changesofpregnancy (1)

7/30/2019 changesofpregnancy (1)

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PHYSIOLOGICAL AND

PSYCHOLOGICAL CHANGES OF

PREGNANCY

DEBBIE AMASON,RN,MS

SPRING 2001


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Changes

affect both parents

physiologic psychological

temporary

state of wellness


3/42

Diagnosis

feelings can be good or bad

confirmation early diagnosis important


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Presumptive Signs

can be caused by other

problems

amenorrhea

nausea and vomiting

fatigue

urinary frequency

breast tenderness

quickening


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Probable Signs

changes in the pelvic organs

Goodells Sign

Chadwicks Sign

Hegars Sign

Increase in size of uterus

Ballottement

Braxton-Hicks contractions

Serum lab tests


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Positive Signs

fetal heart rate

fetal movement felt by examiner

visualization by ultrasound


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Physiological Changes

local- reproductive

systemic- major body organs


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Local

Uterus

pre-pregnancy small semisolid

pear shaped

weight increases from 50Gm to

1000Gm

enlargement primarily a result ofhypertrophy of pre-existing

myometrial cells


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Uterine

development of new fibro-

elastic tissue between bands of

muscles

cells increase as result of

estrogen

measure

lightening


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Uterine

blood flow 15-20ml/min pre-

pregnancy

at term 500-700ml/min

by end of pregnancy 1/6 total

maternal blood volume is

circulating through the uterus

bleeding- serious problem


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Uterus

Braxton Hicks

painless contractions

estrogen

distention of the uterus

felt by 4th month

practicing

no cervical changes occur

amenorrhea


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Cervix

mucosa of cervix undergoes

marked changes

endocervical cells secrete thick,

tenacious mucus which

accumulates and forms the mucus

plug. Seals the cervical canal to prevent

infection

expelled at start of labor


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Cervix

increased mucus leads to

increased discharge

increased vascularity and

increased discoloration


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Vagina

epithelium undergoes

hypertrophy and hyperplasia

estrogen

secretions are acidic> increased

growth of Candida

at term vaginal walls are

relaxed


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Ovaries

cease ovum production related

to active feedback mechanism

of estrogen and progesterone

produced by the corpus luteum

and the placenta


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Breasts

changes are noted soon after

first missed period

increase in size and nodularity

preparing for lactation

2nd month superficial veins areprominent

nipples are more erect


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Breasts

pigmentationof areola is more

prominent

sebacious glands enlarge

(Montgomery Tubercles)

16th week colostrum


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Integumentary System

nipples and areola areas of

breasts are darker

striae gravidarum

linea nigra

chloasma diastasis rectus


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Respiratory

tidal volume increases 40%

respiratory rate increases

small degree of hyperventilation

oxygen consumption increases

by 20%

diaphragm is displaced >SOB

no change in vital capacity


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Respiratory

Progesterone levels signal

hypothalmus to reset

acceptable PCO2 levels

low CO2 levels allows for CO2 to

cross the placenta

maintain pH with load of CO2 fromfetus- mother hyperventilates to

blow off excess


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Respiratory

cumulative effect

SOB

nasal stuffiness

epistaxsis


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Cardiovascular

pressure on diaphragm

displaces the heart

blood volume increases 30-50%

occurs gradually and peaks at 28-

32 weeks

adequate exchange of nutrients

compensate for blood loss


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CV

rise in cardiac output 25-50%

pulse rate increases

BP remains relatively unchanged

concentration of Hgb and

erythrocytes may initially

decline


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CV

femoral venous pressure slowly

rises

stasis

dependent edema

varicosities

fibrinogen levels increase 50%

clotting factors

platelets

wbc protein


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GI

nausea and vomiting associated

with HCG

50% affected

peculiarities of taste and smell

intestines are displaced

heartburn

constipation


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GI

hemorrhoids

acidity of stomach decreases

hypertrophy of gums and

gingival bleeding


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Urinary

alterations

fluid retention,renal, ureter, and

bladder function

result of:

estrogen and progesterone

activity

compression

increased blood volume

postural influences


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Urinary

total body H2O content

increases

must increase Na reabsorption

retained to assist:

increased blood volume

source of nutrients for the fetus


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Urinary

excrete waste from mother and

fetus

breakdown protein

compensate for blood volume

UOP increases 60-80% specific gravity decreases


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Urinary

GFR increases

decrease BUN

increase filtration of glucose

ureters increase in diameter

bladder capacity increases

frequency increases (10-

12X/day)


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Skeletal

no obvious changes in teeth

noted

joints of pelvis relax r/t hormone

relaxin

waddle

shift in center of gravity


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Endocrine

placenta produces:

estrogen

progesterone

HCG

HPL

relaxin

prostaglandins


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Endocrine

thyroid

increased vascularity

hyperplasia

increased BMR

increased oxygen consumption


34/42

Endocrine

pituitary

decreased FSH and LH

Prolactin increases

secretes oxytocin

results in:

anovulation

lactation

increased pigmentation


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Endocrine

pancreas- early pregnancy

there is a decrease in insulin

production r/t increased fetaldemands

after 1st trimester

increase in insulin production r/tinsulin antagonist properties of

estrogen, progesterone, and HPL


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Psychological

attitudes depends on:

environment

social

cultural

family

individuals

gamut of emotions

need time to adjust


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First Trimester

Developmental Task

acceptance of pregnancy

50% are surprises

concerns center on self

partners response


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Second trimester

Acceptance of Baby

quickening

start to make plans

educate

fantasize


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Third Trimester

Preparing for Parenthood

nesting

must complete specific tasks

reworking developmental tasks

role playing

fantasizing


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Emotional Responses

ambivalence

grief

narcissism

introversion vs. extroversion

body image and boundary stress

couvade syndrome


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Responses

emotional lability

change in sexual desire

change in expectant family


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