Physiologic and Psychologic Changes During

Pregnancy:
1. Presumptive Signs- those that are least indicative of pregnancy,
taken as single entities, they could easily
indicate other conditions
- largely subjective
a. Breast changes
b. Nausea and vomiting
c. Amenorrhea
d. Frequent urination
e. Fatigue
f. Uterine enlargement
g. Quickening
h. Linea nigra
i. Melasma
j. Striae gravidarum

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MELASMA .

Sstri STRIAE GRAVIDARUM .

*Reaches a measurable level (50mIU/ml) 79 days after conception *Peaks at about 100mIU/ml but by the 60th80th day after this it declines again and is no longer detectable in the serum. Probable Signsa.softening of the lower uterine segment . Chadwick’s Sign. Goodell’s sign.2.a hormone created by the chorionic villi in the placenta.softening of the cervix d.color change of the vagina from pink to violet c. b. Hegar’s sign. Serum laboratory test hCG.

CHADWICK’ S SIGN WITH LEUKORRHEA .

Sonographic evidence of gestational sac f. Ballotement. Fetal outline felt by the examiner .e. Braxton Hicks contractions.periodic uterine tightening h. the fetus can be felt to rise against the abdominal wall. g.when lower uterine segment is tapped on a bimanual examination.

Sonographic evidence of the fetal outline b.20th-24th weeks AOG . Fetal movement felt by the examiner. Fetal heart audible * 18-20 weeks of pregnancy audible by an ordinary stethoscope 120-160 bpm c. Positive Signs a.3.

Social Influences 2.PsychologicaL Changes During Pregnancy 1. Individual Influences . Family Influences 4. Cultural Influences 3.

spends time recovering from shock of learning they are pregnant and concentrate on what it feels like to be pregnant.moves through emotions such as narcissism and introversion as they concentrate on what will happen and what it feels like to be pregnant.The Psychological Tasks of Pregnancy: First Trimester: Accepting the pregnancy. Second Trimester: Accepting the baby. Third Trimester: Preparing for parenthood .

the way your body appears to yourself Body Boundary. Narcissism-reaction to self-intrusion. Ambivalence.a zone of separation you perceive between yourself and objects or other people . Introversion vs. Grief 3. self centeredness 4. Extroversion 5. Body Image and Boundary Body Image.interwoven feelings of “wanting” and “not wanting” 2.EMOTIONAL RESPONSES TO PREGNANCY: 1.

Stress 7. Changes in sexual desire 10. to some degree or even more intensely than their partners do.men experiencing physical symptoms such as nausea. 8. vomiting etc. Changes in the expectant family . Emotional lability 9. Couvade syndrome.6.

fundus is at the level of the xiphoid process 38th-40th week.fundus is at the level of the umbilicus 36th week. Uterine Changes. depth. Reproductive System A1.uterus is firm and sphenoid under the abdominal wall just above the symphysis pubis 20th-22nd week.increase in length. width weight.PHYSIOLOGIC CHANGES OF PREGNANCY A.lowers . wall thickness and volume 12th week.

Ballottment may be noted *20th-24th week.lower uterine segment just above the cervix becomes soft (Hegar’s Sign) * 12th week of pregnancy.*Increase of blood flow to the uterus. softer to touch than usual *6th week of pregnancy.pre-pregnancy.15-20 ml/min by the end of pregnancy.Braxton Hicks contractions begin *16th-20th week of pregnancy. larger.500-750 ml/min 75 % of which is going to the placenta *Uterus is more anteflexed.fetal outline may be palpated .

