WEEK 4 (Part 2): Physiological Signs of Pregnancy | Prenatal Care: Care of the Mother

1. Presumptive

2. Probable

3. Positive

Classifications for physiologic signs of pregnancy

Presumptive Signs

Signs of pregnancy a woman is experiencing that makes her suspicious and makes her think that she may be pregnant

● Based on her report of them

● Subjective and not definite that a baby is growing

in the uterus because other conditions could cause these presumptive signs

Presumptive; Breast Changes

Identify the type and name of the sign.

Tingling of nipples which happens at 4th week gestation

● Darkening and enlargement of areola

● Enlargement of breast

● Increased number of milk-secreting cells

Presumptive; Nausea & Vomiting

Identify the type and name of the sign.

Most common form of discomfort

● Brought about the increasing levels of HCG

(human chorionic gonadotropin)

Presumptive; Amenorrhea

Identify the type and name of the sign.

First sign of 2 weeks from fertilization because of the persistence of corpus luteum

Presumptive; Frequent Urination

Identify the type and name of the sign.

● Most observable sign especially in the third trimester due to the pressure applied by the enlarging uterus to the bladder

Presumptive; Fatigue

Identify the type and name of the sign.

Estrogen-induced in early pregnancy

Presumptive; Abdominal Enlargement

Identify the type and name of the sign.

● In the early weeks of gestation, the uterus can be palpated over enlargement symphysis pubis

● The uterus turns from a globular shape to an oval

● The increase in size of the uterus is due to the hypertrophy of existing muscles and connective tissue

● No formation of new muscles

Presumptive; Quickening

Identify the type and name of the sign.

Fetal movement; felt by women (sttonger at 20 weeks)

Presumptive; Linea Nigra

Identify the type and name of the sign.

The line of dark pigment on the abdomen

Presumptive; Melasma/Chloasma

Identify the type and name of the sign.

Mask of pregnancy

● Areas of the skin become darker than the

surrounding skin

● Hyperpigmentation

● Typically in the face (forehead, cheeks, above the

upper lip.

Presumptive; Striae Gravidarum

Identify the type and name of the sign.

Red streaks on the abdomen

● Stretch marks

Probable Signs

Pregnancy signs that the nurse or doctor can observe and document

NOT 100% sure that the baby is growing in the uterus since it can be from other causes

Probable; Home Pregnancy Test

Identify the type and name of the sign.

Over the counter pregnancy test kits can detect the presence of HCG in the urine

Laboratory tests can also detect HCG levels in the serum levels

Probable; Chadwick’s Sign

Identify the type and name of the sign.

Bluish discoloration of cervix, vagina and perineum

Probable; Goodell’s Sign

Identify the type and name of the sign.

Softening of the cervix

Through bimanual palpation, you will be able to detect this together with Hegar’s Sign

Probable; Hegar’s Sign

Identify the type and name of the sign.

Softening of the lower uterine segments (isthmus)

Probable; Gestational sac via UTZ

Identify the type and name of the sign.

Characteristic ring is evident through UTZ

Probable; Ballotement

Identify the type and name of the sign.

Rebound of the fetus against the examiner’s finger The cervix is tapped by the examiner’s finger within the vagina causing the fetus to strike against the wall of the uterus

The hand on top of the abdomen will feel the rebound

Probable; Braxton Hicks contraction

Identify the type and name of the sign.

Painless abdominal contractions or periodic uterine tightening relieved by walking

Probable; Fetal Outline felt by the examiner

Identify the type and name of the sign.

Palpated by the examiner through the abdomen

Positive Signs

Conclusive, definite or absolute

Present because they can only be attributed to a fetus and there are no other cause

Definitely pregnant

Baby being the evidence itself

Positive; UTZ

Identify the type and name of the sign.

Visualization of the fetus through this

Positive; Audible fetal heart sound

Identify the type and name of the sign.

Fetal heart beat heard in utz at 6-8 weeks Doppler - 12 weeks

Positive; Fetal Movement by Examiner

Identify the type and name of the sign.

