Adaptations to pregnancy Chp 13
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Description of uterus before conception?
- Small pear shaped organ entirely contained in the pelvic cavity
- weighs up to 70 g (2.5)
- capacity of 10 ml (1 1/3 oz)
What is full term?
THe end of normal pregnancy
Description of uterus by full term?
- weighs 1100 to 1200 g (2.4 to 2.6lbs)
- capacity of 5000ml
Why is there uterine growth during pregnancy?
hyperplasia and hypertrophy
What is a trimester?
one of three 13 week periods of pregnancy
how are the muscles in the uterus in the third trimester?
THin and the fetus can be easily palpated through the abdominal wall.
What causes uterine rotation?
Pressure from the rectosigmoid colon on the left side of the pelvis.
What is the fundus?
THe top of the uterus
Where can the fundus be palpated at 12 weeks?
above the symphysis pubis
WHere is the fundus at 16 weeks?
Midway between the symphiyisis pubis and teh umbilicus
The fundus location at 20 weeks?
at the umbilicus
At 36 weeks where is the fundus?
- At its highest point teh xiphoid process.
- Because it pushes against the diaphragm many expectant mother experience SOB
What is Lightening?
at 40 weeks the fetal head descends into the pelvic cavity and the uterus sinks to a lower level.
What are braxton hicks contractions?
During late pregnancy how much blood flow is directed to the uterus and placenta?
What is Chadwicks sign?
hyperemia caused by estrogen that results in bluish purple color that extends to include the vagina and labia.
What is one of the earliest sighs of pregnancy?
What is goodells sign?
- Cervical softening
- before pregnacy the cervix feels like the tip of the nose
- after conception it feels like lips or and earlobe
An early sign of Labor?
Bloody show- a mucous plug plus a small amount of blood. THis bleeding occurs from disruption of the cervical paillaries as teh mucous plug is disloged when the cervix begins to thin.
Why does the vagina distend during childbirth?
Loosing of the connective tissue, teh vaginal mucosa thicken and vaginal rugae (folds) become very prominent.
What causes rapid sloughing and increased vaginal discharge
Vaginal cells contain increased glycogen
Why is candidiasis common during pregnacy?
glycogen rich enviornment favors the growth of candida albicans, yeast infections
What is the major functions of ovaries after conception?
secrete progesterone from the corpus luteum for the first 6-7 weeks.
WHy is progesterone called the hormone of pregnancy?
adequte amount of progesterone needs to be available in the early stages for pregnacy to be maintatined.
Where is prgesterone secreted from before placeta is developed?
THe corpus leteum
What two hormones cause the breast to grow in pregnacy?
Estrogen and progesteron.
What are striae gravidarum?
When does colostrum a yellowish fluid secrete from the breast?
- beginning at 12-16 weeks
- and can be readily expressed in the third trimester.
WHy is milk sectretion surpressed during pregnacy?
High levels of estrogen and progesterone
Where is the heart moved to in the third trimester, when the uterus elevates diaphragm.
upward and to the left.
When do Changes in heart sounds start?
12-20 weeks and regress during the first week after childbirth.
how much is blood volume increased during pregnacy?
Why is blood volume needed during pregnacy?
- Transport nutrients and O2 to the placenta
- meet demands of the expanded maternal tissue in teh uterus and breasts
- also provides a reserve to protect the pregnant woman from the AR's of blood loss
HOw much does RBC mass increase?
What is physiologic amemia or pseudoanemia of pregnacy?
Dilution of RBC mass causing a decline in maternal H/H.
When is iron supplementation prescibed for pregnant women?
By the second trimester to prevent anemia.
WHen does iron deficiency anemia occur?
- first/third trimester hemo-11 hema-33%
- second trimester hemo-10.5 hema-32%
what is the most efficient position for cardiac output during pregnacy?
- Lying in the lateral position
- the least efficent in the supine positon.