A2.due to suppression to FSH Other possible reasons: uterine infection. Amenorrhea. worry. Cervical Changes.becomes soft in consistency (Goodell’s Sign) due to the high estrogen level Operculum. climate change. chronic illness such as severe anemia or stress A3.becomes vascular and edematous . .mucus plug which acts to seal out bacteria during pregnancy and to help prevent infection in the fetus and membranes.

causes the vaginal epithelium and underlying tissue becomes hypertrophic and enriched with glycogen. *Changes in color from pink to dark violet (Chadwick’s Sign) *pH of vaginal secretions decreases from 7 to 4-5 due to the action of Lactobacillus acidophilus and Doderlein bacillus A5.A4. Vaginal Changes Estrogen. Ovarian Changes .

causes a feeling of fullness. sebaceous glands of the areola (Montgomery tubercles) enlarge. Breast Changes *Estrogen.5-2-3 inches) *There is formation of secondary areola. blue veins become prominent over the surface of the breast. *16th week of pregnancy.colostrums is expelled from the nipples in a form of thin watery fluid which is high in protein and considered to be a precursor of breast milk .5 cm (1. tingling sensation and tenderness * Hyperplasia of the mammary alveoli * Areola darkens and its diameter increases from about 3. increase in vascularity.5 cm to 5 or 7.B.

due to increased estrogen level in the body . Integumentary System A1. Striae gravidarum. Vascular spiders.small. Palmar erythema.separation of rectus muscle. Increased perspiration A7. fiery-red branching spots commonly found on the thighs. Linea nigra.dark line running from the umbilicus to the symphysis pubis A4. A6. A2. Melasma/ chloasma or the mask of pregnancy A5. bluish grooveat the site of the separation *At the 28th week AOG the depression of the umbilicus becomes obliterated and smooth.pink or reddish streaks appearing on the sides of the abdominal wall and sometimes on the thighs. A3. Diastasis.SYSTEMIC CHANGES A.

PALMAR ERYTHEMA .

decreased by 27-32 mHg * PlasmaO2. Respiratory system * NO change in vital capacity * Tidal volume is increased by 30-40 % *Respiratory rate is increased by 1-2 cpm/minute (1820cpm/min) * Residual volume.increased to 104-108 mmHg * Blood pH.decreased by 20% *Increased ventilation .increased to 7.decreased by 20 % * Plasma PCO2.45 *Respiratory minute volume.B.increased by 40% * Expiratory reserve.40-7.

either a hemoglobin concentration of less than 11. Cardiovascular System D1.D. Blood volume increases by at least 30% and possibly as much as 50% Normal blood loss for NSVD.800 mg during pregnancy True anemia.5 g/100 ml or a Hct of less than 30 % D3. Iron needs.300-400 ml Normal blood loss for CS. Folic acid.800-1000 ml * The increase in blood volume peaks at the 28th-32nd week D2.helps in preventing neural tube defects .

light headedness.increase in cardiac output by 25-50% HR increases by 10 bpm *Innocent heart murmurs may be heard r/t altered heart position and decreased blood viscosity.does not normally rise D7. faintness and palpitations Interventions: lie on the left side and rise from bed slowly . Supine hypotension syndrome. BP. Regional blood flow. * Palpitations are also common due to the stimulation of SNS D5. Heart.D4.impaired to the lower extremities D6.

Blood Constitution *Increase in circulating fibrinogen (as much as 50 %) due to increased level of estrogen *Increase in clotting factors VII. IX. and X and platelet count *Increase in WBC * Decrease in total protein which may be a cause of ankle edema *Increase in body lipid by 1/3 and cholesterol by 90-100% . VIII.D8.

E. *Subclinical jaundice may be experienced *Hypertrophy of the gumlines and possible bleeding of the gingival tissue *Decreased pH in the mouth . constipation andf flatulence is common *Nausea and vomiting is common due to increase l level of hCG and progesterone or as a systemic reaction to the increased level of estrogen and decreased level of glucose. Gastrointestinal system *Slow intestinal peristalsis and emptying of the stomach *heartburn.

Urinary System *Glomerular filtration rate.decreased by 25% * Renal threshold for sugar.F.increased by 25-80 % * BUN.increased by 25% * Frequency of urination.increased in the 1st trimester and the last two weeks of pregnancy to 10-12 times/day .increased by 1000 ml * Diameter of ureters.increased by 50 % * Renal plasma flow.decreased by 25% * Plasma creatinine level.decreased to allow spillage * Bladder capacity.

