[7] PRELIMS | NORMAL CHANGES IN PREGNANCY Flashcards
PSYCHOLOGICAL RESPONSES TO PREGNANCY
- Is common initially, even if pregnancy is planned.
- Mother may have concerns about her career, her relationship with her partner, financial implications, and role change.
- She may make comments such as, “I thought I wanted a baby, but now I’m not sure.”
AMBIVALENCE
PSYCHOLOGICAL RESPONSES TO PREGNANCY
- The woman shows a high degree of tolerance for the discomforts she may experience in the first trimester.
- In the second trimester, she begins to wear maternity clothes
- She begins to perceive movement at about 17-20 weeks. She may make comments such as, “Feeling the baby move makes it all seem real” or “It’s finally sinking in that I’m going to be a mother.”
ACCEPTANCE OF PREGNANCY
PSYCHOLOGICAL RESPONSES TO PREGNANCY
- The expectant woman typically becomes more inwardly focused, less interested in outside activities.
- She is using this time to plan and adjust
- Her partner may see this as excluding him. She may say, “I never used to like to be alone, but now I like having time to myself just to think and plant.”
INTROVERSION
PSYCHOLOGICAL RESPONSES TO PREGNANCY
- Sudden shifts of emotions from joy to sadness are common and difficult for the woman and her family.
- The woman often feels a great need for love and affection, but her partner, confused by her emotional changes, may react by withdrawing. She may say, “I’m not usually so emotional, but lately any little thing can set me off.”
MOOD SWINGS
PSYCHOLOGICAL RESPONSES TO PREGNANCY
- The woman tends to feel somewhat negative about her body as pregnancy progresses.
- Her increasing abdomen coupled with the waddling gait of pregnancy may cause a woman to feel ungainly and unattractive. She may say, “I can’t even see my feet anymore” or “I feel as big as a house.”
CHANGES IN BODY IMAGE
PSYCHOLOGIC TASKS OF THE MOTHER
To meet this task, she seeks competent prenatal care, practices, good health behaviors and self-care activities, reads about childbirth, and gathers information.
ENSURING SAFE PASSAGE THROUGH PREGNANCY, LABOR, AND BIRTH
PSYCHOLOGIC TASKS OF THE MOTHER
The expectant woman seeks to gain support for the coming child from her partner and family. She will also work to help her other children accept the coming baby.
SEEKING ACCEPTANCE OF THIS CHILD BY OTHERS
PSYCHOLOGIC TASKS OF THE MOTHER
After she perceives fetal movement (quickening) the mother begins to form bonds of attachment to the child, and the child becomes more real. The woman may talk about the child as a separate person: “The baby was so active today! I don’t think he (or she) appreciated the pizza last night.”
SEEKING COMMITMENT & ACCEPTANCE OF SELF AS MOTHER TO THE INFANT (BINDING IN)
PSYCHOLOGIC TASKS OF THE MOTHER
The woman begins to develop patterns of self-denial and delayed personal gratification to meet the needs of her child. She may, for example, give up smoking or alcohol and make plans to adjust her personal schedule to spend more time with her child.
LEARNING TO GIVE OF ONE’S SELF ON BEHALF OF ONE’S CHILD
SIGNS OF PREGNANCY
- ____
- ____
- ____
- Presumptive (Subjective)
- Probable (Objective)
- Positive (Diagnostic)
- Symptoms the woman experiences and reports
- May have causes other than pregnancy
Subjective (Presumptive) Changes
PRESUMPTIVE SIGNS OF PREGNANCY
- ____
- ____
- ____
- ____
- ____
- ____
- ____
- ____
- ____
- ____
- Amenorrhea
- Excessive Fatigue
- Nausea & Vomiting
- Frequency of Voiding
- Uterine Enlargement
- Linea nigra
- Melasma / Chloasma
- Striae Gravidarum
- Changes in breasts
- Quickening
PRESUMPTIVE SIGNS OF PREGNANCY
The absence of menses, is the earliest symptom of pregnancy. The missing of more than one menstrual period, especially in a woman whose cycle is ordinarily regular, is an especially useful diagnostic clue
Amenorrhea
PRESUMPTIVE SIGNS OF PREGNANCY
Occur frequently during the first trimester. Because these symptoms often occur in the early part of the day, they are commonly referred to as morning sickness
Nausea and Vomiting in Pregnancy (NVP)
PRESUMPTIVE SIGNS OF PREGNANCY
Research suggests that women who experience NVP often have a ____ than those who do not
more favorable pregnancy outcome
PRESUMPTIVE SIGNS OF PREGNANCY
May be noted within a few weeks after first missed menstrual period and may persist throughout the first trimester
Excessive Fatigue
PRESUMPTIVE SIGNS OF PREGNANCY
Is experienced during the first trimester as the enlarging uterus presses on the bladder
Urinary Frequency
PRESUMPTIVE SIGNS OF PREGNANCY
Line of dark pigment forms on the abdomen
Linea Nigra
PRESUMPTIVE SIGNS OF PREGNANCY
Dark pigment forms on face
Melasma
PRESUMPTIVE SIGNS OF PREGNANCY
Stretch marks form on abdomen
Striae Gravidarum
PRESUMPTIVE SIGNS OF PREGNANCY
Are frequently noted in early pregnancy. These changes include tenderness and tingling sensations, increased pigmentation of the areola and nipple, and changes in Montgomery’s glands. The veins also become more visible and form a bluish pattern beneath the skin.
