Maternal

1
Maternal Child Nursing CareSecond Edition
Marcia L. London Patricia W. Ladewig Jane W.
Ball Ruth C. Bindler
Lecture NotesChapter 9Physical and Psychologic
Changes of Pregnancy
2
Anatomic and Physiologic Changes

• Uterus Increased amounts of estrogen and growing
  fetus
• Enlargement in size
• Increase in weight, strength, elasticity, and
  vascularity
• Cervix Increase estrogen levels
• Hyperplasia
• Formation of mucous plug
• Mucous plug prevents organisms entering uterus

3
Anatomic and Physiologic Changes

• Vagina Increased estrogen levels
• Increased thickness of mucosa
• Increased vaginal secretions to prevent bacterial
  infections
• Connective tissue relaxes
• Breasts Increased estrogen and progesterone
  levels
• Increase in size and number of mammary glands
• Nipples more erectile and areolas darken
• Colostrum produced during third trimester

4
Anatomic and Physiologic Changes

• Respiratory system Increasing levels of
  progesterone causes
• Increased volume of air
• Decreased airway resistance
• Increased anteroposterior diameter
• Thoracic breathing occurs as uterus enlarges

5
Anatomic and Physiologic Changes

• Cardiovascular system Increased levels of
  estrogen and progesterone
• Cardiac output and blood volume increases
• Increased size of uterus interferes with blood
  return from lower extremities
• Increased level of red cells to increase oxygen
  delivery to cells
• Clotting factors increase

6
Anatomic and Physiologic Changes

• GI system Action of increasing levels of
  progesterone
• Delayed gastric emptying
• Decreased peristalsis
• GU system Increased blood volume
• Glomerular filtration rate increases
• Renal tubular reabsorption increases

7
Anatomic and Physiologic Changes

• Skin and Hair Increased skin pigmentation caused
  by increased estrogen and progesterone
• Musculoskeletal Relaxation of joints caused by
  increased estrogen and progesterone
• Metabolism Increased during pregnancy
• Demands of the growing fetus and its support
  system
• Weight Gain Recommended 25 to 35 lb
• Overweight, recommended gain is 15 to 25lb.
• Underweight Gain weight needed to reach ideal
  weight plus 25 to 35 lb

8
Anatomic and Physiologic Changes

• Endocrine System
• Thyroid
• Pituitary
• Adrenals
• Pancreas

9
Signs and Symptoms

• Uterus Enlargement of abdomen
• Increased strength and elasticity Allows uterus
  to contract
• Fetus expelled during labor
• Cervix Mucous plug expelled as labor begins
• Increased vascularity may cause bleeding after
  vaginal exams
• Vagina Acid pH increases chance of vaginal yeast
  infections
• Breasts Increase in size causes soreness
• Colostrum may be present during the third
  trimester

10
Signs and Symptoms

• Respiratory system
• Increased size of uterus may cause shortness of
  breath
• Increased vascularity may cause nasal stuffiness
  and nosebleeds
• Cardiovascular system Decreased blood return
  from lower extremities
• Varicose veins
• Hemorrhoids

11
Signs and Symptoms (contd)

• Pressure on vena cava by the enlarged uterus
• Dizziness
• Decreased blood pressure
• Skin and Hair Increased skin pigmentation
• Causes linea nigra and chloasma

12
Signs and Symptoms (contd)

• GI system Increased levels of estrogen cause
• Nausea and vomiting
• Constipation
• Slow peristalsis and motility
• GU system Increased urination caused by
• Increasing size of uterus
• Pressure on bladder
• Increased blood volume and glomerular filtration

13
Signs and Symptoms (contd)

• Musculoskeletal Action of estrogen and
  progesterone
• Relaxation of joints Lordosis of lumbosacral
  spine

14
FIGURE 95 Approximate height of the fundus
at various weeks of pregnancy.
15
FIGURE 92 Linea nigra.
16
FIGURE 91 Vena caval syndrome. The gravid
uterus compresses the vena cava when the woman is
supine. This reduces the blood flow returning to
the heart and may cause maternal hypotension.
17
FIGURE 93 Postural changes during
pregnancy. Note the increasing lordosis of the
lumbosacral spine and the increasing curvature of
the thoracic area.
18
Changes of Pregnancy

• Subjective (presumptive) changes
• Amenorrhea
• Nausea and vomiting
• Fatigue
• Urinary frequency
• Breast changes
• Quickening

19
Differential Diagnosis of Pregnancy - Subjective
Changes
20
Differential Diagnosis of Pregnancy - Subjective
Changes
21
Changes of Pregnancy

• Objective (probable) changes
• Goodells and Chadwicks sign
• Hegars and McDonalds sign
• Enlargement of the abdomen
• Braxton Hicks contractions
• Uterine soufflé
• Skin pigmentation changes
• Pregnancy tests

22
FIGURE 94 Hegars sign, a softening of the
isthmus of the uterus, can be determined by the
examiner during a vaginal examination.
23
Differential Diagnosis of Pregnancy - Objective
Changes
24
Differential Diagnosis of Pregnancy - Objective
Changes
25
Changes of Pregnancy

• Diagnostic (positive) changes
• Fetal heartbeat
• Fetal movement
• Visualization of the fetus

26
Pregnancy Tests

• Over-the-Counter pregnancy tests
• Enzyme immunoassay tests
• Performed on urine
• Sensitive
• Detect even low levels of hCG
• Can detect a pregnancy as early as first day of
  missed period
• Negative result, test may be repeated 1 week if
  period has not occurred

27
Mothers Emotional and Psychological Changes

• First trimester Disbelief and ambivalence
• Second trimester Quickening helps mother to
  view fetus as separate from herself
• Third trimester Anxiety about labor and birth
  nesting (bursts of energy) occurs

28
Mothers Emotional and Psychological Changes
(contd)

• Rubins four tasks Ensuring safe passage through
  pregnancy, labor, and birth
• Seeking acceptance of this child by others
• Seeking commitment and acceptance of herself as
  mother to infant
• Learning to give of oneself on behalf of ones
  child

29
Father/Partners Emotional and Psychologic Changes

• First trimester
• May feel left out
• Disbelief
• May be confused by his partners mood changes
• Might resent the attention she receives
• Second trimester Begins to decide which
  behaviors of own father he wants to imitate or
  discard
• Third trimester Anxiety about labor and birth

30
Familys Emotional and Psychologic Changes

• Siblings
• May view baby as threat to security of their
  relationships with parents
• Reaction depends on age of siblings
• Preparation for birth is essential
• Grandparents
• Usually supportive
• Excited about the birth
• May be unsure about how deeply to become involved

31
Cultural Assessment

• Determines
• Main beliefs
• Wishes
• Traditions of the family
• Values
• Behaviors about pregnancy and childbearing
• Helps to explore womans (or familys)
  expectations of healthcare system
• Allows nurse to provide care that is appropriate
  and responsive to family needs

32
Cultural Factors

• Factors that will impact the familys plans for
  the pregnancy
• Religious preferences
• Language
• Communication style
• Common etiquette practices
• Ethnic background
• Amount of affiliation with the ethnic group
• Patterns of decision makinggt