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Repro A&P Test 3
Sleep/Pain/Thermoregulation/Metabolic Changes in Pregnancy
199
Anatomy
Graduate
05/29/2013
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Term
Sleep _______ and _________ tend to be most prominent in the first and third trimesters
 Definition
quality; insomnia
Term
With advanced gestation, total sleep hours progressively _______.
 Definition
decrease
Term
Sleep time ____ prior to labor onset with _____ in night awakening.
 Definition
decreases; increase
Term
Night awakening is reported to begin ____ days before labor onset
 Definition
5
Term
Sleep is divided into ____ and ____
 Definition
REM; NREM
Term
Both _______ and _____factors alter the pregnant woman's sleep-wake patterns.
 Definition
hormonal; mechanical
Term
__________ has a sedative effect and ________ sleep.
 Definition
Progesterone; NREM
Term
______ and _____ decrease REM.
 Definition
Estrogen; cortisol
Term
__________ increases both REM and NREM sleep
 Definition
Prolactin
Term
Pregnant women tend to have less _____ sleep and more ________.
 Definition
deep; awakenings
Term
During _____ trimester, total sleep time _____ as does napping, daytime sleepiness and insominia
 Definition
1st; increases
Term
There is a _____ in REM sleep and stage 3 and 4 NREM sleep.
 Definition
decrease
Term
By the 2nd half of gestation pregnant women have ____ overall sleep time and _____ night awakenings.
 Definition
less; more
Term
In the 2 half of gestation, pregnant women have _______ REM, stage 3 and stage 4 NREM.
 Definition
decreased
Term
Third trimester sleep changes include increased ______, ______, ________, ________.
 Definition
daytime sleepiness, insomnia, nocturnal awakenings, and stage 1 REM sleep.
Term
Third trimester includes ________ REM, Stage 3 and Stage 4 NREM sleep.
 Definition
decreased
Term
Major causes for night awakenings include ______, _____, ______, ______, ______, and ______.
 Definition
Urinary frequency, backache, leg cramps, RLS, heart burn, and fetal activity
Term
Interventions for night time awakenings include:________, ________, __________, __________, __________, _________, and _________.
 Definition
regular sleep/wake patterns, avoid caffeine, relaxation techniques, massage, heat, modifying sleep environment, and limiting fluids in the evening.
Term
_________ is the balance between heat production and heat loss involved in maintaining thermal regulation.
 Definition
Thermoregulation
Term
Heat is produced by the body as a byproduct of ______ and _________.
 Definition
metabolic processes; muscular activity
Term
_______ and _________ during pregnancy result in changes in maternal temperature.
 Definition
Hormonal; metabolic alterations
Term
The amount of heat generated in pregnancy increases _____.
 Definition
30-35%
Term
The amount of heat generated in pregnancy increases because of the thermogenic effects of _______, _________, __________, and __________.
 Definition
progesterone, alterations in maternal metabolism, alterations in basal metabolic rate and maternal dissipation of heat generated by the fetus
Term
Many pregnant women develop a tolerance for _____ weather and a decrease in tolerance of _________.
 Definition
cooler; heat
Term
The additional heat dissipated by the fetus is by  _________.
 Definition
peripheral vasodilation
Term
There is a ___ to ___ fold increase in _____ and _____.
 Definition
4,7; cutaneous blood flow and activity of the sweat glands
Term
_______ leads to skin warmth
 Definition
Cutaneous vasodilation
Term
The maternal temperature usually increases by ____ degrees.
 Definition
0.5
Term
Both ___ and ____ temperature increase.
 Definition
core and skin
Term
There is a slight _______ in maternal temperature reported late in pregnancy.
 Definition
decrease
Term
The core temperature peaks by __________.
 Definition
mid-pregnancy
Term
The rise in maternal skin temperature is seen mainly in the ____ and ____.
 Definition
hands and feet
Term
The ________________ in pregnancy provides a greater area for heat storage.
 Definition
increase in plasma volume
Term
The increase in plasma volume in pregnancy provides for a greater area of ___________ and may enhance _______ from fetus to mother.
 Definition
heat storage; heat transfer
Term
Changes with exercise in pregnancy are _________ as compared to nonpregnant women.
 Definition
moderate
Term
In the intrapartum period, the increase in maternal body temperature is by ____.
 Definition
1 degree
Term
In the intrapartum period, most women have body temperatures between ______ and _____
 Definition
97.2 and 100.0 F
Term
The most common cause of maternal fever in the intrapartum period is ________.
 Definition
epidural analgesics
Term
The basis for increased pregnant women during the intrapartum period may be due to decreased ______.
 Definition
heat dissipation
Term
Decreased heat dissipation may be due to ________, _______, __________, and _________.
 Definition
decreased sweating threshold, alterations in ventilation, altered hypothalmic responses and increase in heat production
Term
Epidural analgesia inhibits ___________ and _______ in the lower body.
 Definition
peripheral vasoconstriction and sweating
Term
The impairment of sweating and behavioral responses by ______ heat loss.
 Definition
decreases
Term
A transient postpartum _________ or _______ is often experienced 15 minutes after birth of the infant or placenta delivery.
 Definition
chill, shivering
Term
The cause of the postpartum chill or shivering may be related to ___________.
 Definition
muscular exhaustion
Term
Maternal fever postpartum may be a result of ___________, _________, __________, or ________ are not typically seen until at least 24 hrs postpartum.
 Definition
puperal infection, mastitis, endometritis, UTI
Term
In labor, the woman experiences _________ and _______ pain.
 Definition
visceral and somatic
Term
__________ pain is related to the ctx of the uterus and stretching of the cervix.
 Definition
Visceral
Term
Uterine pain during the first stage of labor results from ________ caused by constriction and contraction of the arteries supplying the myometrium.
 Definition
ischemia
Term
_________ pain is pressure of the presenting part on the birth canal, vulva and perineum.
 Definition
Somatic
Term
_________ pain is experienced primarily during the first stage of labor.
 Definition
Visceral
Term
________ pain is experienced during the transition and second stage.
 Definition
Somatic
Term
__________ pain is more intense and localized.
 Definition
Somatic
Term
The corpus of the uterus is relatively _________ by late pregnancy while the cervix remains _________.
 Definition
denervated; densely innervated
Term
The _______ area may be the major site of pain in labor.
 Definition
cervical
Term
Near term, the number of nerve cells and fibers in the spinal column _______.
 Definition
decrease
Term
There is an ________ excitability of mechanosensitive efferents in the cervix.
 Definition
increased
Term

