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Physiological Changes During Pregnancy: From the Uterus to the Breasts, Study Guides, Projects, Research of Nursing

Atlantic Institute of Oriental Medicine (ATOM)Nursing

An overview of the physical changes that occur in a woman's body during pregnancy, focusing on the uterus, cervix, ovaries, vagina, breasts, respiratory system, and cardiovascular system. Topics include the role of hormones in preparing the body for childbirth, the formation of the mucous plug, the cessation of ovum production, the development of colostrum, and the effects of pregnancy on various body systems.

Typology: Study Guides, Projects, Research

2023/2024

Available from 04/03/2024

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NURSING OB Exam1 STUDY

GUIDE

Normal

Antepartum

Signs of

Pregnancy

•

Presumptive

o

I think I might be pregnant

•

Probable

•

Positive

o

TRUE, actually

Pregnant Signs of

Pregnancy: Presumptive

•

Subjective changes the woman experiences, but not proof of pregnancy

Quickening

•

Fetal movements felt by the mother

•

May be experienced between 14 and 22 weeks gestation

•

Most primigravidas first feel movement between 18 and 20 weeks

•

Multiparous women may feel it sooner

•

Precipitates initial recognition by the mother as a distinct individual

Signs of Pregnancy: Probable

•

At term, cervical strength is 1/12 of its pre-pregnant strength which

facilitates the cervical changes during labor

•

Some infertility drugs, ovarian cysts, and gestational trophoblastic disease

can cause false positive pregnancy test results

•

A lot of this is caused by vascular congestion

•

Objective changes that an examiner can detect:

o

Changes in pelvic organs caused by increased vascular congestion

▪

Softening of cervix (Goodell’s Sign)

▪

Softening of the isthmus of uterus (Hegar’s Sign)

Discover Study Guides, Projects, Research of Nursing Atlantic Institute of Oriental Medicine (ATOM)

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NURSING OB Exam1 STUDY

GUIDE

Normal Antepartum Signs of Pregnancy

- Presumptive o **I think I might be pregnant

Probable**
Positive o TRUE, actually Pregnant Signs of Pregnancy: Presumptive
Subjective changes the woman experiences, but not proof of pregnancy Quickening
Fetal movements felt by the mother
May be experienced between 14 and 22 weeks gestation
Most primigravidas first feel movement between 18 and 20 weeks
Multiparous women may feel it sooner
Precipitates initial recognition by the mother as a distinct individual Signs of Pregnancy: Probable
At term, cervical strength is 1/12 of its pre-pregnant strength which facilitates the cervical changes during labor
Some infertility drugs, ovarian cysts, and gestational trophoblastic disease can cause false positive pregnancy test results
A lot of this is caused by vascular congestion
Objective changes that an examiner can detect: o Changes in pelvic organs caused by increased vascular congestion ▪ Softening of cervix (Goodell’s Sign) ▪ Softening of the isthmus of uterus (Hegar’s Sign)

▪ Purple/bluish discoloration of vaginal walls and cervix (Chadwick’s Sign)

Enlargement of the abdomen with continuing amenorrhea
Braxton-Hicks contractions
Uterine soufflé o Sounds of blood flow through the placenta
Positive pregnancy test
Palpable fetal outline o Can be a tumor or stool or something else Signs of Pregnancy: Positive
Fetal heartbeat between 120-160 bpm (can doppler by 10-12 weeks)
Fetal movement detected by examiner
Visualization of fetus on ultrasound Clinical Pregnancy Testing
Based on the analysis of maternal blood or urine (lab or OTC) o Urine tests 95% accurate (OTC) ▪ Accurate if test on the day of expected period ▪ Early morning midstream collection; higher concentration of hCG in the morning ▪ Detect low levels of hCG
Blood tests (lab) o Can be detected as early as 7-8 days before the missed period o Physical Changes of Pregnancy
Body undergoes extraordinary physical changes to sustain a pregnancy

 By term, one sixth of the total maternal blood volume is contained in uterus  The rate of blood flow is 450 – 700 ml/minute!  About 1/3 of the women’s blood is going through the uterus ▪ Ensure hemostasis immediately after birth; can bleed out pretty quickly Physical Changes: Cervix (The mouth of the uterus)