May be felt by a woman as early as 16-20 weeks of pregnancy (what we call aquickening)

● Those felt by examiner are much more reliable because the woman could mistakenly think it is the movement of gas through her intestines

(1) oval

(2) hypertrophy

(3) NO

(4) 60

(5) 1000

(6) symphysis pubis

(7) 12

(8) 20-22nd

(9) 36

Uterus

• Turns from a globular shape to an (1)___.

• The increase in size of the uterus is due to the (2)____ of existing muscles and connective tissues.

• There is (3)____ formation of new muscle fibers in pregnancy.

• Weight of the uterus ↑ from (4) ___g of a non-pregnant woman to (5)_____g when it reaches full term.

• The funding height also changes basing on the (6) ___ ___ , It marks (7)___ week gestation

• (8) ___ to ____ week: fundus is palpable at umbilical level while (9)___ weeks at the xiphoid process level.

1. Lightening: Primigravid vs Multigravid

2. Uterine blood flow

3. Operculum

4. Hagar’s Sign

5. Goodell’s Sign

6. Chadwick’s Sign

7. Leukorrhea

8. Mucus Plug

Uterine Changes

500-750 mL/min

How much does the uterine blood flow increase up to to supply the developing fetus?

Hagar’s Sign

An effect of the estrogen resulting in cervical and uterine changes; the softening of the lower uterine segment called the isthmus.

Estrogen

What hormone causes Hagar’s Sign?

Isthmus

What is the uterine segment that is palpated in Hagar’s Sign?

Goodell’s Sign

• Characterized by the softening of the cervix.

• Its consistency is similar to your ear lobe.

• A nonpregnant cervix has a similar consistency of the tip of the nose, while the ripe cervix, or when a woman goes into labor, is as soft as a whipped butter.

Cervix

What is the portion that softens in Goodell’s Sign?

Chadwick’s Sign

Refers to the bluish or purplish discoloration of the vaginal mucosa and cervix.

Leukorrhea

• a whitish, mucoid, non-phal, non-periodic vaginal secretion that is produced due to the increase of estrogen.

• The vagina also increases its acidity, lessening the bacterial invasion.

Mucus Plug

is in the middle of the cervical OS

• it seals the cervix.

• It also prevents bacterial contamination

  of the uterine cavity During labor.

• It may fall, allowing the amniotic SAC to

  rupture and flow out of the vagina.

• Once this ruptures, the mother will take note of the mucus plug falling out from

  the vagina.

• It will be a bloody show and once the

  amniotic sac ruptures it will then flow out of the vagina.

(1) void

(2) lithotomy

(3) popliteal

(4) chest

(5) distract

Nursing Responsibility: Before Internal Examination

1. Before doing the IE (let client to lie down), let her (1) ____ first, to prevent discomfort during the exam. Position the woman in a (2)____ position.

2. We make sure that there is an equal height of the padded stirrups.

3. Simultaneously, place the legs on the stirrups and ensure there is pressure on the (3) _____ region.

4. Properly drape the patient, exposing what needs to be examined properly.

5. Position the hands across the (4) ____.

6. Teach proper breathing.

7. Do not (5) ____ the woman during IE to allow effective breathing and relaxation.

(1) vascularity

(2) estrogen

Chadwick’s sign is the bluish discoloration of the cervix and also the vagina. This is brought about by the (1) _____ or increased _____ of the perineum brought about by the (2) ______.

Colostrum

• A precursor of breast milk.

• A thin, watery, light yellow and high protein secretion from the breast.

• It is important that upon the delivery of the newborn, they will be able to ingest or take in the ____ because it's very concentrated with minerals.

Minerals

What is colostrum concentrated with?

Immunologic competency

What decreases during pregnancy to prevent a woman’s body from rejecting the fetus as if it were a transplanted organ?

Decreases: IgG

Increases: WBC

What antibody decreases in production during pregnancy, making a woman more prone to infection? However, what increases to compensate?

Striae gravidarum (stretch marks)

• Red streaks on the abdomen, upper thighs and lower breasts due to adrenal hypertrophy

Striae albicantes (old silvery white striae)

• Old silvery white striae

• Becomes prominent postpartum

• If you have observed those women after delivery, you will see white dish streaks

  on their abdomen.

Diastasis recti

• overstretching and separation of the abdominal musculature.

