The uterus increases in weight in a nulliparous woman from 44g to:
and concentration within the uterus causes an increase in the expression of Calcium and channels, which dampens the electrical activity.
Cell-to-cell gap junctions are present in density, indicating poor coupling and limited electrical conduction between the cells. The fragmented bursts of irregular, poorly coordinated, low electrical activity that occurs over is known as contractions (initially described by ).
During the last few weeks of pregnancy Braxton Hicks contractions
become more rhythmic
increase in frequency
occur every 10-20 minutes.
Braxton Hicks contracts do not dilate the cervix. They assist in the circulation of blood to the placenta.
30th Week of Pregnancy:
The uterus and displaces the intestines .
Caecum and appendix (which have been moving upwards from 12 weeks) now reach the .
The abdominal wall supports the and maintains the relation between the long axis of the uterus and the axis of the outlet.
In the position, the uterus falls back to rest on the column, the and the .
36th Week of Pregnancy: The diaphragm is raised by around
The liver is no longer palpable as it has been forced
to the right of the uterus
to the left of the uterus
Label the below (approx 36 weeks gestation)
The development of the uterine divisions in pregnancy is symmetric.
The upper muscular and lower uterine segments grow at equal rates throughout pregnancy.
The decent of the fetal head into the pelvic brim is is known as
In women, during the last 2 weeks of pregnancy the low intensity contractions cause a shortening of the segment in preparation for .
The contractile upper segment of the corpus pulls the open over the presenting part converting it into a thinned out to develop into the lower uterine segment.
This is clinically detected when the previously ‘’ presenting part becomes fixed in the outlet. In multigravida women the lower uterine segment usually develops in early labour.
In all case, the isthmus changes from a sphincter into a thinned out tendon-like structure that open.
Engagement causes changes in the shape of the abdomen and a feeling of the baby dropping. This is know as
Due to the fetal head engaging the woman
can breathe more deeply
is able to eat larger meals.
may feel heartburn is reduced
may need to urinate more frequently
may have increased risk of urinary incontinence
increases blood supply to the cervix which results and softer .
The cervical mucosa proliferates and the glands become more complex and secrete which forms a plug (known as the ), which protects the cervix from ascending .
The held laterally by projections of thickened mucus in the mouths of the .
When is released it is known as at the onset of when the starts to be drawn up to form the lower uterine segment.
(Coad & Dunstall, 2011)
Constipation: The increased production of which hormone causes relaxation and reduced peristalsis in the smooth muscle of the digestive tract?
Follicle Stimulating Hormone
How would you advise a woman suffering from constipation?
Ensure adequate fluid intake (water and caffeine-free drinks)
Maintain regular bowel habits
Eat plenty of fruit, vegetables and grains
Eat live yoghurt
Try to excercise
Rest, with feet elevated
Drink lots of tea and eat cake
Try to include more fibrerich foods in diet
Micturition means urinating.
When is micturition effected most in pregnancy
Frequency of Micturition: There is an increase in the reabsorption of and , which increases the need to urinate at night. This is called . During the day the excess water is trapped in the because of the .
When a woman lies down at night, the pressure on the large veins is and there is an increase in , cardiac , which results in and in urinary output, particularly in the position.
There is also an increased risk of due to ’s effect on ureteric smooth muscle. This may cause
What changes can be made to ease / reduce nocturia?
Restrict fluids in the evening by increasing their intake earlier in the day
Limit the intake of natural diuretics, such as caffeine
Lie down in the left lateral recumbent position during the evening
Encourage a diuresis
Exercise more regularly
Take iron supplementation
In late pregnancy most women experience oedema of the lower extremities
nose and lips
breasts( lower extremities, nose and lips, breasts )
This is due to the effects of progesterone
oestrogen( progesterone, relaxin, oestrogen ) relaxing vascular tone, impeding of the venous return by the gravid uterus
displaced liver( gravid uterus, small intestine, displaced liver ); and the effect of gravity
oxytocin( gravity, stress, oxytocin ).
The peripheral circulatory volume per limb is increase by 500 - 600ml.
1,500 - 2,000ml.( 500 - 600ml., very little., 1,500 - 2,000ml. )
The extent of oedema is increase in hypertensive
hypotensive( hypertensive, hypotensive ) women.
