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Chapter 10

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NUR1 233
Sonia Elizabeth Semenic

Chapter 10: Anatomy and Physiology of Pregnancy Gravidity and Parity Gravida a woman who is pregnant Gravidity pregnancy Multigravida a woman who has two or more pregnancies Multipara a woman who has completed two or more pregnancies to 20 weeks of gestation or more Nulligravida a woman who has never been pregnant Nullipara a woman who has not completed a pregnancy with a fetus or foetuses beyond 20 weeks of gestation Parity the number of pregnancies in which the fetus have reached 20 weeks of gestation, not the number of foetuses (ex. twins) born not affected by whether the fetus is born alive or stillborn Postdate or postterm pregnancy that goes beyond 42 weeks of gestation Preterm pregnancy that has reached 20 weeks of gestation but before completion of 37 weeks of gestation Primigravida a woman who is pregnant for the first time Primipara a woman who has completed one pregnancy with a fetus who has reached 20 weeks of gestation Term a pregnancy from the beginning of the week 38 of gestation to the end of week 42 of gestation Viability capacity to live outside the uterus, occurring about 22-25 weeks of gestation Pregnancy Tests Human chorionic gonadotropin (hCG) is earliest marker recognition of beta subunit o Can begin as early as day of implantation and can be detected as early as 7-10 days after conception o Rises until it peaks at 60-70 days of gestation and declines at 80 days o Remains stable until 30 weeks and increases until term o Higher than normal: ectopic pregnancy, abnormal gestation (ex. fetus with Downs Syndrome) or multiple gestation o Lower than normal: impending miscarriage Serum and urine testing o Serum testing - 7-10mL venous blood sample o Urine testing - first-voided morning ruing specimen because it contains levels of hCG equal to serum o Urine tests less expensive and faster results than serum tests ELISA testing o Most popular method and ones in home pregnancy tests o Uses specific monoclonal antibody (anti-hCG) with enzymes that bond with hCG in urine Medication effects o False positive results: anticonvulsants and tranquilizers o False negative results: diuretics and promethazine Signs of Pregnancy Presumptive changes felt by woman (ex. amenorrhea, fatigue, breast changes) Probable changes observed by examiner (ex. Hegar sign, ballottement, pregnancy tests) Positive signs attributed only to presence of fetus (ex. hearting fetal heart tones, visualizing fetus) Uterus Size o High levels of estrogen and progesterone stimulate growth in first trimester o Early enlargement results from Increased vascularity and dilation of vessels Hyperplasia (new muscle fibers and elastic tissue) Hypertrophy (enlargement of pre-existing muscle fibers and fibroelastic tissue) Development of deciduas o 7 weeks: size of hen egg o 10 weeks: size of orange (2x non pregnancy size) o 12 weeks: size of grapefruit o After 3 months: enlargement primarily the result of mechanical pressure of fetus Shape o Conception: upside down pearo 2 trimester: muscular walls strengthen and more elastic spherical or globular o Later as fetus strengthens, the uterus becomes larger and more ovoid and rises out of pelvis into abdominal cavity Pregnancy shows after 14 week Nullipara abdominal enlargement less apparent Posture influences type and degree of abdominal enlargement Position o 12 -14 week: may be palpated above symphysis pubis o 22 24 week: rises to level of umbilicus and reaches xiphoid process at term th th o 38 40 week: fundal height decreases as fetus begins to descend and engage in pelvis (lightening) o Lightening: nullipara 2 weeks before onset of labor multipara start of labor o Uterus rotates to right as it elevates presence of rectosigmoid colon on left side o Extensive hypertrophy of round ligaments keeps uterus midline o Eventually touches anterior abdominal wall and displaces intestines to either side of abdomen o Hegars sign: softening and compressibility of lower uterine segment (uterine isthmus) at 6 weeks Exaggerated uterine anteflexion during first 3 months of pregnancy Uterine fundus presses on urinary bladder causing woman to have urinary frequency Contractility th o Braxton Hicks contractions: after 4 month contractions can be felt through abdominal wall Irregular and painless and occur intermittently during pregnancy Facilitate uterine blood flow through the intervillous spaces of placenta and promote oxygen delivery to fetus Mistake for true labor do not increase in intensity or duration or cause cervical dilation Uteroplacental blood flow o Placental perfusion depends on maternal blood flow to uterus o Blood flow increases as size of uterus increases o More oxygen extracted from the uterine blood during the latter part of
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