PREGNANCY CHANGES

AND CARE

UTERINE CHANGES

BEFORE: 7.5X5X2.5, 60 G
END: 28X24X21, 1000 G
WALLS THIN AS THEY STRETCH
INCREASED BLOOD/LYMPH
VESSELS
BRAXTON-HICKS CONTRACTIONS

CERVICAL CHANGES

INCREASED CELL NUMBER

MUCOUS PLUG
GOODELLS SIGN-SOFTENING
CHADWICKS SIGNDISCOLORATION
INCREASED VASCULARIZATION

VAGINAL CHANGES

HYPERTROPHY
INCREASED VASCULARIZATION,
HYPERPLASIA
INCREASED VAGINAL DISCHARGE
ACIDIC PH OF DISCHARGE
LOOSENING OF CONNECTIVE
TISSUE

BREAST CHANGES

INCREASED SIZE, NODULARITY

SUPERFICIAL VEINS
NIPPLES ERECT
DARKENING OF AREOLA
STRIAE
COLOSTRUM-12 WK+

RESPIRATORY CHANGES

HYPERVENTILATION
INCREASING TIDAL VOLUME
CONSUMPTION INCREASES
VC INCREASES
DIAPHRAGM ELEVATES, SUBCOSTAL
ANGLE INCREASES, RIB CAGE FLAIRS
THORACIC BREATHING
NASAL STUFFINESS, EPISTAXIS

CARDIOVASCULAR
CHANGES

HEART UP, TO LEFT, ROTATED

FORWARD
INCREASED BLOOD VOLUME-PEAKS
AT MID-3RD TRIMESTER (45%)
DECREASED VASCULAR RESISTANCE
INCREASED C.O. TILL 20-24 WKS,
THEN STEADY

VITAL SIGN CHANGES

BLOOD PRESSURE DECREASES

THROUGH 2ND TRIMESTER,
GRADUAL INCREASE 3RD
INCREASED PULSE (0-15 BPM)
SAME OR INCREASED
RESPIRATIONS

CIRCULATION CHANGES

INCREASED BLOOD TO UTERUS,

KIDNEYS
INCREASED STAGNATION IN
LOWER EXTREMITIES
INCREASED FEMORAL VENOUS
PRESSURE

SUPINE HYPOTENSIVE
SYNDROME

VENA CAVA SYNDROME

DECREASED BP, DIZZY, PALLOR,
CLAMMY
TURN PT ON SIDE IMMEDIATELY

RBC CHANGES

ERYTHROCYTE VOLUME INCREASES

INCREASED PLASMA VOLUME
GREATER THAN ERYRHROCYTE
DECREASED HCT-PHYSIOLOGIC
ANEMIA

WBC CHANGES

SAME OR INCREASED LEUKOCYTE

PRODUCTION OVER BLOOD
VOLUME
INCREASE HIGHER AT LABOR,
POST-PARTUM

CLOTTING FACTORS
CHANGE

FIBRIN LEVEL INCREASES

FIBRINOGEN LEVEL INCREASES
BLOOD FACTORS INCREASE
CLOTTING TIME NML

ALL LEADS TO INCREASED

HYPERCOAGULABLE STATE, DVT RISK

GASTROINTESTINAL
ST
CHANGES 1 TRIMESTER

NAUSEA/VOMITING
CHANGES IN TASTE, SMELL
GUM TISSUE HYPEREMIC, SOFTER
INCREASED SALIVA

GI CHANGES LATER IN
PREGNANCY

HEARTBURN
BLOATING
CONSTIPATION
HEMORRHOIDS
PROLONGED EMPTYING TIME OF
GALLBLADDER

URINARY TRACT CHANGES

FREQUENCY
IMPAIRED DRAINAGE OF
BLOOD/LYMPH FROM BLADDER
KIDNEY/URETER DILATION
INCREASED GFR, RPF
GLYCOSURIA
LOWER BUN VALUE, CREATININE
CLEARANCE MORE ACCURATE

SKIN AND HAIR CHANGES

LINEA NIGRA
CHLOASMA
AREOLA, NIPPLES, VULVA, PERIANAL
DARKER
INCREASED SWEATING
STRIAE
SPIDER NEVI
DECREASED HAIR GROWTH, SHEDDING
POSTPARTUM

