Physiological and Psychosocial Changes During Pregnancy

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Chapter 8

• Physiological and Psychosocial Changes During
  Pregnancy

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Hormonal Influences

• Pituitary hormones
• Influence ovarian follicular development
• Prompt ovulation
• Stimulate uterine lining
• Corpus luteum
• Estrogen growth
• Progesterone maintenance

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Ovarian Hormones

• Maintain endometrium
• Provide nutrition
• Aid in implantation
• Decrease uterine contractility
• Initiate breast ductal system development

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Reproductive System
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Uterus

• Patterns of uterine growth
• Estrogen, progesterone hyperplasia, hypertrophy
  allow uterus to enlarge, stretch
• Weight increases from 70 g to 1100 g at term
• Increased blood flow

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Braxton-Hicks Contractions

• Irregular, painless
• Prepare uterine muscles
• If irregular and last lt60 seconds, reassure woman
• Regular pattern or associated with other
  symptoms, seek medical attention

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Cervix

• Chadwicks sign
• Goodell sign
• Softens
• Forms mucus plug
• Call if discharge bloody or yellow/green, foul
  odor, itching, or pain

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Vagina and Vulva

• Thickening of vaginal mucosa
• Rugae
• Becomes edematous
• More susceptible to yeast infections
• pH decreases from 6.0 to 3.5
• Discuss vulvar hygiene

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Other Reproductive Changes

• Ovaries
• Breasts
• Montgomery tubercles
• Increased pigmentation (areolae)
• Discuss bra size changes, options for infant
  feeding, and strategies for successful
  breastfeeding

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Integumentary System

• Hyperpigmentation
• Chloasma
• Linea nigra
• Cutaneous vascular changes
• Striae gravidarum
• Angiomas
• Palmar erythema

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Neurological System

• Decreased attention span
• Poor concentration
• Memory lapses
• Carpal tunnel syndrome
• Syncope
• Anticipatory guidance regarding changes

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Cardiovascular System
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Heart

• Position pushed upward, laterally to left
• Cardiac hypertrophy due to increased blood
  volume, cardiac output
• Heart sounds exaggerated first and third
  systolic murmurs

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Blood Volume

• Plasma and erythrocyte volume increase
• Increased need for iron
• Physiologic anemia
• Teach regarding adequate hydration and diet high
  in protein, iron
• Increased fibrinogen volume

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Cardiac Output

• Blood pressure
• Stasis of blood in lower extremities risk for
  varicose veins and venous thrombosis
• Encourage daily walks to enhance circulation,
  improve intestinal peristalsis

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Supine Hypotension Syndrome

• Pressure from enlarged uterus decreases venous
  return from lower extremities
• Hypotension, dizziness, diaphoresis, pallor
• Orthostatic hypotension
• Stagnation of blood in lower extremities
• Encourage to rise slowly keep feet moving while
  standing

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Supine Hypotension
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Respiratory System

• Increased tidal volume
• Increased oxygen consumption
• Diaphragm elevates
• Increased chest circumferencedyspnea
• Educate regarding normal changes and symptoms

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Eyes, Ears, Nose, Throat

• Blurred visiondecreased intraocular pressure and
  corneal thickening
• Temporary condition
• Nasal stuffiness, congestionincreased mucus
  production
• Epistaxis
• Encourage increased fluid intake

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Gastrointestinal System
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Upper GI Tract

• Mouth
• Gingivitis, ptyalism, hypertrophy of gums, epulis
• Esophaguspyrosis, reflux
• Stomach and small intestine
• Morning sickness, absorption of nutrients

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Lower GI Tract

• Large Intestineconstipation
• Liver and gallbladder
• Cholestasia, cholecystitis, cholelithiasis

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Urinary System

• Bladder
• Urinary frequency and urgency
• Kidneys and ureters
• Structural changes
• Functional changes
• Glomerular filtration rate increases

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Endocrine System
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Endocrine Glands

• Thyroid gland
• Increased T4
• Progressive increase in basal metabolic rate
• Pituitary gland
• Prolactin
• Oxytocin
• Vasopressin

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Endocrine Glands

• Adrenal glands
• Increased cortisol
• Increased aldosterone
• Pancreas
• Increased number, size of beta cells

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Musculoskeletal System

• Postural changes
• Lumbar lordosis
• Waddle gait
• Calcium storage
• Decreased maternal serum calcium
• Lower extremity cramps

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Assessment and Health Education

• Comprehensive history and physical exam
• Ongoing education focusing on current trimester
  and physical changes

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Maternal Role Transition

• Rubintasks of pregnancy
• Incorporate pregnancy into identity
• Acceptance of the child
• Reorder relationships

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Pregnant Adolescent

• Normal adolescent developmental tasks conflict
  with tasks of pregnancy
• May not seek prenatal care
• Not future orientedmay not accept reality of
  unborn child
• Acceptance of pregnancy hindered

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Paternal Adaptation

• Styles of involvement observer, expressive, and
  instrumental
• Couvade
• Announcement phase
• Moratorium phase
• Focusing phase

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Developmental Processes

• Grappling with the reality of pregnancy and the
  child
• Struggling for recognition as a parent
• Creating the role of involved father
• Seeking parenting information
• Couvade

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Adaptation of Siblings

• Reactions influenced by age and level of
  involvement with pregnancy
• Toddlers
• Regression
• Older children
• May not grasp reality of a baby in the family
• Adolescents

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Adaptation of Grandparents

• Age affects reactions
• Number and spacing of other grandchildren
• Perceptions of the role of grandparents

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Other Considerations

• Single mother
• Cultural influences
• High-tech management
• Societal influences

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Nursing Assessment of Psychosocial Changes

• Thorough history family background, past
  obstetrical events, status of current pregnancy
• Each visitask about pregnancy experience,
  address concerns, offer anticipatory guidance

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Anticipatory Guidance

• Refer to Table 8-5