PHYSIOLOGIC CHANGES OF PREGNANCY Flashcards
signs and symptoms of pregnancy are those signs and symptoms that are usually noted by the patient, which impel her to make an appointment
with a physician.
Presumptive
These signs and symptoms are not proof of pregnancy but they will make the physician and woman suspicious of pregnancy.
PRESUMPTIVE
They could easily indicate other conditions.
PRESUMPTIVE
One of the earliest clues of pregnancy.
Amenorrhea (Cessation of Menstruation)
Usually occurs in early morning during the first 2 weeks of pregnancy.
Nausea and Vomiting (Morning Sickness)
Usually spontaneous and subsides in 6 to 8 weeks or by the twelfth to sixteenth week of pregnancy.
Nausea and Vomiting (Morning Sickness)
referred to as nausea and vomiting that is severe and lasts beyond the fourth month of pregnancy. It causes weight loss and upsets fluid and electrolyte balance of the patient.
Hyperemesis gravidarum.
caused by pressure of the expanding uterus on the bladder.
Frequent Urination
subsides as pregnancy progresses and the uterus rises out of the pelvic cavity.
Frequent Urination
uterus returns during the last weeks of pregnancy as the head of the fetus presses against the bladder.
Frequent Urination
In early pregnancy, changes start with a slight, temporary enlargement of the breasts, causing a sensation of weight, fullness, and mild tingling.
Breast Changes
Darkening of the areola–the brown part around the nipple.
Breast Changes
Enlargement of Montgomery glands–the tiny nodules or sebaceous glands within the areola
Breast Changes
Increased firmness or tenderness of the breasts
Breast Changes
More prominent and visible veins due to the increased blood supply.
Breast Changes
Presence of colostrum (thin yellowish fluid that is the precursor of breast milk).
Breast Changes
can be expressed during the second trimester and may even leak out in the latter part of the pregnancy.
Breast Changes
This is an increase in the white or slightly gray mucoid discharge that has a faint musty odor.
Leukorrhea.
due to hyperplasia of vaginal epithelial cells of the cervix because of increased hormone level from the pregnancy. Leukorrhea is also present in vaginal infections.
Leukorrhea.
This is the first perception of fetal movement within the uterus.
Quickening
It usually occurs toward the 18th week
Quickening
multigravida can feel quickening as early as
16 weeks
primigravida usually cannot feel
quickening until after
18 weeks.
marks noted on the abdomen and/or buttocks.
Striae gravidarum
marks are caused by increased production or sensitivity to adrenocortical hormones during pregnancy, not just weight gain
Striae gravidarum
black line in the midline of the abdomen that may run from the sternum or umbilicus to the symphysis pubis.
Linea nigra.
appears on the primigravida by the 3rd month and keeps pace with the rising height of the fundus.
Linea nigra.
entire line may appear on the multigravida before the third month.
Linea nigra.
“Mask of Pregnancy.”
Chloasma
bronze type of facial coloration seen more on dark-haired women.
Chloasma
CHOLASMA IS seen after the ___ OF PREGNANCY
16TH WK
common complaint by most patients during the first trimester.
Fatigue
may also be a result of anemia, infection, emotional stress, or malignant disease.
Fatigue
signs of pregnancy are those signs commonly noted by the physician upon examination of the patient.
Probable
Probable
These signs include uterine changes, abdominal changes, cervical changes, basal body temperature, positive pregnancy test by physician, and fetal palpation.
By the twelfth week, the uterus rises above the symphysis pubis and it should reach the xiphoid process by the 36th week of pregnancy.
Position
The uterine increases in width and length approximately five times its normal size. Its weight increases from 50 grams to 1,000 grams.
Size
Softening of the lower uterine segment just above the cervix.
Hegar’s sign
When the uterine is compressed between examining fingers, the wall feels tissue paper thin.
Hegar’s sign
The Hegar’s sign is noted by
the 6th to 8th week of pregnancy.
demonstrated during the bimanual exam at the 16th to 20th week.
