Anatomy and Physiology of Pregnancy for bsc

Pregnancy and the associated changes are a normal physiological process in response to the development of the fetus. These changes happen in response to many factors; hormonal changes, increase in the total blood volume, weight gain, and increase in foetus size as the pregnancy progresses.

1. Anatomy and Physiology Anatomy and Physiology
of Pregnancyof Pregnancy
Altaf m nadafAltaf m nadaf

2. Learning ObjectivesLearning Objectives

Determine gravidity and parity using the two- and five-digit Determine gravidity and parity using the two- and five-digit
systems.systems.

Describe the various types of pregnancy tests, including the Describe the various types of pregnancy tests, including the
timing of tests and interpretation of results.timing of tests and interpretation of results.

Explain the expected maternal anatomic and physiologic Explain the expected maternal anatomic and physiologic
adaptations to pregnancy.adaptations to pregnancy.

Differentiate among presumptive, probable, and positive signs Differentiate among presumptive, probable, and positive signs
of pregnancy.of pregnancy.

Identify maternal hormones produced during pregnancy, their Identify maternal hormones produced during pregnancy, their
target organs, and their major effects on pregnancy.target organs, and their major effects on pregnancy.

3. Important Terms: GravidityImportant Terms: Gravidity

Gravida:Gravida: woman who is woman who is
pregnantpregnant

Gravidity: Gravidity: pregnancypregnancy

Multigravida: Multigravida: woman who woman who
has had two or more has had two or more
pregnanciespregnancies

Multipara: Multipara: woman who has woman who has
completed two or more completed two or more
pregnancies to stage of fetal pregnancies to stage of fetal
viabilityviability

Nulligravida:Nulligravida: woman who has woman who has
never been pregnantnever been pregnant

4. Important Terms: ParityImportant Terms: Parity

Parity: Parity: number of pregnancies in number of pregnancies in
which fetus or fetuses have reached which fetus or fetuses have reached
viability, not the number of fetuses viability, not the number of fetuses
bornborn

Nullipara:Nullipara: woman who has not woman who has not
completed pregnancy with a fetus or completed pregnancy with a fetus or
fetuses who have reached the stage of fetuses who have reached the stage of
fetal viabilityfetal viability

Primipara:Primipara: A woman who has A woman who has
completed one pregnancy with a fetus completed one pregnancy with a fetus
or fetuses who have reached 20 or fetuses who have reached 20
weeks of gestationweeks of gestation

Multipara:Multipara: A woman who has A woman who has
completed two or more pregnancies completed two or more pregnancies
to 20 weeks of gestation or moreto 20 weeks of gestation or more

5. Important Terms: Important Terms:
Gestational Age of PregnancyGestational Age of Pregnancy

Preterm: Preterm: a pregnancy that has reached 20 weeks of gestation a pregnancy that has reached 20 weeks of gestation
but ends before completion of 37 weeks of gestationbut ends before completion of 37 weeks of gestation

Late preterm: Late preterm: a pregnancy that has reached between 34 weeks a pregnancy that has reached between 34 weeks
0 days and 36 weeks 6 days of gestation0 days and 36 weeks 6 days of gestation

Early term: Early term: a pregnancy that has reached between 37 weeks 0 a pregnancy that has reached between 37 weeks 0
days and 38 weeks 6 days of gestation days and 38 weeks 6 days of gestation

Full term: Full term: a pregnancy that has reached between 39 weeks 0 a pregnancy that has reached between 39 weeks 0
days and 40 weeks 6 days of gestation days and 40 weeks 6 days of gestation

Late term: Late term: a pregnancy that has reached between 41 weeks 0 a pregnancy that has reached between 41 weeks 0
days and 41 weeks 6 days of gestation days and 41 weeks 6 days of gestation

Post term: Post term: a pregnancy that has reached between 42 weeks 0 a pregnancy that has reached between 42 weeks 0
days and beyond of gestationdays and beyond of gestation

6.  