Estrogen-induced changes cause endocervical glands to secrete thick, tenacious mucus which accumulates and forms a mucous plug (operculum) o Creates a barrier to infection; pretty tenacious, really hard for bacteria to get through it
Mucous plug seals the cervical canal and prevents ascent of bacteria into the uterus
When cervical dilatation begins the mucous plug is expelled Physical Changes: Ovaries
Ovaries cease ovum production during pregnancy o Don’t release eggs during pregnant
Human chorionic gonadotropin (hCG) produced by the fertilized egg maintains the corpus luteum
The corpus luteum then: o Secretes progesterone until mid pregnancy ; supports the pregnancy for the first couple of months until the placenta takes over o Placenta then begins to produce progesterone Physical Changes: Vagina
Estrogen-induced changes cause: o Increased vascularization (Chadwick’s sign) o Hyperplasia and hypertrophy o Vaginal secretions become thicker, whiter, odorless, and more acidic ▪ Called “leucorrhea” – NORMAL ▪ Contributes to the formation of mucus plug ▪ Prevents infection, but favors yeast  Due to lower pH
By term, vaginal wall becomes relaxed to permit distention and passage of infant o Kegels can help to ragain tone, but will never be the same Physical Changes: Breast

Increase in breast size o Results from glandular hyperplasia o Caused by estrogen and progesterone in preparation for lactation
Increased pigmentation of areola (nipple tends to darken) o Sebaceous glands, called Montgomery tubercles, hypertrophy
Striae may develop as pregnancy progresses
Colostrum (antibody rich secretion) may be expressed by the 16th week of pregnancy o Has a golden color (liquid gold); small in quantity, high in quality Physical Changes: Respiratory
Oxygen consumption increases to meet the needs of the mother, fetus and placenta o Hyperventilation of pregnancy caused by increased tidal volume due to increased oxygen needs and decreased threshold for CO 2 (which causes a mild respiratory alkalosis)—may be perceived as shortness of breath
Respirations are normally between 12 and 22 breaths/minute o Hyperventilation during pregnancy o Blowing off more CO2 and sometimes feel short of breath
Diaphragm is elevated as a result of pressure from the enlarging uterus o Feel like its hard to breath
Chest circumference may increase by as much as 6 cms
Nasal stuffiness, congestion and epistaxis o Result of estrogen induced edema and vascular congestion of the nasal mucosa o Saline nasal spray can help to relieve this Physical Changes: Cardiovascular
Heart is pushed up and to the left by enlarging uterus
Systolic murmur can be heard in 90% of women o d/t Increase blood flow

Blood volume increases throughout pregnancy o 30 – 45% above non-pregnant levels o Cardiac output begins to increase in pregnancy and reaches 30% – 50% by 32 weeks
Heart rate mildly increases (10-15 bpm; normal range 60-90 bpm)
Some women may experience benign palpitations
Blood pressure decreases slightly during 2 nd^ trimester, gradual return to prepregnancy levels by end of 3 rd^ trimester o BP should remain <135/ o Due to relaxation of vessels, actually drops during 2 nd^ trimester
Supine Hypotensive Syndrome o Enlarging uterus can put pressure on vena cava in supine position and interferes with returning blood flow. o *when the woman lays on her back, the BP drops ▪ like a bowling ball on a water hose; fetus lays on the aorta o Results in supine hypotensive syndrome or vena caval syndrome: ▪ Decrease in BP ▪ Dizziness ▪ Pallor ▪ Clamminess o Growing uterus exerts pressure that affects return blood flow from the extremities causing: ▪ Stagnation of blood in the lower extremities ▪ Dependent edema, worse by end of day ▪ Tendency toward varicose veins in the legs vulva and rectum in late pregnancy  Elevating legs, wearing support stocking, exercising regularly, drinking enough water, and avoiding prolonged sitting and standing  Exercise o Put the women on her side in order to help with this

o Due to pressure from enlarging uterus and elevated progesterone levels causing relaxation of smooth muscles o Reflux of acidic secretions develops due to relaxation of cardiac sphincter o Intestines displaced laterally and posteriorly by the uterus o Stomach is displaced superiorly o Treatment: avoid spicy or fatty foods and milk; drink liquids 30 minutes after solids; stay upright after meals; Tums