The pain threshold in pregnancy may be altered late in pregnancy enhanced by _________.

 

 Definition
beta endorphins
Term
The inrease in beta endorphins in pregnancy leads to a proposed ____________.
 Definition
pregnancy induced hypoanalgesia
Term
Pain from ctx and dilation of the cervix during the first stage of labor is transmitted by afferent fibers to the sympathetic chain of the posterior spinal cord at ________ and ________.
 Definition
T-10 to T-12 and L-1
Term
In early labor, pain is transmitted to ______ in the spinal cord.
 Definition
T-11 to T-12
Term

Pain during the first stage of labor may be _________.

 

 Definition
referred
Term

Nerve impulses from teh uterus and cervix stimulate ____________, innervating both the uterus and the uterine wall.

 

 Definition
spinal cord neurons
Term
Due to referred pain, the woman experiences pain over the _________ between the umbilicus and the symphsis pubis, around the iliac crests to the gluteal area, radiating down the thighs and in the lumbar and sacral regions
 Definition
abdominal wall
Term
During transition and the 2nd stage of labor __________ pain impulses from distention of the birth canal, vulva and perineum by the presenting part are transmitted by the pudendal nerves through the posterior roots of the parasympathetic chain at S2, S3, and S4.
 Definition
somatic
Term
Name some non-pharmacologic, cognitive, behavioral and sensory techniques for pain
 Definition
Relaxation, cognitive and behavioral childbirth preparation, hypnosis, acupuncture, movement, positioning, vocalizations, touch, massage, music, biofeedback, transcutaneous electrical nerve stimulation (TENS), and hydrotherapy
Term

Techniques to close the gate (inhibit) include stimulation of large nerve fibers to block impulses from ____________; this provides a basis for massage and effleurage during labor.