MUSCULOSKELETAL
CHANGES

NO DENTAL CHANGES
JOINTS OF PELVIS RELAX
LUMBODORSAL CURVE INCREASED
PARESTHESIAS OF EXTREMITIES
DIASTASIS RECTI

METABOLISM CHANGES

MOST ARE ACCELERATED

TISSUE REPLACEMENT
FETAL NEEDS
PREP FOR LABOR/LACTATION

NUTRIENT CHANGES

INCREASED LIPIDS, CHOLESTEROL

INCREASED DEMAND FOR CHO
INCREASED DEMAND FOR IRON
IRON TRANSFER TO FETAL LIVER
INSULIN REQUIREMENT INCREASES
GLYCOSURIA: DIABETES VS.
PHYSIOLOGIC CHANGE GFR HIGHER

SIGNS OF PREGNANCY

PRESUMPTIVE: SUBJECTIVE
PROBABLE: OBJECTIVE
DIAGNOSTIC: POSITIVE

PRESUMPTIVE CHANGES

AMENORRHEA
NAUSEA/VOMITING
EXCESSIVE FATIGUE
URINARY FREQUENCY
BREAST CHANGES
QUICKENING

PROBABLE SIGNS

GOODELLS SIGN-SOFTENING OF CERVIX

HEGARS SIGN-SOFT ISTHMUS
CHADWICKS SIGN-BLUE TINT
UTERINE ENLARGEMENT
UTERINE SOUFFLE
SKIN CHANGES
FETAL OUTLINE PALPABLE
PREGNANCY TESTS

DIAGNOSTIC CHANGES

FHT
FETAL MOVEMENT PALPATED
VISUALIZATION BY U/S

PSYCHOLOGIC RESPONSE

AMBIVALENCE
ACCEPTANCE
INTROVERSION
MOOD SWINGS
BODY IMAGE CHANGES

FATHERS RESPONSE

AMBIVALENCE
RECOGNITION AS FATHER/PARENT
FINANCIAL ISSUES
FEAR RE: BABYS HEALTH
FEAR RE: MOTHERS HEALTH
ROLE IN LABOR
FEAR OF HURTING BABY/MOM W/SEX
MAY DEVELOP PREGNANCY SYMPTOMS

SIBLING RESPONSE

SIBLING RIVALRY
CONSISTENCY IMPORTANT,
REASSURANCE
REGRESSION

PRENATAL: BRING TO VISITS, FAMILY

AFFAIR
POST-PARTUM: INVOLVE CHILDREN,
VISIT AT HOSPITAL

DEFINITIONS

ABORTION: BEFORE END OF 20

WKS
GESTATION: #WEEKS POST LMP
TERM: 38-42 WKS
PRETERM: 20-37 WKS
POST-TERM: AFTER 42 WKS

GRAVIDA

GRAVIDA
NULLIGRAVIDA
PRIMIGRAVIDA
MULTIGRAVIDA

PARITY

PARA: BIRTH AFTER 20 WK

NULLIPARA
PRIMIPARA
MULTIPARA

ALL REFER TO # PREGNANCIES, NOT

# OF CHILDREN BORN

TPAL FOR PARITY

T: TERM INFANTS BORN

P: PRETERM INFANTS BORN
A: ABORTION
L: LIVING CHILDREN (CURRENTLY)

INITIAL HISTORY

CURRENT PREGNANCY
PAST PREGNANCIES
GYN/MENSTRUAL HX
CURRENT MEDICAL HX
PAST MED HX
FAMILY MED HX
SOCIAL, PERSONAL, OCCUPATION,
PERSONAL
RELIGION, CULTURE, LANGUAGE
PARTNER HX

HIGH RISK DESIGNATION

VARY WITH TIME OF PREGNANCY

MEDICAL-PREEXISTING, CURRENT
PSYCHOSOCIAL
NUTRITION
OBSTETRIC
EDUCATIONAL

INITIAL LABS

CBC
BLOOD TYPE, RH FACTOR
RUBELLA
SYPHILIS, CHLAMYDIA, GONORRHEA
ANTIBODY SCREEN
HEPATITIS B/C
PAP SMEAR
U/A
HIV RECOMMENDED

