Maternal Physio - Repro

Question 1

Compare the uterus in nonpregnant and pregnant woman

• General morphology
• Weight
• Capacity
  
  • Nonpregnant
  • Pregnant

Answer 1

• General morphology
  
  • Nonpregnant
    
    • Almost-solid structure
  • Pregnant
    
    • Thin-walled muscular organ
• Weight
  
  • Nonpregnant
    
    • 70 g
  • Pregnant
    
    • 1,100 g
• Capacity
  
  • Nonpregnant
    
    • 10 mL or less
  • Pregnant
    
    • 5 to 20 L (500 to 1,000X greater)

Question 2

Cause of enlargement of uterus

Hypertrophy or hyperplasia

Answer 2

Hypertrophy rather than hyperplasia

Question 3

Uterine hypertrophy early in pregnancy probably is stimulated by:

Answer 3

• Early in pregnancy – estrogen
• After 12 weeks – pressure exerted by the expanding products of conception

Memory aid:

• _E_strogen
• _E_nlarges the uterus

Question 4

T/F. Hypertrophy of early pregnancy occurs entirely due to mechanical distention

Answer 4

False; similar uterine changes are observed with ectopic pregnancy

Question 5

Uterine enlargement is most marked in this portion of the uterus

Answer 5

Fundus

Question 6

The position of the placenta also influences the extent of uterine hypertrophy. Why?

Answer 6

The portion of the uterus surrounding the placental site enlarges more rapidly than does the rest

Question 7

Describe the attachment of the tubes and the ovarian + round ligaments to the fundus

• Early month of pregnancy
• Later months of pregnancy

Answer 7

• Early month of pregnancy
  
  • only slightly below the apex of the fundus
• Later months of pregnancy
  
  • slightly above the middle of the uterus

Question 8

Describe the shape of the uterus as pregnancy progresses

Answer 8

• Pre-pregnancy – pear shape
• First few weeks (8-10 weeks) – pear shape
• 12 weeks – almost spherical
• Subsequent – ovoid

Question 9

Describe the location of the uterus as pregnancy progresses

Answer 9

• 12 weeks - too large to remain entirely within the pelvis
• As uterus enlarges, it:
  
  • contacts the anterior abdominal wall
  • displaces the intestines laterally
  • superiorly reaches almost to the liver

Question 10

With ascent of the uterus from the pelvis, it usually undergoes what? This is caused by what? What is the implication?

Answer 10

• Phenomenon
  
  • Dextrorotation
• Cause
  
  • Rectosigmoid on the left side of the pelvis
• Implication
  
  • The round ligament must be avoided in lower uterine incision

Question 11

Softening of the uterine isthmus

Answer 11

Hegar sign

Question 12

Arrangement of uterine muscle cells and description (indicate the main portion of the uterine wall)

Answer 12

• Outer hoodlike layer
  
  • Arches over the fundus and extends into various ligaments
• Middle layer
  
  • Main portion of uterine wall
  • Figure of 8 configuration
  • Perforated by blood vessels
• Internal layer
  
  • With sphincter-like fibers around the fallopian tube orifices and internal os of the cervix

Memory aid:

• _M_ain
• _M_iddle

Question 13

Uteroplacental blood flow increases progressively, with estimates ranging ___ in near term

Answer 13

450 to 650 mL/m

• Summary:*
• More or less half liter

Question 14

Physiologic reason for increase in uterine blood flow

Answer 14

• Increase in maternal-placental blood flow – vasodilation d/t estrogen action
• Increase fetal-placental blood flow – a continuing growth of placental vessels

Question 15

Uterine finding on bimanual exam

Answer 15

Uterus feels soft and elastic

Question 16

Fundal height by weeks 12, 15, 20, 28, 32, 36, 40 weeks

Answer 16

• 12 – barely palpable above pubic symphysis
• 15 – midpoint between pubic symphysis and umbilicus
• 20 – at the umbilicus
• 28 – 6 cm above the umbilicus
• 32 – 6 cm below the xyphoid process
• 36 – 2 cm below xyphoid process
• 40 – 4 cm below xiphoid process

Question 17

Cervical changes and the physiologic mechanism for such change

Answer 17

• Goodell’s sign
  
  • Due to increased vascularity and edema of cervix
• Cervical mucus beading
  
  • Due to progesterone
• Arias-Stella reaction
  
  • Endocervical gland hyperplasia and hypersecretory appearance

Question 18

What is Goodell’s sign?

Answer 18

Cervical softening and cyanosis due to increased vascularity and edema of the entire cervix

Question 19

Cervical mucus beading occurs as a result of ____

Answer 19

Progesterone

Question 20

What is Arias-Stella reaction?

Answer 20

Endocervical gland hyperplasia and hypersecretory appearance

Question 21

Cervix palpation on pregnant versus nonpregnant

Answer 21

• Nonpregnant
  
  • feels like the cartilage of the nose
• Pregnant
  
  • feels like the lips of the mouth

Question 22

Physiologic mechanism for mucus plug formation

Answer 22

↑ in gland activity leads to the formation of a mucous plug

Question 23

Mucous plug composition and function

Answer 23

Immunoglobulins and cytokines, which act as a barrier to bacteria

Question 24

Corpus luteum

• Origin
• When does it maximally function
• Produces what hormome

Answer 24

• Origin
  
  • Remains of the ovarian follicle that has released a mature ovum during a previous ovulation
• When does it maximally function
  
  • First 6-7 weeks of pregnancy
• Produces what hormome
  
  • Progesterone
• Memory aid:*
• corProgesterone

Question 25

The set of changes in the endometrium of the uterus that prepare it for implantation of an embryo * Phenomenon * Description

Answer 25

* Phenomenon * Decidual reaction * Description * Elevated patches of tissue which bleed easily

Question 26

Relaxin * Produced by * Action

Answer 26

* Produced by * Corpus luteum, deciduas, placenta * Action * Remodelling of reproductive tract connective tissue to accomodate pregnancy *Memory aid:* * *RElaxin* * *REmodelling*

Question 27

Beading versus ferning

Answer 27

* Not pregnant – estrogen effect → ↑ NaCl in mucus → crystallization → ferning * Pregnant – progesterone effect → ↓ NaCl in mucus → no crystallization → beading *Memory aid:* * *Beaded (circle like a pregnant tummy)* * ***_B_**ead **_B_**untis **_B_**aba NaCl* * ***_P_**regnant – **_P_**rogesterone*

Question 28

Describe the vaginal secretion during pregnancy and the physiology of each

Answer 28

* Thicker with a white color due to influence of progesterone * More acidic in nature as a result of ↑ Lactobacillus acidophilus * Memory aid:* * *Puti Pepet Progesterone*

Question 29

Effect of Lactobacillus acidophilus

Answer 29

Inhibits growth of most pathogens and favors growth of yeasts

Question 30

Vaginal pH during pregnancy

Answer 30

3.5 to 6

Question 31

Description of vaginal discoloration and rationale

Answer 31

Blood flow increases → vagina appears dark bluish or purplish-red

Question 32

Sign described as bluish discoloration of the vaginal and cervical mucosa

Answer 32

Chadwick’s sign

Question 33

Chadwick sign ---- Presumptive, probable or positive sign?

Answer 33

Presumptive * Note:* * *Of the three signs (with Hegar and Goodel, this is the only presumptive sign)*

Question 34

When is Chadwick sign observed?

Answer 34

6th week * Note:* * *All of the 3 signs are seen at 6 weeks*