Aripin, Alshammae N.

II - BSN H

THE GROWING FETUS

Nursing role and Nursing care during normal the ovary continues to function rather
pregnancy than atrophying *
● Assessment of maternal and fetal health ○ The uterine endometrium, instead of
○ Complete history sloughing off as in a normal menstrual
○ Thorough physical exam cycle, continues to grow in thickness and
● Providing nursing care vascularity = DECIDUA
● Health teachings ○ Latin word for “falling off ”

Stages of Fetal Development Decidua has 3 separate areas:

● 38 weeks = fertilized egg (ovum) developed fetus
fully
● Fetal Growth and Development typically
divided into 3 periods:
1. Pre-embryonic – 1st 2 weeks beginning w/
fertilization
2. Embryonic - Weeks 3 - 8
3. Fetal – weeks 8 through birth
● Terms to describe fetal growth
○ Ovum - ovulation to fertilization
○ Zygote - from fertilization to implantation
○ Embryo - from implantation to 5-8 weeks
○ Fetus - 5-8 weeks until term
○Conceptus - developing embryo and
placental structures
●Age of Viability
● Fertilization, Conception, Impregnation,
Fecundation*
○ Usually occurs at the outer third of
fallopian tube = ampulla
○ usually only 1 ovum reaches maturity
each month
● Functional life of spermatozoon
○ 42 hrs (possibly up to 72 hrs)
○ Critical time span for (sexual relations
must occur) successful fertilization?
○ 72 hours (48hrs b4 ovulation + 24hrs
after)
EMBRYONIC AND FETAL STRUCTURES
The Decidua
○ After fertilization, the corpus luteum in
○ Decidua basalis
■ part of the endometrium that lies directly
under the embryo
■ or the portion where the trophoblast cells
are establishing communication w/ maternal
blood vessels
○ Decidua capsularis
■ encapsulates the surface of the
trophoblast
○ Decidua vera
■ the remaining portion of the uterine lining
● Chorionic Villi
○ After implantation trophoblast cell matures
○ 11th or 12th day – miniature villi (probing
“fingers”)
○ Chorionic villi
○ At term almost 200 villi have formed
● Chorionic villi have a central core surrounded by
a double layer of trophoblast cells
● Outer of the 2 covering layers is termed the
syncytiotrophoblast, or the syncytial layer
● Inner /Middle layer – cytotrophoblast or
Langhan’s layer
● Outer of the 2 covering layers is termed the
syncytiotrophoblast, or the syncytial layer –
instrumental in the production various placental
hormones:
○ hCG (Human chorionic gonadotrophin)
○ Somatomammotropin (human placental
lactogen [hPL])
○ Estrogen
○ Progesterone

● Inner layer – cytotrophoblast or Langhan’s layer
○ Appears to function early in pregnancy to protect
the growing embryo and fetus from certain
infectious organisms such as the spirochete of
syphilis
○ Disappears bet. 20th and 24th week = syphilis
not a threat before this time
○ Offers little protection viral invasion @ any point
● The Placenta
○ Fetal in origin
○ 15–20cmindiameter,2–3cmin depth
○ Serves as fetal lungs, kidneys, and GI
tract, and as a separate endocrine organ
throughout pregnancy
● Placental Circulation
● 3rd week
○ oxygen
○ glucose
○ amino acids
○ fatty acids
○ minerals
○ vitamins
○ water
● Placental Circulation
○ For practical purposes, there is no direct
exchange of blood between the embryo and
the mother during pregnancy*
○ outer chorionic villi layer – only one cell
thick
○ Only a few substances are able to cross
from the mother into the fetus
○ Almost all drugs are able to cross into
fetal circulation
○ woman should take no non-essential
drugs (including alcohol and nicotine) during
pregnancy
○ All of the specific mechanisms or
processes that allow nutrients to cross the
placenta are affected by:
➔ Maternal blood pressure and
➔ pH of the fetal and maternal plasma
● As the # of chorionic villi increases w/ pregnancy
● Villi form an increasingly complex
Aripin, Alshammae N. II - BSN H
communication network w/ the maternal blood
● Intervillous spaces grow larger and larger
● Becoming separated by a series of partitions or
septa
● Mature placenta – 30 separate segments or
cotyledons
● These compartments make maternal side of the
placenta @ term look rough and uneven
● Placental Formation
○ 100 maternal uterine arteries supply the
mature placenta*
○ 1No additional maternal arteries appear
after the 1st 3 mos. of pregnancy
○ 2mother’s heart rate, total cardiac output,
and blood volume ⇧ to supply
the placenta
Placental Circulation
● In the intervillous spaces – maternal blood jets
from the coiled or spiral arteries in streams or
spurts
● Maternal blood is then propelled from
compartment to compartment by the currents
initiated
● As blood circulates around the villi and nutrients
osmose from maternal blood into the villi
● Maternal blood gradually loses its momentum
and settles to the floor of the cotyledons
● Blood enters the orifices of maternal veins
located in the cotyledons
● Blood is returned to maternal circulation
The Placenta
➢ Braxton Hicks contractions
➢ Present from about 12th weeks of
pregnancy
➢ Aid in maintaining pressure in the
intervillous spaces by closing off uterine
veins momentarily w/ each contraction
➢ When mother lies on her LEFT SIDE
➢ Lifts the uterus away from the inferior vena
cava1
➢ When mother lies on her BACK
➢ weight of the uterus compresses the vena
cava
➢ placental circulation can be sharply

➢ reduced =
➢ SUPINE HYPOTENSION
➢ At term: placenta weighs 400 – 600 gms
➢ (1lb.) or 1/6 the weight of the baby
➢ Diabetic woman - fetus may develop a
larger than usual placenta
Endocrine Function
Syncytial (outer) layer of chorionic villi – serves as
source of oxygen and nutrients, and develops into a
separate, important HORMONE – PRODUCING
system
WHAT HORMONES ARE PRODUCED BY THE
SYNCYTIAL LAYER?
1. Human Chorionic Gonadotrophin (hCG)
▪ 1st hormone produced
▪ Can be found in maternal blood and
urine as early as the 1st missed menstrual period
(shortly after implantation has occurred) through
about 100th day (14th week) of pregnancy
▪ Negative hCG in mother’s serum – w/in 1 – 2
weeks after birth
▪ Testing for hCG can be used as proof that all of
the placental tissue has been delivered
▪ Human Chorionic Gonadotropin (hCG)*
▪ Purpose: to act as a fall-safe measure to ensure
that the corpus luteum of the ovary continues to
produce
progesterone and estrogen1
▪ May also play a role in suppressing the
maternal immunologic response^
▪ 8th week of pregnancy: outer layer of cells of the
developing placenta begins to produce
progesterone – production
of hCG begins to decrease at this point
2. Estrogen
▪ Primarily estriol
▪ “hormone of women”
▪ Contributes to the mother’s mammary
gland development in preparation for
lactation
▪ Stimulates uterine growth to
accommodate the developing fetus
3. Progesterone
▪ “hormone of mothers”
Aripin, Alshammae N. II - BSN H
▪ Appears to reduce contractility of the
uterine muscles during pregnancy preventing
premature labor=
▪ probably produced by a change in electrolytes
(potassium and calcium), w/c es contraction
potential of the uterus
4. Human Placental Lactogen (hPL,
Human Chorionic Somatomammotropin)
▪ w/ both growth-promoting and
lactogenic (milk-producing) properties
▪ produced by the placenta beginning the 6th week
of pregnancy – increasing to a
peak level @ term
▪ promotes mammary gland growth in
preparation for lactation in the mother*
▪ serves the important role of regulating maternal
glucose, protein, and fat levels
Placental Proteins
▪ Placenta also produces several plasma
proteins*
▪ May contribute to decreasing the
immunologic impact of the growing placenta
The Amniotic Membranes
▪ The chorionic villi on the medial surface of
the trophoblast*
▪ begins to gradually thin, leaving the medial
surface of the structure smooth
▪ chorion leave, or smooth chorion
▪ Smooth chorion eventually becomes the
chorionic membrane - ⇩
▪ Once it becomes smooth, it offers support
to the sac that contains the amniotic fluid
▪⇩
▪ 2nd membrane lining the chorionic
membrane = the amniotic membrane or
amnion forms beneath the chorion
▪ the amniotic membranes not only offers
support to amniotic fluid but also actually
produces the fluid* = Phospholipid
● The Amniotic Fluid
▪ constantly being newly formed and
reabsorbed by the amniotic membrane *
▪ reabsorbed @ the rate of 500 mL/24 hours

