Chapter 11: Maternal Adaptation During Pregnancy Flashcards
Presumptive signs
Subjective and signs that mother can perceive. Fatigue Breast tenderness nausea and vomiting amenorrhea urinary frequency hyperpigmentation of the skin fetal movement uterine enlargement breast enlargement
Probable signs of pregnancy
Can be detected with physical examination.
Braxton Hicks contractions from 16 to 28 weeks.
Positive pregnancy test from 4 to 12 weeks.
Abdominal enlargement around 14 weeks.
Ballottement around 16 to 28 weeks.
Goodells sign around five weeks. Chadwicks sign around 6 to 8 weeks.
Hegars sign around 6 to 12 weeks.
Positive signs of pregnancy
The only signs with 100% accuracy Ultrasound verification of embryo or fetus 4 to 6 weeks.
Fetal movement felt by experienced clinician at 20 weeks.
Auscultation of fetal heart tones via a Doppler around 10 to 12 weeks.
Goodell’s sign
Softening of the cervix 6 -8 weeks
Chadwick’s sign
Bluish/purple coloration of the vaginal mucosa and cervix. This is from an increased vascularization of the cervix
Ballottement
Examiner pushes against the women’s cervix during a pelvic examination and feels a rebound from the floating fetus.
HCG
Corresponds to morning sickness around 6 to 12 weeks. Levels double every 48 to 72 hours until peak around 60 to 70 days after fertilization. After that they declined to a plateau around 100 to 130 days. Doubling time can be used to differentiate normal and abnormal gestation
Maintains the maternal corpus luteum, which secretes progesterone and estrogen, with synthesis occurring before implantation
Uterus adaptations
Estrogen stimulates uterine growth. Remains in the pelvic cavity for the first three months and then slowly ascends into the abdomen. The uterus begins as a pear-shaped, becomes ovoid. By 20 weeks the fundus is at the level of umbilicus and measures 20 cm. Fundal height usually corresponds with the weeks between 18 and 32. Between 38 and 40 weeks fetus begins to descend and fundal height drops.
Braxton Hicks contractions
Spontaneous, irregular, and painless contractions that began during the first trimester and continue throughout. During the last month they function testing to thin out or efface the cervix before birth.
Hegar’s sign
Softening and compressibility of the lower uterine segment during the first 6 to 8 weeks. Adds to urinary frequency
Maternal supine hypotensive syndrome
When the mom is in a supine position, the uterus lies on the inferior vena cava resulting in compression. This decreases cardiac output and blood pressure and increases orthostatic hypotension. Symptoms include weakness, lightheadedness, nausea, dizziness, or syncope
Cervix adaptations
Cervix softens around 6 to 8 weeks. The mucous glands increase. Progesterone causes a thick mucous plug that blocks the cervical os and protects the opening. There’s an increase in vascularization. Softening and effacement begins about four weeks before birth.
Vaginal adaptations
Vascularity increases because of estrogen. Mucosa thickens, the vaginal vault lengthens, secretions become more acidic, white, and thick. Increase in discharge called leukorrhea. This increases the risk for Candida albicans.
Ovary adaptations
Increased vascularity causes them to enlarge until around 12 to 14 weeks. Ovulation ceases because of increased estrogen and progesterone. They are important in hormone production until 6 to 7 weeks, when the corpus luteum regresses and the placenta takes over.
Ptyalism
Excessive salivation
G.I. system adaptations
The gums become swollen and tend to bleed easily. This is influenced by estrogen. Increased in Saliva. Dental plaque, and gingivitis increase. Progesterone causes a decrease peristalsis. This leads to constipation There is decreased gastric emptying leading to indigestion or heartburn (pyrosis). Emptying of the gallbladder is prolonged leading to gallstones.
Cardiovascular system changes
Blood volume: increases by 1500 mL or about 50%
Cardiac output: increases from 30% to 50%. The heart rate increases.
Blood-pressure: declines slightly as a result of dilation caused by progesterone. The low is at mid pregnancy.
