Physiological and psychological changes during pregnancy
-
Upload
hi-hi -
Category
Healthcare
-
view
291 -
download
0
Transcript of Physiological and psychological changes during pregnancy
![Page 1: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/1.jpg)
Chapter 4
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 1
![Page 2: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/2.jpg)
Determining Pregnancy and Physiological Changes
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 2
![Page 3: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/3.jpg)
Profile of Previous Obstetric History
Mnemonic commonly used for recording Systematic, quick way to indicate the number
of pregnancies as well as outcomes. GTPALM
G: gravida T: term pregnancies P: premature births A: abortions L: live births M: multiple gestations and births
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 3
![Page 4: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/4.jpg)
Profile of Previous Obstetric History (cont.)
G: gravida Any pregnancy, regardless of duration, including
the present one P: para
number of births after 20 weeks gestation
e.g.: woman pregnant for first time would be:P0, G1
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 4
![Page 5: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/5.jpg)
Determining Date of Birth
EDD: estimated date of delivery Nägele’s rule:
Identify first day of last normal menstrual period (LNMP)
Count backward 3 months Add 7 days
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 5
![Page 6: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/6.jpg)
Duration of Pregnancy
Calculated in 28-day month calendar, called lunar months
10 lunar months in a full-term pregnancy 40 weeks 280 days on average
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 6
![Page 7: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/7.jpg)
Trimester
Pregnancy broken out into 3-month segments called trimesters First trimester: first 14 weeks Second trimester: 15 to 28 weeks Third trimester: 29 weeks to delivery
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 7
![Page 8: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/8.jpg)
Pregnancy Terms
Terminates before fetus reaches 20 weeks gestation: abortion (lay term is miscarriage)
Terminates after 20th week but before full term is reached: preterm (premature) birth
Terminates 2 weeks after EDD, or 42 weeks: postterm birth
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 8
![Page 9: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/9.jpg)
Signs of Pregnancy
Presumptive signs Suggest pregnancy
Probable signs Likely pregnant
Positive signs Definite evidence of pregnancy
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 9
![Page 10: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/10.jpg)
Three Signs that Define Pregnancy
Hearing fetal heart sounds Audible by doppler 10-12 weeks
Palpation of active fetal movements Visualization of a developing fetus via
ultrasound Gestational sac can be viewed as early as 10 days
after implantation
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 10
![Page 11: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/11.jpg)
Pregnancy Tests
Presence of the hormone human chorionic gonadotropin (hCG) Produced by the chorionic villi of the placenta Can be found in woman’s urine as early as 1 week
postconception PROBABLE indicator of pregnancy
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 11
![Page 12: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/12.jpg)
Physiologic Changesin Body Systems
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 12
![Page 13: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/13.jpg)
Major Sources of Change
Hormonal (endocrine system) Mechanical pressure (physical changes
within the body)
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 13
![Page 14: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/14.jpg)
Changes in the Endocrine System
Dramatic hormonal increase affects all body systems
Essential to maintain pregnancy Initially produced by corpus luteum Later by placenta
A temporary endocrine organ Role is to produce high levels of estrogen and
progesterone
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 14
![Page 15: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/15.jpg)
Human Placental Lactogen (hPL)
Increases maternal insulin resistance during pregnancy
Provides fetus with glucose needed for growth
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 15
![Page 16: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/16.jpg)
Changes in the Reproductive System
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 16
![Page 17: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/17.jpg)
Uterus
Enlarges during pregnancy Increase in size of preexisting muscle cells
(hypertrophy) Formation of new cells (hyperplasia)
Circulatory requirements increase as it enlarges
Growth stimulated by hormones Pressure of growing fetus against uterine wall
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 17
![Page 18: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/18.jpg)
Cervix
Becomes shorter and softer during pregnancy Prepares for
Thinning (effacement) Enlargement (dilation)
Softening caused by Hormones leading to increased blood supply Increase in cervical gland secretions
• Mucous plug formation provides barrier to prevent organisms from entering uterus.
