1. Maternal Adaptation During Pregnancy
Chapter 11
Maternal Adaptation During Pregnancy

2. 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

3. 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)

4. 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)

5. 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)

7. 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)

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

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

10. 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

11. 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

12. 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

14. 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

15. 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

16. 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

17. 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.

18. 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

19. 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

20. 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

21. 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

23. 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)

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

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

26. 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

27. 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

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

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

30. 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)

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

32. 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.

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

34. 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)

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