 
A nurse is reading the history and physical in the chart of a pregnant A nurse is reading the history and physical in the chart of a pregnant
client admitted to the labor room and notes documentation that the client client admitted to the labor room and notes documentation that the client
is a nullipara. The nurse plans care knowing that nullipara indicates that is a nullipara. The nurse plans care knowing that nullipara indicates that
the client has:the client has:

1.Had one previous birth
 
1.Had one previous birth
 

2.Been pregnant once2.Been pregnant once

  3.Not completed a pregnancy to at least 20 3.Not completed a pregnancy to at least 20
weeks’ gestation
 
weeks’ gestation
 

4.Had more that two previous births
 
4.Had more that two previous births
 

7. Anatomy and Physiology of Anatomy and Physiology of
PregnancyPregnancy

Pregnancy TestsPregnancy Tests

Human chorionic gonadotropin (hCG) Human chorionic gonadotropin (hCG)
–is the earliest biochemical marker for –is the earliest biochemical marker for
pregnancypregnancy

Production of hCG begins as early as Production of hCG begins as early as
the day of implantation the day of implantation

In urine, about 26 days after conceptionIn urine, about 26 days after conception

Level of hCG increases until it peaks at Level of hCG increases until it peaks at
about 60 to 70 days of gestationabout 60 to 70 days of gestation

Remains stable until about 30 weeks Remains stable until about 30 weeks
and then gradually increases until termand then gradually increases until term

Higher than normal levels of hCG may Higher than normal levels of hCG may
indicate ectopic pregnancy, abnormal indicate ectopic pregnancy, abnormal
gestation, or multiple gestationgestation, or multiple gestation

Abnormally slow increase or decrease Abnormally slow increase or decrease
in hCG levels may indicate impending in hCG levels may indicate impending
miscarriagemiscarriage

8. Anatomy and Physiology of Anatomy and Physiology of
PregnancyPregnancy

Pregnancy TestsPregnancy Tests

Many pregnancy tests are Many pregnancy tests are
availableavailable

9. Signs of PregnancySigns of Pregnancy

Adaptations of PregnancyAdaptations of Pregnancy

Signs of PregnancySigns of Pregnancy

PresumptivePresumptive

Changes felt by the womanChanges felt by the woman

ProbableProbable

Changes observed by an Changes observed by an
examiner examiner

PositivePositive

Those signs that are Those signs that are
attributed only to the attributed only to the
presence of the fetuspresence of the fetus

10. Signs of Pregnancy (cont)Signs of Pregnancy (cont)

11. Adaptions to PregnancyAdaptions to Pregnancy

Reproduction System and BreastsReproduction System and Breasts

UterusUterus

Changes in Size, Shape, and Changes in Size, Shape, and
PositionPosition

Phenomenal uterine growth Phenomenal uterine growth
in the first trimester is in the first trimester is
stimulated by high levels of stimulated by high levels of
estrogen and progesteroneestrogen and progesterone

7 weeks of gestation- is the 7 weeks of gestation- is the
size of a large hen’s Eggsize of a large hen’s Egg

10 weeks gestation-is the 10 weeks gestation-is the
size of an orange (twice size of an orange (twice
nonpregnant size)nonpregnant size)

12 weeks of gestation-is the 12 weeks of gestation-is the
size of a grapefruitsize of a grapefruit

Pregnancy may “show” Pregnancy may “show”
after 14 weeksafter 14 weeks

12. Adaptions to PregnancyAdaptions to Pregnancy

LighteningLightening

Hegar SignHegar Sign

At approximately 6 At approximately 6
weeks of gestation, weeks of gestation,
softening and softening and
comprehension of the comprehension of the
lower uterine segmentlower uterine segment

Uterine fundus presses Uterine fundus presses
on the urinary bladder on the urinary bladder
causing the woman to causing the woman to
have urinary frequencyhave urinary frequency

13. A nurse employed in a prenatal clinic notes physician documentation in a A nurse employed in a prenatal clinic notes physician documentation in a
client’s chart that indicates the presence of Hegar’s sign in the client. The client’s chart that indicates the presence of Hegar’s sign in the client. The
nurse understands that this sign indicates that:nurse understands that this sign indicates that:

1.The mother is feeling fetal movement
 
1.The mother is feeling fetal movement
 

2.The client is complaining of irregular, 2.The client is complaining of irregular,
painless contractions
 
painless contractions
 

3.A soft blowing sound was heard when the 3.A soft blowing sound was heard when the
uterus was auscultated
 
uterus was auscultated
 

4.Lower uterine segment thinning is present4.Lower uterine segment thinning is present

14. Adaptions to PregnancyAdaptions to Pregnancy

Changes in ContractilityChanges in Contractility

Braxton Hicks sign- Soon after the Braxton Hicks sign- Soon after the
fourth month of pregnancy, uterine fourth month of pregnancy, uterine
contractions can be felt through the contractions can be felt through the
abdominal wallabdominal wall

