PSYCHOLOGICAL AND

PHYSIOLOGIC CHANGES OF
PREGNANCY
MARIE JANE T. CUNANAN, RN, MSN
 OBJECTIVES:
01 Describe the common psychological and
physiological changes that occur during
pregnancy

02 Assess a woman for psychological

adjustment and physiologic changes that
occur during pregnancy

03 Formulate nursing diagnoses and identify

expected outcomes in relation to a family’s
psychological and physiological adaption to
pregnancy

04 Plan, implement and evaluate the

effectiveness of care being rendered.
PREGNACY GIVES A HUGE
CHANGE IN WOMAN’S LIFE

• How a woman adjust to pregnancy

depends on the psychological
aspect and the environment she
was raised to.
 PSYCHOLOGICAL ADAPTATIONS OF
PREGNANCY

1. First trimester: Acceptance of Pregnancy

2. Second trimester: Acceptance of the Baby
3. Third trimester: Preparation for Parenthood
 First trimester
Acceptance of Pregnancy
• “I am pregnant.”
• The first task that a woman who is about to
become a mother faces.
• Pregnancy confirmation may leave some
couples with disbelief, shock or amazement
• Most couple experience some degree of
ambivalence
 Second Trimester
Acceptance of the Baby
• “I am going to have a baby.”
• Quickening by 20 weeks helps the woman realize is a
separate individual to care for
• Woman becomes preoccupied with fantasies about her
unborn child.
• Woman and partner begin active preparations for baby
• Partner may feel left out with all the information
focused on the woman and fetus
 Third Trimester
Preparation for Parenthood
• “I am going to be a mother.”
• Couple work on preparing to become parents
• Couple demonstrate “nesting” behaviors
• Couple may attend childbirth education classes
• Review their relationships with parents and fantasizes
about being a parent
 PSYCHOLOGICAL RESPONSES TO
PREGNANCY
1. AMBIVALENCE
• Normal response
• Discomforts of pregnancy cause mixed feelings; fear
• Woman may desire to be pregnant but may not enjoy
the experience

2. GRIEF
• Occurs as a result of changes in women’s role
• Roles: wife, daughter and a mother
3. NARCISSISM 5. STRESS REACTION
• Woman focuses on self and • To some pregnancy can
changing body be a time of stress
• Spends more time of self- • Adequate support
care activities (to protect systems can help to
body and fetus) alleviate some of this
• Partner decreases risky stress
behaviors
4. INTROVERSION OR
EXTROVERSION
• Woman focuses on self or
become more outgoing
6. EMOTIONAL 8. CHANGES IN
LABILITY SEXUAL DESIRE
• Mood changes 1st trimester- libido decreases
• Influenced by hormones 2nd trimester- libido and sexual
• Avoiding fatigue and reducing excitement rise markedly
stress can help
3rd trimester – libido is high\
• May be the result of
introversion and narcissism 9. CHANGES IN THE
7. COUVADE SYNDROME EXPECTANT FAMILY
• Partner identifies with the -older children should be
woman’s pregnancy prepared
• May experience discomforts
such as nausea, vomiting,
fatigue and weight gain
• Temporary and rarely
problematic
 Question #1
Which of the following tasks is the most
important task of the first trimester of
pregnancy?
A. Accepting the pregnancy
B. Accepting a coming child
C. Making plans for the baby
D. Sharing time with a significant other
 Answer #1
A. Accepting the pregnancy
Rationale: Before a fetus moves, adjusting to
pregnancy is a primary task; later, adjusting to
having a baby becomes the primary task.
Normal Changes during
pregnancy
SIGNS & SYMPTOMS OF PREGNANCY
Presumptive Signs- least indicative, subjective, cannot
be documented by the examiner

Nausea and vomiting Melasma/Chloasma

Fatigue
Breast changes
Striae Gravidarum
Uterine enlargement
Quickening
Amenorrhea Linea Nigra

Frequent urination
Images:

