utics PATH 222 Week 12 Pregnancy Terms Related to 2 Pregnancy PATH 222 / W2014  Multipara  Gravida  Nullipara  Null...

Pathophysiology 1 & Pharmacotherape utics PATH 222 Week 12 Pregnancy Terms Related to 2 Pregnancy PATH 222 / W2014  Multipara  Gravida  Nullipara  Nulligravida  Abortion  Primigravida  Gestational age  Multigravida  Fertilization age  Para  Age of viability  Primipara Pregnancy 3 PATH 222 / W2014  Pregnancy is divided into three trimesters.  Approximately 3 months each  Laboratory diagnosis  Presence of human chorionic gonadotropin (hCG) in mother’s plasma or urine  Absolute signs  Later in pregnancy  Include heartbeat  By auscultation or ultrasound Pregnancy 4 PATH 222 / W2014  Estimated date of delivery (EDD) or estimated date of birth (EDB)  Calculated using Nägele’s rule  subtract 3 months from the date of the last menstrual period  add 7 days to that figure  Gestational age (2 weeks longer than biological/fertilization age)  Length of time since the first day of the LMP  280 days (40 weeks) Pregnancy 5 PATH 222 / W2014  Gravidity and parity  Woman’s history of pregnancy and childbirth  Gravidity  Number of pregnancies  Primigravida  Pregnant for the first time  Parity  Number of pregnancies in which the fetus has reached viability  Multipara  Completed two or more pregnancies with viability Determining the 6 Estimated Date of PATH 222 / W2014 Delivery  Average pregnancy is 40 weeks (280 days) after first day of LNMP, plus or minus 2 weeks  Nägele’s rule  Identify first day of LNMP  Count backward 3 months  Add 7 days  Update year, if applicable  Using Nagele’s rule for a woman who’s LNMP began on June 7 and ended on June 12, calculate the EDD  Is it March 14, March 19, March 5 or March 1 Trimesters 7 PATH 222 / W2014  Pregnancy divided into three 13-week parts  Important to know what occurs during each trimester to both woman and fetus  Helps provide anticipatory guidance  Identify deviations from the expected pattern of development Presumptive Signs of 8 Pregnancy PATH 222 / W2014  Amenorrhea  Nausea  Breast tenderness  Deepening pigmentation  Urinary frequency  Fatigue and drowsiness  Quickening Probable Signs of 9 Pregnancy PATH 222 / W2014  Probable  Goodell’s sign  Chadwick’s sign  Hegar’s sign  Abdominal enlargement  Braxton Hicks contractions  Ballottement  Fetal outline  Abdominal striae  Positive pregnancy test Probable Signs of 10 Pregnancy PATH 222 / W2014  Probable  Goodell’s sign  Chadwick’s sign  Hegar’s sign  Abdominal enlargement  Braxton Hicks contractions  Ballottement  Fetal outline  Abdominal striae  Positive pregnancy test Positive Signs of Pregnancy 11 PATH 222 / W2014  Positive  Audible fetal heartbeat  Fetal movement felt by examiner  Ultrasound visualization of fetus Doppler 12 PATH 222 / W2014 From: contecmed.com From: unco.edu Fetoscope 13 PATH 222 / W2014 From: mamasandbabies.blogspot.com From: midwifesupplies.com Normal Physiological 14 Changes PATH 222 / W2014 in Pregnancy Pregnancy causes many changes in body systems:  Endocrine  Reproductive  Respiratory  Cardiovascular  Gastrointestinal  Urinary  Integumentary and skeletal Effects of Pregnancy on the 15 Reproductive System PATH 222 / W2014  Uterus  Becomes temporary abdominal organ  Capacity is 5000 mL (fetus, placenta, amniotic fluid)  Cervix  Changes in color and consistency, glands in cervical mucosa increase  Mucus plug formed to prevent ascent of organisms into uterus  Ovaries  Produce progesterone to maintain decidua (uterine lining) during first 6-7 weeks of gestation until placenta can take over task  Effects of Pregnancy on the 16 Reproductive System (cont.) PATH 222 / W2014  Vagina  Increased blood supply causes it to have a bluish color  Vaginal secretions increase, pH more acidic  Higher glycogen level which promotes Candida albicans (yeast) growth  Breasts  High levels of estrogen and progesterone prepare breasts for lactation  Tubercles of Montgomery secrete substance to lubricate nipples  “Premilk” is expressed and