Contractions are irregular, Contractions are irregular,
painless, and occur painless, and occur
intermittently throughout intermittently throughout
pregnancypregnancy

Contractions facilitate uterine Contractions facilitate uterine
blood flow through the blood flow through the
intervillous space of the intervillous space of the
placentaplacenta

Contractions are painless, some Contractions are painless, some
women complain that they are women complain that they are
annoyingannoying

After the 28After the 28
thth
week, these week, these
contractions become more contractions become more
definitedefinite

Can be mistaken for true laborCan be mistaken for true labor

15. Adaptions toPregnancyAdaptions toPregnancy

Uteroplacental Blood FlowUteroplacental Blood Flow

Placental perfusion depends Placental perfusion depends
on the maternal blood flow to on the maternal blood flow to
the uterusthe uterus

Blood flow increase rapidly Blood flow increase rapidly
as the uterus increase in sizeas the uterus increase in size

Normal term pregnancy, one Normal term pregnancy, one
sixth of the total blood sixth of the total blood
volume is within the uterine volume is within the uterine
vascular systemvascular system

Rate of blood flow through Rate of blood flow through
the uterus average from 450 the uterus average from 450
to 650 ml/min at termto 650 ml/min at term

16. Adaptions to PregnancyAdaptions to Pregnancy

Cervical ChangesCervical Changes

Softening of the cervical tip may be Softening of the cervical tip may be
observed about the beginning of the observed about the beginning of the
sixth weeksixth week

Goodell's sign is brought about by the Goodell's sign is brought about by the
increase vascularity, slight increase vascularity, slight
hypertrophy, and hyperplasia (increase hypertrophy, and hyperplasia (increase
in number of cells)in number of cells)

Muscle and its collagen-rich Muscle and its collagen-rich
connective tissue become loose, connective tissue become loose,
edematous, high-elastic, and increase in edematous, high-elastic, and increase in
volumevolume

Glands near the external os proliferate Glands near the external os proliferate
beneath the stratified squamous beneath the stratified squamous
epithelium, giving the cervix epithelium, giving the cervix
consistency characteristic of pregnancyconsistency characteristic of pregnancy

Friability is increased; that is the cervix Friability is increased; that is the cervix
bleeds easily when scraped or touchedbleeds easily when scraped or touched

17. A nurse is reviewing the record of a client who has just been told that a pregnancy A nurse is reviewing the record of a client who has just been told that a pregnancy
test is positive. The nurse notes that the physician has documented the presence of test is positive. The nurse notes that the physician has documented the presence of
Goodell’s sign. The nurse determines that this sign is indicative of:Goodell’s sign. The nurse determines that this sign is indicative of:

1.The presence of fetal movement1.The presence of fetal movement

  2.A soft blowing sound that corresponds to 2.A soft blowing sound that corresponds to
the maternal pulse while auscultating the the maternal pulse while auscultating the
uterus
 
uterus
 

3.The presence of human chorionic 3.The presence of human chorionic
gonadotropin (hCG) in the urine
 
gonadotropin (hCG) in the urine
 

4.A softening of the cervix4.A softening of the cervix

18. Anatomy and Physiology of Anatomy and Physiology of
PregnancyPregnancy

Changes related to the presence of the fetusChanges related to the presence of the fetus

Ballottement- passive movement of the unengaged fetusBallottement- passive movement of the unengaged fetus

Can be identified generally between the sixteenth and eighteenth Can be identified generally between the sixteenth and eighteenth
week week

Technique of palpating a floating structure by bouncing it Technique of palpating a floating structure by bouncing it
gently and feeling it reboundgently and feeling it rebound

Palpate the fetusPalpate the fetus

Examiner places a finger within the vagina and taps gently Examiner places a finger within the vagina and taps gently
upward causing the fetus to riseupward causing the fetus to rise

Fetus sinks, Fetus sinks,

And a gentle tap is felt on the fingerAnd a gentle tap is felt on the finger

19. Adaptations to Pregnancy Adaptations to Pregnancy

20. Adaptions to PregnancyAdaptions to Pregnancy

Vagina and VulvaVagina and Vulva

Chadwick sign-increased vascularity Chadwick sign-increased vascularity
results in a violet-bluish color of the results in a violet-bluish color of the
vagina mucosa and cervixvagina mucosa and cervix

Leukorrhea- is a white or slightly gray Leukorrhea- is a white or slightly gray
mucoid fluid occurs in response to mucoid fluid occurs in response to
cervical stimulation by estrogen and cervical stimulation by estrogen and
progesteroneprogesterone