 

 Definition
smaller nerve fibers
Term
With continued use of massage and effleurage, the large nerve fibers become habituated and stimuli from _________ are no longer blocked.
 Definition
smaller fibers
Term
As labor progresses, the woman needs to stimulate other fibers using techniques such as ______, ________, and ___________.
 Definition
heat, pressure with change of position, and massage of other areas
Term
Because _______ fibers may also inhibit transmission to the brain, concentration techniques may also be useful
 Definition
descending
Term
The nervous system controls function of ______, ________, ________ and ________.
 Definition
every body system, thought, movement, and emotion
Term
The ________ nervous system detects changes inside and outside the body through sensory receptors and our senses.
 Definition
peripheral
Term
The peripheral nervous system detects voluntary and involuntary _________ and ___________.
 Definition
motor responses; actions via complex pathways
Term
Early in pregnancy when a woman's metabolism and progesterone are _________, she is able to nap and sleep.
 Definition
increasing
Term
During the later stages of pregnancy as _________, sleep becomes more difficult.
 Definition
the baby grows
Term
How does progesterone affect sleep in pregnancy?
 Definition
Has a sedative effect and it increases NREM (deep) sleep.
Term
How does estrogen affect sleep in pregnancy?
 Definition
Decreases REM
Term
How does cortisol affect sleep in pregnancy?
 Definition
Decreases REM sleep
Term
How does prolactin affect sleep in pregnancy?
 Definition
Increases REM and NREM sleep
Term
During the first trimester, total sleep time_______ as does napping.
 Definition
increases
Term
By the ________ half of pregnancy, pregnant women have overall _____ sleep time and more _______ than nonpregnant women.
 Definition
second; less; night awakenings
Term
The pregnant woman has _________ REM sleep in the third trimester.
 Definition
decreased
Term
In the third trimester, the pregnant woman has _________ awakenings and napping and ________ alertness during the day.
 Definition
increased; diminshed
Term
_______ and _______ decrease REM sleep.
 Definition
Estrogen and cortisol
Term
__________ increases both REM and NREM sleep.
 Definition
Prolactin
Term
___________ and ___________ cause night awakenings.
 Definition
Hormonal and mechanical chagnes
Term
What are the major causes of night awakenings in the pregnant woman?
 Definition
Urinary frequency, RLS, leg cramps, back pain, heart burn and fetal activity.
Term
Sleep loss in the last 3-4 weeks of pregnancy may increase ______ and lead to _______.
 Definition
labor length; c-section
Term
Stage 1 REM sleep is ______ immediately after birth.
 Definition
longer
Term
___________ is longer immediatley after birth than before birth with a gradual change to prepregnancy levels by about ______ weeks.
 Definition
NREM; 2
Term
REM sleep is _________ and awake time ________ on the first night postpartum.
 Definition
decreased; increased
Term
The changes in postpartum REM sleep are probably due to _________ and ________ after childbirth, followed by fatigue and restoration.
 Definition
initial euphoria; discomfort
Term
Postpartum women have less overall sleep time and more night awakenings assoc. with_____, _________, _______ and _______.
 Definition
Urinary frequency, discomfort, activity by roommates or nursing staff, and infant feeding.
Term
The main reasons for night awakenings are _______ and _______.
 Definition
newborn sleep and feeding patterns
Term
Maternal night wakefulness _________ significantly from weeks ____-_______.
 Definition
3-12
Term
The decrease in postpartum night wakefulness is related to ________.
 Definition
the development of the infant's sleep-wake cycle
Term
Women who __________ have more deep sleep and overall sleep.
 Definition
breastfeed
Term
Breastfeeding moms have more deep sleep and overall sleep possible related to ________ release, less arousal due to ___________, and __________.
 Definition
prolactin, infant proximity, infant sleep-wake patterns.
Term
____________ pain is related to contraction of the uterus and stretching of the cervix.
 Definition
Visceral
Term
Visceral pain is experienced primarily during the ______ stage of labor.
 Definition
first
