PHYSIOLOGIC

AND
PSYCHOLOGIC
CHANGES OF
PREGNANCY
 PSYCHOLOGICAL TASKS
OF PREGNANCY
 FIRST TRIMESTER:
ACCEPTING THE
PREGNANCY
 THE WOMAN
 ACCEPT THE REALITY OF THE
PREGNANCY

SPEND TIME RECOVERING
FROM SHOCK OF
LEARNING THAT SHE IS
PREGNANT AND
CONCENTRATE ON WHAT
IT FEELS LIKE TO BE
PREGNANT
• AMBIVALENCE –
FEELING BOTH
PLEASED AND NOT
PLEASED ABOUT THE
PREGNANCY
SECOND TRIMESTER:
ACCEPTING THE BABY
 ACCEPT THAT SHE IS HAVING
A BABY
 GROWING ABDOMEN AND
FLUTTERING FETAL
MOVEMENTS HELP TO MAKE
THE PREGNANCY A REALITY
 MOVE THROUGH EMOTIONS
SUCH AS NARCISSISM AND
INTROVERSION AS THEY
CONCENTRATE ON WHAT IT
WILL FEEL LIKE TO BE A PARENT
 ROLE PLAYING AND INCREASED
DREAMING ARE COMMON
 THIRD TRIMESTER:
PREPARING FOR
PARENTHOOD
• USUALLY BEGIN “NEST-
BUILDING” ACTIVITIES
– PLANNING SLEEPING
ARRANGEMENTS
– BUYING CLOTHES
–CHOOSING NAMES FOR THE INFANT
– ENSURING SAFE PASSAGE –
LEARNING ABOUT BIRTH
• GROW IMPATIENT
WITH PREGNANCY AS
THEY READY
THEMSELVES FOR
BIRTH
 EMOTIONAL
RESPONSES TO
PREGNANCY
• AMBIVALENCE
• wanting to be pregnant, yet
may not be enjoying it
• interwoven feelings of
wanting and not wanting that
can exist at high levels
 GRIEF
 before a woman can take
on a mothering role, she has
to give up or alter her
present role
 incorporate new role as
mother into her other roles
as daughter, wife or friend
• NARCISSISM
• self – centeredness
• does things to
unconsciously protect her
body consequently her
baby
 INTROVERSION VERSUS
EXTROVERSION
 turning inward to concentrate
on oneself and one’s body
 more active, appear healthier
than ever before and are more
outgoing
• BODY IMAGE AND
BOUNDARY
• the way the body appears to
oneself
• a zone of separation one
perceive between oneself and
objects or other people
• STRESS
• pregnancy can be a source of
stress
• COUVADE SYNDROME
• men experience physical
symptoms such as nausea,
vomiting and backache which
result from stress, anxiety and
empathy for pregnant women
DIAGNOSIS OF
PREGNANCY
• Officially diagnosed on the
basis of the symptoms
reported by the woman and
the signs elicited by a health
care provider
PRESUMPTIVE
SIGNS
 least indicative of pregnancy,
taken as single entities, they
could easily indicate other
conditions
 largely subjective – experienced
by the woman but cannot be
documented by an examiner
SUBJECTIVE
 AMENORRHEA
 absence of
amenorrhea
 suppression of FSH by
rising estrogen
• NAUSEA AND VOMITING
• morning sickness
• severe protacted vomiting –
hyperemesis gravidarum
• systemic reaction to
increased estrogen levels and
decreased glucose levels
 BREAST SENSITIVITY
 feeling of tenderness,
fullness, or tingling because
of increased stimulation of
breast tissue by high
estrogen levels
 enlargement and darkening
of areola
 URINARY FREQUENCY
AND URGENCY
 sense of having to void
frequently because of
increased level of
progesterone
 bladder irritability, nocturia
• LASSITUDE AND
FATIGABILITY
• listlessness and fatigue
after only slight exertion
• general feeling of
tiredness
•CONSTIPATION
• appears early and
may persist
throughout
pregnancy
• WEIGHT GAIN
– rapid weight gain is not
associated with early
pregnancy
• FINGERNAIL CHANGES
– sixth week some
women notice thinning
and softening of the nails
• QUICKENING
• first recognition of fetal
movements
• fluttering movements
 SIGNS
ELEVATION OF BASAL BODY
TEMPERATURE
 noted persistent temperature
elevation spanning 3 weeks since
ovulation
 body temperature increases slightly
because of the secretion of
progesterone from the corpus luteum
• SKIN CHANGES
– pigmentation is caused by
the anterior pituitary
hormone melanotropin
which increases during
pregnancy
– facial melasma – chloasma
or mask of pregnancy after
16 week
th
– darkening of the nipples,
areola and vulva
–

linea nigra – abdominal

skin at the midline
becomes markedly
pigmented, assuming a
brownish-black color
– striae gravidarum –
reddish, slightly depressed
streaks and fade to
glistening, silvery lines
 EPULIS AND BLEEDING GUMS
 hypertrophy of the gingival
pappilae
Gingival granulomas may
develop as a result of dental
calculus or infection
 BREAST CHANGES
 include enlargement,
prominence of veins
• UTERINE ENLARGEMENT
• because of growing uterus
• uterus can be palpated over
symphysis pubis
PROBABLE
SIGNS
• can be documented by the
examiner
• more reliable than
presumptive signs, they are
still not positive or true
diagnostic findings
• serum laboratory tests
– based on detecting the
presence of human
chorionic gonadotropin
(hcG), a hormone created
by the chorionic villi of
the placenta, in the urine
or blood serum
• CHANGESIN INTERNAL
GENITALIA AND PELVIS
• leukorrhea – white or
slightly gray mucoid
discharge with a faint
musty odor
•chadwick’s sign or
jacquemier’s sign
• cyanosis or bluish
discoloration of the vagina
• color change of the vagina
from pink to violet
•goodell’s sign
– softening of the cervix
– increased vascularity and
edema
• hegar’s sign
– softening of the
isthmus of the uterus
(7 wk)
th
• Ladin’s sign
– softening of the cervical-
uterine junction (5 or 6
th th

wk)
• McDonald’s sign
– easy flexion of the fundus
on the cervix (7 – 8 wk)
th th
• Braun von Fernwald’s sign –
softening and slight fullness
of the fundus near the area
of implantation
• Piskacek’s sign – soft lateral
bulge with cornual
implantation (8 wk)
th
• sonographic evidence of
gestational sac
• characteristic ring is evident
• ballottement
– when lower uterine segment
is tapped on a bimanual
examination, the fetus can be
felt to rise against abdominal
wall
• braxton hick’s contractions
• periodic uterine tightening occurs
• contractions of muscles of
abdominal wall
• fetal outline felt by examiner
• fetal outline can be palpated
through abdomen
POSITIVE
SIGNS
• Demonstration of a fetal
heart separate from the
mother’s
• ultrasonographic
determination of fetal heart
beat as early as 6 to 7 wk
th th
• fetal movements felt by
the examiner
• felt by the woman as early
as 16 – 20 wks
• felt by the examiner is more
reliable by 20 to 24 wk
th th
• visualization of the fetus by
ultrasound
• by 8th week, fetal outline can
be seen clearly within the sac
that the crown-to-rump length
can be measured to establish
the gestational age of
pregnancy