is high in protein, fat-soluble vitamins, and minerals  Low in calories, fats, and sugar Height of Fundus During 17 Gestation PATH 222 / W2014 Effects of Pregnancy on the 18 Cardiovascular System PATH 222 / W2014  Blood volume increases by ~45% than prepregnant state  Increase provides for  Exchange of nutrients, oxygen, and waste products within the placenta  Needs of expanded maternal tissue  Reserve for blood loss at birth  Pulse rate increases by 10 to 15 beats/min Supine Hypotension 19 Syndrome Also called aortocaval Symptoms  PATH 222 / W2014 compression or vena cava  Faintness syndrome  Lightheadedness  Occurs if woman lies flat on her  Dizziness back  Agitation  Allows heavy uterus to compress inferior vena cava  Turning to one side relieves  Reduces blood returned to her pressure on inferior vena heart cava, preferably the left  side Can lead to fetal hypoxia Supine Hypotension 20 Syndrome (cont.) PATH 222 / W2014 Effects of Pregnancy on the 21 Cardiovascular System PATH 222 / W2014  Orthostatic hypotension  Palpitations  Dilutional anemia (a.k.a., pseudoanemia)  Increased clotting factors in second and third trimesters  Increases risk of thrombophlebitis  Varicose veins Cardiovascular Changes 22 PATH 222 / W2014  Increased blood volume  Both fluid and erythrocytes  Increase production of red blood cells for fetus Requires increased iron intake by the mother  Heart rate may increase slightly.  Blood pressure  Frequently drops slightly in first two trimesters  Rises to normal levels in last trimester  Varicose veins  Frequently develop during pregnancy Effects of Pregnancy on the 23 Respiratory System PATH 222 / W2014  Oxygen consumption increases by 15%  Diaphragm rises ~4 cm (1.6 inches)  Causes ribs to flare  Dyspnea can occur until fetus descends into pelvis  Increased estrogen causes edema or swelling of mucous membranes of nose, pharynx, mouth, and trachea  Woman may complain of nasal stuffiness, epistaxis, and voice changes Effects of Pregnancy on the 24 Gastrointestinal System PATH 222 / W2014  Growing uterus displaces stomach and intestines  Increased salivary secretions  Oral mucosa may become tender and bleed more easily  Appetite and thirst may increase  Gastric acid secretions decrease  Delayed gastric emptying and intestinal movement  Progesterone and estrogen relax muscle tone of gallbladder  Leads to retained bile salts  Can cause pruritus during pregnancy Compression of Abdominal Contents as Uterus Enlarges 25 Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. Digestive System 26 Changes PATH 222 / W2014  Nausea and vomiting  Common in first trimester  Not just in the morning  Change in eating pattern often reduces discomfort  Decreased motility in the digestive tract  Relaxation of smooth muscle by progesterone  Slower emptying of the stomach  Reflux of stomach contents (heartburn)  Constipation Effects of Pregnancy on the 27 Urinary System PATH 222 / W2014  Excretes waste products of woman and fetus  Glomerular filtration rate of kidneys increases  Glycosuria and proteinuria more common  Water retention due to increased blood volume and dissolving nutrients provided for fetus  Progesterone causes renal pelvis and ureters to lose tone, leads to urinary stasis  Woman more susceptible to UTIs  99% of sodium is reabsorbed, leads to fluid retention Musculoskeletal Changes 28 PATH 222 / W2014  Marked postural changes  Pelvic joints relax or loosen  Hormones prepare for delivery  Loss of stability – waddling gait  Increased abdominal weight  Tendency toward lordosis  Balance and coordination may be impaired.  