Melasma/Chloasma Striae Gravidarum Linea Nigra

2. Probable Findings- can be documented by the
examiner
- More reliable than the presumptive sign
a. Serum laboratory test
b. Chadwicks sign
c. Goodles sign
d. Hegar’s sign
e. Sonographic evidence of gestational sac
f. Ballotement
g. Braxton Hicks sign
h. Fetal outline felt by the examiner
3. Positive Findings- indicates positive
pregnancy
a. Sonographic evidence of fetal outline
b. Audible fetal heart tone
c. Fetal movement felt by the examiner
PHYSIOLOGIC SIGNS OF
PREGNANCY
 REPRODUCTIVE SYSTEM
Uterus
• At the end of pregnancy, uterus is
large, thin-walled organ, weighing
1,000 g.
• Can hold 3,175 g of fetus plus
1000 ml of amniotic fluid= 4000 g
• Irregular painless uterine
contractions occur (Braxton-
Hicks contractions)
• Hegar’s sign- softening of the
uterine isthmus about the 6th
week.
• 12th week – can be 16th -20th week-
palpated Ballottement
Note: Important factor to 20th-24th week- fetal
assess the uterine growth outline
12th week- Braxton
hicks contraction
Cervix
Normal Cervix
Increase in cell numbers due to
estrogen
• Secretes a thick, sticky mucus
that forms a plug in the cervix
(operculum).
• Goodell’s sign- softening of the
cervix.
• Chadwick’s sign- purplish-blue
color of the cervix and vagina due
to an increased vascularity noted
at 8 weeks.
Ph level- 4-5 ( lactobacillus Chadwick’s Sign

acidophilus)
Ovaries
• Follicles do not mature
• Ovulation does not occur
• Corpus luteum produces progesterone and estrogen
for about 12 weeks.

Vagina
Increase in vaginal secretions called leukorrhea
• Increased levels of glycogen in cells may enhance
growth of organisms such as Trichomonas vaginalis or
Candida albicans.
• Increase in vascularity change in violet color
(Chadwick’s sign)
• pH of vagina changes from the normally acidic to
alkaline (due to increased levels of estrogen).
 WAYS TO COPE WITH LEUKORRHEA
1. Encourage the woman to bathe daily and avoid
using soap on the vulvar area
2. Reinforce the need to wipe from front to back.
3. Urge her to wear loose, absorbent cotton
underwear and to avoid tight pants and panty hose
 Breast
• Enlargement
• Increased vascularity
• Production of colostrum
• Nipples erect
• Areolas darken
• Montgomery’s tubercles enlarge
• 16th week- COLOSTRUM can
be expelled from the
nipple
Montgomery’s Tubercle
 WAYS TO COPE WITH BREAST CHANGES
1.Wear a well-fitting bra with a wide shoulder straps.
2. Maintain a good posture
3. Wash breast and nipple area with water only.
CARDIOVASCULAR SYSTEM
CHANGES
 Consequences of Increased
Total Cardiac Blood Volume
• Easy fatigability and
shortness of breath
• Slight hypertrophy of heart
causing it to be displaced to
the left
• Systolic murmurs are
common due to lowered
blood viscosity
• Nosebleeds may occur
because of marked
congestion of the
nasopharynx
HEART
• Heart displaced to the left and
upward
• Slight cardiac enlargement by
10% due to increased blood
volume
• Palpitations
• CO increased when in left
lateral position
WAYS TO FIGHT
FATIGUE
• Have frequent rest periods
• Obtain rest during the day.
• Eat a balanced diet and take iron
supplements
• Engage in moderate regular
exercise
NURSING ALERT!
Pregnant women should
not be massaged since
blood clots can be released
and cause
thromboembolism
(increased in clotting
factors, venous stasis and
vessel wall injury).
WAYS TO AVOID ANKLE EDEMA
1. Lie on the left side in bed to enhance glomerular
filtration rate of the kidneys
2. Avoid wearing tight, constrictive clothing.
3. Elevate legs during rest periods.
4. Dorsiflex the feet when standing or sitting for
prolonged periods.
5. Get up and move about every 1 to 2 hours when
sitting for long periods
 GASTROINTESTINAL SYSTEM
CHANGES
1. NAUSEA AND VOMITING
• “morning sickness”
• Occurs on the first trimester
• Causes:
a) Increased HCG levels
b) Increased estrogen and progesterone levels
c) Decreased maternal glucose levels as glucose is utilized by
fetus
Hyperemesis gravidarum- excessive vomiting in pregnancy
persisting beyond 3 months.
• Reduce gastric acidity
PICA- Abnormal cravings
PATIENT TEACHING TO PREVENT MORNING
SICKNESS
1. Instruct patients to avoid greasy; highly seasoned foods
2. Encourage her to eat small, frequent feedings
3. Advise her to eat dry toast or crackers before getting out of bed in
the morning.
4. Instruct her to get out of bed slowly; avoid sudden movements.
5. Suggest to eat foods high in protein, such as eggs, cheese, nuts, and
meats as well as fruits and fruit juices.
6. Drink soups and other liquids between, instead of with, meals.
2. CONSTIPATION AND FLATULENCE
• Due to the displacement of the stomach and
intestines, thus slowing peristalsis and gastric
emptying time
• Due to increased progesterone (sluggish peristalsis)
• Oral iron supplements

