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Unit 4
Chapter 14
Physical and psychologic changes
of pregnancy
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Diagnosis
feelings can be good or bad
confirmation
early diagnosis important
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Presumptive Signs
can be caused by other problems
amenorrhea
nausea and vomiting
fatigue
urinary frequency
breast tenderness
quickening
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Probable Signs
Changes in the pelvic organs Goodells Sign- softening of the cervical tip
Chadwicks Sign- deepened violet-bluish color of
vaginal mucosa s/t increased vascularity of the area
Hegars Sign- softening & compressibility of loweruterus
Increase in size of uterus
Ballottement- rebound of unengaged fetus
Braxton-Hicks contractions
Serum lab tests (positive pregnancy test)
Serum & urine test= accurate assessment for presence of hCG
(production begins w/ implantation).
hCG- hormone produced by placenta
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Positive Signs
FHR/ fetal heart sounds
Fetal movement felt by examiner
Visualization by ultrasound
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Physiological Changes
local- reproductive
systemic- major body organs
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Local
Uterus
pre-pregnancy small semisolid pear shaped
weight increases from 50Gm to 1000Gm
enlargement primarily a result ofhypertrophy of pre-existing myometrialcells
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Uterine
development of new fibro-elastic tissue
between bands of muscles
cells increase as result of estrogen
measure
lightening
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Uterine
blood flow 15-20ml/min pre-pregnancy
at term 500-700ml/min
by end of pregnancy 1/6 total maternalblood volume is circulating through the
uterus
bleeding- serious problem
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Uterus
Braxton Hicks
painless contractions
estrogen
distention of the uterus
felt by 4th month
practicing
no cervical changes occur
amenorrhea
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Cervix
mucosa of cervix undergoes marked
changes
endocervical cells secrete thick, tenacious
mucus which accumulates and formsmucus plug.
Seals cervical canal to prevent infection
Expelled at start of labor
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Early signs of pregnancy may
include:
Softening of the uterus (Ladin's sign and Hegar's sign)
Ladin's sign is a clinical sign of pregnancy in which there issoftening in the midline of the uterus anteriorly at the junction of the
uterus and cervix. It occurs at about 6 weeks gestation
Hegar's sign is an indication ofpregnancy in a woman, specificallythe compressibility and softening of the cervical isthmus (the
portion of the cervix between the uterus and the vaginal portion of
the cervix) and the uterine cervix appearing bluish and engorged
Darkening of the nipples Unexplained pelvic or abdominal mass
http://en.wikipedia.org/wiki/Medical_signhttp://en.wikipedia.org/wiki/Pregnancyhttp://en.wikipedia.org/wiki/Uterushttp://en.wikipedia.org/wiki/Cervixhttp://en.wikipedia.org/wiki/Pregnancyhttp://en.wikipedia.org/w/index.php?title=Cervical_isthmus&action=edit&redlink=1http://en.wikipedia.org/wiki/Uterushttp://en.wikipedia.org/wiki/Cervixhttp://en.wikipedia.org/wiki/Cervixhttp://en.wikipedia.org/wiki/Cervixhttp://en.wikipedia.org/wiki/Cervixhttp://en.wikipedia.org/wiki/Uterushttp://en.wikipedia.org/w/index.php?title=Cervical_isthmus&action=edit&redlink=1http://en.wikipedia.org/wiki/Pregnancyhttp://en.wikipedia.org/wiki/Cervixhttp://en.wikipedia.org/wiki/Uterushttp://en.wikipedia.org/wiki/Pregnancyhttp://en.wikipedia.org/wiki/Medical_sign -
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Vaginal changes
Hypertrophy, increased vascularization,
hyperplasia (enlargement) d/t estrogen
Increased secretions, loosening of
connective tissue
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Breasts
changes are noted soon after first missed
period
increase in size and nodularity
preparing for lactation
2nd month superficial veins are prominent
nipples are more erect
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Breasts
pigmentationof areola is more prominent
sebacious glands enlarge (Montgomery
Tubercles)
16th week colostrum
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Respiratory system:
Increasing levels of progesterone causes:
Increased volume of air/increase tidal volume
Oxygen consumption increases
Decreased airway resistance
Increased anteroposterior diameter
Breathing changes from abdominal to
thoracic, occurs as uterus enlarges
Vascular congestion nasal mucosa
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Respiratory
tidal volume (normal breathing) increases
40%
respiratory rate increases
small degree of hyperventilation
oxygen consumption increases by 20%
diaphragm is displaced >SOB no change in vital capacity
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Respiratory
Progesterone levels signal hypothalmus to
reset acceptable PCO2 levels
low CO2 levels allows for CO2 to cross the
placenta
maintain pH with load of CO2 from fetus-
mother hyperventilates to blow off excess
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Respiratory
cumulative effect
SOB
nasal stuffiness
epistaxsis