What is supine hypotension
When the pregnant woman is supine the weight of teh uterus partially occludes the vena cava and the descending aorta.
WHat corrects supine hypotension?
A side lying positon corrects supine hypotension.
A supine hypotension occlusion impedes?
return of blood from the lower extremities and reduce cardiac return cardiac output and blood pressure.
How can supine hypotension affect the fetus?
decreased blood flow to the placenta and can cause fetal hypoxia?
If the patient must lie in a supine positon what can they do to prevent supine hypotension?
Place a wedge or pillow under either hip.
How do progesterone and prostaglandins decrease airway resistance?
Relaxes smooth muscles in the resp tract
What can cause congestion in nasal and sinuses causing epistaxis (nosebleeds) deeper voice feeling fullness in the ears?
Estrogen from increased vascularity of the mucus membranes of upper resp
What is ptyalism?
What is pyrosis?
What can happen when gallbladder tone is reduced?
- gallbladder becomes hypotonic
- emptying is prolonged
- thicker bile
- can lead to gallstones
- retain of bile salts which can lead to itching (Pruritis)
absence of menstration
mask of pregnancy
Excess of blood n a part of the body is?
A woman who has been pregnant more than once is?
A fall in hematocrit that occures because of plasma volume expands more than red blood cell volume is?
Physiologic anemia of pregnacy
Irregular reddish streaks caused by tears in connective tissue "stretch marks"
Pregnancy-related rituals experienced by some prospective fathers is?
Changing from one pattern of behavior to another is?
When can the uterus be palpated above the symphysis in pubis?
Fundus can be palpated about halfway between symphysis pubis?
Fundus is at level of umbilicus?
Fundus is at xiphoid process?
What causes chadwicks sign?
hyperemia and it is bluish color that often extends to the vagina and labia
What causes goodells sign?
Cervical uterine and vaginal softening with increased vascularity and softening of the connective tissue.
What causes a mucus plug?
Plug caused by increased secretion of mucus from cervical glands that blocks ascent of bacteria from the vagina
What causes bloody show?
mixture of cervical mucus and small amount of blood disruption of mucus plug and small capillaries of cervix
what is the possible result of increased vascularity in the vagina during pregnacy?
Chadwicks sign, thickening of vaginal mucosa prominece of rugae hightend sexual intrest.
What is the possible result from growth of connective tissue in the vagina during pregnancy?
Greater pliability and distensibility of vagina
What is the possible result of the vagina during pregnancy with secretion of increased amounts of glycongen?
increased acidic vaginal discharge that retards growth of bacteria but favors growth of candida albicans (yeast)
Why is progesterone essential in pregnancy?
Pregnancy can not be maintained without progesterone
Progesterone is produced first by the ______and then by the_______?
Corpus luteun, placenta
What breast changes occur during pregnancy?
Darkening of the areola, increased nipple and areolae size, areolae become more erect, montgomery tubercles become pominent.
Describe changes in maternal heart sounds that may occure during pregnancy. When do the heart sounds changes occur? Describre common changes in heart sounds?
Changes in heart sounds begin between 12 and 20 weeks and regress during the 1st week after childbirth. They may include splitting of the first heart sound and a systolic murmur. Murmur may persist beyond 4th week.
Why does the pregnancy-induced change in fibrinogen levels have a protective effect yet also increase risk?
Increased fibrogen levels offer protection from excess blood loss but also predispose the woman to thrombus formation.
What nasal changes are common during pregnancy? what causes them?
Vasocongestion from estrogens effects causes increased vacularity and edema, leading to nasal stuffiness, nosebleeds and voice changes. It may also result in ear fullness or earaches.
What two factors contribute to a womans sense of dyspnea?
the growing uterus eventually lifts teh diaphragm and reduces lung expansion. Because the respiratory center becomes more sensitive to carbon dioxide, the minute volume increases and teh partial pressure of carbon dioxide falls.
