chapter14 ob physical and physiological changes during pregnancy

7/31/2019 Chapter14 Ob Physical and physiological changes during pregnancy

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Unit 4

Chapter 14

Physical and psychologic changes

of pregnancy


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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- softening of the cervical tip

Chadwicks Sign- deepened violet-bluish color of

vaginal mucosa s/t increased vascularity of the area

Hegars Sign- softening & compressibility of loweruterus

Increase in size of uterus

Ballottement- rebound of unengaged fetus

Braxton-Hicks contractions

Serum lab tests (positive pregnancy test)

Serum & urine test= accurate assessment for presence of hCG

(production begins w/ implantation).

hCG- hormone produced by placenta


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Positive Signs

FHR/ fetal heart sounds

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 myometrialcells


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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 maternalblood 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 formsmucus plug.

Seals cervical canal to prevent infection

Expelled at start of labor


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Early signs of pregnancy may

include:

Softening of the uterus (Ladin's sign and Hegar's sign)

Ladin's sign is a clinical sign of pregnancy in which there issoftening in the midline of the uterus anteriorly at the junction of the

uterus and cervix. It occurs at about 6 weeks gestation

Hegar's sign is an indication ofpregnancy in a woman, specificallythe compressibility and softening of the cervical isthmus (the

portion of the cervix between the uterus and the vaginal portion of

the cervix) and the uterine cervix appearing bluish and engorged

Darkening of the nipples Unexplained pelvic or abdominal mass
http://en.wikipedia.org/wiki/Medical_signhttp://en.wikipedia.org/wiki/Pregnancyhttp://en.wikipedia.org/wiki/Uterushttp://en.wikipedia.org/wiki/Cervixhttp://en.wikipedia.org/wiki/Pregnancyhttp://en.wikipedia.org/w/index.php?title=Cervical_isthmus&action=edit&redlink=1http://en.wikipedia.org/wiki/Uterushttp://en.wikipedia.org/wiki/Cervixhttp://en.wikipedia.org/wiki/Cervixhttp://en.wikipedia.org/wiki/Cervixhttp://en.wikipedia.org/wiki/Cervixhttp://en.wikipedia.org/wiki/Uterushttp://en.wikipedia.org/w/index.php?title=Cervical_isthmus&action=edit&redlink=1http://en.wikipedia.org/wiki/Pregnancyhttp://en.wikipedia.org/wiki/Cervixhttp://en.wikipedia.org/wiki/Uterushttp://en.wikipedia.org/wiki/Pregnancyhttp://en.wikipedia.org/wiki/Medical_sign


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Vaginal changes

Hypertrophy, increased vascularization,

hyperplasia (enlargement) d/t estrogen

Increased secretions, loosening of

connective tissue


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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 are prominent

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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Respiratory system:

Increasing levels of progesterone causes:

Increased volume of air/increase tidal volume

Oxygen consumption increases

Decreased airway resistance

Increased anteroposterior diameter

Breathing changes from abdominal to

thoracic, occurs as uterus enlarges

Vascular congestion nasal mucosa


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Respiratory

tidal volume (normal breathing) 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 from fetus-

mother hyperventilates to blow off excess


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Respiratory

cumulative effect

SOB

nasal stuffiness

epistaxsis


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Cardiovascular system:

Increased levels of estrogen and progesterone

Cardiac output and blood volume increases

Blood volume increases 40%-45%

Decrease in systemic and pulmonary vascular

resistance

Increased size of uterus interferes with blood

return from lower extremities Increased level of red cells to increase

oxygen delivery to cells

Clotting factors increase


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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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GU system:

Increased blood volume

Glomerularfiltration rate increases

Renal tubular reabsorption increases

Pressure on bladder causes frequency


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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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Skin changes

Hyperpigmentation

Striae

Chloasma Vascular spider nevi

Decreased hair growth

Hyperactive sweat and sebaceous glands Linea nigra

V l id i


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Vascular spider nevi

Chl


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Chloasma


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Linea nigra


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Musculoskeletal changes

Relaxation ofjoints caused byincreased

estrogen andprogesterone

Center of gravity

changes Separation of

rectus

abdominus

E iti d t b li


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Eyes, cognitive and metabolic

changes Decreased intraocular pressure

Thickening of cornea

Reports of decreased attention,concentration, and memory

Extra water, fat, and protein are stored

Fats are more completely absorbed


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Endocrine changes

T4 and BMR increase, TSH decreases

Concentration of parathyroid hormone

increases

Thyrotropin (known also as thyroid stimulating hormone

(TSH) and adrenotropion (adrenal hormone) alter

maternal metabolism

Prolactin is responsible for lactation

secretion of oxytocin and vasopressin

Increased aldosterone


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Endocrine

placenta produces:

estrogen

progesterone

HCG

HPL (human placental lactogen)

relaxin

prostaglandins


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Endocrine

thyroid

increased vascularity

hyperplasia

increased BMR

increased oxygen consumption


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Endocrine

pancreas- early pregnancy

there is a decrease in insulin production r/t

increased fetal demands

after 1st trimester

increase in insulin production r/t insulin

antagonist properties of estrogen,

progesterone, and HPL


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Vena cava syndrome

is a result of obstruction of the inferior

vena cava. It can be caused by invasion or

compression by a pathological process or

by thrombosis in the vein itself.

This is quite common during the third

trimester ofpregnancy when the uterus

compresses the vein in the right sideposition.
http://en.wikipedia.org/wiki/Inferior_vena_cavahttp://en.wikipedia.org/wiki/Inferior_vena_cavahttp://en.wikipedia.org/wiki/Thrombosishttp://en.wikipedia.org/wiki/Pregnancyhttp://en.wikipedia.org/wiki/Uterushttp://en.wikipedia.org/wiki/Uterushttp://en.wikipedia.org/wiki/Pregnancyhttp://en.wikipedia.org/wiki/Thrombosishttp://en.wikipedia.org/wiki/Inferior_vena_cavahttp://en.wikipedia.org/wiki/Inferior_vena_cava


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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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Emotional Responses

ambivalence

grief

narcissism

introversion vs. extroversion

body image and boundary

stress couvade syndrome


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chapter14 ob physical and physiological changes during pregnancy

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