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Physiologic Changes, Discomforts and Hormones in Pregnancy

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Kegel exercise to improve rectal tone ... Encourage Kegel exercises. May not resolve until after delivery. Cardiovascular Discomforts ... – PowerPoint PPT presentation

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Title: Physiologic Changes, Discomforts and Hormones in Pregnancy


1
Physiologic Changes, Discomforts and Hormones in
Pregnancy
  • Randy S. Heninger
  • CNM/WHNP Student
  • N6101
  • September 21st 2004

2
Digestive System Discomforts
  • Nausea and Vomiting (Morning Sickness)
  • Info
  • 70of all pregnancies
  • Lasting from 6-8 weeks until 13-16 weeks
  • Changes in smell and taste contribute
  • More common in primigravidas, young, lt12years
    education, nonsmokers, gt170 lbs.
  • More severe in women with higher hCG levels
    (multiple gestation and hydatidiform mole)
  • Education
  • Smaller more frequent meals
  • Avoid greasy spicy foods, eat protein snack at
    HS
  • 250 mg of ginger 4X per day, 25mg B6 3X per day
  • Self-limiting
  • Contact provider if symptoms not relieved for
    pharmacological interventions
  • Hormones
  • Estrogen
  • hCG

3
Digestive System Discomforts
  • Heart Burn
  • Info
  • Reduced smooth muscle motility-related relaxation
    of the lower esophageal sphincter and cardiac
    sphincter
  • Expanding uterus displaces the stomach up ward
    decreasing stomach size and increasing pressures
    inside the organ
  • Experienced by 85 of pregnant women
  • Education
  • Avoid, overeating, spicy foods, gas producing
    foods, fried foods
  • Avoid lying recumbent soon after eating
  • Eat small frequent meals
  • Sleep on stacked pillows or raise head of bed
    with blocks
  • Antacids containing magnesium hydroxide or
    magnesium trisalicylate
  • Hormone
  • Progesterone
  • Estrogen

4
Digestive System Discomforts
  • Constipation
  • Info
  • Decreased bowel transit time (first trimester
  • Displacement and compression of intestine by
    growing uterus (third trimester)
  • Iron supplementation
  • Education
  • Consuming at least 2 quarts of fluid daily
  • Include bulk fiber in diet (fresh fruits,
    vegetables grains)
  • Regular exercise
  • Mild laxatives (MoM, and stool softeners)
  • Cathartic laxatives and enemas are needed rarely
    use only provider consultation
  • Firm abdominal massage in a clockwise direction
    to stimulate peristalsis
  • Acupressure for 10 seconds midway between the
    pubic and umbilicus over 10 minutes may stimulate
    bowel activity
  • Hormone
  • Progesterone

5
Digestive System Discomforts
  • Hemorrhoids
  • Info
  • Relaxation of smooth muscle contributes to vessel
    wall weakening
  • Increases in venous pressure
  • Usually mildly irritating that can be compounded
    by untreated constipation
  • Often regress after delivery
  • They can worsen after delivery especially if
    prolong second stage and/or excessive pushing
  • Education
  • Alert provider if they become hard and tender
    (possible thrombosis) or cause bleeding
  • Avoid constipation prolonged sitting
  • Kegel exercise to improve rectal tone
  • Proctofoam, Anusol, and preparation H are safe
    and effective
  • Thrombosed external hemorrhoids may require
    incision and evacuation under local anesthesia
  • Hormone
  • Progesterone

6
Digestive System Discomforts
  • Flatulence
  • Info
  • Relaxation of smooth muscles leading to decreased
    motility resulting in gas pockets
  • Causing bloating
  • Gas pain
  • Flatulence
  • Education
  • Avoid foods like
  • Onions
  • Beans
  • Lentils
  • Collard greens
  • Cauliflower
  • Brussels sprouts
  • Cabbage
  • Turnips
  • Eat foods like
  • Yogurt
  • Drinking buttermilk