Linea nigra

• Dark line from symphysis pubis up to xiphoid process

  ○ Due to increase in estrogen

Estrogen

What hormone causes linea nigra?

Melanocyte stimulating hormone

What hormone causes melasma (chloasma)?

Telangiectasis

• Occurs in 2⁄3 of light complexion women

  and 10% of dark complexion women

• Occurs at face, neck, and arms

• Normal change of estrogen production

  causes dilation, instability, proliferation,

  and congestion of blood vessels

• ○  Regresses postpartum

Palmar erythema

• Redenned palms

  • Caused by vascular changes due to

    estrogen increase

• Health Teaching:

  • Can be itchy, instruct patient to NOT ITCH

  • Apply lotion to prevent breakdown of skin

Diaphresis

• Excessive sweating

• Due to increase cavity of sweat and

  sebaceous glands from pregnancy’s increased metabolic rate

(1) 30% (2) 50%

Cardiac output (CO) increases by (1)___% on first and second trimester and (2)___% by third trimester done to meet the tissue demands of pregnancy

10-15

The increase in cardiac output causes heart rate to increase by ___ bpm in second to third trimester

anemia/pseudoamenia

increase in circulating blood volume → physiologic ___/____

(1) vascularity (2) pelvic (3) superficial

Increase estrogen → inc (1)____ → dilatation of (2) ____ veins → (3) ____ veins may be prominent

(1) fibrinogen (2) thrombophlebitis

Increase progesterone → Increase (1) ____ → High tendency of clotting (2) ___)

Homan’s Sign

Since thrombophlebitis is common in pregnant women, what needs to be regularly assessed?

pelvic girdle

Edema in lower extremities is common due to pressure on ____ ____

False; may imply pathology problems, especially kidneys

True or False: Edema aside the lower extremities is normal.

Familiarized na?

FAMILIARIZE FF:

Respiratory System changes

1. Epistaxis

2. Nasal Congestion

3. Coarseness of voice

4. Eustachian tube blockage → Temporary deafness (due to estrogens ability to increase vascularity)

5.  Diaphragm rises as much as 1 inch at 36-38 weeks, thus compressing the lungs upward, resulting to dyspnea or Chronic SOB

   1. Relieved during Lightening

Estrogen causes increased vascularity → Eustachian tube blockage

What causes temporary deafness in pregnancy?

Progesterone regulated by the corpus luteum until 16 weeks and increased activity of the thyroid gland

What causes temp to rise slightly during pregnancy?

10-15. bpm

How much higher does PR increase during pregnancy?

Progesterone

What hormone causes deep and rapid RR?

24 cpm

What is the maximum increase of RR under normal conditions?

hypotensive; Vena Cava Syndrome

Pregnant women tend to be ___ with supine position due to ____.

25-35 lbs

What is the BMI range pregnant women should aim to gain?

1st tri – 0.8 kg or 1.5 lbs/month

■ 2nd & 3rd tri – 0.4 kg or 1 lb/week

Weight gain in pregnancy for each trimester

Hyperptyalism

Due to increased estrogen, this is increased saliva production with nausea, which disappears after delivery

Familiarized na?

FAMILIARIZE

Gastrointestinal System changes during pregnancy

1. Hyperptyalism

2. Gingival changes

3. Morning sickness

   1. Heartburn/pyrosis

4. Decreased peristalsis/acid reflux

5. Gallstone formation

6. Hemorrhoids

Heartburn/Pyrosis

Progesterone decreases motility and slows down digestion causing the cardiac sphincter to relax resulting to esophageal reflux and ___

Increased Glomerular Filtration Rate

the amount of blood that passes through the glomeruli each minute, increases.

Urinary Stasis

Bladder compressed and di kaayo mo agi ang ihi so mo stagnant ang bacteria, making the pregnant woman at risk for UTI

1. Estrogen

2. Progesterone

3. Relaxin

What hormones softens the ligaments and joints which allows the increase of birth canals?

Relaxin

What hormone causes waddling gait?

Lordosis

Inward curvation of pregnant woman spine

calcium phosphorus; gravid uterus

Cramps common from ____ ____ imbalance and pressure of the ___ ___ on nerve supplying the lower extremities.