Changes in the breasts
PRESUMPTIVE SIGNS OF PREGNANCY
The mother’s perception of fetal movement, occurs about 18 to 20 weeks after the last menstrual period in a woman pregnant for the first time by may occur as early as 16 weeks in a woman who has been pregnant before
Quickening
PRESUMPTIVE SIGNS OF PREGNANCY
Is a fluttering sensation in the abdomen that gradually increases in intensity and frequency.
Quickening
An examiner can perceive the objective changes that occur in pregnancy. Because these changes can also have other causes, they do not confirm pregnancy
Objective (Probable) Changes
PROBABLE SIGNS OF PREGNANCY
- ____
- ____
- ____
- ____
- ____
- ____
- ____
- ____
- ____
- ____
- Abdominal enlargement
- McDonald’s Sign
- Uterine souffle
- Braxton Hicks Contractions
- Ballottement
- Hegar’s Sign (uterus)
- Goodell’s Sign (cervix)
- Chadwick’s Sign (vagina)
- Fetal Outline
- Positive Pregnancy Test
PROBABLE SIGNS OF PREGNANCY
Changes in the pelvic organs – the only physical changes detectable during the (1) ____ of pregnancy – are caused by increased (2) ____
(1) first 3 months
(2) vascular congestion
PROBABLE SIGNS OF PREGNANCY
Softening of the cervix
Goodell’s Sign
PROBABLE SIGNS OF PREGNANCY
A bluish, purple, or deep red discoloration of the mucous membranes of the cervix, vagina, and vulva (some sources consider this a presumptive sign).
Chadwick’s Sign
PROBABLE SIGNS OF PREGNANCY
A softening of the isthmus of the uterus, the area between the cervix and the body of the uterus
Hegar’s Sign
PROBABLE SIGNS OF PREGNANCY
Is an ease in flexing the body of the uterus against the cervix.
Mcdonald’s Sign
PROBABLE SIGNS OF PREGNANCY
General enlargement and softening of the body of the uterus can be noted after the (1) ____ of pregnancy. The fundus of the uterus is palpable just above the symphysis pubis at about (2) ____
(1) 8th week
(2) 10 to 12 weeks’ gestation
PROBABLE SIGNS OF PREGNANCY
____ during the childbearing years is usually regarded as evidence of pregnancy, especially of it is continuous and accompanied by amenorrhea
Enlargement of the abdomen
PROBABLE SIGNS OF PREGNANCY
Can be palpated most commonly after 28 weeks. As the woman approaches the end of pregnancy, these contractions may become uncomfortable. They are often called false labor.
Braxton Hicks Contractions
PROBABLE SIGNS OF PREGNANCY
May be heard when the examiner auscultates the abdomen over the uterus. It is a soft, blowing sound that occurs at the same rate as the maternal pulse and is caused by the increased uterine blood flow and blood pulsating through the placenta
Uterine Soufflé
PROBABLE SIGNS OF PREGNANCY
A soft, blowing sound of blood pulsating though the umbilical cord. It occurs at the same rate as the fetal heart rate
Funic Soufflé
PROBABLE SIGNS OF PREGNANCY
During the (1) ____ week of pregnancy, when the fetus is still small in relation to the amount of amniotic fluid present, (2) ____ may be demonstrated
(1) 16th to 20th
(2) ballottement (from the French word balloter, meaning to “to toss about” )
PROBABLE SIGNS OF PREGNANCY
On bimanual examination, if the (1) ____ is tapped sharply by the lower hand, the fetus can be felt to (2) ____ against the top examining hand
(1) lower uterine segment
(2) bounce or rise in the amniotic fluid up
PROBABLE SIGNS OF PREGNANCY
Although the ballottement phenomenon is interesting, it also may be simulated by a ____, and therefore it is no more than a probable sign of pregnancy
uterine tumor
PROBABLE SIGNS OF PREGNANCY
May be identified by palpation in many pregnant women after 24 weeks’ gestation
Fetal Outline
PROBABLE SIGNS OF PREGNANCY
Pregnancy tests detect the presence of (1) ____ in the maternal blood or urine. These are not considered a positive sign of pregnancy because (2) ____
(1) hCG
(2) other conditions can cause elevated hCG levels
POSITIVE SIGNS OF PREGNANCY
- ____
- ____
- ____
- Fetal Heartbeat
- Fetal Movement
- Visualization of Fetus or Gestational Sac (via ultrasound)
POSITIVE SIGNS OF PREGNANCY
- Fetal Heartbeat (____)
- Fetal Movement (____)
- Visualization of fetus (parts & movement at ____) or gestational sac (____)
by ultrasound
- Fetal Heartbeat (10-12 weeks)
- Fetal Movement (20th week)
- Visualization of fetus (parts & movement at 8 wks) or gestational sac (4-5 weeks gestation or 2-3 weeks after conception)
by ultrasound
PHYSIOLOGIC CHANGES IN PREGNANCY
Some of the most dramatic changes of pregnancy occur in the ____
reproductive organs involving the uterus, ovaries, vagina, and breasts
PHYSIOLOGIC CHANGES IN PREGNANCY
UTERUS
- Length increases from approximately ____
- Depth increases from ____
- Width expands from ____
- Weight increases from ____
- Length increases from approximately 6.5 to 32 cm
- Depth increases from 2.5 to 22 cm
- Width expands from 4 to 24 cm
- Weight increases from 50 to 1000 g
By the end of the ____, the uterus is large enough to be palpated as a firm globe under the ____, just above the ____
By the end of the 12th week, the uterus is large enough to be palpated as a firm globe under the abdominal wall, just above the symphysis pubis
By the ____ of pregnancy, the uterus should reach the level of the ____
By the 20th or 22nd week of pregnancy, the uterus should reach the level of the umbilicus