Why are pregnant women more likley to develop gallstones?
Hypotonia prolongs emptying time and allows bile to become thicker.
WHat changes in carbohydrate metabolism and in the production utilization and breakdown of insulin occur during pregnancy? why do the changes occur? how does teh womans body normally respond to these changes?
The fetus draws on maternal glucose and amino acids which reduces the mothers glucose levels and her ability to synthesize glucose. During the 1st trimester the lower maternal blood glucose causes the pancrease to secrete less insulin. during the 2nd timester hormonses (human placental lactogen prolactin progesterone and corisol) reduce the maternal tissue sensitivity to insulin. Thus the mothers blood glucose levels rise to make more available for the fetus. The woman normally responds by increasing insulin production.
LIst the presumptive probable and positive indications of pregnancy. What is teh difference among the three classifications?
Presumptive: some signs are amenorreha nausesa vomiting fatigue urinary frequency breast and skin changes
Probable: Some signs are abdominal enlargement cervical softening ballottement braxton-hicks contractions pregnancy test
Positive- fetal heart sounds, fetal movements felt by examiner, visualization of fetus.
The diffrence among the indications is that presumptive indicators are the least reliable because tehy are oftern caused by other conditions
Probable indicators are stronger evidence but still may have other causes
Positive indicatore are those caused only by pregnacy
WHy is pregnancy risk assessment not a one time evaluation?
Later in the pregnancy, risk factors may appear that were not apparent at previous assesment.
What routine urine testing is preformed during prenatal visits?
Protien glucose ketones
Describe significat maternal changes that occur in a multifetal pregnancy with Blood volume?
THere is a 500ml increase in blood volume over a singleton pregnacy
Describe significat maternal changes that occur in a multifetal pregnancy with cardiac work load
cardiac workload is higher because of increased blood volume.
Describe significat maternal changes that occur in a multifetal pregnancy with respiratory workload?
greater diaphragm elevation increases dyspnea
Describe significat maternal changes that occur in a multifetal pregnancy with Blood vessal compresion?
Greater compression of aorta and inferior vena cava causes earlier and more pronounced supine hypotension
Describe significat maternal changes that occur in a multifetal pregnancy with bowels?
Pressure on the bowels increases constipation
List the typical maternal response for the 1st trimester of pregnancy?
Anxious to find confirmation of pregnancy ambivalence focus on self
List the typical maternal response for the 2st trimester of pregnancy?
Physical evidence of pregnancy focus on fetus marcisism introversion body image sexual intrest
List the typical maternal response for the 3 rd trimester of pregnancy?
Feelings of vulnerability replaced by coming to terms with the stuation fantasies or nightmares incresed dependence desire to see the baby dread about labor or being anxious for teh pregnancy to end.
What changes may occur that make teh fetus seem real to the pregnant women?
Increase in uterine size, weight gain, breast changes, fetal movements (quickening)
How might sexual interest and activity change during pregnancy? What factors may increase or decrease intrest in either partner or couple?
Sexual interest and activity may be heightend or reduced teh woman may be more responsive because pelvic vasocongestion heightens sensititvity and lubricates the vaginal area. Fear of miscarriage, harming the fetus or causing discomfort may suppress sexual desire in either partner. The woman may feel less attractive or her partner may find her less attractive at this time.
How does the womens perception of the baby change during pregnacy in the 1st trimester?
Fetus seems vague and unreal rather than seeming like a baby to her.
How does the womens perception of the baby change during pregnacy in the 2nd trimester?
Perceives fetus as real and needing her protection growing sense of fetus as a separate person.
How does the womens perception of the baby change during pregnacy in the 3rd trimester?
wants to see her baby on the outside and as a separate being.
What is the significance of quickening in the womans developing relationship with her fetus?
It makes the fetus seem much more like a separate being rather a part of the womens body.
Why might grief have a place during a desired and normal pregnancy?
