Expected pregnancy changes

Signs of pregnancy

Amenorrhea- no bleeding

Fatigue

Nausea and vomitting

Urinary frequency

Breasts changes- darkened areolae and enlarged Montgomery glands

Uterine enlargement

Quickening- movement of fetus

Probable signs

Changes that makes the examiner suspect pregnancy

Probable signs

Abdominal enlargement- change in uterine size shape and position

Hegar Sign- softening and compressible lower uterus

Chadwick sign- violet blush color cervix and vagina mucus

Goddell sign- softening if cervical tip

Probable sign of pregnancy2

Ballottement - rebound of unengaged fetus

Braxton Hicks- painless, irregular, false contractions relieved by walking

Positive pregnancy test

Presumptive signs

Changes that client experience and thinks it’s pregnancy but could be possible peristalsis, infection or stress

Verify pregnancy

Blood test and urine test

Positive pregnancy signs

Fetal heart sounds

Visual fetus on ultrasound

Fetal movement

HCG

Increases during pregnancy, can be detected as early as 7-8 days before expected cycle

HCG

Peaks- 60-70 days

Declines- 100-130 days

Levels at lower level the rest of pregnancy

High HCG

Multifetal pregnancy

Ectopic pregnancy

Hydatidiform mole ( Trophoblastic disease)

Down syndrome

Low HCG

Miscarriage

Ectopic pregnancy

Medication show false pregnancy

Anticonvulsant, diuretics, tranquilizers

Positive or negative

Home pregnancy test

First morning void

Measure fundus

Symphysis pubis to top of uterine fundus

18/30 weeks

Nulligravida

Never been pregnant

Primigravida

First pregnancy

Multigravada

Two or more pregnancies

Parity

Fetus reaches 20 weeks

Nulllipara

No pregnancy beyond viability

Primipara

Pregnancy with fetus who has reached 20 weeks

Multipara

Two or more pregnancies that has reached min of 20 weeks

Viability

Baby can survive outside of the uterus; born 22/25 weeks

GTPAL

Gravidity, term births, preterm births( up to 37 weeks) , abortion/miscarriage, living children

Term births

Early term- 37 weeks

Full terms- 39 weeks

Late term- 41 weeks

Post term- greater or equal 42 weeks

Reproductive

Uterus increase in size change shape and position

Cardiovascular

Cardio vascular increase 30-50%

Blood volume- 40-50%

Hr increases - at 5 weeks and peak at 32 wks

Blood pressure

1st trimester no change

Systolic- slight or no change

Diastolic- decreases approx 24-32 weeks, return at end of pregnancy

supine position

Lower BP

Maternal hypertension and fetal hypoxia possible

Supine vena cava syndrome

• supine hypotension syndrome

Dizziness, light headed, pallor and clammy skin

intervention:

• Lay on left lateral side semi fowler or supine with wedge under one hip- relieves pressure to vena cava

Respiratory

Oxygen increases

Chest enlarges in last trimester, lungs expand and uterus push upward

RR increase and lung capacity decrease

Musculoskeletal

Wt increase and pelvic joint relax

Gastrointestinal

Possible Nausea and vomiting

Increase abdominal pressure

Stomach and intestine displaced

Possible constipation

Expected findings

Fetal HR 110-160

Heart changes shape and size- cardiac hypertrophy

Heart sounds change

Uterine size and et changes- 50 to 1000 g.

Wk 36- uterus and fundus at xiphoid process

may experience SOB

cervix purple- blue color and cervix soft

Breast increase size and areolae darkening

Chloasma

Pigment on the face

linea nigra

Dark line down abd from umbilical to pubic

Statist gravidarum

Stretch marks on abd and thigh

Nurse interventions

• Encourage pt to share feelings about pregnancy

• Discuss expected changes and timeline and return to normal

• Goals for postpartum self care and baby

• Encouraged to keep follow up appointment and contact HCP immediately if BLEEDING, LEAKAGE OF FLUID, CONTRACTIONS occurs

Renal

Filtrations increases

Urine production remain the same

Urinary frequency

Endocrine

Placenta produces HCG, progesterone, estrogen, prostaglandin, lactogen.

Body images

Support needed

2nd trimester- breast and abdomen enlargement, stretch marks and hyperpigmentation,

Possible loss of balance

Back and leg discomfort and fatigue

Anxious