Backache caused by these changes Effects of Pregnancy on the Integumentary and Skeletal 29 Systems PATH 222 / W2014  Striae  Spider nevi  Sweat and sebaceous glands become more active  To dissipate heat from woman and fetus  Posture changes  Low back aches  Relaxation of pelvic joints  Waddling gait  Change in center of gravity  Balance may become an issue Effects of Pregnancy on the 30 Endocrine System PATH 222 / W2014  Dramatic increase in hormones affects all body systems  Essential to maintain pregnancy  Produced initially by the corpus luteum, later by the placenta  Most striking change is addition of placenta as a temporary endocrine organ  Primary role is to produce estrogen and progesterone to maintain pregnancy Effects of the Expanding Uterus 31 PATH 222 / W2014  Pressure of expanding uterus  Can interfere with digestive function  Reduces vital capacity  Increases pressure on bladder and rectum  Changes center of gravity  32 PATH 222 / W2014 Potential Complications of Pregnancy Hyperemesis Gravidarum 33 PATH 222 / W2014  Manifestations  Excessive nausea and vomiting  Can impact fetal growth  Dehydration  Reduced delivery of blood, oxygen, and nutrients to the fetus Hyperemesis Gravidarum 34 PATH 222 / W2014  Treatment  Correct dehydration and electrolyte or acid-base imbalance  Antiemetic drugs may be prescribed  In extreme cases  TPN may be required  Hospitalization  Types of Abortions 35  Spontaneous (nonintentional)  Threatened  Inevitable  Incomplete  Complete  Missed  Recurrent  Induced  Therapeutic  Elective Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. Ectopic Pregnancy 36 PATH 222 / W2014  results when a pregnancy implants anywhere outside of the uterus.  95% occur in fallopian tube  Scarring or tubal deformity may result from  Hormonal abnormalities  Inflammation  Infection  Adhesions  Congenital defects  Endometriosis Ectopic Pregnancy 37 PATH 222 / W2014  Tubal pregnancy  Zygote is implanted outside the uterus.  Most often in the fallopian tubes  Spontaneous abortion may follow.  Embryo may continue to develop.  Eventually causes tubal rupture  Severe hemorrhage leading to shock  Death  Considered a surgical emergency Most Common Sites for Ectopic Pregnancies 38 Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. Ectopic Pregnancy 39  Treatment PATH 222 / W2014  Manifestations   Pregnancy test Lower abdominal pain and may have light vaginal bleeding  Transvaginal ultrasound  If tube ruptures  Laparoscopic examination May have sudden severe lower  Priority is to control bleeding abdominal pain  Three actions can be taken Vaginal bleeding No action Signs of hypovolemic shock Treatment with methotrexate to Shoulder pain may also be felt inhibit cell division Surgery to remove pregnancy from the tube  Placenta Previa 40  Abnormal implantation of placenta: in lower uterus or over cervical os  Bright red bleeding occurs when cervix dilates, resulting in painless bleeding  Three degrees  Marginal: w/i 2 -3 cm of cervical os  Partial: partly covers cervical os  Total: completely covers cervical os Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. Placenta Previa 41 PATH 222 / W2014 Complications:  Infection because of vaginal organisms  Postpartum hemorrhage, because if lower segment of uterus was site of attachment, there are fewer muscle fibers, so weaker contractions may occur Placenta Previa 42 PATH 222 / W2014  Placenta previa  Placenta is implanted in the lower uterus or over cervical os.  Placenta may tear at end of pregnancy  Bright red bleeding - painless  Abruptio Placenta 43 PATH 222 / W2014  Normal implantation of placenta has taken place.  Abruptio placentae = premature separation of the placenta from the uterine wall  Dark red bleeding with pain  Enlarging uterus suggest blood is accumulating within the cavity  More common to occur during 3rd trimester Abruptio Placentae 44 PATH 222 / W2014  Abruptio placentae  May occur following motor vehicle accident or spontaneously  Premature separation of the placenta from the uterine wall usually causing bleeding  Blood may be trapped between placenta and uterine wall.  Abdominal pain is common. 