These symptoms are associated with that trimester of pregnancy?

• Your period stops.
• Your breasts may become larger and more tender.
• Your nipples may stick out more.
• You may need to urinate more often.
• You may feel very tired.
• You may feel nauseated and even vomit.
• You may crave certain foods or lose your appetite.
• You may have heartburn or indigestion.
• You may be constipated.
• You may gain or lose a few pounds.

These symptoms are associated with what trimester?

• Your appetite increases and nausea and fatigue may ease.
• Your abdomen begins to expand. By the end of this trimester, the top of your uterus will be near your rib cage.
• The skin on your abdomen and breasts stretches and may feel tight and itchy. You may see stretch marks.
• Your abdomen may ache on one side or the other, as the ligaments that support your uterus are stretched.

Thes sxs are assoc with what trimester?

• A dark line, the linea nigra, may appear down the middle of your stomach from your navel to your pubic hair.
• You may get brown patches (chloasma, or the "mask of pregnancy") on your face.
• Your areolas, the darker skin around your nipples, may darken.
• Your feet and ankles may swell.
• You may feel your uterus in your lower abdomen.

These symptoms are associated with that trimester?

• You can feel the baby's movements strongly.
• You may be short of breath.
• You need to urinate more often as the baby drops and puts extra pressure on your bladder.
• Colostrum—a yellow, watery pre-milk—may leak from your nipples.
• Your navel may stick out.
• You may have contractions (abdominal tightening or pain). These can signal false or real labor

When does this occur: (ie. what month)

• The fertilized egg attaches to the lining of the uterus. Some of these cells will grow into a baby. Other cells will form the placenta.
• Arms and legs begin to form.
• Brain and spinal cord begin to form.
• Heart and lungs begin to develop. The heart begins to beat near the end of this month

First month

(1/2 inch, less than 1 ounce)

At what time would you describe the embryo as the size of a pinhead. It would be during this time that the embryo is in a protective shell of special cells in the uterus wall.

(ie. weeks fertilization vs weeks menstruation)

two weeks fertilization

4 weeks menstruation

When is the embryo and first nerve cells formed?

(ie weeks fertilization vs menstrual)

3 weeks fertilization

5 weeks menstrual

During this many weeks:

a blood vessel forms which will later develop into the heart and circulatory system. It begins to pump blood. At about the same time, a ridge of tissue forms down the length of the mbryo. That tissue will later dvelop into the brain and psinal cord. Arm and leg buds are present.

4 weeks fertilization

6 weeks menstrual

What month does this occur:

• Eyelids form, but remain closed.
• The inner ear begins to develop.
• Bones appear.
• Ankles, wrists, fingers, and toes form.
• The genitals begin to develop.
• By the end of the month, all major organs and body systems have begun to develop.

second month

(1 inch, less than 1 oz)

6 weeks fertilization and or 8 weeks menstrual.

What starts to appear?

What is starting to form?

Cells of the embryo continue to multiply and start to form the brain.

At the other end is a tail bud which will become the end of the spine.

Fingers and otes are starting to appear.

Cells which also are multiplying in other parts of the embryo are starting to form the eyes, ears, jaws, lungs, stomach, intestines and liver

At what weeks, can you start to identify eyes, ears, arms and legs?

What is now developing at this time as well?

8 weeks fertilization/ 10 weeks menstrual

muscles and skeleton are developing

At how many months does this occur?

• Twenty buds for future teeth appear.
• All internal parts are formed, but are not fully developed.
• Fingers and toes continue to grow. Soft nails begin to form.
• Bones and muscles begin to grow.
• The intestines begin to form.
• The backbone is soft and can flex.
• The skin is almost transparent.
• The hands are more developed than the feet.
• The arms are longer than the legs.

Third month

3.5 in, just more than 1 oz

At how many weeks have all major external body features appeared?

What else is unique about this time period?

10 weeks fertilization

fingers and toes are distinct and have nails

Teh eyes are beginning to grow toward the forn tof the head and 20 buds are present for baby teeth. There are eyelids and the nose is developing a bridge.

How many weeks?

12 weeks fertilization

14 weeks menstrual

What month is this:

• Eyebrows, eyelashes, and fingernails form.
• Arms and legs can flex.
• External sex organs are formed.
• The skin is wrinkled and the body is covered with a waxy coating (vernix) and fine hair (lanugo).
• The placenta is fully formed.
• The outer ear begins to develop.
• The fetus can swallow and hear.
• The neck is formed.
• Kidneys are functioning and begin to produce urine.

When does fine, downy hair as well as scalp hair appear on fetus?

Respiratory movements occur, but the lungs have not developed enough to permit survival.

18 weeks

20 weeks menstrual

18 weeks fertilization

20 weeks menstrual

What month does this describe?

• The sucking reflex develops. If the hand floats to the mouth, the fetus may suck his or her thumb.
• He or she is more active. You may be able to feel him or her move.
• The fetus sleeps and wakes regularly.
• Nails grow to the tips of the fingers.
• In girls, all her eggs have formed in the ovaries.
• In boys, the testicles begin to descend from the abdomen into the scrotum

At what many weeks does the fetus become more active (ie. turning side to side)??

kidneys are starting to work and the air sacs of the lungs are starting to develop.

What month does this describe?

• 12 inches, 1–1 1/2 pounds
• Real hair begins to grow.
• The brain is rapidly developing.
• The eyes begin to open.
• Finger and toe prints can be seen.
• The lungs are fully formed, but not yet functioning.

What month does this describe?

• 14 inches, 2–2 1/2 pounds
• The eyes can open and close and sense changes in light.
• Lanugo begins to disappear.
• The fetus kicks and stretches.
• The fetus can make grasping motions and responds to sound.