Grief may be caused by feelings of giving up life as a carefree woman and loss of spontaneity to go places and do things.
Describe the four maternal tasks of pregnancy according to Rubin?
1. Seeking safe passage for herself and baby
2. Securing acceptance of herself and baby
3. Learning to give of herself
4. developing attachment to the unkown child
Describe the three developmental processes that teh expectant father goes through during the pregnancy?
1. Grappling with reality of pregnancy and a new child
2. Struggling for recognition as a parent
3. desire to be seen as relevant to the childbearing process
How may this factor influence a womans psychosocial adaptation to pregnancy Young age.
Has difficulty putting aside her won desires for teh wll being of an infant must give of herself before developmentally pepared to do so
How may this factor influence a womans psychosocial adaptation to pregnancy absence of partner
May be poor and have late prenatal care: must enlist other to provide support that a partner would provide
How may this factor influence a womans psychosocial adaptation to pregnancy Multiparity
May grieve for the exclusive relationship with first child concern about having enough time and energy to spread around concern about acceptance of new infant by other child or children.
Content typically covered in early pregnancy classes 1st timester
Dealing with discomforts common in early pregnancy what to expect value of prenatal care avoiding hazards
Content typically covered in early pregnancy classes 2nd timester
Body mechanics working during pregnancy childbirth choices postbirth needs of mother and infant.
A pregnant woman expect to give birth to her first baby in approximately 1 week. She asks the nurse whether she has a bladder infection because she urinates so much, even though urination causes no discomfort. The nurse should explain to her that?
Her fetus is probably lower in her pelvis puttin more pressure on her bladder.
A women having phusiologic anemia of pregnancy has hemoglobin and hematocrit levels of at least?
Slight reairatory alkalosis during pregnancy enhances?
Transfer of fetal carbon dioxide to maternal blood
A pregnant woman is prone to urinary tract infection primarily because?
Urine statis allows additional time for the bacteria to multiply
A pregnant woman complains that both of her thumbs hurt at times. Neither thumb is inflamed or discolored The nurse should explain to the woman that?
Increased tissue fluid is causing compression of a nerve.
A pregnant woman has a blood glucose screenign at 26 weeks of gestation. THe result is 128 mg/dl the nurse should expect that?
no additional glucose testing will be needed
A woman who is 12 weeks pregnant begind wearing maternity clothes. This is most likely an example of
maternal behavior that best describes role playing during pregnancy?
The woman tries to care for infants while an experienced mother watches
The nurse can best help a man assume his role as a parent by?
Encourage him to ask questions about his partners pregnancy
the most likley reaction of an 8 year old to his mothers pregnacy
Intrest in learning about the developing baby
The nurse is teaching a Laotian woman about self care during pregnancy the nurse can best determind whether she learned the information by?
Having the woman restate the information that is taught
The primary benefit of a preconception class is to?
Reduce the risk of having a baby with a birth defect
The primary benefit of perinatal education is to help?
Parents become active in health maintenace during pregnancy and birth
Brownish patches of pigmentation?
Melasma, Chloasma and mask of pregnancy
What is the linea alba?
The line that marks the longitudinal divison of the midline of the abdomen it darkens and becomes the linea nigra
Increased pigmentation from elevated estrogen and progesteron and melanocyte-stimulating hormone may begin as early as teh 8th week
is there loss of bone density?
No the calcuim needed for the fetus is relativly small.
WHen does the pelvis symphaysis separate?
at 28-30 weeks
What is diastsis recti?
During the third trimester the abd muscles may become so stretched that the rectus abdominis muscles separate.
What does oxytocin do ?
- Stimulates the milk-ejection reflex after childbirth
- stimulates contraction of the uterus but during pregnancy
- keeps the uterus contracted preventing excessive bleeding at placenta site.
How much weight gain is recommended during pregnancy?