Term
___________ pain is caused by pressure of the presenting part on the birth canal.
 Definition
Somatic
Term
Somatic pain is experienced primarily during _______ and _________ of labor.
 Definition
transition; second stage
Term
________ pain is more intense and localized.
 Definition
Somatic
Term
_________ pain during the 1st stage of labor is transmitted by afferent fibers to the sympathetic chain of the posterior spinal cord at T10-T12 and L1.
 Definition
Visceral
Term
Visceral pain during the 1st stage of labor activates peripheral small A-delta and C-afferent nerve fibers and they ascend to the brainstem by the __________ tract.
 Definition
spinothalmic
Term
Somatic pain during the 2nd stage is transmitted to the ______ nerves through the posterior roots of the parasympathetic chain at S2, S3, and L1.
 Definition
pudendal
Term
The major site for pain during labor is probably the _____.
 Definition
cervical area
Term
Pain during the ____ stage of labor may be referred.
 Definition
first
Term
In referred pain, the nerve impulses from the ______ and ________ stimulate spinal cord neurons innervating both the uterus and abdominal wall.
 Definition
uterus and cervix
Term
In the first stage of labor, the woman experiences pain over the abdominal wall between the ________ and the _________, around the iliac crests to the gluteal area, radiating down the thighs and in the lumbar and sacral regions.
 Definition
umbilicus; symphysis pubis
Term
Pain can lead to ______ and influence maternal physiologic responses over the course of labor.
 Definition
anxiety
Term
Physical manifestations of anxiety may include_______, _________, ___________, and _________ which can lead to increased cardiac output, increased BP, increased metabolic rate, and O2 consumption and impaired uterine activity.
 Definition
muscle tension, hyperventilation, increased sympathetic activity, and norephedrine release
Term
Anxiety can also ______ fear and tension, reducing pain tolerance which decreases uterine contractility.
 Definition
increase
Term
___________ block the transduction of visceral pain typically felt in the lower back during the first stage of labor.
 Definition
Sterile water injections
Term
Sterile water injections do not provide relief from _______ but once the back pain is relieved, the laboring woman can better cope with labor pain.
 Definition
contraction pain
Term
Often the relaxation of the back can assist in the proper _____ and ______ of the baby, leading to a shorter labor.
 Definition
descent and positioning
Term
Sterile water injections may become the treatment of choice for pain referral duing the first stage of labor because there are no _______ and ______ entering the body.
 Definition
side effects; medications
Term
Sterile water techniques administered into the ________ have been demonstrated to provide suitable analgesic alternative with none of the negative outcomes.
 Definition
lower back
Term
The injection of sterile water causes ______ and ________ irritation resulting in a brief but significant stinging sensation.
 Definition
somatic and mechanical
Term
Pain relief from sterile water injections may last up to __ hrs and may be repeated several times.
 Definition
2
Term
The physiology of the effect is thought to be related to the stimulation of _______ and _______ pain modulation systems.
 Definition
ascending and descending
Term
The most frequently used sterile water technique consists of _____ intradermal injections into the the skin surrounding the Michaelis rhomboid over the ________ area.
 Definition
4; sacral
Term
__________ levels are twice as high in colostrum and may assist the newborn in the ________ and mediate the stressful events of ________ and ________.
 Definition
B-endorphin; transition to extrauterine life; labor and delivery
Term
The most common forms of headache for pregnant and breastfeeding women are those caused by __________ headaches or ________ without aura.
 Definition
muscular contraction/tension; migraines
Term
__________ is a disorder involving rapid, brief, non-rhythmic , involuntary, jerky movements of the limbs, nonpatterned facial grimacing, and slurred speech.
 Definition
Chorea gravidarium
Term
Symptoms of chorea gravidarium usually begin in the ______ trimester and may persist to the postpartum period.
