Ch 6 Adaptations to Pregnancy

signs of pregnancy

• presumptive

• probable

• positive

presumptive pregnancy signs

• many pregnant ppl experience, but not a guarantee

  • fatigue

  • breast tenderness

  • N/V

  • amenhorrhea

  • urinary frequency

  • hyperpigmentation of skin

  • quickening

  • chadwick sign

breast tenderness + fatigue & presumptive pregnancy

• from hormones

  • mainly progesterone

amenorrhea & presumptive pregnancy

• can happen w/ athletes

• happens w/ pregnancy when implantation is reached

probable pregnancy signs

• braxton hicks contractions

• positive pregnancy test

• abdominal enlargement

• ballottement

• goodell sign

• hegar sign

• palpitation of fetal outline

• urterine souffle

braxton hicks contractions

• lowk a positive sign

• usually happens later on in pregnancy

positive pregnancy tests

• seen as a probable sign as there can be inaccurate test results

positive pregnancy signs

• U/S image of fetus

• fetal movement felt by clinician

• auscultation of heart tones by doppler

goodell sign

• probable pregnacy sign

• softening of cervix

  • bc of increased hormones

chadwick’s sign

• presumptive pregnancy sign

• pink to blueish purple colored uterus

  • from increased blood flow & vascularity

hegar’s sign

• probable pregnancy sign

• softening of uterus isthmus

  • area btwn cervix & body of uterus

  • from increased hormones

• occurs at 6-8wks of pregnancy

• can soften so much that anterior fornix fingers & abdominal fingers can meet eachother during exam

uterine changes during pregnancy

• HUGE!

  • fist sized → 40cm growth

• increases in size, weight, length, width, depth, vol, & overall capacity

• pear to ovoid shape

• enhances urterine contractility

• ascents into abd after 3mo

• 10 wks - uterine growth can be measured in cm

fundus size 20wks on

• at level of umbilicus (20cm)

• reliable determination of gestational age until 36 wks

  • within 2cm ±

fundus

• top of uterus

cervix changes during pregnancy

• softening (goodells sign)

• mucus plug formation

• increased vascularization (chadwick sign)

• ripens abt 4wks before birth

mucus plug

• can be lost wks before birth

• forms @ cervix base → stays almost term → thins & comes out

  • can be a delivering soon sign

vagina changes during pregnancy

• increased vascularity & thickening

• lengthening of vaginal vault

• secretions more acidic, white, & thick

  • increased discharge, yeast infection

• gets more pliable

breast changes during pregnancy

• estrogren promotes growth of mammary duct tissue

• progesterone promotes growth of lobes, lobules, & alveoli

• increase in size & nodularity to prep for lactation

• increase in nipple size

• colustrum production

• more tender

estrogen & breast tissue changes

• growth of mammary duct tissue

  • for breastfeeding!

nipple changes during pregnancy

• more

  • erect

  • pigmented

  • dark

colustrum

• antibody-rich

• yellow

• expressed after 12th wk w/ conversion to milk as sign of delivery

• secretion suppressed from high progesterone & estrogen lvls

  • decreases as term progresses → leaking

ovary changes during pregnancy

• enlargement until 12-14th wk of gestation

• cessation of ovulation

cardiovascular system changes during pregnancy

• increase in blood vol

• increase in CO & HR

• supine hypertension

• increase in RBCs & plasma vol

• hypercoaguable state

blood vol changes during pregnancy

• increased by 30-45%

• bc of increased estrogen

• starting around wk 6, peaks 3rd trimester

cardiac output changes during pregnancy

• increases 30-50%

  • ½ in 1st 8 wks

• bc of increased venous return

supine hypertension & pregnancy

• late in pregnancy (after 20wks) when client lays flat on back

  • occlusion of superior vena cava & aorta

    • bc of uterine growth

• can be from illness related BP issues

• orthostatic hypotension also common

RBC increase during pregnancy

• by 20-30%

• not as much as plasma

plasma increase during pregnancy

• 40-50%

  • more than RBC

• needed for supply delivery

• increases tissue size & support

  • uterus, breasts

• blood loss backup

• mom → fetus

pregnancy anemia

• bc plasma vol increases more than RBC

• hemodilution!

pregnancy hypercoagulability

• increase in

  • iron demands

  • fibrin & plasminogen lvls

  • clotting factors

  • blood stasis

• increase DVT/pulmonary embolism risk

heart changes during pregnancy

• grows by 10-15%

• position changes

  • more up & to the left as uterus grows & compresses diaphragm

HR changes during pregnancy

• increases!

  • not typically exceeding 100bpm

BP changes during pregnancy

• decreases

  • progesterone - smooth muscle dilation → 20% decrease in vascular resistance

• 10-15mmHg first trimester

pregnancy associated CV symptoms

• palpitations

• dizziness

• exercise intolerance

• syncope

• lightheadedness

blood flow changes during pregnancy

• 5!

