PSYCHOLOGICAL AND PSYCHOLOGICAL AND PHYSIOLOGIC CHANGES OF PHYSIOLOGIC CHANGES OF PREGNANCYPREGNANCY

LIEZEL B. CAUILAN RN; MSN

IMPORTANT IMPORTANT DEFINITIONSDEFINITIONSGRAVIDA- A woman who is or who

has been pregnant.PRIMIGRAVIDA- A woman

pregnant for the 1st time.PRIMIPARA- A woman who has

given birth to a fetus that has reached the stage of viability.

MULTIPARA- A woman who has had two or more pregnancies to the stage of viability.

PARA I- A woman who has had 2 children of viable age.

MULTIGRAVIDA- A woman who has been pregnant previously

NULLIGRAVIDA- A woman who has never been and is currently not pregnant

SIGNS AND SYMPTOMS OF SIGNS AND SYMPTOMS OF PREGNANCYPREGNANCY

PRESUMPTIVE SIGNSPRESUMPTIVE SIGNS1. Menstrual Suppression

2. Nausea, vomiting and “morning sickness”

3. Frequency of micturition

4. Tenderness and fullness of the breasts, breast pigmentation and discharge.

5. Quickening –tremulous fluttering low in the abdomen toward the end of the 5th month.

6. “Chadwicks sign”-dark blue discoloration of the vaginal mucous membrane

7. Pigmentation of the skin and abdominal striae

-striae gravidarum- caused by the stretching, rupture and atrophy of the deep connective tissue of the skin

SUMMARY OF SUMMARY OF PRESUMPTIVE SIGNSPRESUMPTIVE SIGNS Changes felt by a woman/Subjective SignMorning sicknessAmenorrheaC-hanges in BreastFatigueLassitudeUrinary FrequencyQuickening (18th-20th weeks)

PROBABLE SIGNSPROBABLE SIGNS1. Abdominal changes2. Changes in the consistency, size, shape of

the uterus (Hegar’s sign- softening of the lower uterine segment)

3. Fetal outline distinguished by abdominal palpation and detection of fetal part vaginally by BALLOTEMENT-

4. Cervical changes (Goodell’s sign)5. Braxton Hicks Contractions-painless

contractions which causes the uterine muscles to contract and relax, thereby enlarging to accommodate the growing fetus.

6. Positive pregnancy test Early chorionic villi secrete hCG which

appears in the maternal blood and is excreted in the urine

SUMMARY OF PROBABLE SUMMARY OF PROBABLE SIGNSSIGNS

Changes observed by an examiner/Objective signChadwick’s sign- bluish discoloration of vaginal

wallHegar’s sign- softening of the lower uterine

segmentUterine enlargement- at 12 wks. Aog, felt just

above symphisis pubisPositive pregnancy testBallotement- sinking and rebound of fetusOutlining of fetal bodyGoodells – softening of the cervixSouflle, contraction and braxton hicks(painless contraction at 28 weeks)

POSITIVE SIGNSPOSITIVE SIGNS1. Fetal Heart Sounds2. Funic and Uterine Souffles Souffle- a blowing murmur or whizzing sound Funis- latin for umbilical cord FUNIC SOUFFLE- Soft blowing murmur

caused by blood rushing through the umbilical cord.

UTERINE SOUFFLE- Produced by blood rushing through the large vessels of the uterus.

3. Fetal movements felt by the examiner4. Roentgenogram (X-ray)5. Sonography

SUMMARY OF POSITIVE SUMMARY OF POSITIVE SIGNSSIGNS Definitive signs of pregnancy/Diagnostic

signs of pregnancy

Can be assessed at 10 weeks by DOPPLER, 16 weeks by FETOSCOPE, 18-20 weeks by AUSCULTATION

Movement- felt by examiner usually after 20 weeks

Skeleton- by sonography or x-ray

Fetal heartbeat

MATERNAL PHYSIOLOGY MATERNAL PHYSIOLOGY DURING PREGNANCYDURING PREGNANCY REPRODUCTIVE SYSTEM1. UTERUS Enlargement and thickening (hypertrophy)

of the uterus, most marked in the fundus. By 12th week, it is large enough to be

palpated as a firm globe under the abdominal wall just above the symphisis pubis.

By the 20th week aog, it is at the level of the umbilicus, xiphoid by the 36th week, descends lighlty during the last 3 w ks. due to fetal descentin the pelvis.

2. CERVIX Pronounced softening and cyanosis-

GOODELLS SIGN Cervical plug is formed by clot or thick

mucus. It is known as OPERCULUM- serves to seal out bacteria during pregnancy.

Before labor, it becomes so soft that it is said to be “ripe for birth”.

3. OVARIES Ovulation cease throughout pregnancy.

4. VAGINA Vaginal epithelium and underlying tissue

becomes hypertrophic and enriched with glycogen.

