PHYSICAL AND PSYCHOLOGIC CHANGES OF PREGNANCY

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PHYSICAL AND PSYCHOLOGIC CHANGES OF PREGNANCY

• CHAPTER 9

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REPRODUCTIVE SYSTEM uterus

• INCREASES FROM 60 G TO 1000G
• HYPERTROPHY OF MYOMETRIAL CELLS AND GROWING FETUS
• 1/6 OF TOTAL MATERNAL BLOOD VOLUME IS CONTAINED
  IN UTERUS AT END OF PREGNANCY
• BRAXTON-HICKS CONTRACTIONS

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CERVIX

• MUCOUS PLUG SEALS CERVIX
• GOODELLS SIGN SOFTENING OF CERVIX
• CHADWICKS SIGN BLUISH COLORATION

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BREASTS

• ENLARGE AND MORE NODULAR
• NIPPLES MORE ERECTILE
• AREOLAS DARKEN
• COLOSTRUM LAST TRIMESTER

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RESPIRATORY

• Progesterone decreases airway resistance
• Increase in O2 consumption and volume of air.
• Nasal stuffiness and epistaxis increase due to
  edema and vascular congestion of nasal mucosa
• Asthma usually decreases, but breathing
  difficulty increases in 3rd trimester

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CARDIOVASCULAR

• BLOOD VOLUME INCREASES TO 45 ABOVE NONPREGNANT
  LEVELS
• CARDIAC OUTPUT INCREASES
• PULSE INCREASE BY 10-15
• DEPENDANT EDEMA VENOUS STASIS
• VENA CAVAL SYNDROME
• PHYSIOLOGIC ANEMIA

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GASTROINTESTINAL SYSTEM

• Nausea and vomiting
• Increase saliva
• Bloating and constipation
• Heartburn
• Hemorrhoids
• Constipation
• Gallstone formation cholecystitis

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URINARY

• Changes by trimester
• Glomerular filtration rises by 50
• Glycosuria
• Stones

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SKIN

• LINEA NIGRA
• FACIAL CHLOASMA
• STRIA
• VASCULAR SPIDER NEVI

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MUSCULOSKELETAL

• Joints of pelvis relax due to hormone-relaxin
• Waddling gait
• Center of gravity changes
• Diastasis recti- separation of rectus abdominis
  muscle

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WEIGHT GAIN

• Normal pre-pregnant BMI 25-35 pounds (30 is
  ideal)
• Overweight- 15 -25
• Underweight- 28 to 40
• 1st trimester 3-5 pounds
• 2nd and 3rd 12 to 15 each

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Endocrine System

• Thyroid
• Pituitary
• Pancreas

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HORMONES IN PREGNANCY

• Human Chorionic Gonadotropin (HCG)
• Human Placental lactogen
• Estrogen
• Progesterone
• Relaxin
• Prostaglandin

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PRESUMPTIVE SIGNS OF PREGNANCY

• Amenorrhea
• Nausea and vomiting
• Excessive fatigue
• Urinary frequency
• Breast changes
• Quickening or fluttering movement

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OBJECTIVE OR PROBABLE CHANGES IN PREGNANCY

• Changes in pelvic organs
• Goodells and Chadwicks sign
• Hegars sign
• McDonalds sign
• Fundus palpable above symphysis pubis at 10-12
  weeks and at the umbilicus at 20 weeks

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• Braxton Hicks contractions
• Uterine souffle
• Funic souffle
• Fetal outline
• Positive Pregnancy test
• Urine
• Serum
• Over the counter

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DIAGNOSTIC OR POSITIVESIGNS OF PREGNANCY

• Fetal Heartbeat
• Fetal movement felt by examiner
• Visualization of the fetus by ultrasound

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PSYCHOLOGIC RESPONSES

• Mother
• Ambivalence
• Introversion
• Mood swings
• Altered body image
• Mood swings
• Acceptance and excitement

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Psychological Tasks of the Mother

• Rubin identified four major tasks that the
  pregnant woman goes through
• Ensuring safe passage through pregnancy, labor
  and forth
• Seeking acceptance of this child by others
• Seeking commitment and acceptance of herself as
  mother to the infant (binding in)