11.5 - 16 kg (25 -35 lbs)
Why does the uterus cause edema?
the weight of the uterus compresses teh veins of the pelvis, which delays venous return causing the veins of the legs to become distended and increases venous pressure resulting in additonal fluid shifts.
WHy does carpal tunnel syndrome cause edema?
it compresses teh median nerve, usually resolves by 3 months postpartum.
Presumptive indications of pregnancy?
- Urinary frequency
- breast skin changes
- Vaginal and cervical color changes (CHADWICKS SIGN)
Probable indications of pregnancy?
- Abd enlargment
- cervical softening (goodells sign)
- Braxton hicks
- palpation of fetal outline
- uterine souffle
- pregnancy test
What is Hegar's sign?
at 6-8 weeks after the last menses the lower uterine segment ( the isthmus) is so soft tht it can be compressed to the thinness of paper
What is ballottement?
a sudden tap on the cervix during vaginal examination may cause the fetus to rise in the amniotic fluid and then rebound to its original postion.
What is uterine souffle?
late in pregnancy a soft blowing sound may be auscultated over the uterus. It is the sound of blood circulation through the dialated uterine vessles and corresponds to the maternal pulse.
What is funic souffle?
sharp whistling sound heard over the umbilical cord that corresponds to the fetal heart rate.
Types of pregnancy tests?
Agglutination inhibition test
- Radioreceptor assay
Positive indications of pregnancy?
- Ascultation of fetal heart rate
- fetal movements felt by examiner
- visualization of embryo or fetus
When can you hear fetal heat sounds first?
- 16- 20 weeks
- a doppler can detect sounds at 9 weeks
- heart beat can be seen on ultrasound at 8 weeks.
Why are the early weeks of pregnancy particularly important?
because fetal organs are forming and are especially sensitve to harm.
What is gravida?
refers to a woman who is or has been pregnant regardless of the duration of the pregnancy
What is a primigravida?
a woman who is pregnant for the first time
What is a multigravida?
A woman who has been pregnant more than once.
what is para?
Number of pregnancys that have ended at 20 or more weeks regardless of whether the infant was born alive or stillborn
What is nullipara?
a woman who has never completed a pregnancy beyond 20 weeks of gestation because she has never been pregnant or has had a spontaneous or elective abortion.
what is a primipara?
A woman who has delivered one pregnancy at 20 or more weeks of gestation.
Wht is a multipara?
A woman who had deliverdd two or more pregnancies at 20 or more weeks of gestation. the number of fetuses in a pregnancy does not change the para
Wht is term birth?
38 -42 weeks
What is a preterm birth?
How does the nageles rule work?
- used to establish estimated date of delivery(EDD)
- Use last normal menstral period (LNMP_
- Subract 3 months
- and add 7 days
The traditional schedule for prenatal care is
- Conception to 28 weeks q 4 weeks
- 29-36 weeks q 2 weeks
- 37 weeks to birth Q week
Common discomforts of pregnancy?
- nausea vomiting
- round ligament pain
- urinary frequency.
- leg cramps
Maternal responses in the 1st trimester?
- The self as primary focus.
maternal responses in the 2nd trimester?
- Physical evidence of pregnancy
- the fetus as primary focus
- Narcissism and introversion
- body image
- Changes in sexuality
Maternal responses in the 3rd trimester?
- increased dependence
- Prepartation for birth.
Rubins steps in maternal role taking?
- Role play
- the search for a role fit
- grief work
maternal tasks of pregnancy (rubin)
- seeking safe passage
- securing acceptance
- learning to give of herself
- Developing attachement and interconnection with the unkown child.
Reality booster for expecting fathers?
- seeing fetus on sonogram
- hearing the baby's heart beat
- feeling the infant move.
Adaptation for a toddler?
Children 2 years or younger are unaware of maternal changes and are unable to understand that a new brother or sister is going to be born.
Factors that influence psychosocial adaptations?
- social support
- absence of partner
- socioeconomic status
- abnormal situations.
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