MCN 1F Flashcards
Confined to reproductive organs
Local Changes
Length or the height of the uterus increases 6.5-32cm
Landmark symphysis pubis to the top of uterine fundus to measure height of uterus
Depth: 2.5-22cm
Width: 4-24cm
Weight: 50-1000grams
End of Pregnancy: muscle fibers come 2-7 times longer
Volume: 2 to more than 1000mL (can hold a 7lbs fetus plus the amniotic fluid
End of 12 Weeks: Uterus is large enough to be palpated above the symphysis pubis
End of 20/22 Weeks: Palpated at the level of Umbilicus
End of 36 Weeks: Touches xiphoid proces (depresses diaphragm)
2 Weeks before Term:Uterus returns to 36 Week height
Amenorrhea
Uterine Wall Thickness:
Early Pregnancy: 1-2cm
End Pregnancy: 0.5cm thick
Uterine Changes
Becomes more vascular and edematous (Goodell’s Sign)
Presence and formation of mucus plug (Operculum - helps prevent infection of the fetus and its membrane)
Cervix
Increased size of vagina
Increased vascularity (Chadwick’s Sign)
Change in Vaginal Secretion
pH now 4/5 = acidic
Acidity make vagina resistant to bacterial invasion
Acidity happens because of action of Lactobacillus acidophilus that grows freely in increased glycogen environment which increases lactic acid content of secretions
pH changes favors the growth of Candida albicans a yeast like fungi
Vagina
Ovulation stops because of the active feedback of estrogen and progesterone produced by corpus luteum
Later part of Pregnancy: Stopping of ovulation is caused by the placenta. Causes pituitary gland to halt production of FSH and LH
Ovaries
Feeling of fullness, timgling,or tenderness
Increased size (+73 to growth of mammary alveoli
Areola darkens and increases the diameter to 5-7.5cm
Blue veins become prominent
Nipples are more erectile
Some women for secondary areola, additional darkening of the skin
Breast
T/F: In the 20th Century Pregnancy was considered a 9 month long illness
TRUE
Best shared with supportive partner and family
Choose level of pain management they want for labor and delivery
Modern Social Influence on Pregnant Woman
Cultural background influence active role in pregnancy
Myths & Taboos may affect behavior and activities
Cultural Influence on Pregnancy
People love as they have loved
How pregnant woman was raised will affect her pregnancy
Pregnant woman won’t believe if all she hears is excruciating pain.
Family Influence on Pregnancy
How pregnant woman copes with their situation along the stresses they are facing
Woman should feel secure in relationship with others esp the father of her child.
Individual Differences
Second Trimester: Accepting the Fetus
As soon as fetal movements are felt, psychological responses change
Narcissism & Introversion
Role playing and Increased dreaming
Start to imagine themselves as parents
Refers to child as he or she
Measure the level of acceptance of the coming baby by how well she follows her prenatal schedule and instructions
Since the focus is on the baby; Partner feels left alone to compensate for this feeling
Partner becomes overly absorbed in work to produce something concrete to show that not only woman is capable of creating something
Emotional Responses that Cause Concerns in Pregnancy: NICEBEDSG
Narcissism
Introversion
Couvade Syndrome
Extroversion
Body Image & Boundary
Emotional Lability
Depression
Stress
Grief
Partner experiences physical symptoms at same degree or even more intensely than pregnant mother
Couvade Syndrome
Changes in Sexual Desire
1st Trimester: decrease in libido due to nausea, fatigue, and breast tenderness that accompany early pregnancy
2nd Trimester: as blood flows to pelvic area increases to supply the placenta, libido, and sexual enjoyment will rise
3rd Trimester: Sexual desire remains high or it may decrease due to difficulty in finding a comfortable position
Experienced by woman and cannot be documented by the examiner; Subjective Symptoms
Presumptive Symptoms
First Trimester: Accepting the Pregnancy
Ambivalence
Partner and Mother still recovering from the surprise of learning that they are pregnant
Mixed emotions
49% of pregnancy is unintended, unwanted, or mistimed; Accept reality of pregnancy
Ambivalence toward pregnancy refers to interwoven feelings of wanting and not wanting
