Maternal Adaptation During Pregnancy Chapter 11 Maternal Adaptation During Pregnancy

Signs of Pregnancy Chadwick’s sign Bluish-purple coloration of the vaginal mucosa and cervix Goodell’s sign Softening of the cervix Hegar’s sign Softening of the lower uterine segment or isthmus

Signs and Symptoms of Pregnancy Presumptive Signs (subjective) Fatigue (12 weeks) Breast tenderness (3–4 weeks) Nausea and vomiting (4–14 weeks) Amenorrhea (4 weeks) Urinary frequency (6–12 weeks)

Signs and Symptoms of Pregnancy (cont’d.) Presumptive signs (cont’d.) Hyperpigmentation of skin (16 weeks) Fetal movements (quickening) (16–20 weeks) Uterine enlargement (7–12 weeks) Breast enlargement (6 weeks)

Signs and Symptoms of Pregnancy (cont’d.) Probable (objective) signs Braxton Hicks contractions (16–28 weeks) Positive pregnancy test (4–12 weeks) Abdominal enlargement (14 weeks) Ballottement (16–28 weeks) Goodell’s sign (5 weeks) Chadwick’s sign (6–8 weeks) Hegar’s sign (6–12 weeks)

Signs and Symptoms of Pregnancy (cont’d.) Positive signs Ultrasound verification of embryo or fetus (4–6 weeks) Fetal movement felt by experienced clinician (20 weeks) Auscultation of fetal heart tones via Doppler (10–12 weeks)

Question Is the following statement True or False? A positive pregnancy test is a positive sign of pregnancy. a. True b. False

Answer b. False A positive pregnancy test is considered a probable sign of pregnancy because conditions other than pregnancy can also elevate hCG levels.

Reproductive System Adaptations Uterus Increase in size, weight, length, width, depth, volume, and overall capacity Pear shape to ovoid shape; positive Hegar’s sign Enhanced uterine contractility; Braxton Hicks contractions Ascent into abdomen after first 3 months Fundal height by 20 weeks’ gestation at level of umbilicus; 20 cm; reliable determination of gestational age until 36 weeks’ gestation

Reproductive System Adaptations (cont’d.) Cervix Softening (Goodell’s sign) Mucous plug formation Increased vascularization (Chadwick’s sign) Ripening about 4 weeks before birth Vagina Increased vascularity with thickening Lengthening of vaginal vault Secretions more acidic, white, and thick; leukorrhea

Reproductive System Adaptations (cont’d.) Ovaries Enlargement until 12th to 14th week of gestation Cessation of ovulation Breasts Increase in size and nodularity to prepare for lactation; increase in nipple size, becoming more erect and pigmented Production of colostrum: antibody-rich, yellow fluid that can be expressed after the 12th week; conversion to mature milk after delivery

GI System Adaptations Gums: hyperemic, swollen, and friable Ptyalism Dental problems; gingivitis Decreased peristalsis and smooth muscle relaxation Constipation + increased venous pressure + pressure from uterus = hemorrhoids Slowed gastric emptying; heartburn Prolonged gallbladder emptying Nausea and vomiting

Cardiovascular System Adaptations Increase in blood volume (50% above prepregnant levels) Increase in cardiac output; increased venous return; increased heart rate Slight decline in blood pressure until midpregnancy, then returning to prepregnancy levels Increase in number of RBCs; plasma volume > RBC leading to hemodilution (physiologic anemia) Increase in iron demands, fibrin & plasma fibrinogen levels, and some clotting factors, leading to hypercoagulable state

Question a. Increase in blood pressure b. Complaints of nausea When assessing a pregnant woman, which of the following would the nurse expect to find? a. Increase in blood pressure b. Complaints of nausea c. Dry mouth d. Diarrhea

Answer b. Complaints of nausea A woman would most likely complain of nausea due to high levels of hCG and circulating estrogens, reduced stomach acidity, and lowered tone and motility of the digestive tract. Blood pressure usually declines and then returns to prepregnant levels after midpregnancy. Constipation, not diarrhea, and excess salivation, not dry mouth, might also be found.