7
Respiratory System Discomforts
  • Shortness of Breath
  • Info
  • Pregnancy-Induced Hyperventilation
  • Reduced residual volume and functional residual
    capacity due the mechanical limitation of a
    growing uterus
  • These changes can cause dyspnea
  • Education
  • Measures to alleviate dyspnea
  • Standing
  • Sit erect
  • While lying use one or more pillows to prop up
    head and shoulders
  • Breathe slowly and deeply
  • Pace herself to accomi8date the added demand that
    pregnancy places on pulmonary function
  • Hormone
  • Progesterone

8
Respiratory System Discomforts
  • Nasal Congestion
  • Info
  • Increased preivascular edema
  • Enlargement of nasal turbinates
  • Exacerbate preexisting allergy or sinus problems
  • Nosebleeds
  • Education
  • Petroleum jelly to nasal mucosa
  • Room humidifier
  • Saline nose drops
  • Topical nasal decongestants limited to 2 to 3
    days to prevent rebound rhinitis medicamentosus
  • Nasal steroids use with patients with chronic
    symptoms
  • Hormones
  • Estrogen
  • Progesterone

9
Urinary System Discomforts
  • Frequency
  • Info
  • First trimester due to increased pressure on the
    bladder from the uterus until it rises out of the
    pelvis in second trimester
  • Third trimester due to fetal engagement of
    presenting part
  • Increased circulation volume
  • Increased glomerular filtration rate
  • Education
  • Burning or pain needs to be ruled out for UTI and
    vaginal infections which can lead to preterm
    labor or acute and chronic pyelonephritis
  • Decrease fluids close to bed time BUT do not
    decrease fluid intake overall

10
Urinary System Discomforts
  • Incontinence
  • Info
  • Stress type is usually caused by
  • Coughing
  • Sneezing
  • Laughing
  • Can be confused with premature rupture of
    membranes
  • Multigravidas experience more due to poor muscle
    tone in the perineal muscles
  • Education
  • Encourage Kegel exercises
  • May not resolve until after delivery

11
Cardiovascular Discomforts
  • Dizziness and Syncope
  • Info
  • Growing uterus causes compression of lower
    extremities and pelvic veins causing venous
    pooling
  • Potentiated in warmer weather when body heat is
    dissipated by peripheral vasodilatation
  • Symptoms occur later in pregnancy while lying
    recumbent secondary to uterine pressure on the
    vena cava causing hypotension
  • Hypoglycemia secondary to nausea and vomiting
    later in pregnancy, fetal demand may lower
    maternal glucose levels
  • Education
  • Calf exercises and long support stockings to
    combat venous pooling
  • Use of left lateral tilt position for correcting
    hypotension

12
Cardiovascular Discomforts
  • Edema
  • Info
  • Slowed venous return caused by uterine pressure
    on vena cava in the third trimester
  • Increased circulating volume
  • Education
  • Avoid sitting and standing for long periods of
    time
  • Daily leg exercises
  • Support stockings
  • Loose fitting waistbands
  • Leg elevation and rest
  • Be alert for edema rapidly progressing or not
    lessening overnight particularly in the third
    trimester (may be a sign of preeclampsia)

13
Cardiovascular Discomforts
  • Varicose Veins
  • Info
  • Relaxation of vessel smooth muscle
  • Increased venous pressure in pelvis and lower
    extremities
  • Can be found in legs and vulva
  • Leads to leg fatigue and painful night time leg
    cramps
  • Education
  • Rest and elevation
  • Elastic stockings
  • Vulvar varicosities respond to added pressure by
    wearing several perineal pads
  • If varicosities become warm, hard or painful see
    provider as phlebitis may be present
  • Hormone
  • Progesterone