Ballottement
when the lower uterine segment or the cervix is tapped by the examiner’s finger and left there, the fetus floats upward, then sinks back and a gentle tap is felt on the finger.
Ballottement
cervix is normally firm like the cartilage at the end of the nose
Goodell’s sign
when there is marked softening of the cervix
Goodell’s sign
GOODELL’S SIGN IS PRESENT AT
6 WKS
due to hyperplasia of the cervical
glands as a result of increased hormones.
Operculum
serves to seal the cervix of the pregnant uterus and to protect it from contamination by bacteria in the vagina.
Operculum
involves painless uterine contractions occurring throughout pregnancy.
Braxton-Hick’s contractions
usually begins about the 12th week of pregnancy and becomes progressively stronger.
Braxton-Hick’s contractions
contractions will, generally, cease with walking
Braxton-Hick’s contractions
Do not cause the cervix to dilate.
Braxton-Hick’s contractions
This is a probable sign in early pregnancy. The physician can palpate the abdomen and identify fetal parts.
Fetal outline Palpation.
It is not always accurate.
Fetal outline Palpation.
signs of pregnancy are those signs that are definitely confirmed as a pregnancy.
Positive
include fetal heart sounds, ultrasound scanning of the fetus, palpation of the entire fetus, palpation of fetal movements, x-ray, and actual delivery of an infant.
Positive
echocardiography can demonstrate a heartbeat
5 weeks
An ultrasound can reveal a beating fetal heart
6th to 7th week
able to detect fetal heart sounds thru doppler
10th to 12th week of gestation.
fetal heart beat can be heard through an
ordinary stethoscope
18 to 20 weeks of pregnancy
The normal fetal heart rate is 120 to 160
beats/min.
18 to 20 weeks of pregnancy
The gestation sac can be seen and photographed.
Ultrasound Scanning of the Fetus.
embryo as early as the 4th week after conception can be identified.
Ultrasound Scanning of the Fetus.
The fetal parts begin to appear by the 10th week of gestation.
Ultrasound Scanning of the Fetus
Palpation must include the fetus head, back, and upper and lower body parts.
Palpation of the Entire Fetus.
positive sign after the 24th week of pregnancy if the woman is not obese.
Palpation of the Entire Fetus.
done by a trained examiner. It is easily elicited at 20th – 24th week of pregnancy.
Palpation of Fetal Movement.
UTERINE Length grows from approx
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 1,000 gms
Early pregnancy – uterine wall thickens from
1 cm to 2 cm
End of pregnancy – the wall thins to become supple and only about
0.5 cm thick
UTERINE CHANGES Due partly to formation of new muscle fibers in the uterine myometrium
PROGESTERONE
UTERINE CHANGES Principally due to stretching of existing muscle fibers
ESTROGEN
Uterus is able to withstand the stretching of its muscle fibers due to formation of ___between fibers that binds them together
fibroelastic tissue
Volume of uterus increases from about
2 ml to more than 1,000 ml
Uterus can hold
7 lb fetus and 1,000 ml 0f amniotic fluid for a total of about 4,000 gms
softening of the lower uterine segment
Hegar’s sign
“ to toss about”
Ballotement
fetus can be felt to bounce and rise in the amniotic fluid
Ballotement
“ practice contractions”
Braxton Hick Contractions
also play a role in ensuring the placenta receives adequate blood.
Braxton Hick Contractions
Softening of the cervix
Goodell’s sign
cervix of the uterus becomes more vascular and edematous than usual causing it to soften in consistency
Goodell’s sign
DUE TO ____ cervix of the uterus becomes more vascular and edematous than usual causing it to soften in consistency
estrogen
A mucus plug forms to seal out bacteria and help prevent infection in the fetus and membranes.
Operculum
The resulting increase in circulation (due to estrogen) changes the color of the vaginal walls from their normal light pink to a deep violet.
Chadwicks Sign
increase in the activity of the epithelial cells
Leukorrhea
fall from ph of greater than 7 ( an alkaline ph ) to 4 or 5 ( acid ph)
Change of vaginal ph
Cessation of ovulation
Ovarian Changes