Bloating and constipation: o Caused by delays in gastric emptying and decreased intestinal motility; fetus also putting pressure on sigmoid colon o Will often be dehydrated when pregnant also, need a ton more water but may not be drinking enough o Treatment: Increase fluids and fiber; increase movement; may take stool softeners as needed; prunes
Hemorrhoids: o Caused by constipation or increased pressure on the vessels below the uterus o Can also pop out during birth too o Treatment: follow recommendations to avoid constipation; kegels, Tucks, Proctofoam
Pruritus: o Can be simply result of stretching or dry skin o Can be caused by decreased gallbladder emptying causing retention of bile salts leading to intense itching* o *intense itching could signal a serious disorder called cholestasis of pregnancy requires medication and/or delivery of baby at 37 weeks. o Characterized by generalized itching starting with palms of hands and soles of feet. No long term sequelae for mother, but can cause sudden fetal death. o Treatment: lotions/cocoa butter; stop scratching; may take Benadryl at night if disturbs sleep
Bleeding Gums: tissue becomes hyperemic as a result of estrogen o Treatment: use a soft toothbrush; reassurance
Ptyalism ( tahy - uh -liz- uh m): increased saliva produced during pregnancy o Treatment: peppermint candies, water o May even carry around a little spit cup

Physical Changes: Urinary Tract

Growing uterus puts pressure on bladder causing urinary frequency and urgency: o 1 st^ and 3rd^ trimester o impairs drainage making it more susceptible to infection and trauma o Renal perfusion best when woman is in a lateral recumbent position
Dilation of kidneys and ureter, usually on the right side, because of the lie of the uterus o Leads to urinary stasis which may increase the risk of urinary tract infection o Pregnant women are prone to asymptomatic bacterial UTI; test urine on a regular basis
Increased glomerular filtration rate o Results in decreased serum creatinine, bun, and uric acid
Glycosuria can occur due to kidney’s inability of reabsorb all of the filtered glucose o Must differentiate from gestational diabetes o If its just a filtration problem, wont be more than trace o More than 1+ or 2+, make sure she isn’t developing gestational diabetes Physical Changes: Integumentary
Changes in skin pigmentation occur due to: o Increased estrogen and progesterone o Melanocyte-stimulating hormone levels
Increased pigmentation of areas already hyperpigmented o Areolae, nipples, vulva, linea nigra o Linea nigra: dark line in the midline of the abdomen
Melasma or chloasma (also known as the “Mask of Pregnancy”) o Affects the cheeks, forehead and nose
Striae (stretch marks):

o Ensure adequate rest and nutrition

Sleep problems (difficulty falling asleep, frequent awakenings, active fetus, nocturia) o Comfort measures; limit fluids in the evening
Carpal tunnel syndrome o Avoid wrist flexion (may need brace); increase fluids
Sciatica o Caused by enlarging uterus putting pressure on nerve, poor posture, edema/tightness of the piriformis muscle o Stretches for gluteals and low back may help o r/t to posture and swelling
Muscle cramps caused by hypocalcemia or dehydration o Encourage adequate calcium intake, prenatal vitamin, and fluids o r/t hypocalcemia or dehydration Physical Changes: Endocrine
Vascularity and hyperplasia of the thyroid o Increase in size of thyroid, can lead to a decrease TSH and increase T o Transient hyperthyroidism; goes away by 2 nd^ trimester usually
TSH may decrease and T4 may increase due to the hormones hCG and estrogen— should normalize by second trimester
Pituitary gland enlarges and supports the pregnancy through the secretion of several hormones o Prolactin supports initial lactation o Oxytocin supports uterine contractility and milk ejection from the breasts
Increased need for insulin o Hormones of pregnancy cause insulin resistance o Need increases as pregnancy advances and placenta enlarges o Latent deficiency can become apparent during pregnancy

Physical Changes: Metabolism

Basal metabolic rate increases by 10-20% due to increased oxygen consumption
Pregnant woman must meet: o Own tissue requirements o Fetal growth/development requirements o Preparation for labor and lactation
Increased water retention o Needed for fetus, placenta, amniotic fluid, blood volume Psychological changes of pregnancy Psychosocial Assessment
History of emotional or physical abuse
History of emotional problems: o Depression and anxiety in general o History of Postpartum depression
Support systems
Acceptance of pregnancy o intended or unintended
Personal preferences about the birth
Plans for care of child following birth
Feeding preferences for the baby o Breast or Bottle Psychological Changes
Mother o Ambivalence o Acceptance o Excitement upon feeling fetal movement o Anxiety as birth nears o Physical awkwardness
Father o Lots of variability, may accept or reject o May be afraid of harming baby with intercourse o Feelings of financial responsibility o Couvade ▪ Men who experience symptoms of pregnancy that their waives are experiencing