ADDITIONAL POSSIBLE
LABS

HGB ELECTROPHORESIS
AFP/QUADRUPLE SCREENING
1 HR PGT or 2 HR 75 OGT
TOX SCREEN
GROUP B STREP
ADDL HCT/HGB, STI SCREEN,
GLUCOSE (individualized to pt)

PSYCHOSOCIAL
ASSESSMENT

REACTION TO PREGNANCY
SUPPORT SYSTEM, FAMILY ISSUES
FINANCIAL ISSUES
LIVING CONDITIONS
HISTORY
ABUSE
CUSTOMS, CULTURE

EDUCATIONAL
ASSESSMENT

EDUCATIONAL LEVEL
PREFERRED WAYS TO LEARN
DESIRE FOR INFO
HX, EXPERIENCE
LANGUAGE

NUTRITIONAL
ASSESSMENT

PREGRAVIDA WEIGHT
HEIGHT, WEIGHT, BMI
FAMILY/PERSONAL MEDICAL HX
DIET RECALL
LAB REVIEW
FINANCES, WIC, FOOD STAMPS

STANDARD DAILY FOOD

PLAN

DAIRY: 4 SERVINGS
PROTEINS: 3 2-OZ SERVINGS (6 0Z)
GRAINS: 6-11
FRUITS: 2-4, MIN 1 VIT C RICH
VEGETABLES: AS DESIRED
FATS: 3-5
FLUIDS: 8-10/DAY, MIN 4-6 H2O

RECOMMENDED WEIGHT
GAIN GENERAL GDLNS

VARIES WITH STARTING WEIGHT

LOW: 28-40 LBS
NML: 25-35
OVER: 15-25
OBESE: 15

WEIGHT GAIN PATTERN

NML WEIGHT PATIENTS:

3.5-5 LB (1.6-2.3 KG) 1ST TRIMESTER

1 LB (O.5 KG)/WEEK TILL TERM
TWINS: 1.5 LB/WEEK 2ND/3RD/ TRIMESTER
LOW WEIGHT GAIN ASSOC WITH PRETERM
BIRTHS, IUGR, LBW INFANTS
HIGH WT GAIN ASSOC WITH LGA INFANTS,
BIRTH COMPLIC, POSS MALFORMATIONS OF
CNS

CALORIE
RECOMMENDATIONS

1ST TRIMESTER: NO INCREASE

2ND/3RD: +300 KCAL/DAY
TWINS: +600 KCAL/DAY
BREASTFEEDING: +200 KCAL OVER
PREGNANCY INTAKE

FACTORS AFFECTING DIET

CULTURE, FAMILY
FINANCES, PSYCHOSOCIAL
FOOD PREFERENCES, INTOLERANCE
PREGNANCY DISCOMFORTS
EATING DISORDERS
EDUCATION, KNOWLEDGE LEVEL
VEGETARIANISM

FACTORS AFFECTING
PREGNANT TEENS DIET

PSYCHOSOCIAL DEVELOPMENT
SELF IMAGE, BODY IMAGE
DENIAL OF PREGNANCY
LIFESTYLE, PREPREGNANT DIET
ANEMIA COMMON, CALCIUM INTAKE
AGE PAST MENARCHE

LESS THAN 4 YRS PAST, TEEN STILL

GROWING, NEED HIGHER KCAL TO HAVE
NML WT INFANT

FOLLOW-UP VISITS

ANY PROBLEMS, COMPLAINTS

REVIEW DANGER SIGNS
WT, BP, URINE PROTEIN, SUGAR,
KETONES
LABS PRN
FHT, MEASUREMENT
EDEMA, PHYSICAL CHANGES
EDUCATION APPROPRIATE FOR GA

FAMILY INVOLVEMENT

INVOLVE FOB,
SIGNIFICANT FAMILY,
FRIENDS IN VISITS
ENCOURAGE
PARTICIPATION IN
VISITS, CLASSES
ANSWER
QUESTIONS OF ALL
PRESENT