Partner feels proud and happy about the pregnancy, ambivalent more than the woman
Third Trimester: Preparing for the Baby and End of Pregnancy or Preparing for Parenthood
Begin nesting activities
Preparing clothing and sleeping arrangements
Name of baby
Ensure safe passage by attending prenatal classes
Grow impatient as they ready themselves for the delivery of the baby
Presumptive Symptoms
a. Breast Changes - tenderness, fullness, tingling, and enlargement felt by the mother, darkening of areola
b. Nausea & Vomiting
c. Amenorrhea (cessation of menstruation)
d. Increase urination
e. Fatigue
f. Uterine Enlargement
g. Quickening - fetal movement felt by the woman
h. Linea Nigra - dark pigmentations on abdomen
i. Melasma - dark pigmentations on face
j. Striae Gravidarum - red streaks formed in the abdomen
Confirm Pregnancy
Positive Signs
Objective Symptoms
Probable Signs
Older children should be well prepared and informed of the baby and assure that it will not replace them or change their parents’ affection toward them
Changes in Expectant Family
Partner plays a great part in her situation
The closer the partner is to the pregnant woman, the closer it is to the child
Partner’s Adaptation
Positive Signs
a. Sonographic Evidence of Fetal Outline
b. Audible Fetal Heart Tone
c. Fetal Movement Felt by Examiner
Probable Signs
a. Positive Maternal Serum Test - presence of hCG
b. Chadwick’s Sign - Pink to Bluish or Violet
c. Goodell’s Sign - Softening of the Cervix
d. Hegar’s Sign - Softening of the lower segment of the uterus
e. Sonography Evidence of Gestational Sac - characteristic ring is evident
f. Ballottement - fetus can be felt to rise against abdominal walls
g. Braxton Hick’s Contraction - Uterine Tightening
h. Fetal outline that is already felt by examiner - examiner can palpitate through abdomen
Mood changes occur frequently in a pregnant woman as a manifestation of narcissism
Emotional Lability
Additional gland of Pregnancy
Produces Estrogen causes breast and uterine enlargement
Produces progesterone maintains endometrium lining
inhibits contractility and aids breast lactation
Presence of hCG & hPL
hCG - stimulates progesterone and estrogen
hPL - serves as antagonists to insulin
Relaxin and Prostaglandins
relaxin - inhibits uterine activity to soften cervix
prostaglandins - initiate labor
Endocrine: Placenta
FSH and LH production stops due to high level of estrogen and progesterone produced by placenta
Increased production of Growth Hormone and Melanocytes stimulating hormone - causes skin pigmentation
Prolactin and Labor Induction - occurs in late pregnancy; helps breast prepare lactation and aid in labor progress
Endocrine: Pituitary Gland
Increase size which increases hormone production
Metabolic Rate increases to 20% or increase Basal Metabolic Rate
Endocrine: Thyroid and Parathyroid Gland
Double production of corticosteroids and aldosterone - help reduce probability of woman to reject foreign protein of the fetus
Endocrine: Adrenal Glands
Increased production of Insulin
Endocrine: Pancreas
Decreased production of Immunoglobin G - to reduce immunologic competency; prevents rejection of fetus
Immune System
Presence of Striae Gravidarum
Presence of Linea Nigra
Presence of Melasma
Presence of Vascular spiders seen on the body
Presence of protrusion of umbilicus
Integumentary System
Shortness of Breath
Respiratory System
Increased circulatory blood volume and plasma - results to pseudoanemia
Increased RBC production - reason why additional iron is needed
Increased cardiac output - 25-50%
Decreased peripheral blood floor during 3rd Trimester
Increased level of fibrinogen and leukocyte
Blood Pressure:
2ND TRIMESTER: slightly decrease due to expanding placenta which causes peripheral resistance to circulation to lower
3RD TRIMESTER: BP rises to 1st Trimester Level
Cardiovascular System
Decrease stomach acidity
Slowed intestinal peristalsis
Slowed emptying time
Digestive System
Increased aldosterone production and sodium reabsorption
Increased GFR and renal plasma flow by 30-50% - leads to filtration of glucose
Increased urinary frequency- due to pressure from growing uterus to bladder
Increased ureter diameter and bladder capacity
Urinary System