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Cardiovascular system:
Increased levels of estrogen and progesterone
Cardiac output and blood volume increases
Blood volume increases 40%-45%
Decrease in systemic and pulmonary vascular
resistance
Increased size of uterus interferes with blood
return from lower extremities Increased level of red cells to increase
oxygen delivery to cells
Clotting factors increase
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Cardiovascular
pressure on diaphragm displaces the heart
blood volume increases 30-50%
occurs gradually and peaks at 28-32 weeks
adequate exchange of nutrients
compensate for blood loss
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CV
rise in cardiac output 25-50%
pulse rate increases
BP remains relatively unchanged
concentration of Hgb and erythrocytes
may initially decline
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CV
femoral venous pressure slowly rises
stasis
dependent edema
varicosities
fibrinogen levels increase 50%
clotting factors
platelets
wbc, protein
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GU system:
Increased blood volume
Glomerularfiltration rate increases
Renal tubular reabsorption increases
Pressure on bladder causes frequency
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Urinary
alterations
fluid retention,renal, ureter, and bladder
function
result of:
estrogen and progesterone activity
compression
increased blood volume
postural influences
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Urinary
total body H2O content increases
must increase Na reabsorption
retained to assist: increased blood volume
source of nutrients for the fetus
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Urinary
excrete waste from mother and fetus
breakdown protein
compensate for blood volume UOP increases 60-80%
specific gravity decreases
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Urinary
GFR increases
decrease BUN
increase filtration of glucose
ureters increase in diameter
bladder capacity increases
frequency increases (10-12X/day)
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Skin changes
Hyperpigmentation
Striae
Chloasma Vascular spider nevi
Decreased hair growth
Hyperactive sweat and sebaceous glands Linea nigra
V l id i
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Vascular spider nevi
Chl
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Chloasma
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Linea nigra
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Musculoskeletal changes
Relaxation ofjoints caused byincreased
estrogen andprogesterone
Center of gravity
changes Separation of
rectus
abdominus
E iti d t b li
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Eyes, cognitive and metabolic
changes Decreased intraocular pressure
Thickening of cornea
Reports of decreased attention,concentration, and memory
Extra water, fat, and protein are stored
Fats are more completely absorbed
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Endocrine changes
T4 and BMR increase, TSH decreases
Concentration of parathyroid hormone
increases
Thyrotropin (known also as thyroid stimulating hormone
(TSH) and adrenotropion (adrenal hormone) alter
maternal metabolism
Prolactin is responsible for lactation
secretion of oxytocin and vasopressin
Increased aldosterone
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Endocrine
placenta produces:
estrogen
progesterone
HCG
HPL (human placental lactogen)
relaxin
prostaglandins
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Endocrine
thyroid
increased vascularity
hyperplasia
increased BMR
increased oxygen consumption
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Endocrine
pancreas- early pregnancy
there is a decrease in insulin production r/t
increased fetal demands
after 1st trimester
increase in insulin production r/t insulin
antagonist properties of estrogen,
progesterone, and HPL
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Vena cava syndrome
is a result of obstruction of the inferior
vena cava. It can be caused by invasion or
compression by a pathological process or
by thrombosis in the vein itself.
This is quite common during the third
trimester ofpregnancy when the uterus
compresses the vein in the right sideposition.
http://en.wikipedia.org/wiki/Inferior_vena_cavahttp://en.wikipedia.org/wiki/Inferior_vena_cavahttp://en.wikipedia.org/wiki/Thrombosishttp://en.wikipedia.org/wiki/Pregnancyhttp://en.wikipedia.org/wiki/Uterushttp://en.wikipedia.org/wiki/Uterushttp://en.wikipedia.org/wiki/Pregnancyhttp://en.wikipedia.org/wiki/Thrombosishttp://en.wikipedia.org/wiki/Inferior_vena_cavahttp://en.wikipedia.org/wiki/Inferior_vena_cava -
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Psychological
attitudes depends on:
environment
social
cultural
family
individuals
gamut of emotions
need time to adjust
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First Trimester
Developmental Task
acceptance of pregnancy
50% are surprises
concerns center on self
partners response
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Second trimester
Acceptance of Baby
quickening
start to make plans
educate
fantasize
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Emotional Responses
ambivalence
grief
narcissism
introversion vs. extroversion
body image and boundary
stress couvade syndrome
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