WAYS TO AVOID CONSTIPATION

a) Increase fluid intake and roughage in the diet
b) Establish regular elimination time
c) Adequate exercises
d) Avoid enemas
e) Avoid harsh laxatives
f) Do not take mineral oil
3. HEMORRHOIDS
Causes:
• Pressure on the pelvic veins by the
enlarging uterus
• Increased pressure secondary to
constipation

WAYS TO AVOID HEMORRHOIDS

1. Avoid prolonged standing.
2. Lie on left side with feet slightly elevated.
3. Avoid constrictive clothing
4. HEARTBURN
• Due to relaxation of esophageal sphincter caused by high
levels of progesterone
WAYS TO AVOID HEARTBURN
a) Avoid fried, fatty foods and chocolate.
b) Acidic foods such as tomato products, citrus fruits, spicy foods
and coffee must be eliminated from the diet.
c) Eat smaller meals.
d) Refrain from eating for 3 hours before bedtime, and stay
upright for 2 hours after meals.
e) Avoid tight clothing and avoid bending
5. CHANGES IN THE ORAL CAVITY
(due to high estrogen levels)
Ptyalism – increased salivation
• Gums usually become soft and edematous and may bleed with
brushing; tooth decay

6. CHANGES IN APPETITE
• Increase in appetite to compensate for the growing needs of the
fetus.
Pica describes dietary cravings or aversions for non-nutritional
substances.
• Ex: clay, starch, coal, soap, toothpaste, ice and newspaper.
 RESPIRATORY SYSTEM
CHANGES
Top 3 Respiratory Changes During
Pregnancy
1. Increased tidal volume
2. Upward displacement of diaphragm
• Shortness of breath
• Chest crowding
3. Slight hyperventilation
Congestion or stuffiness of the nasopharynx
URINARY SYSTEM CHANGES
1. Increased urinary output/ urinary frequency
Causes:
• Uterus exerts pressure on the bladder as it enlarges (First
trimester)
• relieved in the second trimester by the uterus moving into
the abdominal area
• Pressures of the presenting part on the bladder after
lightening (third trimester)
• Increased blood flow to the kidney which increases
glomerular filtration rate, thus urinary output increases
WAYS TO BEAT URINARY URGENCY AND
FREQUENCY
1. Decrease fluid intake in the evening.
2. Limit intake of caffeinated beverages
3. Promptly respond to the urge to void.
4. Perform Kegel’s exercises
2. Glycosuria
• Glucose spills in urine
• Increased in glomerular filtration without an increase in tubular
re-absorptive capacity

3. Increased aldosterone production resulting in

sodium and water retention

4. Dilated ureters and renal pelvis due to progesterone

and pressure from enlarging uterus

5. Nocturia
 INTEGUMENTARY SYSTEM
CHANGES
1. Increased melanin
production
• Anterior pituitary gland
produces more melanotropin
stimulating hormone
a) Chloasma (mask of pregnancy)
• An increase in pigmentation on
the forehead and around the
eyes
• Aggravated by sun exposure
• Due to increase production of
melanocytes
b) Striae gravidarum or
stretch marks
• Appear as reddish
streaks on trunk and
thighs. These
generally change to a
shiny gray-white color
after delivery.
• They do not
disappear.
c. Linea nigra
• Brown line running from umbilicus to symphysis pubis.

