ATI: Normal Physiological Changes During Pregnancy

Changes in Gastrointestinal System in a Pregnant woman:

Nausea & Vomiting may occur due to hormonal changes &/or an increase of pressure with in the abdominal cavity as the pregnant client's stomach & intestines are displaced within the abdomen. Constipation may occur due to increased transit time of food through the gastrointestinal tract &, thus, increased water absorption.

Parity

Number of pregnancies in which the fetus or fetuses reach viability approximately 20 weeks regardless of whether the fetus is born alive.

Gravidity

Number of pregnancies.

Signs of Pregnancy are classified into what 3 groups?

Presumptive, Probable, & Positive.

Ballottement:

Rebound of unengaged fetus

*Define Positive Signs of Pregnancy, Give Manifestations:*

Signs that can be only explained by pregnancy. Fetal Heart Rate. Visualized on Ultrasound. Palpation of fetus.

Quickening:

Slight fluttering movements of the fetus by a woman, usually felt between 16 to 20 weeks gestation.

Hegar's Sign:

Softening and compressibility of lower uterus

Goodell's Sign:

Softening of cervical tip

Manifestations of Presumptive Signs of Pregnancy Include:

Amenorrhea, Fatigue, Nausea & vomiting, Urinary frequency, Breast changes, Quickening, & Uterine enlargement.

What medications can create a false-positive pregnancy test or a false one?

Anticonvulsants. Diuretics.

Braxton Hick's Contractions:

False contractions; painless, irregular, and usually relieved by walking.

Nullipara

No pregnancy beyond the stage of viability

Changes in Reproductive System in a Pregnant woman:

Uterus increases in size & changes shape & position. Ovulation & menses cease during pregnancy.

What is Expected BP during 1st trimester?

Within normal range.

Can position of the pregnant woman affect her BP?

YES Supine= BP may appear lower due to the weight & pressure of the gravid uterus on the vena cava, which decreases the venous blood flow to the heart. Maternal hypotension & fetal hypoxia may occur, which is referred to as supine hypotensive syndrome or supine vena cava syndrome.

Nursing interventions for supine hypotensive syndrome or supine vena cava syndrome?

*POSITIONING.* Left-lateral side, semi-fowler's. wedge placed under on hip if supine. Encourage these positions to alleviate pressure to the vena cava.

BP should return to the pregnancy baseline range after how many weeks gestation?

20 Weeks gestation.

Amenorrhea

An abnormal absence of menstruation.

What is Expected BP during 2nd trimester?

BP decreases 5-10mm Hg diastolic & systolic

Multipara

Has completed 2 or more pregnancies to stage of viability

What hormones can the placenta produce?

hCG. Progesteron. Estrogen. Human placental lactogen. Prostaglandins

How do we approximate the gestational age?

Measure the fundal height. Measured from the symphysis pubis to the top of the uterine fundus.

What would a low hCG blood level indicate?

Miscarriage.

What is Nagele's Rule?

A method in determining Estimated Date of Delivery. Subtract 3 months from Last Menstrual Period, LMP, then add 7 days, & change year.

Primigravida

A woman in her 1st pregnancy

Multigravida

A woman who has had 2 or more pregnancies

Nulligravida

A woman who has never been pregnant.

Physical changes in 2nd trimester?

Abdomen & breast enlargement Stretch marks & hyperpigmentation. Mobility & balance can be affected Back or leg discomfort Fatigue Support is needed. mother may develop a negative image. Resentment toward pregnancy & anxiety may arise.

Probable Signs of Pregnancy Manifestations Include:

Abdominal enlargement related to changes in uterine size, shape, & position. Hegar's Sign. Chadwick's sign. Goodell's sign. Ballottement. Braxton Hicks Contractions. Positive Pregnancy Test. Fetal Outline felt by examiner.

Changes in Musculoskeletal System in a Pregnant woman:

Body alterations and weight increase necessitate an adjustment in posture. Pelvic joints relax.

Manifestations of supine hypotensive syndrome or supine vena cava syndrome include:

Dizzy. Lightheaded. Palor. Clammy skin

hCG production can be seen after how many days after implantation? & How long are these levels increased?

Can be seen as increased after 7 to 10 days. Levels remain increased until term.

Changes in Cardiovascular System in a Pregnant woman:

Cardiac output & blood volume increase 45 to 50% @ term to meet the greater metabolic needs. Heart Rate increases during pregnancy. Cardiac hypertrophy due to increased blood volume. Changes position, up & to right.

Define Probable Signs of Pregnancy:

Changes that make the *examiner suspect* a woman is pregnant, primarily related to physical changes of the uterus. Signs can be caused by physiological factors other than pregnancy, pelvic congestion, or tumors.

Define Presumptive Signs of Pregnancy:

Changes that the woman experiences that make her *think* that she is pregnant. They may be subjective or objective.

What kind of breast changes might the woman see?

Darkened areolae. Enlarged montgomery's glands.

Chadwick's Sign:

Deepened violet-bluish color of cervix and vaginal mucosa

Changes in Renal System in a Pregnant woman:

Filtration rate increases secondary to the influence of pregnancy hormones & an increase in blood volume & metabolic demands. The amount of urine produced remains the same. Urinary frequency is common during pregnancy.

GTPAL

G=Gravida. T=Term births over 38 weeks. P=Preterm Births under 37 weeks. A=Abortions or Miscarriages. L=Living children.

Primipara

Has completed one pregnancy to stage of viability

Changes in Respiratory System in a Pregnant woman:

Maternal oxygen needs increase. During the last trimester, the size of the chest may enlarge, allowing for lung expansion, as the uterus pushes upward. Respiratory Rate increases. Total lung capacity decreases.

Changes in Endocrine System in a Pregnant woman:

The placenta becomes an endocrine organ that produces large amounts of hCG, progesterone, estrogen, human placental lactogen, & prostaglandins. Hormones are very active during pregnancy & function to maintain pregnancy & prepare the body for delivery.

Serum & Urine tests provide an accurate assessment for the presence of what?

hCG (human chorionic gonadotropin) This increase is what changes the pregnancy test to positive.

Are physiological changes obvious in the 1st trimester?

no