Respiratory System Adaptations Breathing more diaphragmatic than abdominal due to increase in diaphragmatic excursion, chest circumference, and tidal volume Increase in oxygen consumption Congestion secondary to increased vascularity

Renal/Urinary System Adaptations Dilation of renal pelvis; elongation, widening, and increase in curve of ureters Increase in length and weight of kidneys Increase in GFR; increased urine flow and volume Increase in kidney activity with woman lying down; greater increase in later pregnancy with woman lying on side

Musculoskeletal System Adaptations Softening and stretching of ligaments holding sacroiliac joints and pubis symphysis Postural changes: increased swayback and upper spine extension Forward shifting of center of gravity Increase in lumbosacral curve (lordosis); compensatory curve in cervicodorsal area Waddle gait

Integumentary System Adaptations Hyperpigmentation; mask of pregnancy (facial melasma) Linea nigra Striae gravidarum Varicosities Vascular spiders Palmar erythema Decline in hair growth; increase in nail growth

Endocrine System Adaptations Thyroid gland: slight enlargement; increased activity; increase in BMR Pituitary gland: enlargement; decrease in TSH, GH; inhibition of FSH & LH; increase in prolactin, MSH; gradual increase in oxytocin with fetal maturation Pancreas; insulin resistance due to hPL and other hormones in 2nd half of pregnancy (see Box 11.2) Adrenal glands: increase in cortisol and aldosterone secretion Prostaglandin secretion Placental secretion: hCG, hPL, relaxin, progesterone, estrogen (see Table 11.3)

Question Is the following statement True or False? Oxytocin is a hormone secreted by the anterior pituitary gland. a. True b. False

Answer False. Oxytocin is a hormone secreted by the posterior pituitary gland.

Nutritional Needs Direct effect of nutritional intake on fetal well-being and birth outcome Need for vitamin and mineral supplement daily Dietary recommendations Increase in protein, iron, folate, and calories (see Table 11.5) Use of USDA’s Food Guide MyPlate (see Figure 11.5) Avoidance of some fish due to mercury content

Maternal Weight Gain Healthy weight BMI: 25 to 35 lb 1st trimester: 3.5 to 5 lb 2nd & 3rd trimesters: 1 lb/week BMI < 19.8: 28 to 40 lb 1st trimester: 5 lb 2nd & 3rd trimesters: 1+ lb/week BMI > 25: 15 to 25 lb 1st trimester: 2 lb 2nd & 3rd trimesters: 2/3 lb/week

Nutrition Promotion USDA Food Guide MyPlate Client education (see Teaching Guidelines 11.1) Special considerations Cultural variations Lactose intolerance Vegetarianism Pica

Maternal Emotional Responses Ambivalence Introversion Acceptance Mood swings Changes in body image

Maternal Role Tasks Ensuring safe passage throughout pregnancy and birth Seeking acceptance of infant by others Seeking acceptance of self in maternal role to infant (“binding in”) Learning to give of oneself (see Box 11.4)

Question Is the following statement True or False? Ambivalence is a normal response during the first trimester of pregnancy. a. True b. False

Answer a. True Ambivalence is a universal feeling and is considered normal when preparing for a lifestyle change and new role. Pregnant women commonly experience ambivalence during the first trimester.

Pregnancy and Sexuality Numerous changes, possibly stressing sexual relationship Changes in sexual desire with each trimester Sexual health and link to self-image

Pregnancy and Partner Family-centered emphasis Partner’s reaction to pregnancy and changes Couvade syndrome, ambivalence Acceptance of roles (2nd trimester) Preparation for reality of new role (3rd trimester)

Pregnancy and Siblings Age-dependent reaction Sibling rivalry with introduction of new infant into family Sibling preparation imperative