ANKLE EDEMA .

estrogen.G.secreted primarily by the corpus luteum .aids in the preparation of the breasts for lactation.inhibits uterine contractions. relaxin and prostaglandins Estrogen. Skeletal System * Ca and Ph needs are increased * There is softening of pelvic ligaments and joints which causes the waddling gait H. softens the cervix and the collagen in joints .causes breast changes and palmar erythema Progesterone. Relaxin. Endocrine System *Placenta. hPL.produces hCG. progesterone.maintains endometrium inhibiting uterine contractions.

hCG.halted FSH and LH release because of increased levels of estrogen and progesterone . hPL.produces “prolactin” which prepares the breasts for lactation .also known as human chorionic somatomammotropin hormone .late in pregnancy it produces oxytocin .affects smooth muscle contractility to such an extent they may be the trigger that initiates labor at term *Pituitary gland. freeing fatty acids for energy Prostaglandin.secreted by the trophoblast in the placenta stimulates estrogen and progesterone synthesis until the placenta can take its role.serves as the antagonist to insulin.

*Thyroid and parathyroid glands. and thyroxine are all elevated as well.increased function due to increased level of corticosteroid and aldosterone. . butanol-extractable iodine. * Adrenal glands.glands enlarges and BMR increases by 20% *Protein based-iodine.aids in suppressing inflammatory reaction . helps in regulating the glucose metabolism in the woman Increase in aldosterone aids in promoting sodium reabsorption .

80-85 mg/100ml I.increased production of insulin in response to increased amount of glucocorticoid produced by the adrenal glands. However insulin are less effective during pregnancy because of the increase level of estrogen.*Pancreas.decreased functioning and decreased level of IgG . progesterone. *FBS. and hPL which are antagonists to insulin. Immune System.

Para.Multigravida.Primipara. Nulligravida.Primigravida. regardless of whether the infants were born alive or not 2.a woman who has given birth to one child past age of viability 5.a woman who has never been and is not currently pregnant .a woman who has carried two or more pregnancies to viability 7.a woman who is or has been pregnant 3.a woman who is pregnant for the first time 4.a woman who has been pregnant previously 6.Gravida.ASSESSING FETAL AND MATERNAL HEALTH 1.The number of pregnancies that reached viability (24 wks. reached 400 g). Multipara.

Android 2. Anthropoid 3. Gynecoid 4.Estimating Pelvic Size—pelvic pelvimetry and fetal sonography *Estimation should be done at least by the 24th week of pregnancy because by this time there is danger that the fetal head will reach a size that will interfere with safe passage and birth if pelvic measurements are small TYPES OF PELVES: 1. Platypelloid .

True conjugate or conjugate vera. subtract the usual depth of the symphysis pubis (assumed to be 1.measurement between the anterior surface of the sacral prominence and of the posterior surface of the inferior margin of the symphysis pubis. -actual diameter of the pelvic inlet (10.22 cm) from the diagonal conjugate measurement.2.cannot be measured directly.5-11 cm) . .

adequate for childbirth (average fetal head is 9 cm) .5 cm.Common Measurements: 1. -suggests the anteroposterior diameter of the pelvic inlet * Measured while the client is in a lithotomy position >12. Diagonal conjugate.distance between the anterior surface of the sacral prominence and the anterior surface of the inferior margin of symphysis pubis -considered to be the most useful measurement for the estimation of pelvic size.

Made at the medial or lowermost aspect of the ischial tubersities at the level of the anus (11 cm) .3. Ischial tuberosity diameter.distance between the ischial tuberosity or the transverse diameter of the outlet.

LEOPOLD’S MANEUVER .

LEOPOLD’S MANEUVER .

Palmar Erythema 3. Varicosities. Constipation 4.due to decreased Calcium and increased Phosphorus 7. Muscle cramps. Nausea Vomitting and Pyrosis 5. Breast Tenderness 2.DISSCOMFORTS DURING THE FIRST TRIMESTER 1. Hypotension 8. Fatigue 6.Let client rest in Sim’s position or with legs raised for 15-20 min 2x a day .

a whitish vaginal discharge or increased vaginal secretions brought about by increased estrogen level and blood supply to the vaginal epithelium and cervix. -apply Witch hazel or cold compress to relieve pain 10. Leukorrhea.modified Sim’s position or knee chest position for 10-15 min.reduce caffeine intake and practice Kegel’s exercise 12. . Frequency of urination. Abdominal discomfort 13. Hemorrhoids. Heart palpitations 11.9.

