Chapter 4 Physiologic and Psychologic Changes During Pregnancy

1
Chapter 4Physiologic and Psychologic Changes
During Pregnancy
2
Prenatal Care

• Terminology see pg 33
• Profile of previous pregnancy history see box4-1
• GTPALM
• PG we will use this one mostly
• P para (number of births after 20 weeks
  gestation)
• G gravida (total number of pregnancies,
  including current pregnancy)

3
Prenatal Care

• Determination of date of birth
• Nägeles rule box 4-2
• Wheel see example
• Duration of pregnancy
• 280 days using 28-day months is called lunar
  months 10 lunar months 40 weeks
• 9 calendar months Divided into 3 trimesters
• Abortion/miscarriage a pregnancy that
  terminates before the fetus reaches 20 weeks
  gestation
• Preterm/premature a pregnancy that terminates
  after the 20th week of gestation, but before full
  term

4
Prenatal Care

• Signs of pregnancy table 4-1
• Presumptive (may suggest pregnancy)
• Probable (strongly indicates pregnancy)
• Positive (confirms pregnancy)
• fetal heart tones are heard
• fetal movement is palpated by the examiner
• fetal outline is visualized by ultrasound

5
Physiologic Changes in Body Systems

• Endocrine System
• increase in hormones
• addition of the placenta during pregnancy
  producing large amounts of estrogen
  progesterone
• see table 4-2

6
Physiologic Changes in Body Systems

• Reproductive system
• Uterus- prepregnancy wt 60g or 2 oz
• postpregnancy wt 1000g or 2.2 lbs
• Cervix becomes shorter softer
• Ovaries follicles cease to develop to maturity
  Ovulation does not occur produces the hormone
  relaxin
• Vagina- walls become thicker, pliable
  expandable in preparation for the tremendous
  stretching necessary for the birth increased
  vaginal discharge
• Breasts preparation for lactation size
  increases breasts become full, sensitive,
  tender darkening of the areola nipple
  Montgomerys glands become more prominent
  lubricate protect nipple in preparation for
  breastfeeding

7
Physiologic Changes in Body Systems

• Musculoskeletal system relaxation of joints and
  adjustments in posture
• joints relax symphysis pubis widens as result
  of relaxin progesterone
• as the uterus enlarges, the center of gravity
  shifts forward causing lordosis
• abdominal muscles may separate causing
  diastasis recti abdominis
• may develop carpal tunnel syndrome due to
  compression of the medial nerve around the wrist
• Cardiovascular system see table 4-3

8
Physiologic Changes in Body Systems

• (Contd)
• Respiratory system thoracic circumference
  increases 02 consumption increases by 15
• Dyspnea caused by a greater sensitivity of the
  respiratory system pressure of the uterus on
  the diaphragm
• Epistaxis caused by increased vascularity due
  to increased estrogen deepening of the voice
• Gastrointestinal system
• gum hypertrophy
• increased saliva production
• nausea with or without vomiting during 1st
  trimester
• increased heartburn
• delayed emptying of intestines leading to
  constipation
• altered CHO metabolism gestational diabetes

9
Physiologic Changes in Body Systems

• Renal system
• frequent urination
• urine stasis
• more prone to developing pyelonephritis
  (infection of the upper urinary tract)
• Integumentary system
• hyperpigmentation of skin
• on the face chloasma mask of pregnancy
• linea nigra dark line on the abdomen fig 4-5
• striae gravidarum or stretch marks

10
Psychologic Changes During Pregnancy

• Body image may change
• appearance may begin to feel ugly or fat
  negative about pregnancy
• function losing control of body urine
  incontinence
• sensation may become more acute change in
  sexuality libido
• mobility may be a problem

11
Psychologic Changes During Pregnancy

• Developmental tasks
• Pregnancy validation 1st trimester focus on
  nurturing protecting the fetus questioning
  identity as a woman mother
• Fetal embodiment 2nd trimester attempts to
  incorporate the fetus into her body image as part
  of self
• Fetal distinction feels quickening or fetal
  movement the fetus becomes separate from her
  fig 4-7
• Role transition 3rd trimester psychologically
  separates self from fetus makes concrete plans
  for the baby

12
Psychologic Changes During Pregnancy

• Responses to pregnancy
• partners response announcement, adjustment,
  focus
• older couple
• adolescent
• single
• grandparents
• siblings