▪ some of it is probably absorbed by direct
contact w/ the fetal surface of the placenta
▪ major method of absorption occurs
because
fetus continually swallows the fluid
○ Amount @ term? - 800 – 1200 mL
Method of absorption:
❖ Fetus swallows amniotic fluid
❖ From the fetal intestine, it will be absorbed
into
❖ the fetal bloodstream
❖ Goes to the umbilical arteries
❖ To the placenta
❖ And it is exchanged across the placenta
If fetus is unable to swallow (esophageal atresia or
anencephaly) =
▪ Hydramnios – >2,000 mL
▪ When fetal kidneys become active = urine adds to
the quantity of the amniotic fluid**
▪ Oligohydramnios (<300 mL)
FUNCTIONS of AMNIOTIC FLUID
1. Shields fetus against pressure or a blow to
the mother’s abdomen
2. Protects fetus from changes in temperature
- because liquid changes temperature more
slowly than air
3. Aids in fetal muscular development
- allows fetus the freedom to move
4. Protects umbilical cord from pressure,
protecting the fetal O2 supply
- Amniotic fluid is slightly alkaline = pH 7.2
- Urine is acidic = pH 5.0 – 5.5
The Umbilical Cord
○ formed from the fetal membranes (amnion and
chorion)
○ provides a circulatory pathway that connects the
embryo to the chorionic villi of the placenta
○ Functions:
■ to transport oxygen and nutrients to the fetus
from the placenta and
■ to return waste products from the fetus to the
placenta
Aripin, Alshammae N. II - BSN H
○ 53 cm (21 inches) in length (@ term)
○ 2 cm (3/4 inch) thick
○ What is the bulk of the cord called?
○ A gelatinous mucopolysaccharide
○ Wharton’s jelly
○ outer surface – covered w/ amniotic membrane
○ the remnant of the yolk sac may be found in the
fetal end of the cord – as a white fibrous streak @
term
Contains how many veins and arteries?
➢ 1 vein
➢ 2 arteries
○ # of veins and arteries in the cord is always
assessed and recorded @ birth:
○ 1% - 5% of all infants are born w/ a cord that
contains a single vein and artery
● Rate of blood flow thru an umbilical cord is rapid
350 mL/min @ term*
● Percutaneous umbilical blood sampling (PUBS)
○ blood is withdrawn from the umbilical vein or
transfused into the vein during intrauterine life for
fetal assessment or treatment
● Nuchal cord
○ loose loop of cord around fetal neck;
○ 20% of all births
○ oxygen supply is not impaired
The Umbilical Cord
○ Walls of the umbilical cord arteries are lined w/
smooth muscle
○ Constriction of these muscles after birth
contributes to hemostasis and helps prevent
hemorrhage of the newborn thru the cord
○ Contains NO nerve supply – can be cut @ birth
w/o discomfort to either mother or child
ORIGIN AND ORGAN SYSTEMS
DEVELOPMENT
- From the moment of fertilization, the zygote and
later the embryo and fetus is composed of active,
growing cells.
▪ Stem Cells

1st 4 days of life – zygote cells = totipotent stem
cells, or cells that are so undifferentiated that they
have the potential to form a complete human being
After another 4 days, as structure implants and
becomes an embryo – cells begin to show
differentiation and are no longer capable of
becoming just any body cell
Become specific body cells such as nerve, brain, or
skin cells = pluripotent stem cells
Another few days, cells grow so specific =
multipotent stem cells – evident what body organ
they will create
▪ If nucleus is removed from an oocyte, and adult
nucleus is transferred into the oocyte = embryo has
the potential to grow into an infant that is identical
to the adult donor = reproductive cloning
▪ If pluripotent stem cells are removed and allowed
to grow in the laboratory = has the potential to be
able to supply any type of body cell needed by the
adult donor = therapeutic cloning
▪ Zygote Growth
o Development proceeds in a
cephalocaudal (head-to-tail) direction
o head development occurs first, followed
by the development of the middle and,
finally, the lower body parts
o As a fetus grows, body organ systems
develop from specific tissue layer called
germ layers
▪ Primary Germ Layers
o @time of implantation blastocyst already has
differentiated (distinguishable) to a pt. at w/c
o 2 separate cavities appear in the inner structure:
▪ Amniotic cavity
▪ Yolk sac
▪ Amniotic cavity
- Large one
- Lined with a distinctive layer of cells =
ECTODERM
- yolk sac progress to become a network of blood
▪ Yolk Sac
Aripin, Alshammae N. II - BSN H
- Smaller cavity
- Lined w/ ENTODERM
- Supply nourishment only until implantation
- After, it provides a source of RBC until the
embryo’s hematopoietic system is mature
enough to perform this function – about 12th
week of intrauterine life
- It then atrophies and remains only as a thin
white streak discernible in the cord @ birth
ECTODERM – lines the amniotic sac
ENTODERM – lines the yolk sac
MESODERM – found bet. Amniotic cavity and yolk
sac
Where these 3 layers meet, embryo starts to
develop = EMBRYONIC SHIELD
o Each of these germ layers of primary
tissue develops into specific body systems
o Co-existing congenital defects Fistula bet.
Trachea and esophagus Both arise from the
entoderm
o Heart and kidney defects Both arise from
mesoderm = commonly seen together
o Malformation of heart (mesoderm) and
lower urinary tract (bladder and urethra –
entoderm) Rare
Rubella Virus - so serious in pregnancy
- is capable of infecting all three germ layers
- Causing congenital anomalies in numerous
body systems
Organogenesis
▪ all organ systems are complete, @ least in a
rudimentary form - @ 8 weeks’ gestation (end of
embryonic period)
▪ Organogenesis – organ formation
▪ growing structure is most vulnerable to invasion
by teratogens
▪ Teach women to minimize exposure to teratogens
CARDIOVASCULAR SYSTEM
▪ One of the 1st systems to become functional in
intrauterine life
▪ Simple blood cells joined to the walls of the