Gradual softening of a woman’s pelvic ligament and joints - to create pliability and facilitate passage; influenced by relaxin and progesterone
Wide separation of symphysis pubis
Pride of Pregnancy - to change center of gravity
Musculoskeletal System
Bathing
Daily tub baths or showers should be strictly followed
Not bathe in hot water for too long
Breast Care
Wear a firm supportive brassiere or brazier with wide straps
avoid soap - causes nipple cracking
Washing should be done daily esp when colostrum secretions begin
drying with soft towel in patting manner
if colostrum is profuse, use gauze squares/breast pads change frequently
Dental Care
Avoid sweets
encourage regular dental visits
brush teeth arising, after meals, bedtime
Discomforts: Breast Tenderness
wear bra/brassier
dress warmly
avoid soap on nipples and areola to prevent skin drying
Discomforts: Palmar Erythema
apply calamine lotion on her hands
palmar erythema is normal
Discomforts: Nausea & Vomiting
Morning sickness
First Trimester and subsides by the third month
Eat dry crackers
Avoid brushing teeth immediately after arising
Eat small frequent, low fat meals during the day
Drink liquids between meals rather than at meals
Avoid fried and spicy foods
Discomforts: Constipation
Drink no less than 2000mL per day
Regular exercise
Eat fiber foods such as whole grains, fruits, and vegetables
Discomforts: Pyrosis
Eat small frequent meals
Sit upright for 30 minutes after a meal
Drinking milk between meals
Avoid fatty and spicy foods
Perform tailor sitting exercises
Fatigue
Frequent rest periods
Correct postures
Regular Exercise
Muscle relaxation and strengthening exercises
Muscle Cramps
Increase calcium intake
Regular exercise
lie on back momentarily and extend the involved leg while keeping knees straight and dorsiflexing foot
Hypotension
Always rest and sleep on their side not on their back
insert a small firm pillow under right hip
Varicosities
Sim’s position/ elevated foot stool for 15-20 minutes twice a day
Avoid cross legs or constrictive knee-high hose or garters
Avoid long standing
Move while standing
Hemorrhoids
Daily bowel evacuation
Adequate fluid intake
Eating high fiber food
Sitting on soft pillow
Soaking in a warm sitz bath
Exercising regularly
Heart Palpitations
move slowly and gradually
Frequent Urination
Void as necessary
Avoid restricting fluid intake and reduce caffeine and cola
Limit fluid intake only in the evening before sleeping
Sleep side lying at night
Performing Kegel exercises
Leukorrhea
Daily baths
Wearing cotton under pads
Sleeping at night without underwear
Avoid douching
Backache
Move slowly
Wear low heeled comfy and supportive shoes
Apply local heat on the area
Squatting when picking up objects than bending over
Pelvic Rocking and Tilting
Lift objects by holding them close to the body
Headache
Avoid eye strains or tension
Rest with ice pack on forehead
Change position
Dyspnea
Advise to sleep with her head and chest elevated
Use two or more pillows
Ankle Edema
Left side lying position and
Elevate legs
Avoid constricting clothes
Avoid sitting or standing in one position for a long time
Why is Positive Maternal Serum Test considered Probable?
Because there is also a disease that causes the release of this hormone
Discoloration of the Vagina from Pink to Bluish/Violet
Chadwick’s Sign
Softening of the Cervix
Goodell’s Sign
Softening of the lower segment of the Uterus
Hegar’s Sign
Characteristic ring is evident
Sonographic Evidence of Gestational Sac
Tapping of the lower uterine segment on a bimanual examination
Ballottement
Periodic uterine tightening
Braxton Hick’s Contraction
Red Streaks that is formed on the abdomen
Striae Gravidarum
Dark pigmentations on face
Melasma
Dark line pigmentations on abdomen
Linea Nigra
Fetal movement felt again by the woman
Quickening
Mother can palpated the uterus over the symphysis pubis
Uterine Enlargement
Fetal outline can be seen and measure by a sonogram
Sonographic Evidence of Fetal Outline
when estrogen and progesterone increases, what hormones decrease in production?
FSH & LH
Because of the increasing level of estrogen occurring during pregnancy
Palmar Erythema
Results from increased in progesterone production, decreased intestinal motility, displacement of intestines, pressure of uterus
Constipation
