Physiologic and Psychologic Changes
During Pregnancy
• Profile of previous pregnancy history –
§ GTPALM
§ PG – we will use this one mostly
§ P: para (number of births after 20 weeks gestation)
§ G: gravida (total number of pregnancies, including current pregnancy)
§ T: Term births
§ P: Preterm births
§ A: Abortions
§ L: living children
Prenatal Care
Determination of date of birth
Nägele’s rule –
Wheel – see example
Duration of pregnancy
280 days using 28-day months is called lunar months; 10 lunar months; 40
weeks
9 calendar months; Divided into 3 trimesters
Abortion/miscarriage – a pregnancy that terminates before the fetus
reaches 20 weeks gestation
Preterm/premature – a pregnancy that terminates after the 20th
week of gestation, but before full term
Prenatal Care
Signs of pregnancy
Presumptive – (may suggest pregnancy)
Probable – (strongly indicates pregnancy)
Positive – (confirms pregnancy)
fetal heart tones are heard
fetal movement is palpated by the examiner
fetal outline is visualized by ultrasound
Physiologic Changes in Body Systems
- Endocrine System
- increase in hormones
- addition of the placenta during pregnancy; producing large amounts of estrogen & progesterone
Reproductive system
Uterus- prepregnancy wt – 60g or 2 oz
postpregnancy wt – 1000g or 2.2 lbs
Cervix – becomes shorter & softer
Ovaries – follicles cease to develop to maturity Ovulation does not
occur; produces the hormone relaxin
Vagina- walls become thicker, pliable & expandable in preparation for the
tremendous stretching necessary for the birth; increased vaginal discharge
Breasts – preparation for lactation; size increases; breasts become full,
sensitive, & tender; darkening of the areola & nipple; Montgomery’s glands
become more prominent & lubricate & protect nipple in preparation for
breastfeeding
Physiologic Changes in Body Systems
Musculoskeletal system – relaxation of joints and adjustments in posture
joints relax & symphysis pubis widens as result of relaxin & progesterone
as the uterus enlarges, the center of gravity shifts forward causing
lordosis
abdominal muscles may separate causing diastasis recti abdominis
may develop carpal tunnel syndrome due to compression of the medial nerve
around the wrist
Cardiovascular system –
• Respiratory system – thoracic circumference increases; 02 consumption increases by 15%
§ Dyspnea – caused by a greater sensitivity of the respiratory system & pressure of the uterus on the diaphragm
§ Epistaxis – caused by increased vascularity due to increased estrogen; deepening of the voice
• Gastrointestinal system
gum hypertrophy
increased saliva production
nausea with or without vomiting during 1st trimester
increased heartburn
delayed emptying of intestines leading to constipation
altered CHO metabolism; gestational diabetes
Physiologic Changes in Body Systems
Renal system
frequent urination
urine stasis
more prone to developing pyelonephritis (infection of the upper urinary
tract)
Integumentary system
hyperpigmentation of skin
on the face; chloasma; mask of pregnancy
linea nigra dark line on the abdomen – fig 4-5
striae gravidarum or stretch marks
Psychologic Changes During Pregnancy
• Body image may change
appearance; may begin to feel ugly or fat; negative about pregnancy
function; losing control of body; urine incontinence
sensation may become more acute; change in sexuality & libido mobility may be a problem
Developmental tasks
Pregnancy validation – 1st trimester; focus on nurturing &
protecting the fetus; questioning identity as a woman & mother
Fetal embodiment – 2nd trimester; attempts to incorporate the
fetus into her body image as part of self
Fetal distinction – feels quickening or fetal movement; the fetus becomes
separate from her – fig 4-7
Role transition – 3rd trimester; psychologically separates
self from fetus & makes concrete plans for the baby
Psychologic Changes During Pregnancy
Responses to pregnancy
partners’ response; announcement, adjustment, focus
older couple
adolescent
single
grandparents
siblings
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