vessels and a single heart tube – w/c forms as
early as the 16th day of life
▪ beats as early as the 24th day
▪ Septum that divides the heart into chambers –
develops during the 6th or 7th week
▪ Heart valves begin to develop in the 7th week
▪ Heartbeat may be heard w/ a Doppler
instrument – 10th – 12th week of pregnancy
▪ Electrocardiogram (ECG) may be recorded on a
fetus – as early as 11th week
▪ more accurate about the 20th week of pregnancy
(conduction is more regulated)
▪ Heart rate of fetus is affected by:
o Fetal oxygen level
o Body activity
o Circulating blood volume
Fetal Circulation
▪ 3rd week of intrauterine life – fetal blood begins to
exchange nutrients w/ the maternal circulation
across the chorionic villi
▪ Fetal circulation differs from extrauterine
circulation in several aspects:
1. Fetus derives oxygen and excretes carbon
dioxide not from oxygen exchange in the
lungs but from the placenta
2. Blood does enter the blood vessels of the
lungs while the child is in-utero, but this
blood flow is to supply the cells of the lungs
themselves, not for oxygen exchange.
3. Specialized structures present in the fetus
shunt blood flow to supply the most
important organs of the body: the brain,
liver, heart, and kidneys.
Fetal Circulation
- Blood arriving @ the fetus from the placenta
is highly oxygenated Enters through the
umbilical vein (called a vein tho’ it carries
oxygenated blood – because direction of the
blood is toward the fetal heart)
- Blood is carried into the inferior vena cava
thru an accessory structure – ductus
venosus, allowing oxygenated blood to be
supplied directly to the fetal liver
Aripin, Alshammae N. II - BSN H
- Oxygenated blood empties into the inferior
vena cava, then, carried to the right side of
the heart
- Because there is no need for the bulk of the
blood to pass thru the lungs, it is shunted as
it enters the right atrium (extrauterine
circulation: pass thru rt. ventricle – lungs)
Fetal Circulation
- Into the left atrium thru an opening in the
atrial septum, called the foramen ovale
- Follows the course of normal circulation into
the left ventricle and into the aorta
- Small amount – returned to the via vena
cava does leave the rt. Atrium by the adult
circulatory route
Larger portion of this blood is shunted away from
the lungs thru an additional structure – ductus
arteriosus directly into the descending aorta
Transported by the umbilical arteries (transporting
deoxygenated blood – away from the fetal heart)
back thru the umbilical cord
placental villi maternal circulation – where new
oxygen exchange takes place
▪ Fetal blood O2 saturation level: 80% of a
newborn’s saturation level
▪ Rapid fetal heart rate during pregnancy =
120 – 160 beats/min; is necessary to supply
O2 to cells, because RBCs are never fully
saturated
Fetal Hemoglobin
▪ Differs from adult hemoglobin in several ways:
▪ Fetal hemoglobin has a different composition:
▪ Fetus: 2 alpha and 2 gamma chains
▪ Adult: 2 alpha and 2 beta chains
▪ It is more concentrated and has greater
oxygen affinity – 2 features that increase its
efficiency
▪ Newborn’s hemoglobin level :17.1 g/100 mL
o Adult’s normal level :11 g/ 100 mL
▪ Newborn’s hematocrit :53%
o Adult’s normal level :45%

Respiratory System
▪ 3rd week of intrauterine life – respiratory and
digestive tracts exist as a single tube
▪ End of 4th week – a septum begins to divide the
esophagus from the trachea;
▪ lung buds also appear on the trachea : 7th week
of life*
▪ If diaphragm fails to close completely the
stomach, spleen, liver, or intestines may be pulled
up into the thoracic cavity
▪ Child will be born w/ Diaphragmatic hernia or w/
intestine still present in the chest*
Important respiratory devtl. milestones:
▪ Alveoli and capillaries begin to form bet. 24th and
28th weeks*
▪ Spontaneous respiratory practice movements
begin as early as 3 months’ gestation and continue
throughout pregnancy
Important respiratory devtl. milestones:
▪ Alveoli and capillaries begin to form between 24th
and 28th weeks
▪ Spontaneous respiratory practice movements
begin as early as 3 months’ gestation and continue
throughout pregnancy
▪ Specific lung fluid w/ a low surface tension and
low viscosity forms in alveoli
▪ 24th week (6 months) of pregnancy,
alveolar cells secrete = Surfactant*
o es alveolar surface tension on expiration,
preventing alveolar collapse and
o improving the infant’s ability to maintain
respirations in the outside environment
Components of surfactant:
o Lecithin (L)
o Sphingomyelin (S)*
o L/S Ratio: 2:1
▪ Analysis of L/S ratio thru amniocentesis
= determines fetal maturity
▪ Respiratory distress syndrome* - ing steroid levels
in the fetus*
Nervous System
▪ 3rd to 4th weeks of life – active formation of the
nervous system and sense organs
Aripin, Alshammae N. II - BSN H
▪ Requires vast quantity of glucose during this time
– embryo takes glucose – leaving mother w/ mild
hypoglycemia = dizziness, vomiting
▪ A neural plate (thickened portion of the ectoderm)
is apparent by the 3rd week of gestation
▪ Its top portion differentiates into the neural tube –
will form the central nervous system (brain and
spinal cord),
▪ And the neural crest – will develop into the
peripheral nervous system
▪ All parts of the brain (cerebrum, cerebellum, pons,
and medulla oblongata) form in utero*
▪ Eye and inner ear develop as projections of the
original neural tube
▪ By 24 weeks – ears is capable of responding to
sound
▪ eyes exhibit papillary reaction, indicating sight is
present
▪ 8th week – brain waves can be detected on an
electroencephalogram (EEG)
▪ Prone to insult during early weeks of embryonic
period
▪ Spinal cord disorders
▪ Meningocele (herniation of meninges) –
▪ Due to lack of folic acid*
▪ All other – during pregnancy and birth –
vulnerable to damage from ANOXIA
Endocrine System
▪ Fetal adrenal glands supply a precursor/basis for
estrogen synthesis by the placenta
▪ Fetal pancreas produces the insulin needed by
the fetus
▪ Thyroid and parathyroid glands play vital roles in
metabolic fxn and calcium balance
Digestive System
▪ 4th week – digestive tract separates from the
respiratory tract
▪ Atresia or stenosis
▪ Proliferated cells shed in the 2nd
recanalization – w/c forms the basis for meconium
▪ 6th week – abdomen becomes too small to
contain the intestine and portion of it guided by the
vitelline membrane (a part of the yolk sac) intestine
is pushed into the base of the umbilical cord where
it remains until about the 10th week*

▪ As intestine returns to the abdominal cavity – it
must rotate 180 degrees
▪ Failure to rotate = inadequate mesentery
attachments = volvulus (twisting of the bowel) of
the intestine in the newborn
▪ Omphalocele – congenital anomaly
▪ Gastroschisis
▪ Meckel’s Diverticulum – a pouch of
intestinal tissue
▪ Meconium – forms in the intestines as early as
16th week
o collection of cellular wastes, bile, fats,
mucoproteins, mucopolysaccharides, and
portions of the vernix caseosa*
o sticky in consistency and
o appears black or dark green
o White meconium – sign of biliary
obstruction
● GI tract is sterile before birth
● Vit. K levels are low in newborns*
● 32 weeks’ gestation: fetus weighs 1,500g;
sucking and swallowing reflexes are
matured enough
● 36 weeks – GI tract is able to secrete
enzymes essential to carbohydrate and
protein digestion
● Amylase– enzyme found in saliva,
necessary
● For digestion of complex starches
● Lipase – necessary for fat digestion
● Liver is active throughout gestation
● functions as a filter between incoming blood
and the fetal circulation, and
● as a deposit site for fetal stores such as iron
and glycogen
● Still immature @ birth
● possibly leading to hypoglycemia and
hyperbilirubinemia – 2 serious problems in
the 1st 24 hours after birth
Musculoskeletal System
▪ 1st 2 weeks of fetal life – cartilage prototypes
provide position and support
▪ 12th week – ossification of bone tissue begins and
continues until adulthood
Aripin, Alshammae N. II - BSN H
▪ Carpals, tarsals, and sternal bones generally do
not ossify (harden) until birth is imminent
▪ 11th week – Fetal movements visible on
ultrasound
▪ Almost 20 weeks of gestation (5th month) –
mother feels the fetal movements (quickening)
Reproductive System
▪ Child’s sex is determined @ the moment of
conception*
▪ 6th week of life – gonads (ovaries or testes) form
▪ If testes form = testosterone is secreted,
influencing the sexually neutral genital duct to form
other male organs (maturity of the wolffian, or
mesonephric ducts)
▪ Absence of testosterone secretion = female
organs will form (maturation of müllerian, or
paramesonephric duct)*
▪ Androgen*
▪ Female and male ducts could develop
=Pseudo-hermaphrodism or intersex
▪ Testes 1st form in the abdominal cavity and do not
descend into the scrotal sac until the 34th – 38th
week
▪ Male preterm infants – born w/ undescended
testes*
▪ Surgery – necessary as undescended testes are
associated with poor sperm production and
testicular cancer
Urinary System
▪ End of 4th week – rudimentary kidneys already
present;
▪ do not appear essential for life before birth
- placenta clears the fetus of waste products
▪ 12th week – urine is formed and excreted thru
the amniotic fluid by the 16th week of gestation*
▪ @ term, fetal urine is excreted @ the rate of 500
mL/day*
▪ Patent urachus – discovered @ birth; persistent
drainage of a clear, acid-pH fluid (urine) from the
umbilicus
Integumentary System
 Aripin, Alshammae N. II - BSN H
▪ Skin of a fetus appears thin and almost ▪ average newborn is potentially susceptible to
translucent until subcutaneous fat begins to be these diseases
deposited @ about 36 weeks ▪ IgA and IgM – cannot cross the placenta
▪ Lanugo – soft downy hairs covering fetal skin* ▪ If present in a newborn = proof that fetus has
▪ Vernix caseosa – cream cheese-like substance, been exposed to a disease
important for lubrication and for keeping the skin
from macerating in utero Determination of EBD
▪ Traditionally: EDC (Expected Date of
Immune System Confinement)
▪ Immunoglobulin G (IgG) - maternal antibodies - Because women are no longer “confined”
▪ cross the placenta into the fetus as early as the after childbirth =
20th week of pregnancy ▪ EDB or EDD used today
▪ gives fetus temporary passive immunity against ▪ Nagele’s Rule
diseases for w/c mother has antibodies ▪ Count backward 3 calendar mos from
▪ These often include: the 1st day of woman’s LMP and
- poliomyelitis ▪ Add 7 days
- rubella (German measles) ▪ -3 +7
- rubeola (regular measles) ▪ LMP: July 23 EDD: April 30, 2024
- diphtheria Estimating Gestational Age
- tetanus ▪ McDonald’s Rule
- infectious parotitis (mumps) ▪ Symphysis-fundal height measurement
- hepatitis B ▪ From notch of the symphysis pubis to
- pertussis (whooping cough) over the top of the uterine fundus as
the woman is lying supine
▪ Level of these acquired passive IgG peaks @ ▪ Inaccurate during 3rd trimester
birth and then es over the next 8 mos. ▪ Fetus is growing more in weight than in
▪ While infant begins to build up his or her own height
stores of IgG, as well as IgA and IgM Gestational age in lunar months
▪ Immunization against diphtheria, tetanus, - FH (incm) x 2 ÷ 7
pertussis, poliomyelitis, rotaviruses, h. influenzae, Example:
and pneumococcus– is typically started (by about 2 FH: 31.5cm
mos) mos?
▪ Passive antibodies to measles – seen to last for ▪ 9 mos.
more than 1 year = measles
- immunization is not given until 12mos. of Gestational age in weeks
age - FH (incm) x 8 ÷ 7
Example:
▪ It has been shown that fetus is capable of active FH: 36cm
antibody production late in pregnancy ▪ 41 – 42 weeks
▪ Tho’ not necessary – antibodies are manufactured
only after stimulation by invading antigen
▪ Infants w/ mother who have had infetion
(rubella) during pregnancy – typically have active
IgM antibodies to rubella in their bld. serum @ birth
▪ little or no immunity to herpes virus (cold sores,
genital herpes)