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 18
![Page 19: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/19.jpg)
Ovaries
Follicles cease to develop to maturity Ovulation does not occur
Corpus luteum produces estrogen and progesterone for first 7 to 10 weeks until placenta can take over Also produces hormone relaxin
• Thought to help relax symphysis pubis and pelvic joint, and softens cervix
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 19
![Page 20: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/20.jpg)
Vagina
Wall thickens, becomes more pliable, and expandable
Rugae (folds) more prominent Discharge increases, leads to increased
glycogen, which increases risk of vaginal infection Increased risk for infection and Candida albicans pH decreases (becomes more acidic), preventing
growth of harmful microbes
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 20
![Page 21: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/21.jpg)
Breasts
Hormones prepare breasts for lactation Rapidly enlarge during first 8 weeks of
gestation Vascular engorgement
Beginning in 9th week Ductal growth stimulated by estrogen Alveolar hypertrophy stimulated by progesterone
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 21
![Page 22: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/22.jpg)
Breast Changes Size increases
Become fuller, more sensitive, and tender Pigmentation of areola and nipple darkens Montgomery’s glands more prominent
Lubricate and protect nipples Striae may occur Colostrum excretion as early as 10th week
Thin, yellowish fluid excreted until 3rd post partum day
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 22
![Page 23: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/23.jpg)
Initiation of Lactation
Profound drop in estrogen and progesterone After delivery of placenta
Increase in prolactin Responsible for milk production
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 23
![Page 24: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/24.jpg)
Changes in the Cardiovascular System
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 24
![Page 25: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/25.jpg)
Cardiovascular
Deliver oxygen and nutrients Blood must be at pressures sufficient to meet
placental circulation 10% of maternal output channeled to uterine blood
flow in third trimester Greatest increase occurs during labor and
delivery More vulnerable to thrombus formation
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 25
![Page 26: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/26.jpg)
Supine Hypotensive Syndrome
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 26
![Page 27: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/27.jpg)
Changes in Respiratory System Thoracic circumference increases
Hormonal influence Lung capacity remains the same Inspiration increases
Allows greater intake of oxygen Expiration increases
Allows greater removal of carbon dioxide Breathing changes from abdominal to
thoracic Oxygen consumption increased by 15-40%
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 27
![Page 28: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/28.jpg)
Dyspnea
Respiratory system has increased sensitivity due to progesterone
Pressure of uterus on diaphragm Normally does not interfere with activities of
daily living
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 28
![Page 29: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/29.jpg)
Epistaxis
Nosebleeds and nasal stuffiness common Likely from increased vascularity related to
estrogen Voice may become deeper
Vocal cords increase in size, likely due to progesterone
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 29
![Page 30: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/30.jpg)
Changes in the GI System Gum hypertrophy Saliva production increased (ptyalism) Nausea and/or vomiting, especially in first
trimester Constipation
Due to increase in progesterone and relaxin Pyrosis (heartburn)
Relaxation of cardiac sphincter from progesterone Carbohydrate metabolism altered
Increased insulin resistance can cause gestational DM
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 30
![Page 31: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/31.jpg)
Compression of Abdominal Contents
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 31
![Page 32: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/32.jpg)
Changes in the Renal System
Early and late pregnancy increase in bladder pressure
Ureters dilate from smooth muscle relaxation Increased risk of pyelonephritis if woman has
asymptomatic bacteriuria
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 32
![Page 33: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/33.jpg)
Fluid and Electrolyte Balance
Increased glomerular filtration rate Increased sodium filtration (up to 50%) Tubular reabsorption (up to 99% reabsorption
of sodium) Increases risk of sodium retention Blood more alkaline
Enhanced by hyperventilation during labor Does not interfere with pregnancy
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 33
![Page 34: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/34.jpg)
Changes in the Integumentaryand Skeletal Systems
Relaxin and placental progesterone Relaxation and softening of pelvic joints
Widening of symphysis pubis “waddling gate”
Facilitates delivery of fetus Center of gravity shifts forward as uterus
enlarges Progressive lordosis
May experience difficulty with balance
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 34
![Page 35: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/35.jpg)
Lordosis
Lordosis
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 35
![Page 36: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/36.jpg)
Changes in the Skeletal System
Uterus stretches round ligaments Woman may develop diastasis recti
abdominis Separation of rectum abdominis muscles
Increased risk of carpal tunnel syndrome Due to weight gain and edema
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 36
![Page 37: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/37.jpg)
Changes in the Integumentary System
Chloasma (“mask of pregnancy”)
Linea nigra (dark line on abdomen)
Striae gravidarum (stretch marks)
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 37
![Page 38: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/38.jpg)
Effect of Pregnancy and Lactation on Medication Ingestion Subtherapeutic levels may occur due to
increased Plasma volume Cardiac output Glomerular filtration
Decreased gastric emptying Changes absorption and can delay onset of action
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 38
![Page 39: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/39.jpg)
Effect of Pregnancyon Medication Ingestion
Parenteral medications may absorb more rapidly due to Increased blood flow Faster onset of action
Increased levels of estrogen and progesterone may alter hepatic function Results in increased drug accumulation
Some drugs can cross placenta
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 39
![Page 40: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/40.jpg)
Effect of Lactation and Medications
Some drugs pass into breast milk If lactating, mother must take medication
immediately after infant breastfeeds
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 40
![Page 41: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/41.jpg)
Psychological ChangesDuring Pregnancy
Body image changes Emotional security Cultural expectations Support from partner Whether pregnancy is unexpected Financial situations
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 41
![Page 42: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/42.jpg)
Psychological ChangesDuring Pregnancy (cont.)
Major factors that influence the psychological impact of pregnancy A woman’s level of maturity Readiness for childbearing
Hormones contribute to mood swings
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 42
![Page 43: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/43.jpg)
Body Image
Considered from four aspects Appearance
• May be difficult and occurs quickly Function
• Difficult if associated with loss of control (urinary incontinence)
Sensation• More sensitive to touch due to increased vasocongestion
Mobility
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 43
![Page 44: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/44.jpg)
Responses to Pregnancy
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 44
![Page 45: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/45.jpg)
Developmental Tasks Relate to sequence of trimesters; more
apparent in some than others Pregnancy validation
Focus is nurturing and protecting fetus May question identity as woman and mother
Fetal embodiment Incorporates fetus into body image; deals with
repressed thought and matures Fetal distinction (when quickening occurs)
Sees fetus as individual Role transition
Makes concrete plans for baby 45
![Page 46: Physiological and psychological changes during pregnancy](https://reader035.fdocuments.us/reader035/viewer/2022070513/58832ff51a28abaf6f8b4de9/html5/thumbnails/46.jpg)
Pregnant Women May Experience
Emotional lability Heightened sensitivity Increased need for affection Greater irritability Fear Anxiety
Needs to receive rather than give emotional support
Provide guidance and support
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 46