Blood components: red blood cells increase. Plasma increases even more leading to hemodilution. This causes anemia. Iron supplements are given
Respiratory system adaptations
Respirations increase and become more deep. Oxygen consumption increases. There is an increase vascularity leading to congestion.
Renal/urinary system adaptations
Kidneys enlarge, glomerular filtration rate increases, urine flow and volume increase.
Integumentary system changes
Estrogen and progesterone cause hyperpigmentation. Complexion changes leading to the mask of pregnancy. There is the Linea nigra from the umbilicus to the pubic area. Striae gravidarum are stretch marks. Varicosities of the legs, vulva, and perineum. Spider veins, palmer erythema, decreased hair growth and loss of hair.
Thyroid gland
Enlarges slightly and becomes more active. Increased thyroid production of T4 is needed for neural development of the fetus. It’s also increases metabolic rate
Pituitary gland/hypophysis
Enlarges during pregnancy and produces multiple hormones. FSH and LH are inhibited. TSH inhibited. GH decreases. Prolactin increases for breast development and lactation. MSH Melanocyte stimulating hormone increases and may be responsible to the skin changes
POSTERIOR PITUITARY GLAND
Oxytocin responsible for contractions, milk ejection. Progesterone decreases in later pregnancy allowing oxytocin contractions.
ADH plays a role in water balance and blood pressure
The pancreas
During pregnancy glucose levels of the mom decrease because of the fetus needing glucose. Insulin levels also decline early on. Insulin does not cross the placenta and the fetus produces its own. Towards the end of the pregnancy more insulin is secreted to counteract the hormones that oppose it.
Adrenal glands
Cortisol increases in response to increased estrogen. This helps the level of glucose, breakdown proteins to repair tissues, has an anti-Insulin, anti-inflammatory, and antiallergic actions. Is needed to make adrenaline.
Aldosterone increases to regulate electrolytes and water balance.
Placental hormones
hCG hPL Relaxin Progesterone Estrogen
hPL
Prepares memory glands, helps make glucose available for fetal growth, antagonist of insulin, increases the amount of circulating free fatty acids, decreases the maternal metabolism of glucose
Relaxin
Secreted by the placenta and the corpus luteum. Acts synergistically with progesterone to maintain pregnancy. Increases flexibility of the pubic symphysis. Dilation of the cervix, may suppress the release of oxytocin
Progesterone
The hormone of pregnancy because it supports the endometrium of the uterus. Provides an environment conducive to fetal survival. Initially produced by the corpus luteum Initially causes thickening of the uterine lining to make implantation ready. Maintains the endometrium, inhibits uterine contractions, assists in breast development
Estrogen
Promotes enlargement of the genitals, uterus, breasts, increases vascularity, vasodilation, relaxes the pelvic ligaments and joints, hyperpigmentation, increased saliva, hyperemia of the gums, aids in breast development.
Immune system adaptations
Enhancement of innate immune which is inflammatory and phagocytosis
Suppression of adaptive which is antigen response
This helps the mom to not reject fetus, but increases her risk for infection.
Nutrition
Too little: preterm, low birth weight, congenital anomalies
Too much: difficult birth, neonatal hypoglycemia, obesity in mom
Iron: form new blood cells, prevent anemia, brain development
Folic acid: essential before pregnancy, neural tube defects. Foods include dark green veggies, broccoli, romaine lettuce, spinach, baked beans, blackeyed peas, citrus fruits, peanuts, liver.
Mercury: low level fish includes shrimp, canned light tuna, pollock, catfish
Weight gain
Underweight 28-40
Normal 25-35
Overweight 15-25
Obese 11-20
3.5 to 5 pounds the first trimester
1 pounds per week after
Emotions
Ambivalence: having conflicting feelings at the same time Introversion: focusing on oneself Acceptance Moodswings Change in body image
Couvade syndrome
The partner may physically gain weight around the middle experience nausea and other G.I. disturbances. This is a sympathetic response to the partners pregnancy
Maternal role tasks
Ensure 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