  • altered to include uretoplacental unit

  • renal plasma flow increases to remove metabolic wastes from mom & fetus

  • skin requires increased circulation to dissipate heat from increased metabolism

  • blood flow increase to breasts

  • inferior vena cava & iliac vein obstuction

IVC & iliac vein compression during pregnancy

• partially obstructed from growing uterus

  • blood return from veins reduced

• blood pools in deep & superficial engorgements

  • varicose veins in legs, vulva, or rectum (hemorrhoids)

  • increased DVT/pulmonary embolism risk

• increased perpiheral swelling

respiratory system changes during pregnancy

• breathing more diaphragmatic than abdominal bc of

  • increased excursion, chest circumference, & tidal vol

• increased O2 consumption by abt 20%

• congestion secondary to increased vascularity

• chronic miild respiratory alkalosis

• uterine compression on diaphragm

• from hormonal stuff

respiratory alkalosis & pregnancy

• w/ metabolic compensation !

• probs bc of progesterone

tidal vol changes during pregnancy

• increases - 40%

• amt of air inhaled/exhaled during normal breathing

uterine compression on diaphragm

• decreases residual vol & ability to compensate

• atelectasis risk

• SOB 1st & 2nd trimester

O2 consumption changes during pregnancy

• increases

  • 50% bc of increased amt used by uterus/baby

  • 30% used by enlarged heart & kidneys

  • 20% used by respiratory muscles & breast tissue

progesterone & respiratory system

• deepens breaths w/ RR unchanged

  • big!

• decreases airway resistance by 50% - smooth muscle relaxation

estrogen & respiratory system

• increased vascularity in mucus membranes

  • nasal congestion

  • nosebleeds

  • deeper voice

GI system changes during pregnancy

• ptyalism

• decreased peristalsis

• smooth muscle relaxation

• dental issues

• hemorrhoids

• slowed gastric & gallbladder emptying

• N&V

• increased appetite by 15-20% w/o morning sickness - cal increase good

• bad breath

• liver movement

gum changes during pregnancy

• hyperemic, swollen, friable

  • bc of increased estrogen → increased vascularity

• gingivitis common

ptyalism

• increased saliva/salivation

• helped w/ chewing gum or throat lozenges

peristalsis changes during pregnancy

• decreased

• leads to bloating, abd distention, conspitation

smooth muscle relaxation in GI during pregnancy

• in esophagus too !

  • GERD

    • also partly bc of uterine push on GI organs, slowed gastric emptying

hemorrhoids & pregnancy

• from constipation + increased venous pressure + pressure from uterus

gallbladder emptying changes during pregnancy

• prolonged

  • bc of progesterone

• estrogen increases cholesterol also → increased gallstone risk

  • cholestasis of pregnancy

• bile stale retention→ itching

cavities & pregnancy

• more common!

  • bc of N/V & increased salivation

• infection? → preterm labor

liver changes during pregnancy

• pushed up & out of way 3rd trimester

• altered fxn

renal/urinary system changes during pregnancy

• big hormone changes

• dilation of renal pelvis, ureters, kidneys

  • increased urinary stasis & infection potential

• GFR increase

• must be able to handle increased maternal intravascular & extracellular vol & metabolic waste as well as excretion of fetal wastes

• increase in bladder capacity

• plasma vol increase → increased urine output

estrogen & renal system

• increased fluid reabsorption

  • increased blood vol/preload

increased urinary frequency & urgency during pregnancy

• bc of uterus pressuing on bladder + progresterone

• know diff btwn pregnancy & bladder infection

renal system dilation during pregnancy

• renal pelvis

  • elongation, widening, & increase in curve of ureters

• kidneys & ureters

  • increase urinary stasis & infection risk

kidney changes during pregnancy

• dilates

• increased length, weight, & size

  • hydronephrosis

• activity increases w/ lying down

  • greater increase later on w/ laying on side

GFR changes during pregnancy

• increases

• increased urine flow & vol

bladder changes during pregnancy

• capacity increased 2x

  • tone decrease bc of progesterone → leaking

  • can retain 300mL at any given time → urinary stasis

musculoskeletal changes during pregnancy

• progressive - from hormones, fetal growth, & maternal weight gain

• softening & stretching of ligments holding sacroiliac & pubic symphysis tgt

  • increased pressure on joints (w/ increased weight too)