PSYCHOLOGIC AND PHYSIOLOGIC
CHANGES IN PREGNANCY
● Pregnancy brings both psychological and
physiological changes to a woman and her partner
● Clients are more interested in learning more
about the changes pregnancy brings – because
these changes verify the reality and mark the
progress of a pregnancy
Physiologic Changes in pregnancy occur gradually
but eventually affect all organ systems of a
woman’s body. Changes are necessary:
- to allow a woman to be able to provide O2
and nutrients for her growing fetus, as well
as extra nutrients for her own ⇧ed
metabolism during the pregnancy
- prepare her body for labor and birth and for
lactation once baby is born
Changes are extensive but temporary – when
pregnancy ends, woman’s body will return to its
pre-pregnancy state
Psychological changes occur in response not
only to the physiologic alterations that are occurring
but also to the increased responsibility associated
with welcoming a new and completely dependent
person to the family.
Despite the magnitude of these changes, they are
all extensions of normal physiology – making
pregnancy represent a time of WELLNESS, not
illness. Because of this, the major responsibility of a
nurse caring for a pregnant woman and family is:
- To help the family maintain a state of
wellness throughout the pregnancy and into
early parenthood
PSYCHOLOGICAL CHANGES OF
PREGNANCY
- Pregnancy is such a huge change in a
woman’s life that it brings about more
psychological changes than any other life
event besides puberty.
Aripin, Alshammae N. II - BSN H
A woman’s attitude toward a pregnancy depends a
great deal on the following factors:
1. SOCIAL INFLUENCE
● Related to their cultural background, personal,
beliefs, experiences of friends and relatives,
available information
● Before: pregnancy was viewed as a 9-month long
illness
- Pregnant woman went alone to a
physician’s office for care
- @ the time of birth – separated from her
family and admitted to a hospital
- Hospitalized in seclusion from visitors and
even from the new baby for a week
afterward
● Today: society view pregnancy as a time of health
- Women now bring their families, instead of
coming alone for prenatal care
- Instead of being given gen. anesthesia –
women are urged to participate actively in
the experience
- Birthing rooms, and an emphasis on
family-centered care – helped involve
families
- Best shared w/ a supportive partner and/or
family
● The way a pregnant woman and her partner feel
about pregnancy and childbirth may be affected by
their cultural background, personal experiences,
and the experiences of friends and relatives, as
well as the current public philosophy of childbirth
● Informing women about their new health care
options, continuing to work w/ other health care
providers to “demedicalize” childbirth – nurses can
help make pregnancy and childbirth more enjoyable
for clients and their families
2. CULTURAL INFLUENCE
● Cultural background strongly influence pregnant
woman’s role in her pregnancy – certain beliefs and
taboos may place restrictions on her behavior and
activities
3. FAMILY INFLUENCE

● The family in w/c a woman was raised can be as
influential to her beliefs about pregnancy as her
cultural environment
● “People love as they have been loved” – if
woman has had difficulty loving others because she
has not received love, she may worry that she will
have difficulty loving and accepting the fetus
growing w/in her
● Woman who views mothering as a positive way is
more likely to be pleased when she becomes
pregnant than one who devalues mothering
4. INDIVIDUAL INFLUENCES
● Woman’s ability to cope w/ or adapt to stress
plays a major role in how she will resolve conflict
and adapt to the new life contingencies that are
coming
● The ability to adapt depends, in part, on her;
- Basic Temperament
- Whether she adapts to new situations
quickly or slowly
- Whether she faces them w/ intensity or
maintains a low-key approach
- Whether she has had experiences coping
w/ change and stress
● The extent to w/c a woman feels secure in her
relationship w/ the people around her, esp. the
father of her child, is usually also important to her
acceptance of a pregnancy – acceptance is easier
if she has confidence in the stability of her
relationship w/ the child’s father and knows that he
will be there to give her emotional support
● Brides – young, mothers – old = may believe
pregnancy will rob her of her youth
● Children are sticky-fingered and time - consuming
= may view pregnancy as taking way
● Pregnancy will permanently stretch her abdomen
and breasts = concern that she will lose her looks
● Pregnancy will rob her financially and ruin her
chances of job promotion
● Woman needs an opportunity to express these
feelings and become aware of their intensity to
resolve them.
The Psychological Tasks of Pregnancy
Aripin, Alshammae N. II - BSN H
● Initial reactions of a woman and her partner to
pregnancy:
- surprise – at finding out the woman is
pregnant (or wishing she were not)
- pleasure and acceptance – of the fact as
they begin to identify w/ the coming child
- worry and fear – for themselves and the
child
- impatience and boredom – near the end of
pregnancy
● 9 - month period of pregnancy
Physiological standpoint – fortunate that pregnancy
is 9 months long:
- Gives fetus time to mature and be prepared
for life outside the protective uterine
environment
Psychological standpoint – 9-month period is
fortunate for the family:
- Gives them time to prepare emotionally
Psychological changes – “guaranteeing safe
passage” for the fetus
● How well a woman adjust to potential stress
of pregnancy can affect her rel/ w/ the child
and even influence whether she can carry
pregnancy to term
First Trimester: Accepting the Pregnancy
THE WOMAN
● Task of women during the 1st trimester is to
accept the reality of the pregnancy
● Receiving confirmation of pregnancy makes
woman feel more pregnant
● Initial reaction – ambivalence, or feeling both
pleased and not pleased about the pregnancy
● Most women are able to change their attitude
toward the pregnancy by the time they feel the child
move inside them
THE PARTNER
● It is recognized today that all partners have an
important role and should be encouraged to have
an emotional interest in the pregnancy
● As a woman adapts to pregnancy, her partner
may go through some of the same psychological
changes

