chapter 10 physiological psychological changes in pregnancy

7/29/2019 Chapter 10 Physiological Psychological Changes in Pregnancy

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Psychological and Physiologic

Changes in Pregnancy

Pregnancy brings both psychological andphysical changes to the woman and her

partner.

Physiologic changes occur gradually buteventually affect all organ systems of a

womans body.

Psychological changes occur in response to

physiologic alterations.

Pregnancy represents wellness not illness.


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Diagnosis of Pregnancy

Marks a major milestone.

Presumptive Signs of Pregnancy:

least indicative of pregnancy, could indicate

other conditions

subjective-experienced by the woman

breast changes, nausea, vomiting,

amenorrhea, frequent urination, fatigue,uterine enlargement, quickening, linea

nigra, melasma, stria gravidarum.


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Probable Signs of PregnancySigns that can be documented by the examiner

Serum laboratory tests:

hCG in urine or blood serum of the women.

accurate 95% to 98 % of the time.

home pregnancy tests are 97% accurate.

women taking psychotropic drugs may have

a false positive result on pregnancy test. discontinue oral contraceptives 5 days

before the test.


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Chadwicks sign

Goodells sign Hegars sign

Sonographic evidence of gestational sac

Ballottement

Braxton Hicks sign

Fetal outline felt by examiner


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Positive Signs of Pregnancy

Sonographic evidence of fetal outline

week 6-8 Fetal heart audible

week 18-20

Fetal movement felt by examiner

week 20-24


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Psychological Changes of Pregnancy

Psychological Changes of Pregnancy:

The womans attitude toward the pregnancy dependson the environment in which she is raised.

Social influences

Pregnancy is not an illness, now the family isincluded.

Use of birthing centers has increased.

Demedicalize childbirth.

Cultural influences How active a role she wants to take.

Certain beliefs and taboos may place restrictionson her behaviors and activities.


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Psychological Changes of Pregnancy

Family influences

Viewed in a positive or negative light.

Stories about pain and endless suffering in

labor.

People love as they have been loved.

Individual influences

Ability to cope with or adapt to stress. Secure in her relationship.

Pregnancy takes away her freedom.


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Psychological Tasks of Pregnancy

1st Trimester:

Accepting the Pregnancy

50% of all pregnancies are unintended,

unwanted or mistimed. Surprise!

Women sometimes experience

disappointment, anxiety or ambivalence.

Partner may go through some changes also.

Partner should give emotional support.

May feel proud, happy, jealous or loss.


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2nd Trimester

Accepting the Baby:

Second turning point is often quickening.

Proof of the childs existence.

Anticipatory role playing.

May accept at conception, at birth or later.

How well she follows prenatal instructions. Partner may feel left out, he may increase

his work, he has misinformation.

Educate both partners.


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3rd Trimester:

Preparing for Parenthood

nest building

attending prenatal classes or parentingclasses.


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Reworking Developmental Tasks

working through previous life experiences.

womans relationship with her parents,particularly her mother.

fear of dying.

Needs confidence in health care providers. Men may need to reconcile feelings toward

fathers and learn a new pattern of behavior.


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.

Role-playing and Fantasizing:

Second step in preparing of parenthood.

Spend time with other mothers to learn how

to be a mother. Needs good role models.

Father may need to change his carefree

individual to a member of a family unit.

Nurturing roles.


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Emotional Responses to Pregnancy

Ambivalence

Grief Narcissism

Introversion versus Extroversion

Body Image and Boundary

Stress

Couvade Syndrome

Emotional Lability

Changes in Sexual Desire

Changes in the Expectant Family


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Physiologic Changes of Pregnancy

Local changes - confined to the reproductive

organs.

Systemic changes - affecting the entire body.

Both subjective (symptoms) and objective

(signs) findings are used to diagnose andmark the progress of the pregnancy.


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Reproductive System Changes:

Uterine changes: Increase in size, length, depth, width, weight,

wall thickness and volume.Length-from 6.5 to 32 cm.

Depth-increases from 2.5 to 22 cm.Width-expands from 4 to 24 cm.

Weight-increases from 50 to 1,000 g.

Uterine wall thickens from 1 cm to 2 cm by the

end of pregnancy, the wall thins so it is supple and0.5 cm thick.

Volume of uterus increases from 2 mL to 1,000mL. It can hold a 7 lb. fetus plus 1,000 mL ofamniotic fluid. Total 4,000 g.


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Uterine growth is due to formation of a few

new muscle fibers and stretching of existingmuscle fibers (2 to 7 times longer).

Week 12 the fetus is palpated just above the

symphysis pubis.Week 20 or 22 the fetus is at the umbilicus.

Week 36 should touch the xiphoid process

which causes some SOB.