Increased vascularity which changes the color of the vaginal walls from light pink to deep violet (chadwicks sign).

Vaginal secretions increase; ph is 3.5-6 and becomes acidic because of increased lactic acid production (doderleins bacilli).

5. BREASTS Tender and tingle in the 1st weeks of

pregnancy

Breast size increases Areola darkens and increases its size Montgomery’s tubercles enlarge and

become protruberant. Colostrum is present by 2nd trimester.

INTEGUMENTARY SYSTEMStriae Gravidarum- pink, reddish streaks

appearing on the sides of the abdominal wall, and sometimes on the thighs.

Linea Nigra- line of dark, pigment extending form the umbilicus down the midline to the symphisis

Melasma (chloasma)-”mask of pregnancy”- darkened areas on the face, particularly on the cheeks and across the nose.

Pigmentation- due to increase MSH from the 2nd month of pregnancy

Vascular spiders –seen on the thighs Palmar erythema –redness and itching on

the hands Scalp hair growth is increased

RESPIRATORY SYSTEM1. Marked congestion or “stuffiness” of the

nasopharynx.2. Hyperventilation occurs.3. Diaphragm is elevated. CARDIOVASULAR SYSTEM1. Cardiac volume increases causing slight

cardiac hypertrophy and increase in CO.2. Pseudoanemia3. PR increases by 10-15 bpm4. Slight decrease in BP in the 2nd or 3rd

trimester.

5. Heart is displaced upward by the diaphragm.6. Decrease blood flow to the venous system.7. Supine Hypotension Syndrome- a decrease in

blood return to the heart and consequently decreased CO and hypotension

S/Sx of Supine Hypotension:1. Lightheadedness2. Faintness3. PalpitationsMgt: instruct a woman to lie on her side

preferably the LEFT!!!

8. Fibrinogen increases9. Clotting factors (VII, VIII, IX and X) &

Platelet count increase.METABOLIC CHANGES1. Average weight gain is 11-13 kgs. (24-28 lbs)1st tri- 2-4 lbs. 2nd tri- 12-14 lbs. 3rd tri- 8-12 lbs.2. An average woman retains 6.5 liters of

water.3. Human placental lactogen, estrogen,

progesterone and insulin produced by the placenta oppose the action of insulin.

4. There is “sparing of glucose”.

5. Plasma lipid level increases.6. Iron requirement increases to 20-40 mg.

daily. ENDOCRINE SYSTEM1. The placenta produces ESTROGEN,

PROGESTERONE, Hcg, hpl.2. Elevated estrogen and progesterone

suppresses LH, FSH, and oxytocin. URINARY SYSTEM1. GFR increases early in pregnancy2. Ureters become dilated and elongated during

pregnancy due to mechanical pressure.

3. Glucosuria may be evident because of decreased renal threshold for glucose.

DIGESTIVE SYSTEM1. Slowed GI motility and digestion2. Displacment of intestines and compression of

sotmach3. Common problemsa. Morning sickness- nausea and vomiting early

in the morningb. Heartburn- reflux of stomach content into the

esophagusc. Pica- abnormal craving for substancesd. Constipation- d/t reduced GI activity,

pressure of

Placental hormone RELAXINe. Flatulencef. Bleeding gums SKELETAL SYSTEMa. Gradual softening of pelvic ligaments and

jointsb. Lordosis (pride of pregnancy)- forward

curvature of the lumbar spine with the shoulders, back and abdomen forward)

c. Leg cramps

PSYCHOLOGICAL TASK PSYCHOLOGICAL TASK OF PREGNANCYOF PREGNANCY

1. First Trimester: ACCEPTING THE PREGNANCY

Description: women and partner spend time recovering from shock of learning they are pregnant and concentrate on what it feels like to be pregnant. A common reaction is AMBIVALENCE.

2. Second Trimester: ACCEPTING THE BABYDescription: woman and partner move through

emotions such as narcissism and introversion as they concentrate on what it feels like to be a parent. Role playing and increased dreaming are common.

3. Third Trimester: PREPARING FOR THE BABY AND END OF PREGNANCY

Description: woman and partner grow impatient with pregnancy as they ready themselves for birth.

EVENTS THAT COULD EVENTS THAT COULD CONTRIBUTE TO CONTRIBUTE TO DIFFICULTY ACCEPTING DIFFICULTY ACCEPTING PREGNANCYPREGNANCY

1. Learning that it is a multiple pregnancy.2. Learning that the fetus has a developmental

abnormality.3. Pregnancy < 1 yr. after a previous one.4. Relocation during pregnancy5. Moving away from the family or back to the

family6. Role reversal 7. Job loss8. Marital infidelity9. Illness in self, husband or relative10. Loss of a significant other

11. Complications of pregnancy12. Having friends or relatives who have had

children born with health disorders13. Series of devaluing experiences14. History of previous miscarriages, fertility

problems, traumatic births15. Previous fetal or neonatal loss