PREGNANCY CHANGES AND CARE

UTERINE CHANGESBEFORE: 7.5X5X2.5, 60 GEND: 28X24X21, 1000 GWALLS THIN AS THEY STRETCHINCREASED BLOOD/LYMPH VESSELSBRAXTON-HICKS CONTRACTIONS

CERVICAL CHANGESINCREASED CELL NUMBERMUCOUS PLUGGOODELLS SIGN-SOFTENINGCHADWICKS SIGN-DISCOLORATIONINCREASED VASCULARIZATION

VAGINAL CHANGESHYPERTROPHYINCREASED VASCULARIZATION, HYPERPLASIAINCREASED VAGINAL DISCHARGEACIDIC PH OF DISCHARGELOOSENING OF CONNECTIVE TISSUE

BREAST CHANGESINCREASED SIZE, NODULARITYSUPERFICIAL VEINSNIPPLES ERECTDARKENING OF AREOLASTRIAECOLOSTRUM-12 WK+

RESPIRATORY CHANGESHYPERVENTILATIONINCREASING TIDAL VOLUMECONSUMPTION INCREASESVC INCREASESDIAPHRAGM ELEVATES, SUBCOSTAL ANGLE INCREASES, RIB CAGE FLAIRSTHORACIC BREATHINGNASAL STUFFINESS, EPISTAXIS

CARDIOVASCULAR CHANGESHEART UP, TO LEFT, ROTATED FORWARDINCREASED BLOOD VOLUME-PEAKS AT MID-3RD TRIMESTER (45%)DECREASED VASCULAR RESISTANCEINCREASED C.O. TILL 20-24 WKS, THEN STEADY

VITAL SIGN CHANGESBLOOD PRESSURE DECREASES THROUGH 2ND TRIMESTER, GRADUAL INCREASE 3RDINCREASED PULSE (0-15 BPM)SAME OR INCREASED RESPIRATIONS

CIRCULATION CHANGESINCREASED BLOOD TO UTERUS, KIDNEYSINCREASED STAGNATION IN LOWER EXTREMITIES INCREASED FEMORAL VENOUS PRESSURE

SUPINE HYPOTENSIVE SYNDROMEVENA CAVA SYNDROMEDECREASED BP, DIZZY, PALLOR, CLAMMYTURN PT ON SIDE IMMEDIATELY

RBC CHANGESERYTHROCYTE VOLUME INCREASESINCREASED PLASMA VOLUME GREATER THAN ERYRHROCYTEDECREASED HCT-PHYSIOLOGIC ANEMIA

WBC CHANGESSAME OR INCREASED LEUKOCYTE PRODUCTION OVER BLOOD VOLUMEINCREASE HIGHER AT LABOR, POST-PARTUM

CLOTTING FACTORS CHANGEFIBRIN LEVEL INCREASESFIBRINOGEN LEVEL INCREASESBLOOD FACTORS INCREASECLOTTING TIME NMLALL LEADS TO INCREASED HYPERCOAGULABLE STATE, DVT RISK

GASTROINTESTINAL CHANGES 1ST TRIMESTERNAUSEA/VOMITINGCHANGES IN TASTE, SMELLGUM TISSUE HYPEREMIC, SOFTERINCREASED SALIVA

GI CHANGES LATER IN PREGNANCYHEARTBURNBLOATINGCONSTIPATIONHEMORRHOIDSPROLONGED EMPTYING TIME OF GALLBLADDER

URINARY TRACT CHANGESFREQUENCYIMPAIRED DRAINAGE OF BLOOD/LYMPH FROM BLADDERKIDNEY/URETER DILATIONINCREASED GFR, RPFGLYCOSURIALOWER BUN VALUE, CREATININE CLEARANCE MORE ACCURATE