14
Hematological
  • Physilolgic anemia of pregnancy
  • Info
  • Because plasma volume increases more than the RBC
    mass, maternal hematocrit falls
  • Anemia reaches a nadir at 30 to 34 weeks
  • Hematocrit may rise at 30 weeks when volume
    expansion has plateaued
  • Education
  • Need to absorb 3.5 mg/day during first two
    trimesters
  • 6 to 7 mg per day in third trimester
  • Increasing iron rich foods is usually not enough
  • 30mg elemental iron /day
  • 325 ferrous gluconate
  • Taking iron prior to 20 weeks and increase nausea
    and vomiting
  • Take with stool softener to decrease constipative
    effects

15
Breast Discomforts
  • Breast Changes
  • Info
  • Breast tenderness ranging mild to severe and
    transient in nature abating by end of first
    trimester
  • Increase in size
  • Become more nodular
  • Nipples become darker and more erectile
  • Colostrum may be produced and seen in third
    trimester
  • Education
  • Wear good support bra one size larger than
    pregnancy size no underwires or seams with wide
    enough shoulder straps and back to prevent
    tension over shoulders and under arms
  • Acetaminophen or cold compresses with severe pain
  • Hormones
  • Estrogen
  • Human placental lactogen
  • hCG
  • Prolactin
  • Progesterone

16
Skin Discomforts
  • Skin Changes
  • Info
  • Skin changes are a result of stimulation of
    melanocytes
  • Areola of breast become darker
  • Linea nigra develops from xiphoid to pubic
    symphysis
  • Mask of pregnancy (reddish brown color over
    bridge of nose and under eyes)
  • Striae (stretch marks) on abdomen, breasts and
    hips which occurs in 65 of all pregnancies and
    usually fade to a pink or silver after delivery
  • Education
  • No proven prevention for stretch marks
  • Cocoa butter, vitamin E and lotions may help with
    itching that can accompany striae formation
  • Hormones
  • Estrogen
  • Progesterone

17
Skin Discomforts
  • Rashes of Pregnancy
  • Info
  • Papular dermatitis
  • 3 to 5 mm erythematous papules anywhere on the
    body
  • Prurigo gestationis
  • Small excoriated Pruritic papules on abdomen,
    trunk, or extensor surface of extremities
  • Pruritic urticarial papules and plaques pf
    pregnancy syndrome (PUPPPS)
  • Discrete erythematous papules and urticarial
    plaques over the abdomen, thighs, buttocks, legs
    and arms
  • Pruritus gravidarum
  • Abdominal pruritus without distinct lesions
  • Education
  • Oatmeal baths
  • Loose-fitting clothing
  • Calamine lotion
  • Severe cases
  • Topical corticosteroids
  • Antihistamines

18
Skin Discomforts
  • Increased perspiration
  • Info
  • Increases in eccrine glands all over the skin
    surface
  • Possibly caused by increased thyroid activity
  • Increased dilation of the blood vessels in the
    skin enhances the bodys ability to eliminate
    waste and dissipate excess heat
  • Education
  • Reassure that this is a normal occurrence
  • Bathing
  • Loose fitting clothing of absorbent material
  • Control room temp

19
Skin Discomforts
  • Uncomfortable warmth
  • Info
  • Vasodilatation that increases skin temperature
  • Maternal fatty stores
  • In latter stages, placenta may contribute to
    increased body temperature
  • Education
  • Reassurance normalcy in absence of infection
  • Wear light layered clothing
  • Keep thermostat at a lower setting
  • Hormone
  • Progesterone

20
Skeletalmuscular Discomforts
  • Lower Backache
  • Info
  • Altered center of gravity (increased abd wt and
    breast wt)
  • Stretched abdominal muscles
  • Compensatory lumbar lordosis causing
    predisposition to lower back pain
  • Latter half of pregnancy joints and ligaments in
    the body become more lax
  • Women with poor abdominal muscle tone are more
    susceptible
  • Education
  • Avoid excessive weight gain
  • Improve posture
  • Proper bending with back straight
  • Proper lifting techniques
  • Sleeping on a firm mattress
  • Local heat application
  • Massage
  • Report unilateral leg pain or weakness to
    provider (possible lumbar disk disease)
  • Hormones
  • Progesterone
  • Relaxin

