EXAM 2 STUDY GUIDE
Week 4
OB
1. Describe the significant changes in growth and development of the embryo
and fetus.
a. Growth of Embryo
b. Growth of Fetus
2. Explain the expected maternal anatomic and physiologic adaptations to
pregnancy.
,a. Cardio
Slight cardiac hypertrophy
Apical pulse shifts more to the left
Heart rate increases ~10 to 15 bpm between 14 and 20 weeks
i. Blood Pressure
First Trimester:
o remains same as pre-pregnancy
level Second Trimester:
o decrease in blood pressure: related to blood vessel tone
decreased and decreased peripheral vascular resistance
Third Trimester:
o returns to first trimester levels
ii. Blood
Physiologic anemia: hemodilutional effect of increased
plasma Increase in WBC’s second and third trimester
Increases in clotting factors
o greater tendency for blood to clot
o protective function, to combat childbirth blood loss
o More vulnerable to thrombosis
(DVT) Increases by 1-2 liters
o buffers circulatory system to make up for blood loss
during childbirth, and
o Cardiac Output increases 30-50% above baseline
b. Respiratory
i. Increase in maternal oxygen
requirements Diaphragm displaced
(rises ~ 4 cm) Dyspnea
Increase in vascularity (from estrogen stimulation)
ii. Nasal and sinus stuffiness, nose bleeds
iii. Respiratory rate slightly increased (~ 2 breaths per minute)
iv. Increased oxygen requirement – 10 to 20% as a result of increased BMR
c. Urinary/Renal
i. Larger volume of urine is held in the pelves and
ureters urine flow rate is slowed
results in urinary stasis
increases susceptibility to UTI’s
ii. Bladder irritability, nocturia, frequency, urgency occurs in early pregnancy
and returns near term.
iii. Bladder has increased capacity, walls hypertrophy in later pregnancy,
more susceptible to injury and trauma at birth.
d. Reproductive
i. Uterus
Enlargement…Duh!
Braxton Hicks Contractions
Uteroplacental Blood Flow
ii. Cervix
Goodell (Softening of Cervix) and Chadwick (Increase vascularity,
violet bluish color of vaginal mucosa).
Mucus plug - seals off uterus from vaginal canal mucus increases in
amount and thickness
, Bloody show: usually a sign of cervical changes
Friability: bleeds easily when scraped or
touched Nullipara vs Multipara
o Multipara-Some dilation, cervical opening more oval shape
o Nullipara- No dilation, cervical opening more round shape
iii. Vagina
leukorrhea: thick white acidic discharge, prevents pathogenic infections o
response to cervical stimulation by estrogen and progesterone
Glycogen stores increased
o prone to yeast infections
Increased vascularity: edema, varicosities of vulva
Perineum: increased vascularity, hypertrophy of skin and muscles,
loosening of connective tissue
iv. Breasts
Increase fullness and size; due to increase levels of progesterone and
estrogen Pigmentation changes; areola darkening, nipples more erect
Colostrum: thick yellow fluid can be expressed from 2nd trimester on.
e. Integumentary
i. Hyperpigmentation
ii. Mechanical stretching
Striae gravidarum (stretch marks)
f. Musculoskeletal
i. Alterations in posture (lordosis)
ii. Musculoskeletal discomforts
uterine ligaments
stretching legs cramping
iii. Relaxation and increased mobility of the pelvic
joints Change in gait
Relaxin
Diastasis recti abdominis
g. Neurological
i. Compression of nerves or vascular stasis sensory changes in legs
ii. Numbness and tingling of hands
iii. Tension headaches
iv. Lightheadedness, syncope
h. GI
i. Intestinal – decreased peristalsis and hypotonic, displaced by uterus
ii. Heartburn, constipation, hemorrhoids
Relaxed cardiac sphincter causes reflux
iii. Appetite and food intake fluctuate
i. Endocrine
i. Estrogen
Promotes enlargement of genitals, uterus, breasts
Increase in size and number of myometrial cells
Produced by corpus luteum until ~ 14 days, then the
placenta Relaxation of pelvic ligaments and joints
Increases vascularity and
vasodilation Water retention
ii. Progesterone
Produced by corpus luteum until ~ 14 days, then the placenta
Week 4
OB
1. Describe the significant changes in growth and development of the embryo
and fetus.
a. Growth of Embryo
b. Growth of Fetus
2. Explain the expected maternal anatomic and physiologic adaptations to
pregnancy.
