Physiological changes in pregnancy (Class 5)

Subjective changes experienced by the woman herself.

Presumptive signs

Presumptive signs of pregnancy

\-Amenorrhea

-Nausea and vomiting \n -Urinary frequency;

\-constipation 

\-Breast tenderness, enlargement

-Quickening \n -Fatigue

Objective changes assessed on physical exam by health care professional.

probable signs

probable signs of pregnancy

 -**Uterine/ abdominal enlargement**

 -***Chadwick’s sign*** (Bluish – purple discoloration of the vaginal mucosa and cervix around 6-8 weeks)

 -***Hegar’s sign*** **-**softening of lower uterine segment around 6 – 12 weeks

- **Ballottement** \n  -**Goodell’s sign** – Cervical softening around 5- 6

weeks

- **Braxton Hick’s contractions** \n  -**Positive pregnancy test**

Chadwicks sign

early sign of pregnancy that is typically characterized by a bluish discoloration of the cervix, vagina, and vulva.

Hegars sign

characterized by the compressibility and softening of the cervical isthmus (i.e., the portion of the cervix between the uterus and the vaginal portion of the cervix).

Ballottement

the uterus is pushed with a finger to feel whether a foetus moves away and returns again

Goodells sign

Cervical spftening around 5-6 weeks

These confirm that a fetus is growing in the uterus.

Completely objective and cannot result from any other cause or pathology

Positive signs

Positive signs

\-Fetal heart heard

\-Fetal movements 

\-Visualization of fetus by ultrasound

physiologic changes in pregnancy

o Reproductive system 

Uterus, cervix, vagina 

Ovaries \n Breasts

\
o Cardiovascular System

o Respiratory System \n o Integumentary System

o Musculoskeletal system

o Urinary system

o Gastro-intestinal System

Estrogen or Progesterone:

Builds tissue and changes tissue Character

Estrogen

Estrogen or Progesterone:

Maintains pregnancy

Progesterone

estrogen

• The most common estrogens in the body are Estradiol (ovaries), estrone and estriol (maternal liver; fetus/placenta)

• Primary Effect on Physiological processes:

  • 1. Building tissue

       2. Change in character of the

tissue

Progesterone

Effect on physiological processes:

1. Plays a role in preparing the
body for pregnancy as well as
maintaining the pregnancy

2\. Decreases sensitivity to oxytocin

3\. Inhibits myometrium contractibility (Allows smooth muscle relaxation)

4\. Works in conjunction with estrogen to develop tissue ; prepare for implantation (menstrual cycle) and prepares breast for lactation 5. Aids in fetal development (neuro and sexual development)

Estrogen:

Builds tissue:

\-Increases size of uterus through hyperplasia, hypertrophy

\- Increase in the size of external genitalia

\- Increase in blood, lymphatics and nerve supply to the uterus and throughout the body

\- Increase in breast size (glandular and s/c)

\-increase in subcutaneous tissues

\-Increase WBC

Estrogen:

Change in character of tissue

\-Change in composition of the blood (increases availability of blood proteins for fetal dev)

\-Softening of connective and collagen tissues

\- Uterus stretches as it grows

\-Changes in blood vessel walls to become more permeable

- Skin changes

\- Increased deposition of fat.

\-Increased acidity in the vagina

- Decrease in gastric secretion of hydrochloric acid and pepsin

Anticipatory Guidance: Pregnancy

• Bathing: tub baths acceptable if membranes are intact ;water temperature <39°C; avoid saunas and whirlpool baths

• Working:not contraindicated unless in high-risk area;rest periodically if possible

• Travel:not contraindicated unless pregnancy is high risk ;wear lap and shoulder belts; during long flights, wear support hose, exercise legs frequently

• Exercise: unless contraindicated. encourage aerobic and strength conditioning exercises; avoid activities where client might fall

Kegal exercises – Very IMPT **

• Dental care: good dental care is important; active periodontal disease may increase risk for pregnancy complications

• Sexual concerns: coitus safe in uncomplicated pregnancy; avoid in last 4 weeks; contraindicated in placenta previa, or with ruptured membranes

• Clothing: loose clothing ;supportive bra

• Nutrition: ensure that client and fetus receive adequate calories and nutrients

• Pets: avoid contact with cat litter box and areas of yard frequented by cats

• Tetrogens: substances that the woman may come in contact with that may affect adversely fetal growth and development

• Travel

• Complementary and alternative medicine:massage,vitamin and mineral

  supplements, relaxation techniques, aromatherapy

urinary frequency

\-common pregnancy discomfort

\-decrease fluid intake in evening, void whenever urge is felt

Integumentary system adaptations to pregnancy

Chloasma \n Linea nigra 

Striae gravidarum 

Palmar erythema 

Epulis

Nail growth

Supine hypotension syndrome

\-common discomfort during pregnancy

\-side lying position on **left side**

\-rise slowly from a sitting to a standing position

Backache

\-common discomfort during pregnancy

\-wear shoes with lower heels ; firmer mattress ;good body mechanics; pelvic rocking exercises; avoid heavy lifting

Fatigue, sleep difficulties, and discomforts

\-common

\-frequent rest periods; go to bed early; rest in modified Sims’ position and use pillows under abdomen and between legs

Musculoskeletal system adaptations

- Relaxation of the joints, ligaments and cartilage \n Eg.) sacroiliac joint and symphysis pubischanging

postureinstability, waddling, sway back

- Centre of gravity shiftsincreased curvature of the spine

\- Abdominal muscles stretch and lose some tone

Respiratory related concerns (common discomforts during pregnancy)

–Dyspnea: use extra pillows at night

–Nasal stuffiness: humidify room air; use saline drops

–Epistaxis (nose bleed) : apply a moisturizer locally

Physiologic Adaptations in Pregnancy:

Respiratory system

\-Increased tidal volume, \n - vital capacity, \n  -respiratory reserve, \n - oxygen consumption, \n - production of carbon dioxide, 

-dyspnea is common

Basal metabolic Rate increases during pregnancy

Your Basal Metabolic Rate (BMR) is the number of calories you burn as your body performs basic (basal) life-sustaining function.

The rate rises in specific proportion to the size of the fetus and represents the effects of the mother's activities plus those of the fetus and the uterine structures.