What month does this describe?

• With its major development finished, the fetus gains weight very quickly.
• Bones harden, but the skull remains soft and flexible for delivery.
• The different regions of the brain are forming.
• Taste buds develop and the fetus can taste sweet and sour.
• The fetus may now hiccup.

What month does this describe?

• The fetus usually turns into a head-down position for birth.
• The skin is less wrinkled.
• The lungs mature and are ready to function on their own.
• Sleeping patterns develop.
• The fetus will gain about 1/2 pound per week this month.

initially in a non prego glands occupy small fraction o fcervix.

In prego: glands occupy half of the cerviz, producing more mucous of more tenacious consistency

What color does the vagina become during pregnancy? why?

why increased thickness of mucosa?

Color: due to hyperemic state

Increased thickness of mucosa: to allow increased distensibility

Chloasm

What is another name for it?

What is it?

Melasma

tan or dark skin discoloration

2/3 of white women

10% African American

What happens to the breasts during pregnancy?

(ie nipples, alveoli)

nipples: larger, more pigmented

alveolar growth

small decrease in systolic

large decrease in diastolic

What is the non prego state/size of uterus?

What is prego state/size of the uterus?

non-prego: 70 gm

prego: increases to 1100 gm; cavity enlarges to hold an avg of 5000 mL

In the first 3 months, the uterus grows is response to ______ and _______.

Thereafter it grows in response to ________

an increase in the plasma component is GREATER than in RBC component.

*RBC increase due to increase in maternal plasma erythropoeitin

sitting>left lateral>supine

due to vena caval compression, decreased venous return

small decrease in systolic BP

LARGE decrease in diasolic

*becomes more pronounced mid pregnancy

Why is venous pressure increased with lower extremities in pregnant woman?

what is the effect of this?

BECAUSE OF GROWING FETUS

-no valves btw inf vena cava and femoral blood vessels

-cause stasis and varicosities

-edema secondary to elevated pressure and decreased oncotic pressure

stroke volume AND heart rate

stroke volume makes the greater contribution initially but at the end of pregnancy CO is secondary to HR

uterus

then renal blood flow

**brain and liver do not see increase in blood flow-remain constant

due to decreased residual volume

-due to elevation of diaphragm and decreased chest wall stiffness which reduces trapped air volume

-tidal volume is increased, probably mediated by progesterone

airflow

diffusion capacity

ventilation

partial ureteral obstruction at the pelvic brim by growing uterus

-growing uterus is dextro-rotated

-relaxation effect of progesterone

-increased volume of urine-changes persist up to 3 months postpartum

Diffusion capacity in normal pregnancy:

explain what happens in early pregnancy vs at 24 weeks

diffusion capacity increased in early pregnancy due to increased pulmonary blood flow

Diffusion capacity decreased at 24 weeks due to decreased hemoglobin concentration

What do you expect levels to be for BUN, Cr in pregnancy?

why?

Explain why pregnant woman is predisposed to UTI?

(domino effect of events going on....hint: start with her breathing...)

pt has increased breathing so more alkaline

therefore, kidneys choose to NOT absorb more bicarb which causes urine to be more alkalotic which is the perfect environment for bacteria; hence UTI infection (also bacteria love glucose)

Uric acid in pregnancy

where is it filtered?

where is it absorbed?

Where is it excreted?

where is it filtered? glomerulus

where is it absorbed? proximal convoluted tubules

Where is it excreted? distal tubules

Na needed to expand intravascular and extravascular compartments

increased GFR, increases tubular absorption of Na, prevents Na depletion

Oropharyngeal:

why do gums become edematous and bleed more during pregnancy?

Esophagus:

why is their lower esophageal spincter pressure during pregnancy?

with increased gestational age due to increased progesterone.

will return to normal 1-7 weeks post partum

Stomach in pregnancy:

what is the result of progesterone?

decreased motility and tone--therefore always have a full stomach

gastric acid secretion is decreased

constipation

hemorrhoids due to increased venous pressure

Liver and pregnancy:

what happens to liver proteins?

fibrinogen synthesis

What happens to the following levels during pregnancy:

serum Fe

Total Fe binding capacity

Ferritin

serum Fe: decreases

Total Fe binding capacity: increase

Ferritin: normal

WBC-total count as well as % of neutrophils increased due to estrogen

total lymphocyte count decreased

Coag factors: all but factor XI and XIII increased (reason why increased clotting activity in pregos)

uterine contractions cause hemostasis

You will see an increased T4 value, but not free T4 in pregnancy.

Why?

due to increased production of thryoid binding globulin

T3 uptake decreased

What month do these happen?

bones appear

ankles, wrists, fingers and toes form

genitals BEGIN to develop

at the end of this month, all major organs and body systems have begun to develop!!!!!!!

what month?

twenty buds for future teeth appear

What month?

all internal parts are formed, but are not fully developed!

intestines begin to form

arms are longer than legs

At what month can arms and legs flex?

external organs are formed

kidneys are functioning and begin to produce urine?

When does the sucking reflex develop?

What month?

fifth month

think fifth month--could view the thumb as the fifth digit..

What month:

in boys, testicles begin to descend from the abdomen into the scrotum.

in girls, all her eggs have formed in the ovaries.

When do eyes beging to be open?

when do fingers and toe prints come into view?

this is also when lungs are fully developed!!!

Be nice to the baby: this is when the eyes open and close and are sensitive to changes in light.

baby becomes a soccer player and starts kicking you! fetus makes grasping motions and responds to sound

When do taste buds develop and the fetus can taste sweet and sour?

development finished now maturation and wt gain from this point on.