■ For partners, accepting the pregnancy means not
only accepting the certainty of the pregnancy and
the reality of the child to come but also accepting
the woman in her changed state
■ Partner should try to give the woman emotional
support while she is learning to accept the reality of
pregnancy
■ Woman should also reciprocate when the partner
begins to go through the process
Second Trimester: Accepting the Baby
THE WOMAN
● During the 2nd trimester, the psychological task
of a woman is to accept that she is having a baby, a
separate step from accepting the pregnancy
● Quickening – 2nd turning point in pregnancy;
woman is able to give the child an identity – as a
separate entity; begins to imagine how she will feel
@ the birth, imagine herself as a mother =
anticipatory role-playing, an important task for a
pregnant woman – makes her realize that not only
is she pregnant but also there is a child inside her
● Woman’s Acceptance of the baby may occur
when:
- she announces the news to her parents and
hears them express their joy
- she sees a look of pride on her partner’s
face
- moment of quickening
- shopping for baby clothes for the first time
- setting up the crib
- seeing a blurry outline on a sonogram
screen
● a good way to measure the level of a
woman’s acceptance of the coming baby is t
measure how well she follows prenatal
instructions
THE PARTNER
● partner may feel left out, waiting to be asked to
take part in the event = may become overly
absorbed in his work/ pre-occupation w/ work,
limiting amount of time spent with his family, just
when pregnant woman most needs emotional
support
● Misinformation about sexuality, pregnancy and
women’s health:
Aripin, Alshammae N. II - BSN H
■ Breast-feeding will make his wife’s breasts no
longer attractive and will advise against it
■ Childbirth will stretch his wife’s vagina – sexual
relations will no longer be enjoyable – will advocate
cesarean birth
● Needs education to correct misinformation
Third Trimester: Preparing for Parenthood
● During the 3rd trimester, couples usually begin
“nest-building” activities – planning the infant’s
sleeping arrangements, buying clothes, choosing
names for the infant, and “ensuring safe passage”
by learning about birth = all are evidence that
woman is completing the 3rd trimester task of
pregnancy or preparing for parenthood
● Couples at this point are interested in attending
prenatal classes or preparation for childbirth
classes
● It is helpful to ask a couple what specifically they
are doing to get ready for birth in order to document
how prepared they will be for the baby’s arrival
OTHER SPECIFIC TASK THAT A COUPLE MUST
COMPLETE TO BE READY TO BE PARENTS:
REWORKING DEVELOPMENTAL TASK:
Working through previous life experiences:
- Woman’s relationship w/ parents,
particularly w/ mother – negative feelings,
unless resolved, may continue to have
negative effect on the woman’s views about
becoming a mother
- Fear of being separated from family or dying
– common childhood fear that can be
revived during pregnancy
Clue: “Am I ever going to make it thru this?” – might
simply mean she is tired of her backache, but it
also might be a plea for reassurance that she will
survive this event in her life
- Woman needs to have confidence in those
who provide healthcare for her during
pregnancy – so she can express some of
these disturbing thoughts and work thru
them
- As a rule: a woman who is comfortable
seeking information experiences less
anxiety than one who is unable to do this.

- Pregnant woman’s partner needs to do the
same reworking of old developmental tasks:
values and forgotten
- Rethink his relationship w/ his father – to
understand better what kind of father he will
be
Role-Playing and Fantasizing
● 2nd step in preparing for parenthood is
role-playing or fantasizing – about what it will be
like to be a parent
■ Pregnant woman begins to spend time w/ other
pregnant women or mothers w/ young children – to
learn how to be a mother
■ Finds that her own mother becomes more
important
■ Women’s dreams tend to focus on the pregnancy
and concerns about keeping themselves and their
coming child safe
● Father-to-be also has role-playing to do
■ he has to imagine himself as the father of a
boy and as the father of a girl
Emotional Responses to Pregnancy
● It is important to caution pregnant woman and her
partner about common changes they may expect
so as not to misinterpret them as loss of interest in
their relationship.
1. AMBIVALENCE
● Pregnancy is an intrusive process that
cannot be ignored
● A separate individual is growing inside the
woman, changing how she looks and feels
● She may want to be pregnant, and yet she may
not be enjoying it = leading to some degree of
ambivalence
● Refers to the interwoven feelings of wanting and
not wanting that can exist @ high levels = normal
● PARTNERS - also experience ambivalence –
afraid to voice their concerns, not well-prepared for
parenthood or have had little experience w/ children
2. GRIEF
● Before a mother can take on a mothering
role, she has to give up or alter her present roles
Aripin, Alshammae N. II - BSN H
● She must incorporate her new role as a mother
into her roles as a daughter, wife, or friend (same
w/ partner)
3. NARCISSISM
● self-centeredness - an early reaction to
pregnancy
● previously - barely conscious of her body;
suddenly begins to concentrate on these
aspects
● a woman may manifest her narcissism by a
change in her activity level
■ stop playing tennis
■ criticize husband’s driving; does these things to
unconsciously protect her body and her baby
■ this need to protect her body has implications for
nursing care
■ may regard unnecessary nudity as a threat to her
body – be sure to drape properly for pelvic and
abdominal examinations
■ may resent casual remarks such as, “You’ve
gained weight!” – threat to her appearance
■ “You don’t like milk?” – threat to her judgment
Woman may be much more interested in doing
things for herself because it is her body, her
tiredness, and her well-being that will be directly
affected
4. INTROVERSION VS EXTROVERSION
INTROVERSION – turning inward to concentrate
on oneself and one’s body – common finding during
pregnancy
Some women react in an entirely opposite fashion
and become more EXTROVERTED
- Become more active
- Appear healthier than ever before
- More outgoing
BODY IMAGE AND BOUNDARY
● BODY IMAGE – the way your body appears to
yourself
● BODY BOUNDARY – a zone of separation you
perceive between yourself and objects or other
people

● these 2 change during pregnancy as the woman
begins to envision herself as a mother, in addition
to being a daughter or wife and begins to see
herself becoming “bigger” in many different ways
● change in body image is part of the basis for
narcissism and introversion
● changes in body boundary - perceived as
extremely vulnerable, as if body were delicate and
easily harmed
STRESS
● Pregnancy brings w/ it a major role change – can
be a time of extreme stress for a woman
● Stress of pregnancy can make it difficult for the
woman to make decisions, be as aware of her
surroundings as usual, or maintain time
management w/ her usual degree of skill
● Stress on pregnant women may cause people
who were dependent on her before pregnancy to
feel neglected – she seems to have strength only
for herself
● Woman w/ few support people – have more
difficulty adjusting to and accepting a pregnancy
and a new child
● Stress may lead to acute loneliness, depression,
and a further inability to function
COUVADE SYNDROME
● Many men experience physical symptoms such
as nausea, vomiting, and backache to the same
degree or even more intensely than their partners
do during a pregnancy = couvade syndrome
● These symptoms result from stress, anxiety, and
empathy for the pregnant woman
● The more the partner is involved in or attuned to
the changes of the pregnancy, the more symptoms
he may experience:
■ As woman’s abdomen begins to grow – father
may perceive himself as growing larger, too, or has
changing boundaries
EMOTIONAL LABILITY
● mood changes/mood swings occur frequently in a
pregnant woman – as a manifestation of narcissism
(feelings are easily hurt by remarks), and partly
because of hormonal changes (sustained ⇧ in
estrogen and progesterone)
Aripin, Alshammae N. II - BSN H
■ what she finds acceptable one week she may find
intolerable the next
CHANGES IN SEXUAL DESIRE
● Changes to some degree during pregnancy
■ Worried about becoming pregnant – might truly
enjoy sex for the first time during pregnancy
■ Others feel a loss of desire due to the estrogen
increase
■ Or might unconsciously view sexual relations as
a threat to the fetus they must protect
■ Having sex could bring on early labor
● 1st trimester – most women report a decrease in
libido because of the nausea, fatigue, and
breast tenderness that accompany early
pregnancy
● 2nd trimester – increase blood flow to pelvic area
to supply placenta = libido and sexual enjoyment
rise markedly
● 3rd trimester – sexual desire remain high, or
may decrease because of difficulty finding a
comfortable position and increasing abdominal
size
CHANGES IN THE EXPECTANT FAMILY
● Most parents are aware that their older children
need preparation when a new baby is on the way
● Both preschool and school – age children may
need to be reassured periodically during pregnancy
that a new baby will be an addition to the family and
will not replace them in their parents’ affection
The Diagnosis of Pregnancy Presumptive Signs
of Pregnancy
● Least indicative of pregnancy
● Largely subjective – experienced by the woman
but cannot be documented by an examiner
● Strong possibility
○ Breast changes – after the 2nd month – feeling of
tenderness, fullness, or tingling sensation;
enlargement and darkening of areola
○ Nausea and vomiting – “morning sickness”;
appears about 2 weeks after the 1st missed period
and subsides spontaneously 6 or 8 weeks later;
also present in other conditions such as indigestion

