PHYSIOLOGICAL AND PSYCHOLOGICAL CHANGES OF PREGNANCY

DEBBIE AMASON,RN,MS SPRING 2001

Changes
affect both parents physiologic psychological temporary state of wellness

Diagnosis
feelings can be good or bad confirmation early diagnosis important

Presumptive Signs

can be caused by other problems

amenorrhea nausea and vomiting fatigue urinary frequency breast tenderness quickening

Probable Signs

changes in the pelvic organs

Goodells Sign Chadwicks Sign Hegars Sign

Increase in size of uterus Ballottement Braxton-Hicks contractions Serum lab tests

Positive Signs

fetal heart rate fetal movement felt by examiner

visualization by ultrasound

Physiological Changes

local- reproductive systemic- major body organs

Local

Uterus
pre-pregnancy small semisolid pear shaped weight increases from 50Gm to 1000Gm enlargement primarily a result of hypertrophy of pre-existing myometrial cells

Uterine
development of new fibroelastic tissue between bands of muscles cells increase as result of estrogen measure lightening

Uterine
blood flow 15-20ml/min prepregnancy at term 500-700ml/min by end of pregnancy 1/6 total maternal blood volume is circulating through the uterus bleeding- serious problem

Uterus

Braxton Hicks
painless contractions estrogen distention of the uterus felt by 4th month practicing no cervical changes occur

amenorrhea

Cervix

mucosa of cervix undergoes marked changes

endocervical cells secrete thick, tenacious mucus which accumulates and forms the mucus plug. Seals the cervical canal to prevent infection expelled at start of labor

Cervix
increased increased increased increased

mucus leads to discharge vascularity and discoloration

Vagina
epithelium undergoes hypertrophy and hyperplasia estrogen

secretions are acidic> increased growth of Candida

at term vaginal walls are relaxed

Ovaries

cease ovum production related to active feedback mechanism of estrogen and progesterone produced by the corpus luteum and the placenta

Breasts
changes are noted soon after first missed period increase in size and nodularity preparing for lactation 2nd month superficial veins are prominent nipples are more erect

Breasts
pigmentationof areola is more prominent sebacious glands enlarge (Montgomery Tubercles) 16th week colostrum

Integumentary System
nipples and areola areas of breasts are darker striae gravidarum linea nigra chloasma diastasis rectus

Respiratory
tidal volume increases 40% respiratory rate increases

small degree of hyperventilation

oxygen consumption increases by 20% diaphragm is displaced >SOB no change in vital capacity

Respiratory

Progesterone levels signal hypothalmus to reset acceptable PCO2 levels

low CO2 levels allows for CO2 to cross the placenta maintain pH with load of CO2 from fetus- mother hyperventilates to blow off excess

Respiratory

cumulative effect
SOB nasal stuffiness epistaxsis

Cardiovascular
pressure on diaphragm displaces the heart blood volume increases 30-50%

occurs gradually and peaks at 2832 weeks adequate exchange of nutrients compensate for blood loss

CV

rise in cardiac output 25-50%

pulse rate increases BP remains relatively unchanged

concentration of Hgb and erythrocytes may initially decline

CV

femoral venous pressure slowly rises

stasis dependent edema varicosities

fibrinogen levels increase 50%

clotting factors platelets

wbc, protein

GI

nausea and vomiting associated with HCG

50% affected peculiarities of taste and smell intestines are displaced heartburn constipation

GI
hemorrhoids acidity of stomach decreases hypertrophy of gums and gingival bleeding

Urinary

alterations
fluid retention,renal, ureter, and bladder function

result of:
estrogen and progesterone activity compression increased blood volume postural influences

Urinary
total body H2O content increases must increase Na reabsorption retained to assist:

increased blood volume source of nutrients for the fetus

Urinary
excrete waste from mother and fetus breakdown protein compensate for blood volume UOP increases 60-80% specific gravity decreases

Urinary

GFR increases
decrease BUN increase filtration of glucose

ureters increase in diameter bladder capacity increases frequency increases (1012X/day)

Skeletal
no obvious changes in teeth noted joints of pelvis relax r/t hormone relaxin

waddle shift in center of gravity

Endocrine

placenta produces:
estrogen progesterone HCG HPL relaxin prostaglandins

Endocrine

thyroid
increased vascularity hyperplasia increased BMR increased oxygen consumption

Endocrine

pituitary
decreased FSH and LH Prolactin increases secretes oxytocin

results in:
anovulation lactation increased pigmentation

Endocrine

pancreas- early pregnancy

there is a decrease in insulin production r/t increased fetal demands

after 1st trimester

increase in insulin production r/t insulin antagonist properties of estrogen, progesterone, and HPL

Psychological

attitudes depends on:

environment social cultural family individuals

gamut of emotions
need time to adjust

First Trimester

Developmental Task
acceptance of pregnancy 50% are surprises concerns center on self partners response

Second trimester

Acceptance of Baby
quickening start to make plans educate fantasize

Third Trimester

Preparing for Parenthood

nesting must complete specific tasks reworking developmental tasks role playing fantasizing

Emotional Responses
ambivalence grief narcissism introversion vs. extroversion body image and boundary stress couvade syndrome

Responses
emotional lability change in sexual desire change in expectant family