Maternal Adaptation During Pregnancy

What are the 3 classifications of Signs of Pregnancy

- Presumptive

- Probable

- Positive

What are Presumptive Signs of pregnancy?

Subjective changes experienced and reported by the pregnant woman.

What are the common Presumptive Signs of Pregnancy

- Nausea / Vomiting

- Fatigue

- Breast tenderness

- Amenorrhea

- Fetal movements ("quickening")

- Uterine/Breast enlargement

What is quickening?

The pregnant woman's perception of fetal movement (16-20 weeks)

Is quickening a presumptive, probable, or positive sign of pregnancy?

Presumptive

What are probable signs of pregnancy?

Objective findings that strongly suggest pregnancy but do not definitively confirm it.

Common Probable Signs of Pregnancy

- Braxton Hicks contraction

- Positive pregnancy test

- Goodells sign

- Chadwick's sign

- Hegar's sign

What is Goodell's Sign

softening of the cervix (week 5)

What is Chadwick's Sign

Bluish-purple coloration of vaginal mucosa and cervix (6-8 weeks)

What is Hegar's Sign

Softening of the lower uterine segment or isthmus (6-12 weeks)

What are Braxton Hicks contractions (16-28 weeks)

Practice contractions = tightening of the uterus

Are Braxton Hicks contractions a positive sign of pregnancy?

No, a probable sign

Is a positive pregnancy test considered a positive/diagnostic sign of pregnancy?

No, a probable sign

Presumptive

MOM feels / notices it

Probable

PROVIDER can observe/test it, but it isn't proof

Positive

BABY is directly detected

What hormone are they detecting in a pregnancy test

hCG

hCG production can start as the day of ? and can be detected as early as ?-? days before expected menses

implantation, 7-8

HIGHER OR LOWER levels of serum hCG may indicate multifetal pregnancy, ectopic pregnancy, hydatidiform mole, or a genetic abnormality like Down's syndrome

Higher

What urine sample should be used for a home pregnancy test?

The first voided urine of the morning because its more concentrated

What are the 3 positive signs/symptoms of pregnancy

- Transvaginal Ultrasound (visualization of embryo/4-6 weeks)

- Fetal movement felt by clinician (20 weeks)

- Auscultation of fetal heart tones via Doppler (10-12 weeks)

What happens to the uterus during pregnancy?

increases in size, weight, length, width, depth, volume and overall capacity

How does the shape of the uterus change during pregnancy?

Changes from Pear to Ovoid shape (positive hegars sign)

T/F: The enhanced uterine contractility = Braxton Hicks contractions

true

What causes the uterus to ascend into the abdomen?

Its increasing in size, ascends after first 3 months

Where should the fundus be at 20 weeks' gestation?

Level of Umbilicus, approximately 20cm

How is fundal height measured during pregnancy?

Top of the pubic bone (symphysis pubis) to the top of the uterus (fundus)

From approximately 20-36 weeks, how should fundal height in centimeters compare with gestational age?

The fundal height should approximately equal the gestational age in weeks.

Until approximately what gestational age is fundal height a reliable way to estimate gestational age?

Until approximately 36 weeks

What is "Lightening"

fetal head begins to descend and engage in the pelvis

When does "Lightening" typically occur

Approximately 2 weeks before or immediately before labor

What cervical change produces Goodell's Sign

softening of the cervix

What forms in the cervix during pregnancy to help protect the uterus?

Mucus Plug

What causes Chadwick's sign?

Increased vascularization of the cervix

What happens to the cervix approximately 4 weeks before birth

Begins "Ripening"

What vaginal changes occur during pregnancy?

- increased vascularity with thickening

- lengthening of vaginal vault

- secretions more acidic, white, and thick = leukorrhea

What is Leukorrhea

The increased acidic, white, thick vaginal secretions that occur during pregnancy.

What happens to ovulation during pregnancy

Ovulation ceases

Until approximately when do the ovaries enlarge during pregnancy?

Until approximately 12-14 weeks

What breast changes occur in preparation for lactation?

Increased breast size and nodularity and nipples that become larger, more erect, and more pigmented

What is Colostrum

An antibody-rich yellow fluid produced by the breasts

When can colostrum be expressed during pregnancy?

After approximately the 12th week

How can the Gums change during pregnancy

they become hyperemic, swollen, and friable

What is Ptyalism

Excessive salivation

Why is constipation common during pregnancy?

decreased peristalsis and smooth muscle relaxation

Why are pregnant women at increased risk for hemorrhoids?

constipation + increased venous pressure + pressure from the uterus

Why are heartburn and flatulence common during pregnancy?

Slowed gastric emptying

What common GI symptoms occur during pregnancy?

