Module 3: maternal adaptation during pregnancy

  1. Presumptive signs of pregnancy
    • Fatigue 
    • Breast tenderness
    • Nausea and vomiting 
    • Amenorrhea
    • Urinary frequency 
    • Hyperpigmentation of skin 
    • Fetal movement 
    • Uterine enlargement 
    • Breast enlargement
  2. Probable signs of pregnancy 
    Goodell's sign
    Chadwick's sign 
    Hegar's sign
    • Goodell's sign: softening of cervix 
    • Chadwick's sign: Purple coloration of cervix
    • Hegar's sign: softening of lower uterine segment. 

    • Braxton Hicks contractions (false labor, practice contractions) 
    • Positive pregnancy test (urine test) 
    • Abdominal enlargement 
    • Ballottement (return impact of displaced fetus)
  3. Positive signs of pregnancy
    • Ultrasound verification of fetus 
    • Fetal movement felt by clinician 
    • Auscultation of fetal heart tones
  4. Human Chorionic gonadotropin (HCG)
    • Maintains corpus luteum, which secretes progesterone and estrogen 
    • Produces fetal trophoblast cells 
    • Earliest hormone for pregnancy test (urine test)
  5. Human chorionic somatomammotropin (HPL)
    aka Human placental lactogen
    • Prepares mammary glands for lactation 
    • Insulin antagonist (alters ability to use insulin) 
    • Increase free fatty acids for maternal needs
    • Decrease maternal metabolism of glucose for fetal growth
  6. Relaxin
    • Act synergistically with progesterone to maintain pregnancy 
    • Increase flexibility of pubic symphysis 
    • Dilation of cervix
    • Suppress release of oxytocin 
  7. Progesterone
    • The "hormone of pregnancy" 
    • Supports the endometrium of uterus for fetal survival 
    • Causes thickening of uterine lining for implantation 
    • Inhibits uterine contractility 
    • Development of breast for lactation
  8. Estrogen
    • Promotes enlargement of genitals, uterus and breast
    • Increases vascularity 
    • Relaxation of pelvic ligaments and joints
    • hyperpigmentation 
    • Aids in development of ductal system of breasts
  9. Gastrointestinal Adaptations
    • Nausea and vomiting (HCG) 
    • Peristalsis: hemrrhoids, heartburn, constipation (Progesterone) 
    • Prolonged emptying of gallbladder
    • Bleeding gums (estrogen) 
    • Ptyalism: excessive salivation
  10. Cardiovascular adaptation
    • Blood volume increases by 1500 or 50% above non pregnant levels 
    • CO increases to 50% 
    • HR increases 10 - 15 BPM 
    • BP declines (limit 140/80) 
    • Physiologic anemia of pregnancy (diluted by extra volume) 
    • Vena caval syndrome (while laying on back, uterus presses on vena cava causing hypotension)
  11. Respiratory Adaptations
    • Uterus pushes up on diaphragm, decreasing lung space (difficulty breathing) 
    • RR increases (increased due to greater O2 requirements to grow baby)
    • Thoracic breathing (chest breathing)
    • Congestion r/t increased vascularity 
    • Epitaxis (nosebleed) and rhinitis (stuffy nose)
  12. Renal/Urinary adaptation
    • GFR increases due to more blood volume 
    • Urinary frequency 
    • 1st trimester uterus is a pelvic organ 
    • 2nd trimester uterus moves up and becomes abdominal organ (urinary frequency decreases) 
    • 3rd trimester frequency returns
  13. Musculoskeletal adaptation
    • Lordosis: increase in curvature of spine
    • Waddle gait- relaxin hormone 
    • Diastasis recti (seperation of abdominal muscles)
  14. Integumentary adaptation
    • Hyperpigmentation
    • Chloasma: "mask of pregnancy"
    • Linea nigra (black line down the abdomen) 
    • Breast (darker nipples) 
    • Striae gravidarum (stretch marks) 
    • Altered hair growth (thick beautiful/thin hair)
  15. Endocrine adaptation
    • Thyroid: promote fetal neurologic development 
    • Pituitary: promote breast development and lactation 
    • Oxytocin: contractions
    • ADH: water balance
    • Pancrease: insulin production 
    • Adrenal: cortisol increased
  16. Nutritional needs of pregnancy
    • Prenatal vitamin 
    • Folic acid: prevent neural tube defects 
    • Ferrous sulfate (Iron) 
    • Calorie needs (300 extra)
    • -Each woman has a different calorie need based on height and weight before pregnancy
  17. Weight gain during pregnancy
    • weight gain: based on pre-pregnant weight
    • average weight gain should be 25-35 lbs
    • underweight
    • (BMI <18.5) should gain 28-40 lbs
    • overweight
    • (BMI= 25-29.9) should gain 15-25 lbs
    • Obese
    • (BMI=/>30) should gain 11-20 lbs
  18. Maternal nutrition: nursing interventions
    • Assessment: 
    • Physical health 
    • Knowledge 
    • Type of diet 
    • Cultural variations 
    • Psychosocial influence: 
    • socioeconomic
    • Level of education 
    • Coping mechanisms
    • Adolescent pregnancy
  19. PICA
    PICA: Compulsive ingestion of non food substances (ice, clay, cornstarch) usually associated with iron deficiency anemia
  20. Psychosocial adaptation
    • Ambivalence: conflicting emotions regarding pregnancy 
    • Introversion: focusing on oneself 
    • Acceptance: reality and validity of pregnancy
    • Mood swings
    • Changes in body image
  21. Psychosocial adaptation of family
    • Couvade syndrome: partner undergoes a sympathetic response to pregnancy
    • weight gain 
    • food aversions 
    • Sibilings reactio to pregnancy is age dependent
  22. First prenatal visit
    • Complete health history 
    • EDC (Nagele's rule) 
    • Gynecological health history 
    • Medication history (Ibiprofen D/C)
    • Life style history (alcohol, smoking, work intensity) 
    • Psychosocial history
  23. Pregnancy risk categories of medications
    • Category A: No increased risk of fetal abnormalities
    • Category B: Animal studies revelead no evidence of harm to fetus 
    • Category C: Animal studies have shown an adverse effect 
    • Category D: Demonstrated a risk to the fetus (adequate studies)  
    • Category X: Positive evidence of fetal abnormalities or risk (adequate studies)
  24. Reproductive History