Mucus fills the endocervical canal, Mucus fills the endocervical canal,
resulting in the formation of the mucous resulting in the formation of the mucous
plugplug

pH of vaginal secretions is more acidic pH of vaginal secretions is more acidic
during pregnancy, ranging from 3.5 to during pregnancy, ranging from 3.5 to
6.0 6.0

Result of increased production of lactic Result of increased production of lactic
acid caused by Lactobacillus acidophilus acid caused by Lactobacillus acidophilus
acting on glycogen in the vaginal acting on glycogen in the vaginal
epithelium epithelium

21. A pregnant client calls the nurse at the health care clinic and reports that A pregnant client calls the nurse at the health care clinic and reports that
she has noticed a thin, colorless, vaginal drainage. The nurse most she has noticed a thin, colorless, vaginal drainage. The nurse most
appropriately tells the client:appropriately tells the client:

1.To come to the clinic immediately1.To come to the clinic immediately

  2.That this is a normal occurrence during 2.That this is a normal occurrence during
pregnancy
 
pregnancy
 

3.To douche once daily
 
3.To douche once daily
 

4.To use tampons if the discharge is 4.To use tampons if the discharge is
bothersome
 
bothersome
 

22. Adaptions to PregnancyAdaptions to Pregnancy

BreastBreast

Fullness, heightened Fullness, heightened
sensitivity, tingling, and sensitivity, tingling, and
heaviness of the breastsheaviness of the breasts

Nipples and areolae Nipples and areolae
become more pigmented, become more pigmented,
secondary pinkish secondary pinkish
areolae develop areolae develop

Colostrum- the creamy, Colostrum- the creamy,
white-to-yellowish to white-to-yellowish to
orange pre-milk fluidorange pre-milk fluid

23. Adaptions to PregnancyAdaptions to Pregnancy

24.  

 
A nurse is providing instructions to a pregnant client in the third trimester of A nurse is providing instructions to a pregnant client in the third trimester of
pregnancy regarding measures to assist in reducing breast tenderness. The nurse pregnancy regarding measures to assist in reducing breast tenderness. The nurse
tells the mother to:tells the mother to:

1.Avoid wearing a bra
 
1.Avoid wearing a bra
 

2.Wash the nipples and areola area daily with 2.Wash the nipples and areola area daily with
soap
 
soap
 

3.Wear tight-fitting blouses or dresses to 3.Wear tight-fitting blouses or dresses to
provide support
 
provide support
 

4.Wear soft-textured clothing
 
4.Wear soft-textured clothing
 

25. Adaptions to PregnancyAdaptions to Pregnancy

General Body SystemGeneral Body System

Cardiovascular SystemCardiovascular System

Slight cardiac hypertrophy Slight cardiac hypertrophy
(enlargement) Heart returns to (enlargement) Heart returns to
normal after childbirthnormal after childbirth

Diaphragm is displaced Diaphragm is displaced
upward by the enlarging upward by the enlarging
uterus uterus

Between 14 and 20 weeks of Between 14 and 20 weeks of
gestation the pulse increase gestation the pulse increase
about 10 to 15 beats/min about 10 to 15 beats/min

Palpitations may occurPalpitations may occur

27. Anatomy and Physiology of Anatomy and Physiology of
Pregnancy Pregnancy

Blood PressureBlood Pressure

Arterial blood pressure Arterial blood pressure
(brachial artery) is affected by (brachial artery) is affected by
age, activity level, presence of age, activity level, presence of
health problems, and the health problems, and the
circadian rhythmcircadian rhythm

Diastolic blood pressure Diastolic blood pressure
usually remains the same as usually remains the same as
the prepregnancy level but the prepregnancy level but
then gradually decreases until then gradually decreases until
24 to 32 weeks 24 to 32 weeks

After 32 weeks, the diastolic After 32 weeks, the diastolic
blood pressure gradually blood pressure gradually
returns to normalreturns to normal

28. Anatomy and Physiology of Anatomy and Physiology of
PregnancyPregnancy

Blood PressureBlood Pressure

Some degree of the vena cava occurs Some degree of the vena cava occurs
in all women who lie flat on their in all women who lie flat on their
backs during the second half of the backs during the second half of the
pregnancypregnancy

Some women experience a decrease Some women experience a decrease
in their systolic blood pressure of in their systolic blood pressure of
more than 30 mm Hg more than 30 mm Hg