SKIN AND HAIR CHANGESLINEA NIGRACHLOASMAAREOLA, NIPPLES, VULVA, PERIANAL DARKERINCREASED SWEATINGSTRIAESPIDER NEVIDECREASED HAIR GROWTH, SHEDDING POSTPARTUM

MUSCULOSKELETAL CHANGESNO DENTAL CHANGESJOINTS OF PELVIS RELAXLUMBODORSAL CURVE INCREASEDPARESTHESIAS OF EXTREMITIESDIASTASIS RECTI

METABOLISM CHANGESMOST ARE ACCELERATEDTISSUE REPLACEMENTFETAL NEEDSPREP FOR LABOR/LACTATION

NUTRIENT CHANGESINCREASED LIPIDS, CHOLESTEROLINCREASED DEMAND FOR CHOINCREASED DEMAND FOR IRONIRON TRANSFER TO FETAL LIVERINSULIN REQUIREMENT INCREASESGLYCOSURIA: DIABETES VS. PHYSIOLOGIC CHANGE GFR HIGHER

SIGNS OF PREGNANCYPRESUMPTIVE: SUBJECTIVEPROBABLE: OBJECTIVEDIAGNOSTIC: POSITIVE

PRESUMPTIVE CHANGESAMENORRHEANAUSEA/VOMITINGEXCESSIVE FATIGUEURINARY FREQUENCYBREAST CHANGESQUICKENING

PROBABLE SIGNSGOODELLS SIGN-SOFTENING OF CERVIXHEGARS SIGN-SOFT ISTHMUSCHADWICKS SIGN-BLUE TINTUTERINE ENLARGEMENTUTERINE SOUFFLESKIN CHANGESFETAL OUTLINE PALPABLEPREGNANCY TESTS

DIAGNOSTIC CHANGESFHTFETAL MOVEMENT PALPATEDVISUALIZATION BY U/S

PSYCHOLOGIC RESPONSEAMBIVALENCEACCEPTANCEINTROVERSIONMOOD SWINGSBODY IMAGE CHANGES

FATHERS RESPONSEAMBIVALENCERECOGNITION AS FATHER/PARENTFINANCIAL ISSUESFEAR RE: BABYS HEALTHFEAR RE: MOTHERS HEALTHROLE IN LABORFEAR OF HURTING BABY/MOM W/SEXMAY DEVELOP PREGNANCY SYMPTOMS

SIBLING RESPONSESIBLING RIVALRYCONSISTENCY IMPORTANT, REASSURANCEREGRESSIONPRENATAL: BRING TO VISITS, FAMILY AFFAIRPOST-PARTUM: INVOLVE CHILDREN, VISIT AT HOSPITAL

DEFINITIONSABORTION: BEFORE END OF 20 WKSGESTATION: #WEEKS POST LMPTERM: 38-42 WKSPRETERM: 20-37 WKSPOST-TERM: AFTER 42 WKS

GRAVIDAGRAVIDANULLIGRAVIDAPRIMIGRAVIDAMULTIGRAVIDA

PARITYPARA: BIRTH AFTER 20 WKNULLIPARAPRIMIPARAMULTIPARAALL REFER TO # PREGNANCIES, NOT # OF CHILDREN BORN

TPAL FOR PARITYT: TERM INFANTS BORNP: PRETERM INFANTS BORNA: ABORTIONL: LIVING CHILDREN (CURRENTLY)

INITIAL HISTORYCURRENT PREGNANCYPAST PREGNANCIESGYN/MENSTRUAL HXCURRENT MEDICAL HXPAST MED HXFAMILY MED HXSOCIAL, PERSONAL, OCCUPATION, PERSONALRELIGION, CULTURE, LANGUAGEPARTNER HX

HIGH RISK DESIGNATIONVARY WITH TIME OF PREGNANCYMEDICAL-PREEXISTING, CURRENTPSYCHOSOCIALNUTRITIONOBSTETRICEDUCATIONAL

INITIAL LABSCBCBLOOD TYPE, RH FACTORRUBELLASYPHILIS, CHLAMYDIA, GONORRHEAANTIBODY SCREENHEPATITIS B/CPAP SMEARU/AHIV RECOMMENDED