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Terms

Primigravida - woman in her 1st pregnancy.

Multipara - a woman who has had 1 or more

children.


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Lightening - 2 weeks before term (week 38)

the fetal head settles into the pelvis toprepare for birth and the uterus returns to

the height it was at on the 36 week.

This permits better lung expansion andeasier breathing.

This is predictable in 1st birth but not

others. Uterine growth is a presumptive sign of

pregnancy.

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As the uterus increases in size it:

pushes the intestines to the side elevates the diaphragm and liver

puts pressure on the bladder

Uterine blood flow increases:

before pregnancy - 15 to 20 mL/ min.

by the end of pregnancy - 500 to 750

mL/min. with 75% going to the placenta.

Uterine bleeding can be a major blood loss.

Uterus is anteflexed, larger and softer.


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Hegars sign - extreme softening of the lower

uterine segment. The wall can not be felt orit feels as thin as tissue paper with bimanual

exam.

Ballottement - on bimanual exam, tapping oflower segment the fetus is felt to bounced or

rise in the amniotic fluid up against the to

top examining hand (week 16 to 20).Braxton Hicks contractions - practice

contractions. Week 12 until term. Waves of

hardness or tightening across the abdomen.

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They serve as warm-up exercise and

increase placental perfusion.

False labor, the do not cause cervical

dilation.

Amenorrhea - absence of menstruation dueto suppression of FSH.

Presumptive sign.

Cervical changes:

Cervix more vascular and edematous.

Increased fluid between the cells causes


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the cervix to soften and increased

vascularity causes it to darken from pale

pink to a violet hue.

A tenacious coating of mucus fills the

cervical canal.

Operculum - mucous plug - seals out

bacteria during pregnancy.

Goodells sign - softening of the cervix.

Nonpregnant cervix is like the nose.

Pregnant is like earlobe.

Ph i l i Ch f P


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Just before labor the cervix becomes soft

like butter and is ripe for birth.Vaginal changes:

vaginal epithelium become hypertrophic

and enriched with glycogen which results inwhite vaginal discharge throughout

pregnancy.

Chadwicks sign - vaginal walls are deepviolet color due to increased circulation.

pH 4 to 5 (from pH over 7) favors growth of

Candida albicans (yeast like fungi).

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due to Lactobacillus acidophilus a bacteria

that grows freely in glycogen environment,

so this increases the lactic acid content.

Ovarian changes:

ovulation stops.

Corpus luteum increases in size until week

16 and then the placenta has taken over as

provider of progesterone and estrogen.


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Changes in the breasts:

result of estrogen and progesterone

production. (1st change)

feeling of fullness, tingling or tenderness.

Size increases due to hyperplasia of

mammary alveoli and fat deposits.

aerola darkens and diameter increases to 3.5

cm to 5 or 7.5 cm (1 1/2 to 3 inches)

blue veins become prominent.

Montgomerys tubercles-sebaceous glands

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of the areola enlarge and become protuberant.

secretions keep the nipple supple and help

prevent cracking and drying during lactation

week 16 colostrum-a thin, watery, high

protein fluid can be expelled from the breast

Systemic Changes:

Integumentary System

Abdominal wall must stretch

Striae gravidarum - pink or reddish

streaks on sides of abdomen and thighs.

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Systemic Changes

Caused by rupture and atrophy of the

connective layer of the skin. After birth this lightens to silvery-white

color. (permanent)

Diastasis-rectus muscles separate, willappear after pregnancy as a bluish groove.

Umbilicus stretches until it is smooth.

Extra pigmentation on abdominal wall. Linea nigra - brown line from umbilicus to

symphysis pubis.

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Systemic Changes

Melasma - darkened areas on face due to

melanocyte-stimulating hormone secretedby the pituitary.

Vascular spiders - small fiery-red branching

spots on thighs, increases estrogen. Palmar erythema - redness and itching.

Increased sweat gland activity.

Scalp hair growth increases.

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Systemic Changes

Respiratory System

SOB Chronic respiratory alkalosis compensated

by chronic metabolic acidosis.

Diaphragm is displaced by 4 cm upward. Vital capacity does not decrease.

Total O2 consumption is increased by 20%.

Mild hyperventilation.

Polyuria - increased urination due to

plasma bicarbonate excreted by the kidneys.

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Systemic Changes

respirations > 20/min.

congestion of nasopharynx - increasedestrogen levels

Temperature:

increased for 16 weeks due to secretion ofprogesterone from the corpus luteum,

returns to normal once the placenta takes

over.

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Systemic Changes

Cardiovascular System:

Changes are extreme and significant to thehealth of the fetus.