Dyspnea 4. Headache 3. Backache.Pelvic rocking and tilting exercise 2. Ankle edema 5.DISCOMFORTS DURING MIDDLE AND LATE PREGNANCY 1. Braxton Hicks Contractions .

Persistent vomiting 3.Danger Signs of Pregnancy: 1. Abdominal or chest pain . Vaginal bleeding 2. Sudden escape of clear fluid from the vagina 5. Chills and fever 4.

gain (over 2 lbs/week in the 2nd trimester and 1lb/week in the 3rd trimester) 6b. Flashes of light or dots before the eyes 6d.6. decreased urine output 7. Severe continuous headache 6f. Swelling of the face and the fingers 6c. rapid wt. Dimness or blurring of vision 6e. Increased or decreased fetal movement . PIH 6a.

VARICOSITIES .

HEMORRHOIDS .

ELASTIC STOCKINGS .

LEFT SIDE LYING POSITION .

SQUATTING

TAILOR SITTING

BACKACHE

PELVIC ROCKING .

KNEE-CHEST POSITION .

. embryo or fetus.PREVENTION OF EXPOSURE TO TERATOGENS Teratogen. chemical and physical that adversely affects the fertilized ovum.any factor.

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* Effect to fetus: CNS damage. microcephaly.antiprotozoal drug but an antifolic acid drug at the same time .Maternal Infection TO. intracerebral Calcification and retinal deformities. and through handling cat stool in soil or cat litter.TOxoplasmosis * a protozoan infection spread through uncooked meat. *Dx: Serum analysis *Tx: sulfonamides.but this can lead to increased bilirubin in the newborn Pyrimethamine. hydrocephalus.

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> 1:8 suggests immunity < 1:8 susceptible to viral invasion Greatly increased. mental or motor challenges. thrombocytopenic purpura. Rubella titer. dental and facial clefts.R. *Dx. retarded intrauterine growth.suggests recent infection . cataract. cardiac defects (PDA or pulmonary stenosis).Rubella *otherwise known as German measles *Effect to fetus: deafness.

RUBELLA .

skin covered with large petechiae (blueberry muffin lesions) *Dx. Isolation of CMV antibodies in the serum * No treatment .Cytomegalovirus (CMV) * a member of the herpes virus family *MOT: Droplet * Effect to the fetus: neurologically challenged (hydrocephalus. microcephaly spasticity with eye damage [optic atrophy and chorioretinitis]) deafness. chronic liver disease.C.

CHILD AFFECTED WITH CMV .

intrauterine growth retardation and continuing infection Other viral infection Rubeola Coxsackievirus Mumps Varicella (chickenpox) Poliomyelitis Influenza Viral hepatitis .H.premature birth.Herpes simplex *1st trimester.congenital anomalies or spontaneous miscarriage *2nd or 3rd trimester.

VDRL and rapid plasma regain.remains to be (+) up to 3 mos.remains high for more than 2oo days *infants born of a mother with syphilis.Parvovirus B19. even if the dse has already been treated. Benzathine penicillin .causative agent of Erythema infectiosum (5th dise. cognitive challenge.caused by Trepenoma pallidum *causes damage to the fetus after the 16th-18th week of intrauterine life when the cytotrophoblastic layer of the placental villi has atrophied * causes deafness. osteochondritis and death *Dx. ) attacks the RBC -associated with fetal death in early pregnancy and anemia and congenital heart defect in late pregnancy Syphylis. *Tx.

SYPHILIS .

Lyme disease. Tetracycline or doxycyclinenot safe for pregnant women Penicillin.drug of choice .Borrelia burdorferi *Tx.

TRICHOMONIASIS & VAGINITIS .

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FETAL ALCOHOL SYNDROME .

AMELIA .

PHOCOMELIA .