Supine hypotensive syndrome- after 4 Supine hypotensive syndrome- after 4
to 5 minutes, a reflex bradycardia is to 5 minutes, a reflex bradycardia is
noted noted

Compression of the iliac veins and Compression of the iliac veins and
inferior vena cava by the uterus inferior vena cava by the uterus
causes increase venous pressure causes increase venous pressure

Alterations contribute to the Alterations contribute to the
dependent edema, varicose veins in dependent edema, varicose veins in
the legs and vulva and hemorrhoids the legs and vulva and hemorrhoids
that develop in the latter part of term that develop in the latter part of term
pregnancypregnancy

29. Anatomy and Physiology of Anatomy and Physiology of
PregnancyPregnancy

Blood Volume and CompositionBlood Volume and Composition

Blood volume increases by Blood volume increases by
approximately 1200 to 1500 ml approximately 1200 to 1500 ml

Increase consists of 1000 ml of Increase consists of 1000 ml of
plasma plus 450 ml red blood plasma plus 450 ml red blood
cells (RBCs)cells (RBCs)

Blood volume starts to increase Blood volume starts to increase
at about the tenth to twelfth week at about the tenth to twelfth week

Plasma increases exceeds the Plasma increases exceeds the
increase in the RBC production increase in the RBC production

Total white cell count increase Total white cell count increase
during the second trimester and during the second trimester and
peaks during the third trimesterpeaks during the third trimester

30. Anatomy and Physiology of Anatomy and Physiology of
PregnancyPregnancy

Cardiac OutputCardiac Output

Cardiac output increases Cardiac output increases
from 30% to 50% over from 30% to 50% over
the nonpregnant rate by the nonpregnant rate by
the thirty-second week of the thirty-second week of
pregnancypregnancy

Circulation and Circulation and
Coagulation TimesCoagulation Times

Circulation time Circulation time
decreases slightly by decreases slightly by
week 32week 32

31. Anatomy and Physiology of Anatomy and Physiology of
PregnancyPregnancy

Respiratory SystemRespiratory System

Maternal oxygen Maternal oxygen
requirements increase in requirements increase in
response to the acceleration in response to the acceleration in
the metabolic rate and the the metabolic rate and the
need to add to the tissue mass need to add to the tissue mass
in the uterus and breastsin the uterus and breasts

Upper respiratory tract Upper respiratory tract
becomes more vascular in becomes more vascular in
response to elevated levels of response to elevated levels of
estrogenestrogen

Congestion within the tissues Congestion within the tissues
of the respiratory tract gives of the respiratory tract gives
rise to several conditions rise to several conditions
commonly seen during commonly seen during
pregnancypregnancy

32. Anatomy and Physiology of Anatomy and Physiology of
PregnancyPregnancy

Pulmonary FunctionPulmonary Function

Respiratory changes in Respiratory changes in
pregnancy are related to the pregnancy are related to the
elevation of the diaphragm elevation of the diaphragm
and chest wall changesand chest wall changes

Pregnant women become Pregnant women become
more aware of the need to more aware of the need to
breathe; some may even breathe; some may even
complain of dyspnea at rest, complain of dyspnea at rest,
especially in the third especially in the third
trimester trimester

33. Anatomy and Physiology of Anatomy and Physiology of
PregnancyPregnancy

Basal Metabolic Rate Basal Metabolic Rate
(BMR) (BMR)

BMR varies considerably in BMR varies considerably in
women at the beginning of women at the beginning of
and during pregnancy and during pregnancy

BMR returns to nonpregnant BMR returns to nonpregnant
levels by 5 to 6 days after levels by 5 to 6 days after
birthbirth

Pregnant women may Pregnant women may
experience heat intoleranceexperience heat intolerance

Lassitude and fatigability Lassitude and fatigability
after only slight exertion are after only slight exertion are
experienced by many women experienced by many women
in early pregnancyin early pregnancy

Greater need to sleepGreater need to sleep

34. Anatomy and Physiology of Anatomy and Physiology of
PregnancyPregnancy

Acid-Base BalanceAcid-Base Balance

Alterations in acid-base Alterations in acid-base
balance indicate that the balance indicate that the
pregnancy is a state of pregnancy is a state of
respiratory alkalosis respiratory alkalosis
compensated by mild compensated by mild
metabolic acidosismetabolic acidosis

Changes also facilitate the Changes also facilitate the
transport of CO2 from the transport of CO2 from the
fetus and O2 release from fetus and O2 release from
the mother to the fetusthe mother to the fetus