 Definition
first
Term
About ____ % of people with chorea gravidarium become asymptomatic after delivery.
 Definition
30
Term
The cause of chorea gravidarium may be related to ________  and is most common in women with a history of ________ or ________.
 Definition
strep infection; rheumatic fever, heart disease
Term
RLS in pregnancy is characterized by what?
 Definition
An urge to move the legs accompanied by unpleasant sensations, "creeping, wormy, burning ache" that develops in the legs.
Term
_________ is usually bilateral and symmetric, occasionally involves the arms, usually appears in the third trimester and disappears shortly after delivery.
 Definition
RLS
Term
RLS may have a genetic basis or be related to hormonal changes of pregnancy or be related to alterations in ________ metabolism.
 Definition
dopamine
Term
RLS may be associated with __________ and _________.
 Definition
polyneuropathy, vascular insufficiency
Term
Treatment for RLS may include______, _______, or ________.
 Definition
iron, folic acid, walking
Term
Increased heat generation in pregnancy may be caused by thermogenic effects of ________, alterations in maternal _______ and _______, and maternal dissipation of heat from the _____.
 Definition
progesterone; metabolism, basal metabolic rate; fetus
Term
_______ plasma volume provides a greater area for heat storage and may enhance transfer of heat from fetus to mother.
 Definition
Increased
Term
_________ with a 4-7-fold increase in cutaneous blood flow and increased activity of sweat glands are the physiologic mechanisms for heat dissipation in pregnancy.
 Definition
Peripheral vasodilation
Term
__________ is the most likely etiology for maternal fever in women with epidural analgesia.
 Definition
Inflammation of the placenta and membranes (chorioamnionitis)
Term
___________ are thought to be due to muscular exhaustion or result from disequilibrium between the internal and external thermal gradients secondary to muscular exertion during labor and delivery.
 Definition
Postpartum chills
Term
Sudden changes in _________ with emptying of the uterus or small amniotic fluid embolism are thought to be some causes of postpartum chills.
 Definition
intraabdominal pressure
Term
Postpartum chills are seen in ______ % of women with no epidural and more with women who have epidurals.
 Definition
20
Term
The potential effects of maternal fever on the fetus are ________, _________, ________ and __________.
 Definition
hypoxia secondary to maternal and fetal tachycardia, altered hemodynamics, teratogenosis, PTL (from underlying infection)
Term
The most likely causes of low grade temperature 12 hrs postpartum are _____ and _________.
 Definition
dehydration, transient bacterial endometritis
Term
If a postpartum fever occurs after 24 hrs, the most likely causes are _______, ______, _______, and ________.
 Definition
purpeural infection, mastitis, endometritis, and UTI
Term
Problems with memory, attention, and concentration are due to changes in the _______ in pregnancy.
 Definition
CNS
Term
________ is decreased due to swollen mucous membranes of upper respiratory tract, thereby affecting the taste of food.
 Definition
Smell
Term
_________ will inhibit the activity of the uterus, is activated by fear and anxiety and catecholamines are released, therefore stopping contractions.
 Definition
Sympathetic nervous system
Term
_________ evokes emotions and thoughts associated with pain.
 Definition
Limbic system
Term
_________ is caused by increased edema of pregnancy that puts pressure on the median nerve of the hand causing numbness and tingling and in some cases pain.
 Definition
Carpal tunnel syndrome
Term
Impingement of the _______ nerve occurs with skeletal changes of pregnancy and resolves, usually, during the postpartum period.
 Definition
sciatic
Term
Depression and mild postpartum depression may be suggested causes of decreased ________.
 Definition
sleep
Term
Physiologic pituitary ________ occurs in normal pregnancies.
 Definition
hyperplasia
Term
The pituitary will grow to about ____ % of the prepregnancy size.
 Definition
135
Term
The ______ enlarges slightly in pregnancy.
 Definition
thyroid
Term
Adrenal glands do not change in size but their function is ________.
 Definition
enhanced
Term

