Expected maternal anatomic & physiologic adaptations to pregnancy

Question 1

What are some Expected maternal anatomic & physiologic adaptations to pregnancy

Answer 1

• Changes caused by pressure from the expanding uterus
• uterine contractions (UC)- increase blood flow to uterus and strengthen muscles for birth process- Braxton Hicks
  DO NOT CAUSE CERVICAL DILATION.
• Braxton Hicks are OFTEN MISTAKEN FOR EARLY LABOR. Sometimes patients perceive as painful, but usually are not. May be felt as early as the 4th month, can cause urinary frequency
• Cervical: Mucus plug (operculum) seals endocervical canal - prevents ascent of bacteria from vagina to the uterus

Question 2

Expected maternal anatomic & physiologic adaptations to pregnancy

Breast

Answer 2

o Colostrum – may leak from nipple (precursor to milk – yellow in color), high in protein and immune properties
o Breast size increases – nipples and areola darken
o May have striae gravidarum (stretch marks)
o Superficial veins become prominent
o What hormone causes the production of milk? PROLACTIN
o Estrogen and Prolactin have an inverse relationship. When placenta delivered then prolactin becomes dominant.
o Oxytocin responsible for milk letdown. Prolactin responsible for production

Question 3

Expected maternal anatomic & physiologic adaptations to pregnancy

Vaginal

Answer 3

o pH of vaginal vault 3.5= Acidic
o Vaginal secretions increased (leukorrhea)
o Screening – Evaluate for pathology and presence of STD’s (gonorrhea, chlamydia, syphilis, herpes)

Question 4

Expected maternal anatomic & physiologic adaptations to pregnancy

Cardio

Answer 4

o Expansion of vascular volume up to 45-50%
o Peaks 32 -34th week- 3rd trimester
o Increase in vascular volume > increase in RBC’s >hemodilution > pseudoanemia of pregnancy
§ Hemoglobin below 11g/dL usually caused by iron deficiency anemia
§ Folic acid and iron SUPPLEMENTS to meet demands of increased blood supply and fetus
o This is a significant event for those with heart disease
o Murmurs caused by the increases in blood volume & cardiac output. Always tilt the patient. She does not need to lay flat on her back
o CO increases 25-50% (maximum at about 28 weeks) and is affected by maternal position - Vena cava syndrome
o More than 95% of pregnant women develop systolic murmurs: check left sternal border

Question 5

Expected maternal anatomic & physiologic adaptations to pregnancy

Blood pressure

Answer 5

o BP DOES NOT increase during pregnancy: progesterone, prostaglandins & Relaxin effect. May even decrease during second trimester.
o Absolute value determination of gestational hypertension
o Watch the MAP (Mean Arterial Pressure) when HTN (MAP 86.4 +/– 7.5 mm Hg)
o Absolutes for preeclampsia
o 140/90 mmHg (DANGER SIGNAL)
o Systolic elevated 30 mmHg over baseline and Diastolic elevated 15 mmHg over baseline

Question 6

Expected maternal anatomic & physiologic adaptations to pregnancy

Clotting factor

Answer 6

§ Pregnant women hypercoagulable state- 45-50% more blood volume during pregnancy
§ Risk of blood clots- do not massage legs

Question 7

Expected maternal anatomic & physiologic adaptations to pregnancy

Respiratory

Answer 7

§ Client may appear SOB or even complain of dyspnea
§ Slight hyperventilation 2 increased tidal volume
§ Increased chest circumference
§ Respiratory rate unchanged or increased only slightly
§ Diaphragm excursions are greater during breathing in pregnant state than in non-pregnant state. Diaphragm elevated by the chest wall is expanded … results in diaphragmatic breathing
§ State of Alkalosis (Hyperventilation> decreased CO2 levels> alkalosis), compensated by metabolic acidosis
o Pulmonary congestion- epistaxis is common (check bp), symptomatic nasal congestion (bridge of nose spreads)

Question 8

Expected maternal anatomic & physiologic adaptations to pregnancy
renal

Answer 8

§ ALL PREGNANT CLIENTS ARE SCREENED FOR GESTATIONAL Diabetes at 24-28 weeks’ gestation.

Teach clients:
§ Report symptoms of UTI especially urgency to urinate
§ Importance of screening for Gestational Diabetes- BIG BABY, HARD DELIVERY
§ Side-lying position improves urinary output and helps decrease edema
§ Protein in urine: cardinal signs of preeclampsia- PROTEIN IN URINE, EDEMA, ELEVATED BP, HEADACHES OR DIZZINESS, BLURRED VISION

Question 9

Expected maternal anatomic & physiologic adaptations to pregnancy

WBC

Answer 9

Increases

Question 10

Expected maternal anatomic & physiologic adaptations to pregnancy

Skin

Answer 10

§ Linea nigra - Darkly pigmented line from the umbilicus to the pubic area, goes away
§ Striae gravidarum - Stretch marks on trunk and thighs r/t stretching of connective tissue
§ Chloasma - Facial pigmentation
§ Palmar erythema - Darker red palms r/t hyperemia (excess blood in vessels supplying an organ or part of the body

Question 11

Expected maternal anatomic & physiologic adaptations to pregnancy

Musculoskeletal

Answer 11

§ Postural and gait changes
§ Lumbar lordosis as center of gravity shifted forward. Lumbar and dorsal curves accentuated à results in low back pain
§ No center of gravity
§ Typical “waddling gait” as Relaxin hormone relaxes pelvic points
§ Relaxes the joints and especially the pubic arch
§ Public symphysis & sacroiliac joints loosen due to Relaxin to allow passage of the baby
§ Muscle cramps or tetany r/t hypocalcemia. (Or Hypokalemia or Hypomagnesia)

Question 12

Expected maternal anatomic & physiologic adaptations to pregnancy

GI

Answer 12

§ Nausea and Vomiting
-Early subjective sign of pregnancy
-May be related to hormonal changes
-Subsides past 1st trimester.
§ R/O hyperemesis gravidarum if persists longer than 1st trimester.
§ Gallbladder sluggish. Along with increased secretion of cholesterol may predispose to gallstones.
§ Pica – craving non-nutritive substances.
§ Pulmonary aspiration of gastric contents can occur following vomiting or regurgitation

Question 13

Expected maternal anatomic & physiologic adaptations to pregnancy

neurologic

Answer 13

§ Changes in sensorium (light-headed or dizzy)
§ R/O postural hypotension/hypoglycemia
§ Carpal tunnel syndrome, edema, and compression of median nerve in wrist
§ Lordosis (Back Sway)
§ Hypocalcemia can cause cramps & tetany

Question 14

• Describe Hyperemesis Gravidarum and the effects on the fetus (This is covered in the high-risk Power point too)

Answer 14

o Nausea and vomiting are an early subjective sign of pregnancy and may be related to hormonal changes. N/V usually subsides after the first trimester.
o Hyperemesis gravidarum is N/V that persists past the first trimester. Severe, constant, and does not subside. Results in dehydration and can interfere with nutrition due to the inability to keep food down.
o Treat with Phenergan if the woman is not working due to the sedative side effects.
o Treat with Zofran.