    Total number of pregnancies regardless of the duration; includes current pregnancy
    Gravida: Total number of pregnancies regardless of the duration; includes current pregnancy
  25. Total births beyond the period of viability; 20 weeks or 500 gms
    Para: total births beyond the period of viability; 20 weeks or 500 gms
  26. TPAL
    • T- term >38 weeks to 42 weeks 
    • P- preterm (20 - 37 weeks at birth) 
    • A- abortions (termination of pregnancy before viability; spontaneous or elective, 20 weeks) 
    • L- living children
  27. Nagele's rule
    • Nagele's rule 
    • Subtract 3 months of LMP 
    • Add 7 days to first day of LMP 
    • Correct year by adding 1 to it where necessary
  28. First prenatal visit 
    Physician exam for pap smear and probable signs of pregnancy 
    Fundal height
    Lab tests 
    CBC, T&S, Rubella, Hepatitis B surface antigen, HIV, VDRL, STI cervical smear
    • Physician look at probable signs of pregnancy 
    • Fundal height: used to monitor fetal growth (umbilicus at 20 weeks) 
    • Not accurate after 36 weeks because baby drops
  29. Follow up visits

    Every __ weeks up to 28 weeks gestation 
    Every __ weeks from 29 - 36 weeks 
    Every week from 37 weeks to birth
    • Every 4 weeks up to 28 weeks gestation 
    • Every 2 weeks from 29 - 36 weeks
    • Every week from 37 weeks to birth
  30. Follow up assessments
    • Blood pressure 
    • weight 
    • Urine test for protein and glucose 
    • Fundal height
    • Fetal movement assessment (mother monitors) 
    • Fetal heart rate assessment
  31. Fetal movement
    • patient performs daily self assessment of fetal movement 
    • Self assessment useful tool to determine fetal well being 
    • Decreased fetal movement associated with fetal hypoxia 
  32. Factors affecting fetal movement
    • Fetal sleep cycle (1.5 hours)
    • Maternal blood glucose levels 
    • Gestational age
    • Maternal smoking 
    • Maternal medications (CNS depressants) 
    • Maternal exercise 
    • Bilateral hip dislocation
  33. Fetal heart rate assessment
    • Normal FHR 110 - 160 BPM
  34. Non stress test
    • Indirect measurement of uteroplacental function 
    • Heart rate accelerations with fetal movement (good sign of health) 
    • Reactive VS non reactive 
    • 15 BPM x 15 seconds (20 minute NST strip) 
  35. Contraction stress test
    Diagnostic procedure to determine fetal heart rate response under stress 

    • Deceleration= HR decreases under stress
    • Late fetal heart rate decelerations occurring with contractions associated with poorer fetal outcomes.
  36. Biophysical profile
    • Real time ultrasound which applies score to following assessments: 
    • Body movement (2 points) 
    • Fetal tone (2 points) 
    • Fetal breathing (2 points)
    • Amniotic fluid index (2 points) 
    • NST (2 points) 

    • *Diabetic mothers have a lot of amniotic fluid 
    • *Bad tone = sign of hypoxia, accidosis
  37. Gestational diabetes screen and Ultrasound
    • Gestational diabetes screen 
    • Tested between 24 - 28 weeks 
    • Normal is <130 

    • Ultrasound 
    • Performed in each trimester to assess size, fluid, placental location and fetal well being
  38. Alpha fetoprotein
    • Alpha fetoprotein: glycoprotein associated with neural tube defects with increased levels. Decreased levels may be down syndrome.
    • Performed at 16 -18 weeks
  39. Amniocentesis
    Amniocentesis: transabdominal puncture of amniotic sac to obtain a sample of amniotic fluid. Used to detect chromosomal abnormalities, neural tube defects and lung maturity.
  40. Amniocentesis procedure
    • Performed with ultrasound 
    • Physician inserts long needle in amniotic cavity to aspirate fluid 
    • Pt must empty bladder prior 
    • Administer Rhogam if pt Rh negative 
  41. Chorionic villus
    • Chorionic villus sampling (CVS) 
    • Chromosomal disorders, enzyme deficiency, sex link disorders
    • Performed at 10 - 13 weeks 
    • Complications: abortion, vaginal bleeding, limb abnormalities, fetal maternal hemorrhage
  42. Interventions to alleviate common discomforts
    • Nausea/vomiting (crackers) 
    • Urinary frequency (no fluids after 7 pm) 
    • Fatigue (nap) 
    • Breast tenderness (good bras) 
    • Heartburn (smaller meals) 
    • Edema (elevate legs) 
    • Hemorrhoids (colace, water)
    • Constipation
    • Backache (exercise) 
    • Dyspnea
  43. Client education for self care
    • Avoid hot tubs and saunas
    • Dental care 
    • Breast care 
    • Sexual activity
    • Travel 
    • Rest
    • Exercise (contraindication for high risk pregnancies)
  44. Birthing methods
    • Lamaze (breathing) 
    • Bradley (coach method)
Author
geoerguera
ID
325744
Card Set
Module 3: maternal adaptation during pregnancy
Description
Module 3: maternal adaptation during pregnancy
Updated