Blood volume

increases by 30 to 50 %

blood loss at birth-300 to 400 mL

cesarean birth-800 to 1,000 mL

increase blood volume peaks at week 28 to

32

Systemic Changes


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Systemic Changes

Pseudoanemia - concentration of

hemoglobin and erythrocytes decline.

Iron needs

fetus requires 350 to 400 mg to grow.

Mother has an increase in RBC needing anadditional 400 mg of iron.

Prenatal vitamins and foods supply needs.

Heart cardiac output increases by 25 to 50 %

heart rate increases by 10 beats/ min.

heart is shifted more transverse

Systemic Changes


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Systemic Changes

Innocent heart murmurs due to positioning.

Palpitations SNS

Regional blood flow:

3rd trimester blood flow to lower

extremities is impaired due to pressure onveins and arteries.

leads to edema and varicoaities.

Blood pressure:

does not normally rise

may decrease in 2nd trimester

S stemic Changes


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Systemic Changes

Supine hypotension syndrome:

when woman lies supine the weight of theuterus presses on the vena cava obstructing

blood return to the heart.

risk fetal hypoxia lightheadedness, faintness and palpitations.

rest on left side.

Blood constitution: level of circ. fibrinogen increases 50%.

Factors VII, VIII, IX, X and platelets

increase.

Systemic Changes


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Systemic Changes

Blood lipids increase by 1/3

cholesterol level increase 90 to 100 %

Gastrointestinal system

Uterus displaces the stomach and intestines

toward the back and sides of the abdomen. Pressure slows peristalsis and the emptying

time of the stomach.

Leads to heartburn, constipation andflatulence.

Nausea and vomiting in early morningwhen hCG and progesterone begin to rise.

Systemic Changes


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Systemic Changes

May be a systemic reaction to increases

estrogen or decreased glucose levels.

Subsides after 3 months

Generalized itching due to reabsorption of

bilirubin into the mothers blood stream due

to decreased emptying of bile from the GB.

Hypertrophy of the gumlines and bleeding.

Peptic ulcers improve.

Systemic Changes


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Systemic Changes

Urinary System

Effects of estrogen and progesteroneactivity.

Compression of the bladder and ureters.

Increased blood volume Postural influences

Fluid retention:

total body water increases to 7.5 L increase sodium reabsorption

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Systemic Changes

Increased aldosterone production.

Potassium remains adequate.

Water retension increases blood volume to

serve as a source of nutrients to the fetus.

Renal Function:

Kidneys change size.

Urinary output increases by 60 to 80 %. GFR and renal plasma flow increase.

Creatinine clearance tests for renal function.

Systemic Changes


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Systemic Changes

Ureter and Bladder Function

ureters increase in diameter due to increasedprogesterone.

bladder capacity increases to 1,500 mL

pressure on the urethra may lead to poorbladder emptying and infections.

May lead to kidney infection.

Systemic Changes


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Systemic Changes

Skeletal System

Calcium and phosphorus increase for fetal

skeleton.

Softening of pelvic ligaments and joints.

Relaxin (ovarian hormone) and placental

progesterone.

Separation of symphysis pubis-3 to 4 mm.

Stand straighter and taller - lordosis

Center of gravity is changed.

Systemic Changes


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Systemic Changes

Endocrine System

Almost all aspects of the endocrine system

increase.

Placenta is an endocrine organ

Produces estrogen, progesterone, hCG,

human placental lactogen,relaxin,

prostaglandins.

Pituitary Gland

there is a halt to FSH and LH due to high

estrogen and progesterone levels.

Systemic Changes


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Systemic Changes

Increase in production of growth hormone

and melanocyte-stimulating hormone. Late in pregnancy it produces oxytocin and

prolactin.

Thyroid and Parathyroid Glands thyroid enlarges and BBM (metabolism)

increases by 20%

iodine and thyroxine are elevated.

Parathyroid enlarges due to increased

calcium requirements.

Systemic Changes


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Systemic Changes

Adrenal Gland

Elevated levels of corticosteroids and

aldosterone are produced.

Aids in suppressing an inflammatory

reaction or helps to reduce the possibility of

rejection of the fetus.

Regulates glucose metabolism.

Promotes sodium reabsorption and

maintaining osmolarity in fluid retained.

Safeguards blood volume and perfusion

Systemic Changes


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Systemic Changes

Pancreas

Increases insulin production in response tohigh glucocorticoid production.insulin is

less effective then normal because estrogen,

progesterone and hPL are antagonists toinsulin.

Diabetic needs more insulin.

Maternal glucose levels are usually higher. Fat stores and available glucose are utilized.

Systemic Changes


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Systemic Changes

Immune System

Competency decreases (IgG) to not rejectthe fetus.

Increase in WBC to counteract the decrease.

chapter 10 physiological psychological changes in pregnancy

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