35. Anatomy and Physiology of Anatomy and Physiology of
PregnancyPregnancy

Renal SystemRenal System

Anatomic changesAnatomic changes

Urine of pregnancy contains Urine of pregnancy contains
more nutrients, including glucose more nutrients, including glucose

Bladder irritability, nocturia, and Bladder irritability, nocturia, and
urinary frequency and urgency urinary frequency and urgency
(without dysuria) are commonly (without dysuria) are commonly
reported in early pregnancyreported in early pregnancy

Near term, bladder symptoms Near term, bladder symptoms
may return, especially after may return, especially after
lightening occurslightening occurs

Bladder tone may decrease, Bladder tone may decrease,
which increases the bladder which increases the bladder
capacity to 1500 mlcapacity to 1500 ml

36. Anatomy and Physiology of Anatomy and Physiology of
PregnancyPregnancy

Fluid and Electrolyte BalanceFluid and Electrolyte Balance

Pooling of fluid in the legs Pooling of fluid in the legs
latter pregnancy decreases latter pregnancy decreases
renal blood flowrenal blood flow

Pooling of blood in the lower Pooling of blood in the lower
legs is sometimes referred as legs is sometimes referred as
to physiologic edema or to physiologic edema or
dependent edema and requires dependent edema and requires
no treatmentno treatment

In pregnant women, however, In pregnant women, however,
tubular reabsorption of tubular reabsorption of
glucose is impaired glucose is impaired

Proteinuria usually does not Proteinuria usually does not
occur in normal pregnancy occur in normal pregnancy
except during labor or birthexcept during labor or birth

37. Anatomy and Physiology of Anatomy and Physiology of
PregnancyPregnancy

Integumentary SystemIntegumentary System

Chloasma- facial melasma Chloasma- facial melasma

Usually fades after birthUsually fades after birth

Linea nigra- is a pigmented Linea nigra- is a pigmented
line extending from the line extending from the
symphysis pubis to the top of symphysis pubis to the top of
the fundus in the midlinethe fundus in the midline

Striae gravidarum- or stretch Striae gravidarum- or stretch
marks seen over the abdomenmarks seen over the abdomen

Birth they usually fade, Birth they usually fade,
although they never disappear although they never disappear
completelycompletely

38. Anatomy and Physiology of Anatomy and Physiology of
PregnancyPregnancy

Integumentary SystemIntegumentary System

Vascular spiders (angiomas)-are Vascular spiders (angiomas)-are
tiny, star-shaped or branched tiny, star-shaped or branched

Bluish in color and do not blanch Bluish in color and do not blanch
with pressurewith pressure

Palmar erythema-pinkish-red, Palmar erythema-pinkish-red,
diffuse mottling or well-defined diffuse mottling or well-defined
blotches that are seen over the blotches that are seen over the
palmar surfaces of the handspalmar surfaces of the hands

Cholestasis of pregnancy-the Cholestasis of pregnancy-the
most common cause of pruritic most common cause of pruritic
rashrash

Epulis- a red, raised nodule on Epulis- a red, raised nodule on
the gums that bleeds easilythe gums that bleeds easily

Nail growth may be acceleratedNail growth may be accelerated

Hirutism- excessive growth of Hirutism- excessive growth of
hair or growth of hair in unusual hair or growth of hair in unusual
placesplaces

39. Anatomy and Physiology of Anatomy and Physiology of
PregnancyPregnancy

Musculoskeletal SystemMusculoskeletal System

Walking is more difficult, and the Walking is more difficult, and the
waddling gait of the pregnant waddling gait of the pregnant
woman called “the proud walk of woman called “the proud walk of
pregnancy”pregnancy”

Ligamentous and muscular of the Ligamentous and muscular of the
middle and lower spine may be middle and lower spine may be
severely stressedseverely stressed

42. Anatomy and Physiology of Anatomy and Physiology of
PregnancyPregnancy

Neurologic SystemNeurologic System

Edema involving the peripheral Edema involving the peripheral
nerves, which may result in carpal nerves, which may result in carpal
tunnel syndrometunnel syndrome

Tension headache is common Tension headache is common
when anxiety or uncertainty when anxiety or uncertainty
complicates pregnancycomplicates pregnancy

““Light-headedness”, faintness, Light-headedness”, faintness,
and even syncope are common and even syncope are common
during early pregnancyduring early pregnancy