▪ Quickening Gestational Wheel

o The gestational wheel can be used to calculate the due date. o To use it, place the arrow labeled “first day of last period” on the date of the woman’s LMP. o Then read the EDB at the arrow labeled 40. o In this case, the LMP is September 8th and the EDB is June 15th. Screening Tests (Routine)
Initial Visit: o Pap smear, CBC, HIV, Rubella titer, ABO and RH typing, urinalysis and urine culture, Hepatitis B screen, Gonorrhea, Chlamydia, RPR o Ultrasound to date pregnancy o Sickle cell screen if of African descent
Gestational diabetes screen—1 hour GcT o Between 24 and 28 weeks ▪ If increased risk of GDM (prior history of GDM or birth of LGA infant, morbid obesity, PCOS, glycosuria, strong family history

of type 2 DM) should screen ASAP ▪ If screen is >140, will need a 3 hour GTT to diagnosis o Retest a CBC and antibody screen (if Rh negative) at this time

HIV/RPR (rapid plasma reagent, screening test of syphilis) o In third trimester, usually Between 32 and 33 weeks
Group Beta Strep Testing o Between 35 and 37 weeks o Vaginal culture o If present during labor, can affect baby and cause significant problems for baby Screening Tests (Non-Routine) for chromosomal & neural tube defects
ACOG (American college of Obstetricians and Gynecologists) recommends that all women be offered screening for Down syndrome regardless of age o Risk increases for women > 35 years old
Nuchal Translucency ultrasound with serum markers o Beta hCG and PAPP-A (pregnancy associated plasma protein) o 11 – 14 weeks o looks at fluid in babies neck, the thicker the fluid, the more the chance of down syndrome in baby
Quadruple Screen o Blood test (AFP, hCG, diametric inhibin-A, estriol) o 15-22 weeks o pretty accurate
Maternit21 plus o Screening blood test for chromosomal disorders o Can be done as early as 10 weeks o 91.7% to 99.9% sensitive with low false positive rates ▪ really reliable Diagnostic Tests (Non-Routine) for chromosomal & neural tube defects
Chorionic Villus Sampling (take from placenta) o Diagnostic (cannot detect neural tube defects) o 10 – 12 weeks o 0.3% risk of spontaneous abortion o for chromosomal defects

▪ Persistent glycosuria = diabetes mellitus o Protein (negative) ▪ Proteinuria, albuminuria = UTI, dehydration, preeclampsia  Preeclampsia: Blood pressure rises during pregnancy o This practice is being discontinued by many practices because the evidence does not support it.

Fetal Heart Tones (FHT) o Doppler device o FHT may be detected by 10 to 12 weeks gestation o Normal range: 110-160 bpm
Fundal Height o Rough estimate of fetal growth o Correlates with weeks of gestation between weeks 18 and 30 (i.e. 26 cms = 26 weeks) o At 20 weeks, the fundus should be at the umbilicus o ± 2 cms is considered normal—if outside this range, may need to do ultrasound for growth o Measure the distance from the top of the pubic symphysis to the top of the fundus o In third trimester, fetal weight decreases the accuracy o Danger Signs of Pregnancy
Gush of fluid from vagina; Water breaking
Vaginal bleeding; could indicate miscarriage or separation of placenta from uterine wall
Abdominal pain

Fever; can lead to dehydration
Dizziness, blurred vision, spots before eyes
Persistent vomiting; hyperemesis, needs to be hospitalized
Severe headache
Seizures or convulsions
Epigastric or RUQ pain
Severe itching; cholestasis of pregnancy, buildup of bile salts that go to the skin and can end up in fetal demise
Dysuria, urgency
Absent or decreased fetal movement o Need to monitor regularly; fetal movement is good o No movement is a real danger sign Kick Counts
Best indicator of fetal well-being o Slowing or cessation of fetal movement warning sign
Monitored by mother starting at 28 weeks
Do these EVERY DAY
Cardiff Count-to-ten method: o Best to do at same time each day o Side-lying position o Document each movement and note how long it takes to feel 10 movements
Call the provider if: o Fewer than 10 movements in 3 hours o Movement is slowing o No fetal movement in the morning Iom guidelines for Weight Gain
Pre-gestational obesity and excess weight gain during pregnancy can

Physiological Changes During Pregnancy: From the Uterus to the Breasts, Study Guides, Projects, Research of Nursing

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NURSING OB Exam1 STUDY

GUIDE