Anatomy and Physiology of Pregnancy Chapter 7 Anatomy and Physiology of Pregnancy All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Gravidity and Parity Understanding of following terms is essential to study of maternity care: Gravida: woman who is pregnant Gravidity: pregnancy Multigravida: woman who has had two or more pregnancies All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Gravidity and Parity (Cont.) Multipara: woman who has completed two or more pregnancies to stage of fetal viability Nulligravida: woman who has never been pregnant Nullipara: woman who has not completed a pregnancy with fetus or fetuses who have reached stage of fetal viability All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Gravidity and Parity (Cont.) Parity: number of pregnancies in which fetus or fetuses have reached viability, not number of fetuses (e.g., twins) born. Whether fetus is born alive or is stillborn (fetus who shows no signs of life at birth) after viability is reached does not affect parity Postdate or postterm: pregnancy that goes beyond 42 weeks of gestation All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Gravidity and Parity (Cont.) Preterm: pregnancy that has reached 20 weeks of gestation but before completion of 37 weeks of gestation Primigravida: woman pregnant for first time Primipara: woman who has completed one pregnancy with fetus or fetuses who have reached stage of fetal viability All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Gravidity and Parity (Cont.) Term: pregnancy from beginning of week 38 of gestation to end of week 42 of gestation Viability: capacity to live outside uterus; about 22 to 25 weeks gestation are on the threshold of viability These very premature infants are vulnerable to brain injury All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Summarizing Obstetric History Two digits G – gravida P - para 5 digits GPTAL Gravidity, term, preterm, abortions, living children All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Pregnancy Tests Human chorionic gonadotropin (hCG) is earliest biochemical marker of pregnancy Pregnancy tests based on recognition of hCG or β subunit of hCG Can be detected in serum or urine as early as 7 to 8 days after ovulation All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Pregnancy Tests (Cont.) Many different pregnancy tests are available Enzyme-linked immunosorbent assay (ELISA) testing is most popular method of testing for pregnancy ELISA technology is the basis for most over-the-counter home pregnancy tests Medication use, hormone based tumors, or improper collection may cause inaccurate results All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Adaptations to Pregnancy Signs of pregnancy Presumptive Those changes felt by the woman Probable Those changes observed by an examiner Positive Those signs attributed only to the presence of the fetus All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Adaptations to Pregnancy (Cont.) Reproductive system and breasts Uterus Changes in size, shape, and position Changes in contractility Uteroplacental blood flow Cervical changes Changes related to the presence of the fetus Ballottement Quickening Vagina and vulva All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Adaptations to Pregnancy (Cont.) Breasts Fullness, heaviness Heightened sensitivity from tingling to sharp pain Areolae become more pigmented Montgomery tubercles Colostrum All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Adaptations to Pregnancy (Cont.) General body systems Cardiovascular system Blood pressure Supine hypotensive syndrome Blood volume and composition Cardiac output Circulation and coagulation times Increases in various clotting factors All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Adaptations to Pregnancy (Cont.) General body systems Respiratory system Pulmonary function Basal metabolism rate Acid-base balance Renal system Anatomic changes Functional changes Fluid and electrolyte balance All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Adaptations to Pregnancy (Cont.) General body systems Integumentary system Chloasma (mask of pregnancy) Linea nigra Striae gravidarum Angiomas Palmar erythema Musculoskeletal system Neurologic system All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Adaptations to Pregnancy (Cont.) General body systems Gastrointestinal system Appetite PICA Mouth and teeth Esophagus, stomach, and intestines Gallbladder and liver Abdominal discomfort Endocrine system All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Question Probable signs of pregnancy are: determined by ultrasound. observed by the health care provider. reported by the client. diagnostic tests. ANS: B Feedback A Incorrect: Fetal visualization is a positive sign of pregnancy. B Correct: Probable signs are those detected through trained examination. C Incorrect: Presumptive signs are those reported by the client. D Incorrect: The term diagnostic test is open for interpretation. To actually diagnose pregnancy, one would have to see positive signs of pregnancy. DIF: Cognitive Level: Comprehension OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.