Hypocalcemia may cause Hypocalcemia may cause
neuromuscular problem such as neuromuscular problem such as
muscle cramps and tetany muscle cramps and tetany

43. Anatomy of Physiology and Anatomy of Physiology and
PregnancyPregnancy

Gastrointestinal SystemGastrointestinal System

AppetiteAppetite

Morning sickness or nausea and Morning sickness or nausea and
vomiting of pregnancy appears at about vomiting of pregnancy appears at about
4 to 6 weeks of gestation and usually 4 to 6 weeks of gestation and usually
subsides by the end of the third monthsubsides by the end of the third month

Pica- nonfood cravings, such as for ice, Pica- nonfood cravings, such as for ice,
clay, and laundry starchclay, and laundry starch
MouthMouth

Pytalism- excessive salvation, which Pytalism- excessive salvation, which
may be caused by the decrease in may be caused by the decrease in
unconscious swallowing by the woman unconscious swallowing by the woman
when nauseated or from stimulation of when nauseated or from stimulation of
salivary glands by eating starchsalivary glands by eating starch
Esophagus, Stomach, Intestines,Esophagus, Stomach, Intestines,

Pyrosis- “Acid Indigestion” or heartburnPyrosis- “Acid Indigestion” or heartburn

Constipation Constipation

Pregnant woman has hemorrhoids and is Pregnant woman has hemorrhoids and is
constipated, the hemorrhoids may constipated, the hemorrhoids may
become everted or may bleed during become everted or may bleed during
straining at stoolstraining at stool

44. A pregnant client calls a nurse in the clinic and reports the presence of A pregnant client calls a nurse in the clinic and reports the presence of
brownish patches on the forehead, cheeks, and nose. The nurse most brownish patches on the forehead, cheeks, and nose. The nurse most
appropriately tells the client:appropriately tells the client:

1.To come to the clinic to have the patches 1.To come to the clinic to have the patches
checked by the physicianchecked by the physician

  2.Not to worry about the patches2.Not to worry about the patches

  3.That the patches occur as a result of 3.That the patches occur as a result of
hormone changes and will disappear after hormone changes and will disappear after
childbirth
 
childbirth
 

4.To change the type of soap being used on the 4.To change the type of soap being used on the
faceface

45. A nurse has provided instructions to a pregnant client regarding A nurse has provided instructions to a pregnant client regarding
measures that will assist in alleviating heartburn. Which statement by the measures that will assist in alleviating heartburn. Which statement by the
client indicates an understanding of these measures? client indicates an understanding of these measures?

1.“I should sit upright after eating.”
 
1.“I should sit upright after eating.”
 

2.“I should eat snacks that contain fat.”2.“I should eat snacks that contain fat.”

  3.“I should eat three large meals a day.”
 
3.“I should eat three large meals a day.”
 

4.“I should eat a snack at bedtime.”
 
4.“I should eat a snack at bedtime.”
 

46. A nurse has provided instructions regarding treatment for hemorrhoids A nurse has provided instructions regarding treatment for hemorrhoids
to the client who is in the second trimester of pregnancy. Which statement to the client who is in the second trimester of pregnancy. Which statement
by the mother indicates a need for further instruction? by the mother indicates a need for further instruction?

1.“I should eat foods that are high in fiber.”1.“I should eat foods that are high in fiber.”

2.“I should apply hot packs to the hemorrhoids 2.“I should apply hot packs to the hemorrhoids
to help them shrink.”
 
to help them shrink.”
 

3.“I should increase my fluid intake.”3.“I should increase my fluid intake.”

  4.“Warm sitz baths will help in relieving the 4.“Warm sitz baths will help in relieving the
discomfort.”
 
discomfort.”
 

47. Anatomy and Physiology of Anatomy and Physiology of
PregnancyPregnancy

Abdominal DiscomfortAbdominal Discomfort

Intraabdominal Intraabdominal
alterations that can cause alterations that can cause
discomfortdiscomfort

Displacement of the Displacement of the
intestinesintestines

Pressure from the Pressure from the
expanding uterus causes expanding uterus causes
an increase in venous an increase in venous
pressure in the pelvic pressure in the pelvic
organsorgans

48. Anatomy and Physiology of Anatomy and Physiology of
PregnancyPregnancy

Pituitary and Placental HormonesPituitary and Placental Hormones

Progesterone is essential for Progesterone is essential for
maintaining pregnancy by maintaining pregnancy by
relaxing smooth muscles relaxing smooth muscles