- nausea/vomiting

- constipation

- heartburn

- increased salivation

- gingivitis

How does heart position change during pregnancy?

Heart is elevated slightly and to the left because the enlarging uterus displaces the diaphragm

What is vena caval syndrome?

Compression of the aorta and vena cava by the enlarging uterus when the pregnant women lies down

What symptoms can occur with vena caval syndrome?

- decreased BP

- dizziness

- pallor

- claminess

Approximately how much does blood volume increase during pregnancy?

50% above pregnant levels

What happens to Cardiac Output, Venous Return, and Heart Rate during pregnancy?

They increase

What normally happens to blood pressure during pregnancy?

It declines slightly until mid-pregnancy, then returns toward pre-pregnancy levels

Why does Physiologic Anemia occur during pregnancy?

Plasma volume increases more than RBCs, producing hemodilution

Why is pregnancy considered a hypercoagulable state?

Fibrin, plasma, fibrinogen, and some clotting factors increase

How does breathing change during pregnancy?

Breathing becomes more diaphragmatic than abdominal

What happens to oxygen consumption during pregnancy?

It increases

Why may pregnant women experience nasal congestion?

Increased vascularity

What happens to the diagram as pregnancy progresses

Increasing pressure is placed on it

What happens to the Renal Pelvis during pregnancy

It becomes dilated.

What happens to the Ureters during preganancy

ureters elongate, widen, and increase in curve

What happens to GFR during pregnancy?

It increases

Why does urinary frequency increase during pregnancy?

Increased GFR causes increased urine flow and volume

The kidneys increase in ? and ? during pregnancy

length and weight

When does kidney activity increase during pregnancy?

When the woman is lying down, greater increase later in pregnancy

Why does Joint Relaxation occur during pregnancy?

Ligaments holding the sacroiliac joints and pubic symphysis soften and stretch

Why are Backaches common during pregnancy?

The uterus causes the woman's center of gravity to shift forward

What is lordosis in pregnancy?

An increased lumbosacral curve

What gait change is commonly seen during pregnancy?

A waddle gait

What happens to the rectus abdominis muscles during pregnancy?

They separate to accommodate the enlarging uterus

What is Melasma during pregnancy?

Facial hyperpigmentation known as the mask of pregnancy

What is linea nigra?

A darkened line that develops on the abdomen during pregnancy

What are striae gravidarum?

Stretch marks associated with pregnancy

What other integumentary changes can occur during pregnancy?

- Varicosities (varicose veins)

- Vascular spiders

- Palmar Erythema

- Decline in hair growth, increase in nail growth

What happens to basal metabolic rate (BMR) during pregnancy?

It increases during to increased thyroid activity

What happens to FSH and LH during pregnancy?

They are inhibited

What happens to prolactin during pregnancy?

It increases

What happens to Oxytocin as the fetus matures

Gradually increases

What causes increased Insulin Resistance during the second half of pregnancy?

hPL and other pregnancy hormones

During pregnancy the Adrenal Glads increase in

cortisol and aldosterone secretion

What hormones are secreted by the placenta

- hCG

- hPL

- Relaxin

- Progesterone

- Estrogen

Is oxytocin secreted by the anterior or posterior pituitary?

Posterior Pituitary Gland

Why does physiologic anemia occur during pregnancy even though RBCs increase?

plasma volume increases more than RBC volume, causing hemodilution.

What happens to blood pressure during a normal pregnancy?

slightly decreases until midpregnancy, then returns toward prepregnancy levels.

Which nutrients should especially be increased during pregnancy?

- protien

- iron

- folate

- calories

How much caffeine should be consumed at most during pregnancy

- 200mg/day

Which high-mercury fish should pregnant women avoid?

- swordfish

- shark

- orange roughy

- marlin

How many additional calories are needed each day during pregnancy?

Approximately 300 kcal/day.

How many additional calories are needed when breastfeeding?

Approximately 500 kcal/day.

Why is increased protein important during pregnancy?

For basic fetal growth and healing after delivery

How much folic acid should be taken before pregnancy?

400mcg/day

How much folic acid should be taken during pregnancy?

600mcg/day

Why is folic acid especially important during pregnancy?

Crucial for neurologic development and prevention of neural tube defects

How much iron is included in the prenatal vitamin

27mg

How should iron be taken for best absorption?

Between meals with a source of Vitamin C

How much calcium should pregnant adults consume daily?

1,000mg/day

How much calcium should pregnant teens consume daily?

1,300mg/day

Why is calcium important during pregnancy?

For fetal bone and tooth formation.

What is the recommended total pregnancy weight gain for a healthy BMI of 18.5-24.9?

Gain 25- 35 lb