Chapter 11 Maternal Adaptation During Pregnancy
Maternity and Pediatric Nursing
Objectives:
• Upon completion of the chapter the learner will be able to:
• 1. Define the key term ued in thi chapter.
• !. Differentiate between ub"ecti#e $preumpti#e%& ob"ecti#e $probable%& and diagnotic $poiti#e% ign of pregnancy.
• '. ()plain maternal phyiologic change that occur during pregnancy.
 
Key Terms
• Pica
• 4uickening
Assessment of Pregnancy
 
!
uterine segment)  wile te cer!ix is
still firm
Signs and Symptoms of Pregnancy
• Presumptive Signs (subjective)
6 9auea and #omiting $*81* week%
6 Amenorrhea $* week%
 
Signs and Symptoms of Pregnancy (contd)
• Presumptive signs (contd) 
6 7etal mo#ement $uickening% $1;8!< week%
6 Uterine enlargement $=81! week%
6 /reat enlargement $; week%
 
Signs and Symptoms of Pregnancy (contd)
• Probab!e (objective) signs
6 Poiti#e pregnancy tet $*81! week%
6 Abdominal enlargement $1* week%
6 /allottement $1;8!> week%
6 2oodell ign $- week%
 
Signs and Symptoms of Pregnancy (contd)
• Positive signs
6 Ultraound #erification of embryo or fetu $*8; week%
6 7etal mo#ement felt by e)perienced clinician $!< week%
 
"uestion
the following tatement 5rue or 7ale?
 
Ans#er
7ale.
 
Pregnancy Adaptations
 
 
$eproductive System Adaptations
• Uteru
6 ncreae in i,e& weight& length& width& depth& #olume& and o#erall capacity
6 Pear hape to o#oid hape@ poiti#e 0egar ign
6 (nhanced uterine contractility@ /ra)ton 0ick contraction
6 Acent into abdomen after 1t ' month
 
 
$eproductive System Adaptations (contd)
• Cer#i)
6 ipening about * week before birth
• Bagina
6 3engthening of #aginal #ault
6 +ecretion more acidic& white& and thick@ leukorrhea
 
$eproductive System Adaptations
• #arie
6 (nlargement until 1!th to 1*th week of getation
6 Ceation of o#ulation
• /reat
6 ncreae in i,e and nodularity to prepare for lactation@ increae in nipple i,e& becoming more erect and pigmented
 
%ena &ava &ompression
' System Adaptations
• Ptyalim
• Dental problem@ gingi#iti
• Decreaed peritali and mooth mucle rela)ation@ contipation
• Contipation increaed #enou preure preure from uteru E hemorrhoid
• +lowed gatric emptying@ heartburn
• Prolonged gallbladder emptying
&ardiovascu!ar System Adaptations
• ncreae in blood #olume $-<F abo#e prepregnant le#el%
• ncreae in cardiac output@ increaed #enou return@ increaed heart rate
• +light decline in blood preure until midpregnancy& then returning to prepregnancy le#el
 
"uestion
Ihen aeing a pregnant woman& which of the following would the nure e)pect to find?
A. ncreae in blood preure
/. Complaint of nauea
Ans#er
/.
 
$espiratory System Adaptations
• /reathing more diaphragmatic than abdominal due to increae in diaphragmatic e)curion& chet circumference& and tidal #olume
• ncreae in o)ygen conumption
• Congetion econdary to increaed #acularity
 
$ena!*rinary System Adaptations
• Dilation of renal pel#i@ elongation& widening& and increae in cur#e of ureter
• ncreae in length and weight of kidney
• ncreae in 27@ increaed urine flow and #olume
 
Muscu!os+e!eta! System Adaptations
• +oftening and tretching of ligament holding acroiliac "oint and pubi ymphyi
• Potural change: increaed wayback and upper pine e)tenion
• 7orward hifting of center of gra#ity
• ncreae in lumboacral cur#e $lordoi%@ compenatory cur#e in cer#icodoral area
• Iaddle gait
ntegumentary System Adaptations
• 3inea nigra
 
Pa!mer ,ryt-ema
.acia! Me!asma
•3inea nigra
,ndocrine System Adaptations
• 5hyroid gland: light enlargement@ increaed acti#ity@ increae in /M
• Pituitary gland: enlargement@ decreae in 5+0& 20@ inhibition of 7+0 H 30@ increae in prolactin& M+0@ gradual increae in o)ytocin with fetal maturation
• Pancrea@ inulin reitance due to hP3 and other hormone in !nd half of pregnancy $ee /o) 118!%
• Adrenal gland: increae in cortiol and aldoterone ecretion
• Protaglandin ecretion
 
"uestion
 
Ans#er
7ale.
 
Nutritiona! Needs
• Direct effect of nutritional intake on fetal well8being and birth outcome
• 9eed for #itamin and mineral upplement daily
• Dietary recommendation
• ncreae in protein& iron& folate& and calorie $ee 5able 118-%
• Ue of U+DA 7ood 2uide Pyramid $ee 7igure 118 -%
 
 
Materna! /eig-t 'ain
6 1t trimeter: '.-8- lb
6 !nd H 'rd trimeter: 1 lbJweek
• /M K 1L.>: !> to *< lb
6 1t trimeter: - lb
6 !nd H 'rd trimeter: 1 lbJweek
• /M G !-: 1- to !- lb
6 1t trimeter: ! lb
6 !nd H 'rd trimeter: !J' lbJweek
 
Nutrition Promotion
• +pecial conideration
6 Cultural #ariation
Materna! ,motiona! $esponses
Materna! $o!e Tas+s
• +eeking acceptance of infant by other
• +eeking acceptance of elf in maternal role to infant $binding inN%
 
"uestion
the following tatement 5rue or 7ale?
 
Ans#er
5rue.
 
Pregnancy and Se0ua!ity
• +e)ual health and link to elf8image
 
Pregnancy and Partner
• 7amily8centered emphai
6 Acceptance of role $!nd trimeter%
 
Pregnancy and Sib!ings
• +ibling ri#alry with introduction of new infant into family
• +ibling preparation imperati#e
$evie#
1. Ihat factor would change in a pregnancy if the hormone progeterone were reduced or withdrawn?
  A. 5he woman gum would become red
and wollen and would bleed eaily.
  /. 5he uteru would contract more and peritali
would increae.
prolonged.
  D. t would inhibit the ecretion of prolactin by the
pituitary gland.
$evie#
•  5he correct repone i /.
 
$evie#
!. Ihich ign i a preumpti#e ign of pregnancy?
  A. etlene
$evie#
• 5he correct repone i C.
 
$evie#
• '. During pregnancy& which of the following hould the e)pectant mother reduce or a#oid?
  A. aw meat or uncooked hellfih
  /. 7reh wahed fruit and #egetable
  C. Ihole grain
 
$evie#
• . 5he correct repone i A.
 
$evie#
*. 5he feeling e)preed by mot women upon learning the they are pregnant?
  A. Acceptance
  /. Depreion
$evie#
• -. 5he correct repone i D.
 
"uestions1