○ Amenorrhea – absence of menstruation; altho’
cessation of menstruation is the earliest and one of
the most important symptoms of pregnancy, it shd
be noted that pregnancy may occur w/o prior
menstruation and occasionally menstruation may
continue after conception; may result from a
number of other conditions
○ Frequent urination – sense of having to void
frequently; attributed to the fact that the growing
fetus or uterus stretches the base of the bladder,
same sensation felt when bladder wall is stretched
w/ urine
○ Fatigue – general feeling of tiredness; lassitude
and drowsiness
○ Uterine enlargement – uterus can be palpated
over symphisis pubis
○ Quickening – fetal movement first felt by woman
○ Linea nigra – brown line running on the
abdomen,
from the umbilicus to the symphysis pubis
○ Melasma (chloasma) – “mask of pregnancy”;
dark pigment on face particularly on the cheeks and
across the nose
○ Striae gravidarum – red streaks on abdomen,
breast and thighs
Probable Signs of Pregnancy
● can be documented by the examiner
● objective
● more reliable than presumptive signs, but still not
positive or true diagnostic findings
○ Laboratory tests – commonly used lab tests for
pregnancy are based on detecting the presence of
human chorionic gonadotropin (hCG), hormone
created by the chorionic villi of the placenta, in the
urine or blood serum
■ 95% - 98% accurate
■ Serum: Radioimmunoassay
(RIA), assay enzyme-linked immunosorbent
(ELISA), or radioreceptor assay (RRA)
techniques – measurement of hCG (international
units)
● Trace amounts of hCG appear in serum as early
as 24 – 48 hours after implantation
● Reach measurable level 7 – 9 days after
conception – about 50 mIU/mL
Aripin, Alshammae N. II - BSN H
● Levels peak bet. 60th and 80th day of gestation –
100 mIU
■ Urine:
- now used rarely because blood serum tests
give earlier results;
○ Home Pregnancy Tests – available OTC; have a
high degree of accuracy (about 97%); convenient;
can detect as little as 35 mIU/mL of hCG
- Women taking psychotropic drugs
(antianxiety agents), oral contraceptives, w/
proteinuria, postmenopausal, or
hyperthyroid dse. – may have false-positive
results
Chadwick’s sign – color change of the vagina from
pink to violet
Goodell’s sign – softening of the cervix; from tip of
nose to the one resembling an earlobe
Hegar’s sign – softening of the lower uterine
segment
Sonographic evidence of gestational sac –
characteristic ring is evident
Ballottement – when lower uterine segment is
tapped in a bimanual examination, the fetus can be
felt to rise against abdominal wall
Braxton Hicks Contractions – “painless
contractions”; periodic uterine tightening or
hardening felt across the abdomen; also called
Hicks sign
Fetal outline felt by examiner – about 5 – 6
months of pregnancy, uterus has become thinned
to such degree that a fetal outline w/in the uterus
may be palpated through the abdomen and
identified by a skilled examiner
Positive Signs of Pregnancy
Demonstration of a Fetal Heart Separate from the
Mother

● Transabdominal UTZ – growing embryo
inside a gestational sac as early as 5th or
6th week beyond the last menstrual period
○ Visualization of fetal heart and show it beating as
early as 6th or 7th week of pregnancy
● Doppler technique – ultrasonic monitoring
systems that convert ultrasonic frequencies
to audible frequencies; detect fetal heart
sounds as early as the 10th – 12th week of
gestation
● Echocardiography – as early as 5 weeks
● Auscultation of the abdomen thru
ordinary stethoscope – 18 – 24 weeks of
pregnancy (tho’ heart has been beating
since the 24th day after conception)
● Fetal heart sounds:
○ difficult to hear if abdomen has a great deal of
subcutaneous fat or in hydramnios
○ best heard when position of fetus is determined
by palpation (Leopold’s maneuver) and
stethoscope is placed over the area of the fetus’
back
● Fetal heart rate: 120 – 160 beats/minute
Fetal Movements Felt by the examiner
● Fetal movements 1st felt by the woman as early
as 16 – 20 weeks of pregnancy (presumptive sign)
● Those felt by an objective examiner are much
more reliable (positive sign) – felt 20th – 24th week
of pregnancy, unless woman is extremely obese
● Visualization of Fetus by Ultrasound
● Characteristic ring, indicating the gestational sac
will be revealed on the oscilloscope screen as early
as 4th – 6th week of pregnancy
● 8th week – fetal outline can be seen so clearly
w/in the sac; crown-to-rump length can be
measured to establish gestational age of the
pregnancy
PHYSIOLOGIC CHANGES OF PREGNANCY
● Can be categorized as LOCAL (confined to the
reproductive organs) or SYSTEMIC (affecting the
entire body)
Aripin, Alshammae N. II - BSN H
● Both symptoms (subjective findings) and signs
(objective findings) of the physiologic changes are
used to diagnose and mark the progress of
pregnancy
Local Changes: Reproductive System Changes
● Uterine Changes:
● Uterus increases in size to make room for the
growing fetus
● Length grows from approx. 6.5 – 32 cm
● Depth increases from 2.5 – 22 cm
● Width expands from 4 – 24 cm
● Weight increases from 50 – 1000 g
● Uterine wall thickens (early in pregnancy)
from 1 – about 2 cm; toward the end of
pregnancy, thins to become supple and only
about 0.5 cm thick
● Volume increases from 2 mL to more than
1000 mL; can hold a 7lb (3.175 g) fetus plus
1000 mL of amniotic fluid (total of about
4000 g)
● Great uterine growth is due partly to formation of
a few muscle fibers in the uterine myometrium but
principally due to the stretching of existing muscle
fibers
● End of 12th week of pregnancy – large enough to
be palpated as a firm globe under the abdominal
wall, just above the symphysis pubis
● Uterine growth is constant, steady and
predictable
● 20th – 22nd week = level of the umbilicus
● 36th week = touch the xiphoid process
● 2 weeks before term (38th week) –
primigravida, woman in her 1st pregnancy –
fetal head settles into pelvis to prepare for
birth, uterus returns to the height it was @
36 weeks = termed lightening, because
woman’s breathing is so much easier it
seems ti lighten the woman’s load
● Lightening not predictable in multipara
(woman who has had one or more children)
● Fundal Height during pregnancy
● Uterine height is measured from the top of the
symphysis pubis over the top of the uterine fundus
● Uterine blood flow increases during pregnancy as
placenta grows and requires more and more blood
for perfusion