When pregnant women take on fluids it appears to increase
decrease( increase, decrease ) the leg volume and expected diuresis is delayed until the woman lies down
drinks tea and eats cake( lies down, exercises, drinks tea and eats cake ). Therefore there is an increase in nocturia
haemorrhoids( nocturia, haemorrhoids ).
Blood pressure not measurable
increased( not measurable, increased ) on the side of placental implantation
the appendix( placental implantation, the appendix ) and oedema may also be more marked in the leg
breast( leg, breast ) on the side of placental implantation.
The effect of increase venous pressure is to increase the incidence and severity of varicose veins of the legs, vulva and haemorrhoids.
What is D sleep?
Sleep involving Rapid Eye Movement
Sleep where we dream
Sleep that allows the integration of the day’s events into long term memory, promoting learning, reprogramming and brain development
Studies have found that what percentage of women in late pregnancy report waking at night?
(Hutchinson et al., 2012)
What can a women who have difficulty sleeping do to help sleep better at night?
sleep on a side or in a propped up position
try relaxation techniques
drink lots of tea and eat cake
Posture alters the curvature of the lower spine, which is exaggerated to balance the increasing anterior weight of the gravid uterus.
At least of women may experience backache in pregnancy.
The should try to find the cause so can seek or advise appropriate .
can be a contributing factor resulting in with overstretched abdominal and strained muscles.
The relaxing effect of on the pelvic ligaments allows the movement of and joints.
Relaxin may make unstable as they try to support the of pregnancy.
It is advised that the woman lies in a lateral position as opposed to supine?
When sitting the woman should choose a comfortable
green( comfortable, high, green ) chair which supports the back and thighs
arms( back and thighs, bottom, arms ) and sit well back. A small cushion
book( cushion, cat, book ) may be needed behind the lumbar spine to support
warm( support, warm ).
When standing, stand tall with tummy and buttocks
chin and bottom( tummy and buttocks, chin and bottom ) tucked in and weight even distributed on both legs with flat
high-heeled( flat, high-heeled ) shoes.
Increase frequency of( Avoid, Increase frequency of ) lifting or dragging heavy objects.
Which of the below does the National Institute of Health and Care Excellence state may help with backache (2014)?
Exercising in water
Back care classes
Heartburn be due to oestrogen relaxing the upper oesophageal sphincter, resulting in gastro-oesophageal reflux. Also, position of liver has been displaced due to growing uterus.
Why is it important to distinguish between the pain of heartburn and epigastric pain? Epigastric pain is associated with
To help with the symptoms of heartburn, the woman can be advised to in an position after meals, to sleep in a position, eat frequent means and to reduce the quantity of foods and gastric irritants (eg ).
may also be considered where lifestyle and dietary modifications are not effective in relieving symptoms
Leg cramps: What two acids are responsible for involuntary contractions of a muscle?
Lactic acid and pyruvic acid
Carbonic acid and lactic acid
Pyruvic acid and uric acid
Folic acid and citric acid
The chances of fainting are increased due to the increased production of progesterone and its effect on smooth muscle.
What two things can be resonsible for bringing about fainting?
Increase in blood pressure
Standing for too long
The increase in vasodilation by being too warm
Vasoconstriction due to being too cold
Later in pregnancy, supine
left-lateral( supine, left-lateral ) hypotension can be a problem. It is caused by the gravid uterus
displaced liver( gravid uterus, heart, displaced liver ) pressing on the inferior vena cava
pulmonary veins( inferior vena cava, aorta, pulmonary veins ), preventing venous return to the heart and so reducing
increasing( reducing, increasing ) cardiac output. It is easily prevented or reverse by avoiding total supine position
tea and cake
left-lateral position( total supine position, tea and cake, left-lateral position ) or turning the woman quickly onto her left
right( left, right ) side if she feels faint.
(Macdonald, Magill-Cuerden & Mayes, 2012)
A woman in her third trimester should avoid all excerise.
Why a woman should exercise during pregnancy?
Improves mental wellbeing
Relieves symptoms of constipation
Helps woman prepare for labour
Helps women lose weight