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Pregnancy brings both psychological and physical changes to the woman and her partner. Physiologic changes occur gradually but eventually affect all organ systems of a womans body. Psychological changes occur in response to physiologic alterations. Pregnancy represents wellness not illness.
Diagnosis of Pregnancy
Marks a major milestone.
Chadwicks sign Goodells sign Hegars sign Sonographic evidence of gestational sac Ballottement Braxton Hicks sign Fetal outline felt by examiner
Reworking Developmental Tasks working through previous life experiences. womans relationship with her parents, particularly her mother. fear of dying. Needs confidence in health care providers. Men may need to reconcile feelings toward fathers and learn a new pattern of behavior.
Terms
Primigravida - woman in her 1st pregnancy. Multipara - a woman who has had 1 or more children.
Systemic Changes
Caused by rupture and atrophy of the connective layer of the skin. After birth this lightens to silvery-white color. (permanent) Diastasis-rectus muscles separate, will appear after pregnancy as a bluish groove. Umbilicus stretches until it is smooth. Extra pigmentation on abdominal wall. Linea nigra - brown line from umbilicus to symphysis pubis.
Systemic Changes
Melasma - darkened areas on face due to melanocyte-stimulating hormone secreted by the pituitary. Vascular spiders - small fiery-red branching spots on thighs, increases estrogen. Palmar erythema - redness and itching. Increased sweat gland activity. Scalp hair growth increases.
Systemic Changes
Respiratory System SOB Chronic respiratory alkalosis compensated by chronic metabolic acidosis. Diaphragm is displaced by 4 cm upward. Vital capacity does not decrease. Total O2 consumption is increased by 20%. Mild hyperventilation. Polyuria - increased urination due to plasma bicarbonate excreted by the kidneys.
Systemic Changes
respirations > 20/min. congestion of nasopharynx - increased estrogen levels Temperature: increased for 16 weeks due to secretion of progesterone from the corpus luteum, returns to normal once the placenta takes over.
Systemic Changes
Cardiovascular System: Changes are extreme and significant to the health of the fetus. Blood volume increases by 30 to 50 % blood loss at birth-300 to 400 mL cesarean birth-800 to 1,000 mL increase blood volume peaks at week 28 to 32
Systemic Changes
Pseudoanemia - concentration of hemoglobin and erythrocytes decline. Iron needs fetus requires 350 to 400 mg to grow. Mother has an increase in RBC needing an additional 400 mg of iron. Prenatal vitamins and foods supply needs. Heart cardiac output increases by 25 to 50 % heart rate increases by 10 beats/ min. heart is shifted more transverse
Systemic Changes
Innocent heart murmurs due to positioning. Palpitations SNS Regional blood flow: 3rd trimester blood flow to lower extremities is impaired due to pressure on veins and arteries. leads to edema and varicoaities. Blood pressure: does not normally rise may decrease in 2nd trimester
Systemic Changes
Supine hypotension syndrome: when woman lies supine the weight of the uterus presses on the vena cava obstructing blood return to the heart. risk fetal hypoxia lightheadedness, faintness and palpitations. rest on left side. Blood constitution: level of circ. fibrinogen increases 50%. Factors VII, VIII, IX, X and platelets increase.
Systemic Changes
Blood lipids increase by 1/3 cholesterol level increase 90 to 100 % Gastrointestinal system Uterus displaces the stomach and intestines toward the back and sides of the abdomen. Pressure slows peristalsis and the emptying time of the stomach. Leads to heartburn, constipation and flatulence. Nausea and vomiting in early morning when hCG and progesterone begin to rise.
Systemic Changes
May be a systemic reaction to increases estrogen or decreased glucose levels. Subsides after 3 months Generalized itching due to reabsorption of bilirubin into the mothers blood stream due to decreased emptying of bile from the GB. Hypertrophy of the gumlines and bleeding. Peptic ulcers improve.
Systemic Changes
Urinary System Effects of estrogen and progesterone activity. Compression of the bladder and ureters. Increased blood volume Postural influences Fluid retention: total body water increases to 7.5 L increase sodium reabsorption
Systemic Changes
Increased aldosterone production. Potassium remains adequate. Water retension increases blood volume to serve as a source of nutrients to the fetus. Renal Function: Kidneys change size. Urinary output increases by 60 to 80 %. GFR and renal plasma flow increase. Creatinine clearance tests for renal function.
Systemic Changes
Ureter and Bladder Function ureters increase in diameter due to increased progesterone. bladder capacity increases to 1,500 mL pressure on the urethra may lead to poor bladder emptying and infections. May lead to kidney infection.
Systemic Changes
Skeletal System Calcium and phosphorus increase for fetal skeleton. Softening of pelvic ligaments and joints. Relaxin (ovarian hormone) and placental progesterone. Separation of symphysis pubis-3 to 4 mm. Stand straighter and taller - lordosis Center of gravity is changed.
Systemic Changes
Endocrine System Almost all aspects of the endocrine system increase. Placenta is an endocrine organ Produces estrogen, progesterone, hCG, human placental lactogen,relaxin, prostaglandins. Pituitary Gland there is a halt to FSH and LH due to high estrogen and progesterone levels.
Systemic Changes
Increase in production of growth hormone and melanocyte-stimulating hormone. Late in pregnancy it produces oxytocin and prolactin. Thyroid and Parathyroid Glands thyroid enlarges and BBM (metabolism) increases by 20% iodine and thyroxine are elevated. Parathyroid enlarges due to increased calcium requirements.
Systemic Changes
Adrenal Gland Elevated levels of corticosteroids and aldosterone are produced. Aids in suppressing an inflammatory reaction or helps to reduce the possibility of rejection of the fetus. Regulates glucose metabolism. Promotes sodium reabsorption and maintaining osmolarity in fluid retained. Safeguards blood volume and perfusion
Systemic Changes
Pancreas Increases insulin production in response to high glucocorticoid production.insulin is less effective then normal because estrogen, progesterone and hPL are antagonists to insulin. Diabetic needs more insulin. Maternal glucose levels are usually higher. Fat stores and available glucose are utilized.
Systemic Changes
Immune System Competency decreases (IgG) to not reject the fetus. Increase in WBC to counteract the decrease.