45  Gestational Hypertension 46 PATH 222 / W2014  Formerly known as pregnancy-induced hypertension (PIH)  GH = state of persistently elevated BP >140/90 that develops after 20 weeks of gestation and returns to normal after delivery  An increase over baseline blood pressure of 30 mm Hg or more systolic and 15 mm Hg diastolic will place the woman in a high-risk category for GH  BP normally decreases during 1st & 2nd trimesters Gestational Hypertension 47 PATH 222 / W2014  Persistently elevated blood pressure  Greater than 140/90 mm Hg  Develops after 20 weeks of gestation  May lead to stroke or damage to retina  Returns to normal after delivery Risk Factors for GH 48 PATH 222 / W2014  First pregnancy  Obesity  Family history of GH  Age over 40 years or under 19 years  Multifetal pregnancy  Chronic hypertension  Chronic renal disease  Diabetes mellitus Manifestations of and 49 Systems Affected by GH PATH 222 / W2014  Hypertension  Central nervous system  Edema  Eyes  Proteinuria  Urinary tract  Blood clotting  Respiratory system  Gastrointestinal system and liver Gestational Hypertension 50 PATH 222 / W2014  Pre-eclampsia  Progressively higher BP  Kidney dysfunction, weight gain, generalized edema, proteinuria  Complication – HELLP (Hemolysis, Elevated Liver enzymes, Low Platelets)  Eclampsia  Extremely high blood pressure – seizures or coma  High risk of stroke  May require cesarean section delivery to reduce maternal risk Management of GH 51 PATH 222 / W2014  Depends on severity of the hypertension and on the maturity of the fetus  Treatment focuses on  Maintaining blood flow to the woman’s vital organs and to the placenta  Preventing convulsions Conservative Treatment 52 GH PATH 222 / W2014 Activity restriction  Maternal assessment of fetal  Drug therapy activity (kick counts)  Magnesium sulfate to  Blood pressure monitoring prevent seizures  Calcium gluconate  Daily weight reverses effects of  Checking urine for protein magnesium sulfate  Antihypertensives Rh Incompatibility 53 PATH 222 / W2014  Results when the mother is Rh-negative and the fetus is Rh-positive  Usually not a problem during first pregnancy  Rh-positive blood enters maternal circulation due to placental tears.  Formation of maternal antibodies to Rh-positive blood  Subsequent pregnancies – maternal antibodies destroy red blood cells of fetus Rh Incompatibility 54 PATH 222 / W2014 Rh Incompatibility 55 PATH 222 / W2014  Hemolysis of red blood cells in newborn  Severe anemia, low hemoglobin  Jaundice may be severe.  Possible heart failure and death  Early birth or intrauterine transfusion may be recommended.  Exchange transfusion after birth may be required.  Rh Incompatibility 56 (Cont’d) PATH 222 / W2014  Prevention  Prenatal blood testing of woman and, if RH negative, her partner  Monitoring for Rh antibodies in maternal blood  Administration of RhoGAM antibodies within 48 - 72 hours of delivery or termination of pregnancy to neutralize Rh-positive cells in maternal blood. Thus, no immunologic memory to Rh-positive cells.  Administration of RhoGAM is also given after chorionic villi sampling, amniocentesis, miscarriage, ectopic pregnancy, abortion, uterine bleeding or any trauma during pregnancy that could leak some of the fetal cells into maternal blood. Sensitization 57 PATH 222 / W2014  The leaking of fetal Rh-positive blood into the Rh-negative mother’s circulation, causing her body to respond by making antibodies to destroy the Rh-positive erythrocytes  With subsequent pregnancy, the woman’s antibodies against Rh-positive blood cross the placenta and destroy the fetal Rh-positive erythrocytes before the infant is born Erythroblastosis Fetalis 58 Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. Erythroblastosis Fetalis 59 PATH 222 / W2014  Occurs when the  Fetal assessment tests maternal anti-Rh must be done antibodies cross the throughout pregnancy placenta and destroy  fetal erythrocytes An intrauterine transfusion may be  Requires RhoGAM to be done for the severely given at 28 weeks and anemic fetus if mother within 72 hours of has been sensitized delivery to the mother (ie. developed  Also given after antibodies) amniocentesis, woman who experiences bleeding during pregnancy Any questions? 60 PATH 222 / W2014