Progesterone and estrogen cause Progesterone and estrogen cause
fat to deposit in subcutaneous fat to deposit in subcutaneous
tissues over the abdomen, back, tissues over the abdomen, back,
and upper thighsand upper thighs

Estrogen also promotes the Estrogen also promotes the
enlargement of the genitals, enlargement of the genitals,
uterus, and breasts and increase uterus, and breasts and increase
vascularity, causing vascularity, causing
vasodilatationvasodilatation

Oxytocin can stimulate uterine Oxytocin can stimulate uterine
contractions during pregnancy contractions during pregnancy
Oxytocin also stimulates the let-Oxytocin also stimulates the let-
down or milk-ejection reflex down or milk-ejection reflex
after birth in response to the after birth in response to the
infant sucking at the mother’s infant sucking at the mother’s
breastbreast

50. Key Points Key Points

The biochemical, physiologic, and anatomic The biochemical, physiologic, and anatomic
adaptations that occur during pregnancy are profound adaptations that occur during pregnancy are profound
and revert to the nonpregnant state after birth and and revert to the nonpregnant state after birth and
lactation.lactation.

Maternal adaptations are attributed to the hormones Maternal adaptations are attributed to the hormones
of pregnancy and to mechanical pressures arising of pregnancy and to mechanical pressures arising
from the enlarging uterus and other tissues.from the enlarging uterus and other tissues.

Adaptations to pregnancy protect the woman’s Adaptations to pregnancy protect the woman’s
normal physiologic functioning, meet the metabolic normal physiologic functioning, meet the metabolic
demands that pregnancy imposes, and provide for demands that pregnancy imposes, and provide for
fetal developmental and growth needs.fetal developmental and growth needs.

51. Key Points (Cont.)Key Points (Cont.)

Accuracy of results of home pregnancy tests Accuracy of results of home pregnancy tests
depends on following instructions correctly.depends on following instructions correctly.

Presumptive, probable, and positive signs of Presumptive, probable, and positive signs of
pregnancy aid in the diagnosis of pregnancy; only pregnancy aid in the diagnosis of pregnancy; only
positive signs (identification of a fetal heart tone, positive signs (identification of a fetal heart tone,
verification of fetal movements, and visualization of verification of fetal movements, and visualization of
the fetus) can establish the diagnosis of pregnancy.the fetus) can establish the diagnosis of pregnancy.

Physiologic anemia of pregnancy results from Physiologic anemia of pregnancy results from
increase in plasma volume greater than the increase increase in plasma volume greater than the increase
in red blood cells.in red blood cells.

52. Key Points (Cont.)Key Points (Cont.)

During pregnancy maternal blood pressure During pregnancy maternal blood pressure
remains the same or decreases slightly.remains the same or decreases slightly.

Heart rate increases 10 to 15 beats/minute by 32 Heart rate increases 10 to 15 beats/minute by 32
weeks of gestation and persists until term.weeks of gestation and persists until term.

Respiratory rate is unchanged during pregnancy, Respiratory rate is unchanged during pregnancy,
although tidal volume and minute ventilation although tidal volume and minute ventilation
increase by 30% to 50%.increase by 30% to 50%.

Pregnancy is a hypercoagulable state with Pregnancy is a hypercoagulable state with
increased risk for thrombotic disease.increased risk for thrombotic disease.

53. Key Points (Cont.)Key Points (Cont.)

Dilation of renal pelves and ureters during Dilation of renal pelves and ureters during
pregnancy increases the risk of urinary tract pregnancy increases the risk of urinary tract
infection.infection.

Balance and coordination are affected by changes Balance and coordination are affected by changes
in joints and in the woman’s center of gravity as in joints and in the woman’s center of gravity as
pregnancy progresses.pregnancy progresses.

Decreased muscle tone during pregnancy Decreased muscle tone during pregnancy
contributes to heartburn, reflux, and constipation.contributes to heartburn, reflux, and constipation.

Endocrine changes are essential to maintaining Endocrine changes are essential to maintaining
pregnancy and promoting fetal growth.pregnancy and promoting fetal growth.

54. QuestionQuestion
1.1.A number of changes in the integumentary A number of changes in the integumentary
system occur during pregnancy. What change system occur during pregnancy. What change
persists after birth?persists after birth?
a.a.EpulisEpulis
b.b.ChloasmaChloasma
c.c.TelangiectasiaTelangiectasia
d.d.Striae gravidarumStriae gravidarum