physiological changes during pregnancy

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physiological changes during pregnancy
2011-11-28 10:56:29
physiological changes during pregnancy

physiological changes during pregnancy
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  1. Presumptive signs of pregnancy
    • amenorrhea
    • fatigue
    • nausea and vomiting
    • urinary frequency
    • breast changes (darkened areola, enlarged montgomery tubules)
    • quickening-slight movements of the fetus felt by a woman, usually between 16-20 weeks of gestation
    • uterine enlargement
    • linea nigra (dark line that appears vertically on the abdomen when pregnant)
    • chloasma (pregnancy mask)
    • striae gravidarum (strech marks)
  2. Probale signs of pregnancy
    • abnormal enlargement related to changes in uterine size, shape, and position
    • cervical changes
    • hegar's sign (softening and compressibility of lower uterus
    • Chadwick's signs (deepened violet-bluish color of vaginal mucosa secondary to increased vascularity of the area)
    • Goodell's signs(softening of cervical tip)
    • Ballottement (rebound unengaged fetus)
    • Braxton Hicks contractions (false contractions, painless, irregular, and usually relieved by walking)
    • positive pregnancy test
    • fetal outline felt by examiner
  3. Positive signs of pregnancy
    • Fetal heart sounds
    • visualization of the fetus by ultrasound
    • fetal movement palpatated by an experienced examiner
  4. Verrifying possible pregnancy using serum and urine pregnancy testing
    hyman chorionic gonadotropin (hCG) can be detected 6 to 11 days in serum and 26 days in urine after conception
  5. hCG levels during pregnancy
    (urine samples should be first-void in the morning)
    • begins with implantation
    • peaks at about 60 to 70 days of gestation
    • declines until around 80 days (begins to gradually increase until term)

    • Higher levels indicate
    • multifetal
    • ectopic
    • hydatidiform mole
    • genetic abnormality (down syndrome)

    lower levels suggest a miscarrage or ectopic pregnancy
  6. Caculating delivery date
    Nagel's rule (take the first day of last menstrual cycle, subtract 3 month's, and then add 7 day's and 1 year)

    McDonald's method (measure uterine fundal hieght in centimeters from the symphysis pubis to the top of the uterine fundus (between 18-30 weeks of gestation) the gestational age is equal to that of the fundal height
  7. Nulligravida
    • never beeen pregnant
    • no pregnancies past 20-24 (viablility) weeks
  8. primigravida
    • first pregnancy
    • has dilvered
  9. multigravida
    • had two or more pregnancies
    • has delivered
  10. parity
    the number of pregnancies in which the fetus reach approximately 20-24 weeks or fetal weight of 2 or more pounds regardless of whether the fetus was stillborn or not
  11. GTPAL acronym
    • Gravidity
    • Term births (38 weeks or more)
    • preterm births (from 20-24 {viability} weeks to 37 weeks)
    • Abortions/miscarriages (prior to viability)
    • Living Children
  12. Cardiovascular changes during pregnancy
    • cardiac output and blood volume increase 45-50% to meet metabolic needs
    • Heart Rate increases
  13. Respiratory changes during pregnancy
    oxygen needs increase

    during last trimester the size of the chest may enlarge allowing for lung expansion

    the uterus pushes upward

    increased respiratory rate and decreased lung capacity
  14. Gastrointestinal changes during pregnancy
    Nausea and vomiting may occur due to hormonal changes and/or increase of pressure within the abdominal cavity as the pregnant client's stomach and intestines are displaced within the abdmon

    Constipation may occur due to increased tranist time of food through out the gastronintestinal system and thus increased water absorption
  15. Renal changes during pregnancy
    filtration rate increases due to hormones, increased blood volume, and metabolic demands

    the amount of urine remains the same

    urinary frequency due to pressure of fetus on the bladder

    Increased risk of UTI
  16. Ednocrine changes during pregnancy
    • the placenta becomes and endocrine organ that produces large amounts of hCG, Progesterone, estrogen, human placental lactogen, and prostaglandins,
    • hormones are very active during pregnancy and function to maintain pregnancy and prepare the body for deliivery

    Nose bleeds Epitaxis due to increased estrogen

    • Progesterone is the hormone of pregnancy
  17. Body image changes during pregnancy
    in the first trimester of pregnancy physiological changes are not very obvious. Many women look forward to the changes so that pregnancy will be more noticable

    in the second trimester there are rapid physical changes. The most obvious is enlargement of the abdmon and breast.

    • Skin changes such as stretch marks and hyperpigmentation of the face (chloasma).
    • the physical changes can also affect a woman's mobility. She may find herself losing her balance and feeling back or leg discomfort and fatigue.

    These changes may lead to a negative body image. The patient may make statements of resentment and express anxiousness for the pregnancy to be over soon
  18. Blood pressure changes during pregnancy
    first trimester: are within the prepregnancy range

    second trimester: decreases 5 to 10 mm Hg for both the diastolic and the systolic

    returns to prepregnancy baseling after approximately 20 weeks of gestation

    postiton of the pregnant woman may also affect her blood pressure

    • Surpine: may appear to be lower due to the weight and pressure of the gravid uterus on the vena cava
    • which decreases venous blood flow to the heart

    Maternal hypotension and fetal hypoxia may occure which is referred to as supine hypotensive syndrome or supine vena cava syndrome (signs and symptoms include dizziness, lightheadedness, and pale, clammy skin) Encourage the patient to engage in maternal positioning on the left-lateral side, semi-fowlers postion, or, if supine, with a wedge palced under one hip to alleviate pressure to the vena cave
  19. Pulse changes during pregnancy
    increases 10/15 min around 20 weeks of gestation and remains elevated throughout the remainder of the pregnancy
  20. Respiration changes during pregnancy
    increase by 1-2/min respiratory changes in pregnancy are attributed to the elevation of the diaphragm by as much as 4cm as well as changes to the chest wall to facilitate increased maternal oxygen demands. Some shortness of breath may be noted
  21. Expected physical assessments during pregnancy
    fetal heart tones are heart at a normal baselin rate of 110 to 160/min with reassiromg FHR accelerations noted, which indicates and intacty fetal CNS

    uterine size changes from a uterine weight of 50 to 1,000 g by 36 weeks of gestation the top of the uterus and the fundus will reach the xiphoid process this may cause the pregnant woman to have shortness of breathas the uterus pushes against the diaphragm

    • Cevical changes: the color changes the cervix becomes purplish-blue in color (Chadwick's sign)
    • the cervix markedly softens in consistency, which is referred to as goodell's sign

    Breast changes due to hormones secreted during pregnancy the breasts increase in size and the areolas take on a darkened pigmentation

    • Skin:
    • Cholasma- Mask of pregnancy (pigmentation increases on the face)
    • Linea nigra- dark line of pigmentation from the umpilicus extending to the pubic area
    • Striae gravidarum- strech marks most notably found on the abdomen and thighs