2. Estrogen effects
• Palmar erythema – redness and itching of the hands
• Vascular spider nevi- prominent capillaries under the skin
• Activation of sweat gland and sebaceous gland
Palmar erythema
MUCULOSKELETAL CHANGES
1. Relaxation of the pelvic joints results in the classic
“waddling” gait seen in pregnancy
2. Physiologic lordosis (“pride of pregnancy”)
• Curvature of the lumbar spine increases to
compensate for the weight of the gravid uterus.
• Results in low back pain
WAYS TO BEAT BACKACHES
1. Use proper body mechanics.
2. Maintain a good posture.
3. Wear low-to-mid heel shoes.
4. Walk with pelvis tilted forward.
5. Use a board under the mattress to add
firmness.
6. Perform pelvic or tilting exercises.
Leg cramps
Causes:
• increase pressure of gravid uterus on lower
extremities
• Poor circulation
• Fatigue
• Low calcium, high phosphorus intake
Management:
Dorsiflex the foot
WAYS TO RELIEVE LEG CRAMPS
Frequent rest periods with feet elevated
• Wear warm, more comfortable clothing
• Increase calcium intake
• Do not massage- blood clots can cause
embolism.
• Most effective relief is press knee of the
affected extremity and dorsiflex the foot.
ENDOCRINE SYSTEM CHANGES
1. Increased basal metabolic rate
• Average weight gain is 3 to 5 pounds in the first
trimester and 12 to 15 pounds in each of the following
trimester.
• Increase in total weight is 22-25 lbs
• Water retention occurs during pregnancy due to
increased sex hormones and decreased serum protein.
2. Increased production of prolactin
3. Increased estrogen levels
4. Increased cortisol levels
Distribution of weight gain during
pregnancy
Fetus 7 lbs
Placenta 1 lb
AF 1.5 lbs
Increased weight of uterus 2 lbs
Increased blood volume 1 lb
1.5-3 lbs
Increased weight of the
breasts 2 lbs
Weight of additional fluid 4-6 lbs
Fat and fluid accumulation
 DANGER SIGNS DURING
PREGNANCY
• Vaginal bleeding (any)
• Chest pain
• Sudden gush of fluid from the vagina

Gestational Hypertension
• Rapid weight gain ( 2lbs/week in 2nd tri)
• Severe, continuous headache
• Swelling of face, hands, legs, feet when arising in
morning
• Visual disturbances: blurring, double vision,
flashes of light, spots before eyes
• Dizziness
• Fever over 100oF (37.8oF) and chills
• Pain in the abdomen or cramping
• Epigastric pain
• Irritating vaginal discharge
• Uterine contraction before 37 weeks
• Noticeable reduction or absence of fetal
movements
Nursing Diagnosis
- Altered breathing pattern related to respiratory
system changes
- Disturbed body image related to weight gain from
pregnancy
- Deficient knowledge related to normal changes of
pregnancy
- Imbalance nutrition, less than body requirement
related to every morning nausea
- Powerlessness related to unintended pregnancy
- Possible impaired health and pre natal care
behaviors associated with cultural beliefs
 Nursing Diagnoses: Psychological and
Physiologic Changes of Pregnancy
1. Altered breathing patterns related to
respiratory system changes of pregnancy
2. Disturbed body image related to weight gain
from pregnancy
3. Deficient knowledge related to normal changes
of pregnancy
4. Imbalanced nutrition, less than body
requirements, related to early morning nausea
Nursing Diagnoses: Psychological and
Physiologic Changes of Pregnancy

5. Powerlessness related to unintended pregnancy

6. Possible impaired health and prenatal care behaviors
associated with cultural beliefs
 PRACTICE Question
As a pregnant woman lies on the examining table, she grows very
short of breath and dizzy. The nurse recognizes which as the
probable cause?
A. Her cerebral arteries are growing congested with blood.
B. The uterus requires more blood in a supine position.
C. Blood is trapped in the vena cava in a supine position.
D. Sympathetic nerve responses cause dyspnea when a woman lies supine.
 Answer
C. Blood is trapped in the vena cava in a supine position.
Rationale: Supine hypotension syndrome, or an interference with blood
return to the heart, occurs when the weight of the fetus rests on the vena
cava.
 Question
Blood volume normally increases during pregnancy. The extent of
this increase is what percentage of prepregnancy volume?
A. 1% to 10%
B. 20% to 30%
C. 30% to 50%
D. 70% to 90%
 Answer
C. 30% to 50%
Rationale: To supply adequate blood for fetal circulation, blood volume
increases 30% to 50%.
 Question
A woman during her first trimester questions how much longer she
will have urinary frequency. Which should the nurse advise her
regarding urinary frequency?
A. It is a common complaint during the first trimester and again later in the
third trimester.
B. It is a common concern reported during the entire pregnancy.
C. It will subside after the first trimester.
D. It is a concern until the last trimester of pregnancy.
 Answer
A. It is a common complaint during the first trimester and again
later in the third trimester.
Rationale: The weight of the growing uterus causes urinary frequency
during the first trimester. After lightning occurs in the last trimester, urinary
frequency reoccurs.