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:
Building tissue
2. Change in character of the
tissue
Progesterone
Effect on physiological processes:
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.