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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