● Doppler ultrasonography – from 15 – 20 mL/min
(before pregnancy) to 500 – 750 mL (end of
pregnancy)
● 75% of that volume goes to the placenta;
● Toward end of pregnancy – 1/6 of the total body
blood supply is circulating through the uterus
● Uterine bleeding is always potentially dangerous
– vaginal blood loss (suggesting uterine bleeding),
shd be reported to health care practitioners
● Bimanual examination – (one finger of the
examiner is placed in the vagina, the other hand on
the abdomen) – shows that uterus is more
anteflexed (bent forward), larger and softer to the
touch than usual;
Hegar’s sign
● 16th – 20th week ⇨ fetus is small in relation to the
amount of amniotic fluid = ballottement (French
word balloter, meaning to toss about)
● Braxton Hicks contractions- 12th week; “practice”
contractions – serve as warm-up exercises for labor
and also increase placental perfusion; become so
strong and noticeable in the last month; may be
mistaken from labor contractions (false labor) – no
cervical dilatation
Amenorrhea
● Occurs with pregnancy due to suppression of
follicle stimulating hormone (FSH) by rising
estrogen levels
● Healthy woman – amenorrhea strongly suggests
impregnation ha occurred
● May also indicate onset of menopause, uterine
infection, worry over becoming pregnant, chronic
illness (severe anemia, stress); athletes who train
strenuously, %age of body fat drops below critical
point – making amenorrhea only a presumptive
sign
Cervical Changes
● Cervix of the uterus becomes more vascular and
edematous – response to the increased level of
circulating estrogen from the placenta during
pregnancy
● Softening of the cervix (Goodell’s sign) – due to
increased fluid between cells
■ Nonpregnant cervix – tip of nose
Aripin, Alshammae N. II - BSN H
■ Pregnant cervix - earlobe
■ Just before labor – consistency is like butter or is
said to be “ripe” for birth
● Darkening of the cervix from a pale pink to violet
– due to increased vascularity
● Gland of the endocervix undergo both
hypertrophy and hyperplasia and distend w/ mucus
■ Tenacious coating of mucus fills cervical canal –
mucus plug, called operculum – acts to seal out
bacteria and helps prevent infection in the fetus and
membranes
Vaginal Changes
● Vaginal epithelium and underlying tissue become
hypertrophic and enriched w/ glycogen – due to
influence of estrogen
● Structures loosen from connective tissue
attachments – in preparation for great distention @
birth = resulting in a white vaginal discharge
throughout pregnancy
● Change in the color of the vagina from normal
light pink to a deep violet (Chadwick’s sign) – due
to increase in the vascularity of the vagina,
increase in circulation
● Vaginal secretions fall from a pH of greater than 7
(alkaline) to 4 or 5 (acid pH) – due to the action of
Lactobacillus acidophilus, bacteria that
grow freely in the glycogen enriched environment,
increasing lactic acid content of secretions
- Helps make vagina resistant to bacterial
invasion for the length of pregnancy
- Change in pH favors growth of Candida
albicans – a specie of yeast-like fungi;
candidal infection is manifested by itching,
burning sensation, cream cheese-like
discharge;
- Candidal infection in the newborn – thrush
or oral monilia
Ovarian Changes
● Ovulation stops w/ pregnancy – due to the active
feedback mechanism of estrogen and progesterone
produced by the corpus luteum (early in pregnancy)
and placenta (later)
- Feedback causes the pituitary gland to halt
production of FSH and LH

Breast Changes
● One of the 1st physiologic changes in pregnancy
(@ about 6 weeks) – feeling of fullness, tingling, or
tenderness in her breast – due to increased
stimulation of breast tissue by the high estrogen
level
● Breast size increases as pregnancy
progresses – due to hyperplasia of the
mammary alveoli and fat deposits
● Areola of the nipple darkens, diameter ⇧s
from about 3.5 cm(1.5in)to5or7cm(2–3in)
● Darkening of skin surrounding the areola in
some women – forming secondary areola
● Blue veins may become prominent over
surface of the breasts – due to increased
vascularity of the breasts
● Montgomery’s tubercles – sebaceous
glands of the areola – enlarge and become
protuberant
- Secretions from these glands keep the
nipple from cracking and drying during
lactation
- 16th week – colostrum, the thin, watery,
high-protein fluid that is the precursor of
breastmilk – can be expelled from the
nipples
Systemic Changes
1. Integumentary system
● As uterus increases in size, abdominal wall must
stretch to accommodate it
- Stretching (plus possibly adrenal cortex
activity) – can cause rupture and atrophy of
small segments of connective layer of the
skin = pink or reddish streaks (striae
gravidarum) appearing on the sides of the
abdominal wall and sometimes on thighs
and breasts
● Weeks after birth – lighten to silvery – white color
(striae albicantes or atrophicae); tho’ permanent,
become barely noticeable
● Occasionally, abdominal wall has difficulty
stretching enough to accommodate growing fetus
causing rectus muscles to actually separate =
known as diastasis
Aripin, Alshammae N. II - BSN H
● Umbilicus is stretched – by 28th week
depression becomes obliterated and smooth
because it has been pushed so far outward
- Most women – may appear as if it has
turned inside out, protruding as a round
bump @ the center of the abdominal wall
● Linea nigra, melasma – caused by
melanocyte-stimulating hormone (secreted by the
pituitary)
● Vascular spiders – small, fiery-red branching
spots, sometimes seen on the skin of pregnant
woman, particularly on the thighs = increased level
of estrogen; may fade out but not completely
disappear after childbirth
● Increased activity of sweat glands – increase
in perspiration
● Palmar erythema – redness and itching on the
hands; increased estrogen level
2. Respiratory System
● Marked congestion, or “stuffiness” of the
nasopharynx – response to increased estrogen
levels
● Pressure from growing uterus – diaphragm may
be displaced
- Crowding of chest cavity – causes SOB
late in pregnancy until lightening relieves
the pressure
● To keep mother’s pH level from becoming acid
due to the load of carbon dioxide being shifted to
her by the fetus – increased ventilation (mild
hyperventilation) to blow off excess CO2 begins
early in pregnancy
3. Temperature
● Early in pregnancy – body temperature
increases slightly = due to secretion of
progesterone from the corpus luteum
● As the placenta takes over the function of the
corpus luteum @ about 16 weeks – temperature
usually decreases to normal
4. Cardiovascular System
● Changes in the circulatory system are extremely
significant to the health of the fetus – necessary for
adequate placental and fetal circulation
● Blood Volume

- Total circulatory blood volume increases by
@ least 30% (as much as 50%) – to provide
for adequate exchange of nutrients in the
placenta and to provide adequate blood to
compensate for blood loss @ birth
● Blood loss @ normal vaginal birth: 300–400mL
■ From C/S: 800 – 1000 mL
- Increase in blood volume occurs gradually
beginning end of 1st trimester
■ Peaks about the 28th to the 32nd week then
continues @ high level throughout 3rd trimester
- Because plasma volume increases faster
than RBC production does – concentration
of hemoglobin and erythrocytes decline =
giving the woman a pseudoanemia, early in
pregnancy
■ Woman’s body compensates by producing more
RBC, creating near-normal levels by the 2nd
trimester
Iron Needs
- Fetus requires a total of about 350 – 400
mg of iron to grow
- Increases in the mother’s circulatory RBC
mass require an additional 400 mg of iron
- Total increased need of about 800 mg
- Average woman’s stores of iron is less –
only about 500 mg
■ Additional iron is often prescribed to prevent true
anemia – because iron absorption is impaired
during pregnancy as a result of decreased gastric
acidity (iron is absorbed best from an acid medium)
- Need for folic acid increases more during
pregnancy
■ Not enough intake of folic acid =
megalohemoglobinemia (large, non-functioning
RBC)
■ Inadequate folic acid levels have also been linked
to an increased risk for neural tube disorders in
fetus
■ Eat food high in folic acid (spinach, asparagus,
legumes) during prepregnancy and pregnancy
period
■ Folic acid is also routinely prescribed as a
prenatal vitamins
Aripin, Alshammae N. II - BSN H
Heart
○ to handle the increase in blood volume in the
circulatory system, a woman’s cardiac output es
significantly, by 25% - 50% - heart has more blood
to pump through the aorta
○ HR increases by 10 beats/minute (80 – 90
beats/min)
○ Because the diaphragm is pushed upward by
growing uterus late in pregnancy – heart is shifted
to a more transverse position in the chest cavity
(making it appear enlarged on x-ray examination
○ Palpitation are not uncommon particularly on
quick motion
■ In early months – due to sympathetic nervous
system stimulation
■ In later months – due to increased thoracic
pressure caused by pressure of the uterus against
the diaphragm
■ Caution women not to feel frightened
Blood Pressure
○ BP does not normally rise – because the
increased heart action takes care of the greater
amount of circulating blood
○ Most women, BP increases slightly during the
2nd trimester – because peripheral resistance to
circulation is lowered as the placenta expands
rapidly
○ 3rd trimester – BP rises again to 1st trimester
levels
Peripheral Blood Flow
- 3rd trimester – blood flow to lower
extremities is impaired by the pressure of
the expanding uterus on veins and arteries
- in blood flow in the venous system can lead
to edema and varicosities of the vulva,
rectum and legs
Supine Hypotension Syndrome
When lying supine, the weight of the growing uterus
presses the vena cava against the vertebrae,
obstructing blood flow from the lower extremities
■ Causes a in blood return to the heart and,
consequently ed cardiac output and hypotension