,a. Cardio
Slight cardiac hypertrophy
Apical pulse shifts more to the left
Heart rate increases ~10 to 15 bpm between 14 and 20 weeks
i. Blood Pressure
First Trimester:
o remains same as pre-pregnancy
level Second Trimester:
o decrease in blood pressure: related to blood vessel tone
decreased and decreased peripheral vascular resistance
Third Trimester:
o returns to first trimester levels
ii. Blood
Physiologic anemia: hemodilutional effect of increased
plasma Increase in WBC’s second and third trimester
Increases in clotting factors
o greater tendency for blood to clot
o protective function, to combat childbirth blood loss
o More vulnerable to thrombosis
(DVT) Increases by 1-2 liters
o buffers circulatory system to make up for blood loss
during childbirth, and
o Cardiac Output increases 30-50% above baseline
b. Respiratory
i. Increase in maternal oxygen
requirements Diaphragm displaced
(rises ~ 4 cm) Dyspnea
Increase in vascularity (from estrogen stimulation)
ii. Nasal and sinus stuffiness, nose bleeds
iii. Respiratory rate slightly increased (~ 2 breaths per minute)
iv. Increased oxygen requirement – 10 to 20% as a result of increased BMR
c. Urinary/Renal
i. Larger volume of urine is held in the pelves and
ureters urine flow rate is slowed
results in urinary stasis
increases susceptibility to UTI’s
ii. Bladder irritability, nocturia, frequency, urgency occurs in early pregnancy
and returns near term.
iii. Bladder has increased capacity, walls hypertrophy in later pregnancy,
more susceptible to injury and trauma at birth.
d. Reproductive
i. Uterus
Enlargement…Duh!
Braxton Hicks Contractions
Uteroplacental Blood Flow
ii. Cervix
Goodell (Softening of Cervix) and Chadwick (Increase vascularity,
violet bluish color of vaginal mucosa).
Mucus plug - seals off uterus from vaginal canal mucus increases in
amount and thickness
, Bloody show: usually a sign of cervical changes
Friability: bleeds easily when scraped or
touched Nullipara vs Multipara
o Multipara-Some dilation, cervical opening more oval shape
o Nullipara- No dilation, cervical opening more round shape
iii. Vagina
leukorrhea: thick white acidic discharge, prevents pathogenic infections o
response to cervical stimulation by estrogen and progesterone
Glycogen stores increased
o prone to yeast infections
Increased vascularity: edema, varicosities of vulva
Perineum: increased vascularity, hypertrophy of skin and muscles,
loosening of connective tissue
iv. Breasts
Increase fullness and size; due to increase levels of progesterone and
estrogen Pigmentation changes; areola darkening, nipples more erect
Colostrum: thick yellow fluid can be expressed from 2nd trimester on.
e. Integumentary
i. Hyperpigmentation
ii. Mechanical stretching
Striae gravidarum (stretch marks)
f. Musculoskeletal
i. Alterations in posture (lordosis)
ii. Musculoskeletal discomforts
uterine ligaments
stretching legs cramping
iii. Relaxation and increased mobility of the pelvic
joints Change in gait
Relaxin
Diastasis recti abdominis
g. Neurological
i. Compression of nerves or vascular stasis sensory changes in legs
ii. Numbness and tingling of hands
iii. Tension headaches
iv. Lightheadedness, syncope
h. GI
i. Intestinal – decreased peristalsis and hypotonic, displaced by uterus
ii. Heartburn, constipation, hemorrhoids
Relaxed cardiac sphincter causes reflux
iii. Appetite and food intake fluctuate
i. Endocrine
i. Estrogen
Promotes enlargement of genitals, uterus, breasts
Increase in size and number of myometrial cells
Produced by corpus luteum until ~ 14 days, then the
placenta Relaxation of pelvic ligaments and joints
Increases vascularity and
vasodilation Water retention
ii. Progesterone
Produced by corpus luteum until ~ 14 days, then the placenta