• increased swayback & upper spine extention

• forward shifting of center of gravity - bc of enlarged uterus

• waddle gait

posture changes during pregnancy

• increased swayback & upper spine extention

  • lordosis w/ compensatory curve in cervicodorsal area

integumentary system changes during pregnancy

• hyperpigmentation

• line nigra

• striae gravidarum

• varicosities

• palmar erythema

• decline in hair growth, increase in nail growth

hyperpigmentation & pregnancy

• from elevated estrogen, progesterone, & melanocyte-stimulating hormone

• occurs in 90% of pregnant pts

• melasma - mask of pregnancy

linea nigra & pregnancy

• pigmented line in middle of abdomen

striae gravidarum & pregnancy

• stretch marks

  • esp from growing uterus & breasts

varicosities & pregnancy

• varicose veins

  • legs

  • vulva

  • perineum

vascular spiders & pregnancy

• appearance of small blood vessels on neck, thorax, face, & arms

  • typically disappear after giving birth

palmar erythema & pregnancy

• well-delinated pinkish area on palmar surface of hands

  • r/t increase in estrogen lvls

endocrine system changes in pregnancy

• hormonal changes play huge role in

  • controlling supplies of maternal glucose, amino acids, & lipids to fetus during development

• thyroid

• pituitary gland

• pancreas

• adrenal glands

• prostaglandin secretion

• placental secretions

thyroid gland changes in pregnancy

• slight enlargement

• increased activity

• increase in BMR

pituitary gland changes in pregnancy

• enlargement

• decrease in TSH, GH

• inhibition of FSH, LH

• increase in prolactin, MSH

• gradual increase in oxytocin w/ fetal maturation

pancreas changes in pregnancy

• insulin resistance bc of hPL & other hormones in 2nd half of pregnancy

adrenal gland changes in pregnancy

• increase in cortisol & aldosterone secretion

placental hormone secretion

• hCG

• hPL

• relaxin

• progesterone

• estrogen

human chorionic gonadotropin source

• trophoblast

human chorionic gonadotropin major effects

• aka hCG

• prevents involution of corpus luteum to maintain production of estrogen & progesterone until placenta is formed

progesterone & estrogen source

• corpus luteum of overy

• placenta

estrogen major effects

• suppresses FSH & LH

• stimulates development of uterus & breats

• causes vascular changes in skin, uterus, respiratory tract, & bladder

• causes hyperpigmentation

• insulin antagonist

• increases fat stores

progesterone major effects

• maintains urterine lining for implantation

• relaxes smooth muscles

• decreases uterine contractions

• develops breasts for lactation

• inhibits FSH

nutrition & pregnancy

• healthy eating enables optimal gestational weight gain & reduces complications

• needs to meet demands of pregnancy

• direct effect on fetal well-being and birth outcome

• need for vit & mineral daily supplements

pregnancy dietary reccomendations

• prenatal vitamins !

• increase in protein, iron, folate, & calories

• use MyPlate from USDA

• avoid some fish due to mercury content

  • ie: no nigiri

• increase H2O consumption

  • low? contractions

healthy maternal weight gain

• 25-35lbs

pregnancy weight gain

• 3.5-5lbs in 1st trimester

• 1lb/wk in 2nd & 3rd trimesters

first trimester pregnancy psychosocial factors

• uncertainty

• ambivalence

• self as primary focus

uncertainty & pregnancy

• early weeks

• client unsure of pregnancy & needs to confirm it

• scared!

ambivalence & pregnancy

• conflicting feelings

  • is this the right time?

  • was it planned?

self as primary focus & pregnancy

• focusing on self

  • esp mentally!

  • N/V, fatigue, mood swings

• hormone changes

second trimester pregnancy psychosocial factors

• physical evidence of pregnancy

• fetus is primary focus

• narcissism & introversion

• body image

• changes in sexuality

physical evidence of pregnancy

• fetus becomes real

• U/S lets client see fetus

fetus is primary focus in pregnancy

• client shifts thinking to having healthy pregnancy & baby

  • bond formed!

narcissism + introversion & pregnancy

• client concerned about being able to protect & provide for fetus

  • spends a lot of time thinking abt fetus & what life will be like when born

body image & pregnancy

• may be happy w/ advancement

• may have negative feelings

  • help w/ this!

  • discourage dieting

changes in sexuality & pregnancy

• increased sensitivity of sexual organs

• more energy

• more frisky lol

third trimester pregnancy psychosocial factors

• vulnerability

• increasing dependence

• prep for birth

vulnerability & pregnancy

• client worries that something might go wrong

  • what if I can’t do this?

increasing dependence & pregnancy

• more dependent on partner

• needs client to be available

• may have difficulty concentrating

prep for birth

• worried!

  • abt not knowing when they are in real labor

  • what labor will be like

factors influencing psychosocial adaptation

• age

• multiparity

• social support

• absence of partner

age & pregnancy

• teenagers

  • struggle w/ adolescence & becoming a parent

    • self focused, hard to change thinking

• advanced maternal age (35+)

  • lifestyle change struggle

  • possible medical issues

multiparity & pregnancy

• 2+ babies

• increased fatigue

• trouble bonding w/ more than 1 baby after birth

• increased work caring for more than one baby