21
Skeletalmuscular Discomforts
  • Abdominal Pain
  • Info
  • Sharp pain caused by spasm of the round ligaments
    are the most common
  • Enlarged uterus makes these ligaments more
    susceptible to strain
  • Pain is associated with abrupt movements and felt
    mostly on the right side
  • Contractions, gastroenteritis, appendicitis and
    renal or biliary colic should be considered as
    well
  • Education
  • Increase physical exercise and abdominal muscle
    tone
  • Rise and sit gradually
  • Avoid sudden movements
  • Rest with local heat application
  • Analgesia is necessary occasionally with
    acetaminophen

22
Miscellaneous Discomforts
  • Leukorrhea
  • Info
  • Vaginal flow is increased
  • Whitish in color and variable consistency
  • Non-problematic unless accompanied with itching,
    burning, foul odor or labial swelling
  • Change in quantity or quality should be
    differentiated form leaking or ruptured membranes
  • Education
  • Bathe daily
  • Wear cotton underwear
  • Dushing is not indicated unless advised by
    provider
  • Hormone
  • Estrogen

23
Miscellaneous Discomforts
  • Headaches
  • Info
  • Can be related to
  • Sinus congestion
  • Increased vascular blood flow
  • Nasal edema
  • Fatigue
  • Tension eyestrain
  • Migraines
  • Education
  • Relaxation and warm compresses
  • Acetaminophen may be necessary
  • Be alert for HAs that are accompanied by
    dizziness, blurred vision, scotomata, and or
    unrelieved by acetaminophen (possible sign of
    preeclampsia
  • Hormones
  • Estrogen
  • Progesterone

24
Miscellaneous Discomforts
  • Fatigue
  • Info
  • Can be related to
  • Increased basal metabolism rate
  • Increased demand on cardiovascular and renal
    systems
  • Loss of sleep due to urinary frequency
  • Emotional factors
  • Stress
  • Anxiety
  • Depression
  • Lessens in second trimester then increases in
    late pregnancy due to
  • Increased wt
  • Difficulty finding a comfortable position
  • Fetal factors
  • Urinary frequency
  • Education
  • Proper nutrition and exercise
  • Treat possible anemia with diet and exercise

25
Miscellaneous Discomforts
  • Sleep Difficulty
  • Info
  • Early in pregnancy
  • Psychologic stressors
  • Frequency of urination
  • Later in pregnancy
  • Difficulty finding position of comfort
  • Fetal movements
  • Feeling short of breath
  • Education
  • Plan quiet time before going to bed
  • Limit fluid intake prior to sleeping
  • Pillows to support back, abdomen and legs
  • Warm bath or shower and massage
  • Meditation and visualization
  • Warm milk
  • Raspberry leaf tea
  • Skullcap tincture (30 drops of commercial
    tincture ½ hour before bedtime)

26
Miscellaneous Discomforts
  • Dental Problems
  • Info
  • Gum hypertrophy
  • Gum bleeding
  • Tooth decay progresses more rapidly
  • Education
  • Soft toothbrush
  • Mild toothpaste
  • Daily flossing
  • Dental work can be done during pregnancy with
    local anesthesia (General anesthesia should be
    avoided)
  • Hormone
  • Estrogen

27
References
  • Gabe, S. G., Niebyl, J. R., Simpsom, J. L.
    (2002) Obstetrics Normal and problem
    pregnancies. (4th ed.). Philadelphia Churchill
    Livingstone.
  • Ratcliffe, S. D., Baxley, E. G., Byrd, J. E.,
    Sakronbut, E. L. (2001) Family Practice
    Obstetrics (2nd ed.). Philadelphia Hanley
    Belfus Inc.
  • Walsh, L. V. (2001) Midwifery Community-based
    care during the childbearing years. Philadelphia
    W. B. Saunders Company.
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