PHYSIOLOGICAL AND PSYCHOLOGICAL CHANGES OF PREGNANCY

1
PHYSIOLOGICAL AND PSYCHOLOGICAL CHANGES OF
PREGNANCY

• DEBBIE AMASON,RN,MS
• SPRING 2001

2
Changes

• affect both parents
• physiologic
• psychological
• temporary
• state of wellness

3
Diagnosis

• feelings can be good or bad
• confirmation
• early diagnosis important

4
Presumptive Signs

• can be caused by other problems
• amenorrhea
• nausea and vomiting
• fatigue
• urinary frequency
• breast tenderness
• quickening

5
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

6
Positive Signs

• fetal heart rate
• fetal movement felt by examiner
• visualization by ultrasound

7
Physiological Changes

• local- reproductive
• systemic- major body organs

8
Local

• Uterus
• pre-pregnancy small semisolid pear shaped
• weight increases from 50Gm to 1000Gm
• enlargement primarily a result of hypertrophy of
  pre-existing myometrial cells

9
Uterine

• development of new fibro-elastic tissue between
  bands of muscles
• cells increase as result of estrogen
• measure
• lightening

10
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

11
Uterus

• Braxton Hicks
• painless contractions
• estrogen
• distention of the uterus
• felt by 4th month
• practicing
• no cervical changes occur
• amenorrhea

12
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

13
Cervix

• increased mucus leads to increased discharge
• increased vascularity and increased discoloration

14
Vagina

• epithelium undergoes hypertrophy and hyperplasia
• estrogen
• secretions are acidicgt increased growth of
  Candida
• at term vaginal walls are relaxed

15
Ovaries

• cease ovum production related to active feedback
  mechanism of estrogen and progesterone produced
  by the corpus luteum and the placenta

16
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

17
Breasts

• pigmentationof areola is more prominent
• sebacious glands enlarge (Montgomery Tubercles)
• 16th week colostrum

18
Integumentary System

• nipples and areola areas of breasts are darker
• striae gravidarum
• linea nigra
• chloasma
• diastasis rectus

19
Respiratory

• tidal volume increases 40
• respiratory rate increases
• small degree of hyperventilation
• oxygen consumption increases by 20
• diaphragm is displaced gtSOB
• no change in vital capacity

20
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

21
Respiratory

• cumulative effect
• SOB
• nasal stuffiness
• epistaxsis

22
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

23
CV

• rise in cardiac output 25-50
• pulse rate increases
• BP remains relatively unchanged
• concentration of Hgb and erythrocytes may
  initially decline

24
CV

• femoral venous pressure slowly rises
• stasis
• dependent edema
• varicosities
• fibrinogen levels increase 50
• clotting factors
• platelets
• wbc, protein

25
GI

• nausea and vomiting associated with HCG
• 50 affected
• peculiarities of taste and smell
• intestines are displaced
• heartburn
• constipation

26
GI

• hemorrhoids
• acidity of stomach decreases
• hypertrophy of gums and gingival bleeding

27
Urinary

• alterations
• fluid retention,renal, ureter, and bladder
  function
• result of
• estrogen and progesterone activity
• compression
• increased blood volume
• postural influences

28
Urinary

• total body H2O content increases
• must increase Na reabsorption
• retained to assist
• increased blood volume
• source of nutrients for the fetus

29
Urinary

• excrete waste from mother and fetus
• breakdown protein
• compensate for blood volume
• UOP increases 60-80
• specific gravity decreases

30
Urinary

• GFR increases
• decrease BUN
• increase filtration of glucose
• ureters increase in diameter
• bladder capacity increases
• frequency increases (10-12X/day)

31
Skeletal

• no obvious changes in teeth noted
• joints of pelvis relax r/t hormone relaxin
• waddle
• shift in center of gravity

32
Endocrine

• placenta produces
• estrogen
• progesterone
• HCG
• HPL
• relaxin
• prostaglandins

33
Endocrine

• thyroid
• increased vascularity
• hyperplasia
• increased BMR
• increased oxygen consumption

34
Endocrine

• pituitary
• decreased FSH and LH
• Prolactin increases
• secretes oxytocin
• results in
• anovulation
• lactation
• increased pigmentation

35
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

36
Psychological

• attitudes depends on
• environment
• social
• cultural
• family
• individuals
• gamut of emotions
• need time to adjust

37
First Trimester

• Developmental Task
• acceptance of pregnancy
• 50 are surprises
• concerns center on self
• partners response

38
Second trimester

• Acceptance of Baby
• quickening
• start to make plans
• educate
• fantasize

39
Third Trimester

• Preparing for Parenthood
• nesting
• must complete specific tasks
• reworking developmental tasks
• role playing
• fantasizing

40
Emotional Responses

• ambivalence
• grief
• narcissism
• introversion vs. extroversion
• body image and boundary
• stress
• couvade syndrome

41
Responses

• emotional lability
• change in sexual desire
• change in expectant family

42
(No Transcript)