Changes of Pregnancy

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Changes of Pregnancy

• Class 42
• April 3, 2003

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Terms

• Ballottement
• Couvade
• Morning Sickness
• Braxton Hicks Contractions
• Goodells Sign
• Physiologic anemia of pregnancy
• Chadwicks sign
• Hegars sign
• Quickening
• Cholasma

• Linea Nigra
• Striae
• Colosterum
• McDonalds Sign
• Supine
• Hypertensive syndrome

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Diagnostic Tests

• Hemagglutination-Inhibition test
• Enzyme-Linked Immunosorbent Assay
• Latex
• Agglutination Test
• Fluroimmunoassay
• hCG
• Radioreceptor Assay

• B-Subunit
• Radioimmunoassay
• Home Pregnancy Tests
• Immunoadiometric Assay

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Know Anatomy and Physiology of Pregnancy

• Enlargement of Uterus hyperplasia
• Wall thickening initial changes due to hormones
• Wall thinning after the first few months 5 mm by
  term
• 1/6th of the toatl maternal blood volume is
  contained within the vasculature of the uterus
• Braxton-Hicks contractions stimulate blood
  movement through placenta
• Confused with true labor

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Cervix

• Thick tenacious mucus forms a plug
• Also an increase in mucorrhea discharge
• Increased vascularization
• Goodells sign softening of cervix
• Chadwicks sign purple discoloration of the
  cervix
• Vessels are engorging below the growing uterus

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Ovaries

• Cease ovum production
• hCG maintains the corpus luteum regresses by
  mid pregnancy

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Vagina

• Hypertrophy
• Increased vascularization
• Hyperplasia
• Acidic secretions (infection prevention)
• Chadwicks sign

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Breasts

• Increased size and nodularity
• Superficial veins present
• Nipples more erectile, areola pigmentation darker
• Striae develop
• Colostrum by 12th week of pregnancy

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Respiratory System

• Hyperventilation tidal volume increases
• Vital capacity increases slightly
• Increases in oxygen consumption
• Pressure from the enlarging uterus cause chest
  wall changes
• Breathing changes from abdominal to throacic
• Rhinitis of pregnancy and epistaxis may occur
  (estrogen induced edema and vascular congestion
  of nasal mucosa)

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Cardiovascular System

• Pressure on diaphragm pushes heart upward and to
  the left, rotating it forward
• Blood volume increases
• Cardiac output increases and peaks at 20-24 weeks
  gestation and remains elevated the duration of
  pregnancy
• Pulse rate increases and the blood pressure
  should decrease slightly at first. Then it comes
  back to normal toward the end of pregnancy.

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Cardiovascular System continued

• Increased blood volume to lower extremities may
  cause postural hypotension.
• Pressure on vena cava when patient is supine
  supine hypotensive syndrome or vena cava
  syndrome. May cause dizziness, pallor and
  clamminess. Patient should lie on her side.

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Cardiovascular System continued

• Total erythrocyte count increases with iron
  supplements
• Increase in plasma volume occurs
• The plasma volume is greater than the erythrocyte
  increase causing a lower hematocrit
• Called the physiologic anemia of pregnancy
• WBC production equals the increase in blood
  volume
• Fibrin levels increase. Puts mom at risk for
  developing venous thrombosis

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Gastrointestinal System

• Nausea and vomiting due to increased levels of
  hCG. Cravings and taste may change Smells may
  be a problem.
• Gum tissue may become hyperemic and bleed
• Later pressure of growing uterus displaces
  stomach and intestines

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Urinary tract

• Pressure on bladder from uterus first
  trimester.
• Near term, the pressure from the uterus returns
  as the uterus engages in the pelvis.
• Suceptable to infection and trauma
• Increased renal function during pregnancy

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Skin and Hair

• Hyper-pigmentation increased estrogen
• Linea nigra on midline of abdomen
• Facial chloasma mask of pregnancy
• Vascular spider nevi chest, neck, face, neck,
  arms and legs
• Deceased hair growth

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Musculoskeletal System

• Center of gravity changes postural changes
  seen. Check out p. 231 in text for illustration.
• Diastasis recti occurs in the abdominal muscle
• Parasthesias of extremities as a result of
  pressure on peripheral nerves

