Review of Maternal Physiological Adaptations to Pregnancy Nurse

First Trimester Emotional Responses

Ambivalence is normal (the state of having mixed feelings or contradictory ideas about something or someone.)

even in planned pregnancies. Financial and career concerns may arise.

Second Trimester Emotional Changes

Quickening (fetal movement) makes pregnancy feel more real. Some ambivalence may persist.

Third Trimester Emotional Responses

Mothers may become more introverted. Relationship strain is possible.

Prenatal Visit Schedule

First visit in the first trimester, monthly visits until 28 weeks, biweekly visits until 36 weeks, weekly visits until birth.

Gravida & Para System

G = total pregnancies, P = number of births after 20 weeks.

GTPAL System

G = total pregnancies, T = term births, P = preterm births, A = abortions (spontaneous or induced), L = living children.

Calculating Due Date (Naegele’s Rule)

EDB = First day of last period + 7 days - 3 months.

Routine Prenatal Lab Values

Hgb ≥11 g/dL (1st & 3rd trimesters), ≥10.5 g/dL (2nd trimester); Hct ≥33% (1st & 3rd), ≥32% (2nd).

Vital Sign Changes in Pregnancy

BP: Slight/no decrease in systolic; diastolic decreases mid-pregnancy then returns to normal. HR: Increases by 15-20 bpm.

First Prenatal Visit Assessments

Includes medical history, mental health screening, substance use screening, sexual health history, IPV screening, and full obstetric history.

Methods to Determine Pregnancy Status

Two-digit system (Gravida/Para) and five-digit system (GTPAL).

Routine Labs in Pregnancy

Includes CBC, HIV, Hep B & C, rubella, syphilis, blood type & Rh, STI screening, varicella, TB test, genetic screening, urine analysis.

Fundal Height Growth in Pregnancy

20 weeks: At umbilicus; 24 weeks: 2-4 fingerbreadths above umbilicus; 27 weeks: Halfway between umbilicus and xiphoid; 36-38 weeks: 1 fingerbreadth below xiphoid.

Fetal Heart Rate (FHR) Detection

Detectable by Doppler at 10-12 weeks; Normal range: 110-160 bpm.

Iron Needs in Pregnancy

27 mg/day. Best absorbed with vitamin C. Avoid taking with tea, coffee, or milk.

Common First Trimester Symptoms

Nausea, vomiting, breast tenderness, constipation, fatigue, urinary frequency.

Management of First Trimester Symptoms

Nausea: Eat small, frequent meals; Fatigue: Increase rest; Constipation: Increase fiber and water intake.

Second Trimester Maternal Adaptations

Uterus rises above pelvic brim; fundus at umbilicus by 20 weeks; fetal movements (quickening) felt between 16-20 weeks.

Skin Changes in Pregnancy

Areolas darken, veins become more visible, striae gravidarum (stretch marks) appear.

Common Second Trimester Symptoms

Gas, nasal congestion, ligament pain, back pain, varicose veins, increased GFR, increased insulin resistance.

Third Trimester Maternal Adaptations

Thoracic breathing replaces abdominal breathing, cardiac output increases 30-50%, BP increases slightly.

Common Third Trimester Symptoms

Dyspnea, heartburn, swollen ankles, Braxton Hicks contractions, lightening (baby dropping).

Kick Counts

Mothers should monitor fetal movements. Report decreased movement.

Signs of Pre-Eclampsia

Severe headache, vision changes, swelling of face/hands, high BP.

Preterm Labor Symptoms

Regular contractions, pelvic pressure, lower back pain, cramping, watery discharge.

Labor Warning Signs

Vaginal bleeding, rupture of membranes, contractions increasing in intensity and frequency, decreased fetal movement.

Postpartum Education

Teach newborn care, warning signs of postpartum complications, mental health support, contraception options.

Postpartum Warning Signs

Severe vaginal bleeding, fever, leg pain, chest pain, shortness of breath, swelling.

Contraceptive Counseling

Discuss postpartum birth control options before discharge.