■ This maternal hypotension is potentially
dangerous because it can cause fetal hypoxia
■ Feeling of lightheadedness, faintness, and
palpitations
Can easily be corrected by having the woman
turn unto her side (preferably the left side) so that
blood flow through the vena cava es again.
Blood Constitution
○ Level of circulating fibrinogen, a constituent of the
blood necessary for clotting - es as much as 50%
during pregnancy
○ Other clotting factors (factors VII, VIII, IX, and X)
and platelet count also es
○ These es are a safeguard against major bleeding
should the placenta be dislodged and the uterine
arteries or veins be opened
○ Total WBC count rises slightly – both as a
protective mechanism and as a reflection of the
woman’s total blood volume
○ Total CHON level es – indicating amount CHON
being used by the fetus
■ Lower Total CHON load and hypervolemia = fluid
readily leaves the blood vessels to equalize
osmotic and hydrostatic pressure common ankle
and foot edema of pregnancy
5. Gastrointestinal System
● Stomach and intestines are pushed toward the
back and sides of the abdomen – due to growing
uterus
● Midpoint of pregnancy – intestinal peristalsis and
emptying time of stomach is slowed heartburn
(burning sensation in the substernal area due to
reflux of acid contents of the stomach into the
esophagus), constipation, and flatulence
● Pressure from the uterus on veins returning from
the extremities can lead to hemorrhoids
● Relaxin – hormone produced by the ovary – may
contribute to decreased gastric motility
● At least 50% of women experience some nausea
and vomiting early in pregnancy
Aripin, Alshammae N. II - BSN H
○ Most apparent in early morning, on rising, or if
woman becomes fatigued during the day; more
frequent in women who smoke cigarettes
○ Usually subsides after the 1st 3 months, after w/c
woman may have a voracious appetite
● Some women notice hypertrophy @ their gum
line and bleeding of gingival area when they brush
their teeth
● ed saliva formation – hyperptyalism – probably as
a local response to increased levels of estrogen
○ Lower than normal pH of saliva ed tooth decay if
tooth brushing is not done conscientiously
6. Urinary System
● Changes in the urinary system result from the
following:
● Effects of high estrogen and progesterone levels
● Compression of the bladder and ureters by the
growing uterus
● Increased blood volume
● Postural influences
● Fluid Retention
- to provide sufficient fluid volume for effective
placental exchange, total body water es to
7.5L – requires the body to increase its
sodium reabsorption in the tubules to
maintain osmolarity
- influence of progesterone ed response of
the angiotensin-renin system in the kidney
in aldosterone production
- Aldosterone aids in reabsorption sodium
● Water is retained during pregnancy:
- to aid the increase in blood volume and
- to serve as a ready source of nutrients to
the fetus
Renal Function
● Woman’s kidneys must excrete not only waste
products of her body but also those of the fetus
● Her kidneys must be able to excrete additional
fluid and manage the demands of increased renal
blood flow
● Kidneys may in size – changing their structure
and affecting their function
● Urinary output gradually - 80%)
● Specific gravity decreases es (by about 60%

● GFR and renal plasma flow begin to increase in
early pregnancy to meet the increased needs of the
circulatory system
● Renal threshold for glucose decreases and
glucose and lactose is frequently seen in the urine
● Traces of albumin may be present in urine – due
to congestion in renal capillaries
Aripin, Alshammae N. II - BSN H
● Standing this way – shoulders back and
abdomen forward = lordosis (forward curve of the
lumbar spine) – may lead to backache
8. Endocrine System
Most striking change is the addition of placenta as
an endocrine organ

Ureter and Bladder Function Endocrine Gland Changes and Effects During
● Increased urinary frequency during 1st trimester Pregnancy
(10 – 12 times/day) – until uterus rises out of the
pelvis and relieves pressure on the bladder
GLAND CHANGES EFFECTS
● May return @ the end of pregnancy – fetal head
exerts pressure on bladder Thyroid Gland - Slightly - Increased
● Because of high progesterone levels = ureters in enlargement basal
diameter and bladder capacity es to abou 1,500 mL - Increased metabolic rate
● Pressure of the uterus on the right ureter may thyroid (20%)
hormone - Increased O2
lead to urinary stasis and pyelonephritis if not
production consumption
relieved
● Pressure on the urethra = may lead to poor Parathyroid - Slight - Better
bladder emptying and bladder infection – Gland enlargement utilization of
dangerous coz it: - Increased calcium and
- may ascend and become kidney infections parathyroid vitamin D
hormone
and
production
- dangerous to fetus coz UTI are associated
w/ preterm labor Pancreas - Early in - Additional
pregnancy, glucose is
7. Skeletal System âed insulin available for
● Calcium an phosphorus needs are increased – production fetal growth
because of
fetal skeleton must be built
heavy fetal
● As pregnancy advances – gradual softening of demand for
the woman’s pelvic ligaments and joints – to create glucose
pliability and to facilitate passage of baby through - After 1st
the pelvis @ birth trimester,
● Softening is caused by influence of both the increased
insulin
ovarian hormone relaxin and placental
production
progesterone because of
● Excessive mobility of the joints can cause insulin
discomfort antagonist
● Wide separation of the symphysis pubis – as properties of
much as3–4mmby32weeksofpregnancy= makes estrogen,
women walk w/ difficulty because of pain progesterone,
and hPL
● To change her center of gravity and make
ambulation easier – pregnant woman tends to Pituitary Gland - FSH and LH - Anovulation
stand straighter and taller than usual = stance is increased - Breasts
referred to as the “pride of pregnancy” - Prolactin prepared for
increased lactation
 Aripin, Alshammae N. II - BSN H
● Blood volume: 2 – 4 lb.
- - Increased
Melanocyte-sti skin ● Weight of breast: 3 lbs.
mulating pigmentation ● Weight of additional fluid, fat, etc: 4 – 9 lbs.
hormone
increased
- Human
growth
hormone
increased

Placenta - Estrogen and - Uterine and

progesterone breast
produced enlargement,
- Relaxin fat deposits
increased - Increased
- Human blood
placental coagulation,
lactogen sodium and
water retention
- Softening of
the cervix and
collagen of
joints
- áes glucose
available for
fetus
- âes utilization
of CHON for
energy, áing
CHON
available for
fetal growth

9. Immune System
● Immunologic competency during pregnancy
decreases – probably to prevent the woman’s body
from rejecting fetus as if it were transplanted organ
● Immunoglobulin (IgG) production is particularly
decreased = making woman more prone to
infection during pregnancy
● Increase in WBC – may help counteract the
decrease in IgG response

10. Weight
● 24 – 30 lbs – desirable total weight gain for
pregnant woman
● Fetus : 7.5 lbs.
● Placenta : 1.5 lb.
● Amniotic Fluid: 2 lbs.
● Uterus: 2.5 lbs.
Aripin, Alshammae N. II - BSN H