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Eyes

• Intraocular pressure decreases
• Slight thickening of cornea
• (Temporary changes may cause problems while
  wearing contact lenses)

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Metabolism

• Water Metabolism
• Nutrient Metabolism
• Weight Issues

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Endocrine System

• Thyroid
• Parathyroid
• Pituitary
• Adrenals
• Pancreas

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Hormones of Pregnancy

• Discussed in last hours class
• hCG
• hPL
• Estrogen
• Progesterone
• Relaxin
• Prostaglandins

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Signs of Pregnancy

• Subjective (Presumptive) Changes
• Amenorrhea
• Nausea and vomiting (morning sickness)
• Excessive fatigue
• Urinary frequency
• Changes of the breast
• Quickening (18-20 weeks after the LMP)

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Objective (probable) Changes

• Hegers sign softening of the isthmus of uterus
• McDonalds sign Ease in flexing body of uterus
  against cervix
• Enlargement of abdomen
• Uterine souffle (vs. funic souffle)
• Changes of pigmentation of skin
• Fetal outline and Ballottement of fetal parts
• Pregnancy tests

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Pregnancy Tests

• Hemagglutination-inhibition test 95 accurate
• Immunoassay
• Of the urine no clumping of cells occurs when
  the urine of a pregnant woman is added to
  hCG-sensitized RBCs of sheep
• Latex agglutination test 95 accurate

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Pregnancy tests continued

• RIA, IRMA, ELISA, Fia, RRA
• All immunoassays. See text, p. 237 for
  descriptions
• Over the counter pregnancy tests
• (HPTs)are also immunoassay tests and detect even
  low levels of hCG in urine
• Few false positives, but higher rate of false
  negatives. Follow up if signs of pregnancy
  develop

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Diagnostic or Positive Changes

• Completely objective
• Fetal heartbeat fetoscope detects from 17-20
  weeks of pregnancy Dopplers can pick it up from
  10-12 weeks. FHR is 120-160. Count and compare
  to maternal pulse. Differentiate from a maternal
  aortic pulse or uterine souffle.
• Visualization of fetus Commonly from 4-5 weeks
  gestation.

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Psychologic Response

• Developmentally a developmental crisis
• Changes
• For the family
• For the individuals
• Mom
• Dad
• Siblings
• Developmental stage for the adults - Erickson
• Usually Generativity vs. Stagnation

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Parental Reactions by Trimester -First

• Ambivalent feelings about pregnancy common in the
  mom. Baby may not seem real.
• Fears of possible miscarriage
• Checks out personal identity
• The dad may be stressed, concerns with
  mother-in-law. And/or he may be pleased
  depends on circumstances surrounding pregnancy

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Second Trimester

• Emotionally, things settle
• Quickening verifies pregnancy personally to mom
• Body changes adaptation occurs normally
• With dad, coping skills vary individually
• May increase involvement
• Should hear the fetal heart and feel movement

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Third Trimester

• Mom feels anxious and proud.
• May need help and perhaps enjoy the extra
  attention
• Concerns about the actual childbirth experience
  increase
• Nesting instincts increase - with bursts of
  energy for cleaning and organization.

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In General -

• Mom becomes introverted and more aware of
  herself may be a problem for her partner.
• Mood swings - joy to despair again difficult
  for the partner. They need to realize how
  characteristic of pregnancy this emotional ride
  is.
• Body Image Changes - weight, size, appearance all
  change

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Concept of Couvade

• Unintentional development of pregnancy symptoms
  in the father.
• Fatigue
• Increased appetite
• Difficulty sleeping
• Depression, headache and backache

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Siblings and Grandparents

• Sibling rivalry
• Prepare the sibling in advance
• Consistency is important
• Toilet train if possible
• Clear up misconceptions of older siblings
• May demonstrate aggressive or regressive behavior
• Grandparents promote a close relationship
• Must be sensitive and communication must be good!
• Sometimes there are grandparenting classes that
  may be helpful

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Cultural Considerations

• There will be culturally diverse people in our
  hospitals giving birth!
• No way to generalize about the diverse group
• Attitudes vary
• Health beliefs vary from culture to culture
• Be aware of health practices of various cultures
• Avoid ethnocentrism!
• Practice cultural assessment

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The End. Have a good day!