Increase in hypothalamic-pituitary-adrenal (HPA) axis is mediated primarily by ________, ________, and _________.

 

 Definition
placental ACTH, GH and CRH
Term
Lactotroph ________ and ______ occurs during pregnancy.
 Definition
hypertrophy and hyperplasia
Term
There is a progressive _____ in serum prolacin during pregnancy.
 Definition
increase
Term
Doubling or more of ________ occurs in pregnancy.
 Definition
anterior pituitary volume
Term
_________ in gonadotropins, LH and FSH occurs during pregnancy.
 Definition
Decrease
Term
There is a production of placental variant of _______ during pregnancy.
 Definition
growht hormone
Term
There is an ____ in CRH, mainly in placental origin during pregnancy.
 Definition
increase
Term
Placental corticotropin stimulating hormone activates _________
 Definition
maternal and fetal pituitary gland
Term
There is an _______ in ACTH and cortisol in pregnancy.
 Definition
increase
Term
Increase in cortisol stimulates placental ____ leading to hypercortisolism.
 Definition
CRH
Term
There is a ______ in TSH in the first trimester b/c of the thyrotropic effect of hCG.
 Definition
decline
Term
There is a ________ in plasma osmolality by __ -___ mOsm/kg as a result of resetting of osmoreceptors for vasopressin release.
 Definition
decline; 5-10
Term
A _______ in osmotic threshold for thirst occurs in pregnancy.
 Definition
decline
Term
An increase in metabolic clearance of __________ occurs as a result of a placental vasopressinase.
 Definition
vasopressin
Term
In the nonpregnant women, 2/3 of the _____ is bound to thyroxine-binding globulin (TBG), increasing to 75% or greater during pregnancy.
 Definition
T4
Term
Increased serum transthyretin (TTR) ______ total T3 and T4.
 Definition
increases
Term
The increased TBG is accompanied by 10-15% ________ in free T3 and free T4 if iodine is sufficient.
 Definition
decrease
Term
If iodine is inadequate, _______ levels increase.
 Definition
T4
Term
Thyroid iodine uptake _______ in pregnancy because the total body iodine pool is decreased.
 Definition
increases
Term
There is _______ iodine loss d/t increased RBF, and GRF and placental transfer of iodine to the fetus.
 Definition
increased
Term
What hormone increases 7 times normal limits with labor onset and during labor?
 Definition
Maternal plasma CRH, ACTH, B-endorphins, cortisol
Term
Levels of free T3 and free T4 ____ during labor and reflects the energy demands of labor on the maternal system.
 Definition
increase
Term
T3 and T4 have similar functions but T3 is 3-5 times _____.
 Definition
more active
Term
Iodine deficiency is the most frequent cause worldwide of preventable _________.
 Definition
mental retardation (most often the damage is done by birth)
Term
Iodine deficiency is associated with _______ and _______.
 Definition
SAB and stillbirth
Term
The hypothalamus regulates the function of the ______.
 Definition
endocrine system
Term
The hypothalamus produces _____, _______, _______, __________, _________, __________, ________, and ________.
 Definition
oxytocin, ADH, TSH, gonadotropin-releasing hormone, GH releasing hormone, GH inhibiting hormone, CRH, and dopamine
Term
The anterior pituitary releases ______, _______, _________, _________, _________, and _______.
 Definition
TSH, ACTH, FSH, LH, GH and prolactin
Term
The posterior pituitary releases oxytocin which is responsible for ______ and _____.
 Definition
uterine contractions and milk 'let-down' reflex
Term
ADH inhibits ________ formation.
 Definition
urine
Term
During pregnancy, fetoplacental hormones inhibit secretion of ____ and _____ to prevent ovulation.
 Definition
LH and FSH
Term
T4 ______in pregnancy, beginning at 6-9 weeks.
 Definition
increases
Term
The thyroid gland ______ during pregnancy d/t glandular hyperplasia and increased vascularity.
 Definition
enlarges
Term
TSH secretion is ________ in the first trimester and is normal in the remainder of pregnancy.
 Definition
reduced
Term
Thyroid-binding globulin is manufactured in the liver and increases and the ability to bind with T4 ______ during pregnancy due to estrogen effects.
 Definition
doubles
Term
Free T4 ______ in pregnancy.
 Definition
increases
Term
Pregnancy is a normal ________ state.
 Definition
hyperthyroid
Term
Serum ACTH is _____ in early pregnancy but rises as the pregnancy progresses.
 Definition
reduced
Term
Serum cortisol is _____ in pregnancy.
 Definition
increased
Term
Plasma maternal androgens are ______ in pregnancy.
 Definition
increased
Term
The HPA (hypothalamic-pituitary-adrenal) axis is ____ and may cause some autoimmune disorders to become worse.
 Definition
depressed
Term
The most important mineralcorticoid, aldosterone, is found in the _______
 Definition
adrenal cortex
Term
Catecholamines (epinephrine and norepinephrine) are found in the ________.
 Definition
adrenal medulla
Term
Some plasma maternal androgens are converted to ____ in the placenta but levels remain higher than nonpregnant women; this may explain hirsutism in some women.
 Definition
estrodiol
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