Maternal Ch 14, 15, 16, 17 Changes of Pregnancy

Passive fetal rebound against cervix when cervix is pushed up against by examiner

Blue-purple discoloration of cervix

• Mask of pregnancy
• facial darkening - irregular pigmentation of the cheeks, forehead, nose
• Accentuated by sun eposure
• More prominent in dark-haired women

Observances of rituals/taboos by dad to signify transition into fatherhood

May be intentional or unintentional

May include sympathy pains, etc.

Softening of cervix

Heart pushed upward and to left/forward: Fetus exerts pressure on diaphragm

• Systolic murmur 90% preg women
• First/third heart sounds are louder

Blood volume increases to 50% over non-preg

• Vascular resistence down
• Femoral venous pressure increases: dependent edema, veric veins

Cardiac output up by 505

Supine hypotensive syndrome (vena caval syndrome) or (aortocaval compression)

Pulse increases 10 - 15 bpm

Physiologic anemia of pregnancy

Plasma volume increases more than erythrocyte volume (50%:30%), so Hct appears to drop in blood tests.

Increase of rbc's is only 18% in women who don't receive additional iron.

• Secretions thicken
• Become acidic (pH 3.5 - 6)
• Prevents infections during pregnancy
• FAVORS yeast infections (moniliasis)

• Decreased intraocular pressure
• Thickening of cornea
• May be uncomfortable to wear normal contacts

• Increased fat demands and fat metabolism
• Fats more completely absorbed
• R/f ketosis during night, between meals

Incr demand for iron

Symptoms the woman reports:

• Amenorrhea
• N/V (elevated hCG)
• Fatigue
• Frequency
• Breasts
• Quickening (16 - 20 wks)

Observed by examiner:

• Goodells: softening
• Chadwick's: purple
• Hegar's: softening of isthmus
• Ladin's: soft spot
• McDonald's: ease in flexing uterus against cervix

• Enlargement of abdomen
• Braxton Hicks
• Uterine Souffle (mom's)
• Funic Souffle (baby's)
• Pigmentation changes
• Fetal outline
• Ballottement
• Pregnancy test

Fetal heartbeat: Doppler @ 12 wks, Fetoscope @ 17-20wks

Fetal movement: actively palpable by 20 wks

Visualization: ultrasound (4-5 wks gestation)

Between conception to onset of labor (prenatal)

Onset of labor until birth of infant and placenta

Brith till woman's body returns to prepregnant condition

Number of wks since first day of last menstrual period (LMP)

Birth that occurs before 20 wks gestation or birth of fetus less than 500g

Normal duration of pregnancy (38 - 42 wks)

Labor that occurs after 20 wks, but before end of 37th wk of gestation

Pregnancy

• Nulligravida: never been pregnant
• Primigrafida: first pregnancy
• Multigravida: second or subsequent gravida

Birth after 20 wk's gestation (alive or dead)

• Nullipara: never given birth after 20 wks
• Primipara: 1st birth after 20 wks
• Multipara: 2+ after 20 wks
• Stillbirth: fetus born dead after 20wks gestation

• T: Term
• P: Preterm
• A: Abortion
• L: Living children

Estimated date of birth (EDB):

• First day of LMP
• Subtract 3 months
• Add 7 days
• (adjust year)

Increased whitish vaginal discharge - common in pregnancy

Excessive, bitter saliva is produced

• More acidic; encourages growth of candida albicans
• Woman more susceptible to MONILIAL VAGINITIS

• Pelvic rocking
• Reduces lower back strain/pain