ADDITIONAL POSSIBLE LABSHGB ELECTROPHORESISAFP/QUADRUPLE SCREENING1 HR PGT or 2 HR 75 OGT TOX SCREENGROUP B STREPADDL HCT/HGB, STI SCREEN, GLUCOSE (individualized to pt)

PSYCHOSOCIAL ASSESSMENTREACTION TO PREGNANCYSUPPORT SYSTEM, FAMILY ISSUESFINANCIAL ISSUESLIVING CONDITIONSHISTORYABUSECUSTOMS, CULTURE

EDUCATIONAL ASSESSMENTEDUCATIONAL LEVELPREFERRED WAYS TO LEARNDESIRE FOR INFOHX, EXPERIENCELANGUAGE

NUTRITIONAL ASSESSMENTPREGRAVIDA WEIGHTHEIGHT, WEIGHT, BMIFAMILY/PERSONAL MEDICAL HXDIET RECALLLAB REVIEWFINANCES, WIC, FOOD STAMPS

STANDARD DAILY FOOD PLANDAIRY: 4 SERVINGSPROTEINS: 3 2-OZ SERVINGS (6 0Z)GRAINS: 6-11 FRUITS: 2-4, MIN 1 VIT C RICHVEGETABLES: AS DESIREDFATS: 3-5FLUIDS: 8-10/DAY, MIN 4-6 H2O

RECOMMENDED WEIGHT GAIN GENERAL GDLNSVARIES WITH STARTING WEIGHTLOW: 28-40 LBSNML: 25-35OVER: 15-25OBESE: 15

WEIGHT GAIN PATTERNNML WEIGHT PATIENTS:3.5-5 LB (1.6-2.3 KG) 1ST TRIMESTER1 LB (O.5 KG)/WEEK TILL TERMTWINS: 1.5 LB/WEEK 2ND/3RD/ TRIMESTERLOW WEIGHT GAIN ASSOC WITH PRETERM BIRTHS, IUGR, LBW INFANTSHIGH WT GAIN ASSOC WITH LGA INFANTS, BIRTH COMPLIC, POSS MALFORMATIONS OF CNS

CALORIE RECOMMENDATIONS1ST TRIMESTER: NO INCREASE2ND/3RD: +300 KCAL/DAY TWINS: +600 KCAL/DAYBREASTFEEDING: +200 KCAL OVER PREGNANCY INTAKE

FACTORS AFFECTING DIETCULTURE, FAMILYFINANCES, PSYCHOSOCIAL FOOD PREFERENCES, INTOLERANCEPREGNANCY DISCOMFORTSEATING DISORDERSEDUCATION, KNOWLEDGE LEVELVEGETARIANISM

FACTORS AFFECTING PREGNANT TEENS DIETPSYCHOSOCIAL DEVELOPMENTSELF IMAGE, BODY IMAGEDENIAL OF PREGNANCYLIFESTYLE, PREPREGNANT DIETANEMIA COMMON, CALCIUM INTAKEAGE PAST MENARCHELESS THAN 4 YRS PAST, TEEN STILL GROWING, NEED HIGHER KCAL TO HAVE NML WT INFANT

FOLLOW-UP VISITSANY PROBLEMS, COMPLAINTSREVIEW DANGER SIGNSWT, BP, URINE PROTEIN, SUGAR, KETONESLABS PRN FHT, MEASUREMENTEDEMA, PHYSICAL CHANGESEDUCATION APPROPRIATE FOR GA

FAMILY INVOLVEMENTINVOLVE FOB, SIGNIFICANT FAMILY, FRIENDS IN VISITSENCOURAGE PARTICIPATION IN VISITS, CLASSESANSWER QUESTIONS OF ALL PRESENT