Expected Physiological Changes During Pregnancy

Signs of Pregnancy

• Presumptive Signs: Subjective changes indicating possible pregnancy, including:

  • Amenorrhea (missed period)
  • Fatigue
  • Nausea and vomiting
  • Increased urinary frequency
  • Breast changes: darkened areolae, engorged Montgomery glands
  • Quickening: fetal movement felt by the client (16-20 weeks)
  • Uterine enlargement

• Probable Signs: Objective signs suspected by healthcare providers, including:

  • Abdominal enlargement due to uterine changes
  • Hegar's sign: softening of the lower uterus
  • Chadwick's sign: bluish color of cervix and vaginal mucosa
  • Goodell's sign: softening of the cervical tip

• Positive Signs: Definitive indicators of pregnancy, including:

  • Fetal heart sounds
  • Visualization of the fetus via ultrasound
  • Fetal movement felt by an experienced examiner

Verifying Pregnancy

• Human chorionic gonadotropin (hCG) produced post-implantation can be detected in blood and urine, becoming detectable 7-8 days before expected menses.
• hCG peaks at 60-70 days, declines, then remains lower throughout pregnancy.
• Elevated hCG levels may indicate multifetal pregnancies, ectopic pregnancies, or genetic issues; low levels may suggest miscarriage or ectopic pregnancy.
• Home tests are most accurate with first-morning urine samples.

Calculating Delivery Date

• Naegele's Rule: Calculate due date by taking the first day of the last menstrual period, subtracting 3 months, adding 7 days, and adjusting the year if necessary.
• Fundal Height Measurement: Estimates gestational age between 18–30 weeks, allowing a variance of ±2 weeks.
• Gravidity: Counts the number of pregnancies; terms defined include:
  • Nulligravida: never been pregnant
  • Primigravida: first pregnancy
  • Multigravida: two or more pregnancies

Physiological Changes in Body Systems

• Reproductive Changes: Uterus enlarges, ceasing ovulation and menstruation.

Parity

• Counts pregnancies reaching at least 20 weeks:
  • Nullipara: no viable pregnancies
  • Primipara: one viable pregnancy
  • Multipara: two or more viable pregnancies

GTPAL Acronym

• G: Gravidity
• T: Term births (≥37 weeks)
• P: Preterm births (20-37 weeks)
• A: Abortions/miscarriages (before viability)
• L: Living children

Skin Changes During Pregnancy

• Chloasma: Facial pigmentation increase
• Linea Nigra: Dark line from umbilicus to pubic area
• Striae Gravidarum: Stretch marks on abdomen and thighs

Nursing Care and Routine Tests

• Perform Leopold maneuvers to assess fetal position.
• Routine laboratory tests include:
  • Blood type, Rh factor (assessing incompatibility risk)
  • CBC, Hgb, Hct (detect anemia/infection)
  • Rubella titer (immunity assessment)
  • Hepatitis B screen (carrier identification)
  • Group B Streptococcus screening at 36-37 weeks
  • Urinalysis for various conditions
  • Glucose tolerance tests for gestational diabetes

Danger Signs During Pregnancy

• First trimester symptoms needing immediate reporting:
  • Burning during urination
  • Severe vomiting
  • Diarrhea
  • Fever or chills
  • Abdominal cramping/vaginal bleeding

Supine Hypotension

• Results from the uterus compressing the vena cava when supine, causing lightheadedness.
• Recommended to lie on one side or in a semi-sitting position with knees flexed.

General Danger Signs

• Gush of amniotic fluid before 37 weeks
• Vaginal bleeding or abdominal pain
• Decreased fetal activity
• Persistent vomiting or severe headaches
• Elevated temperature, dysuria, blurred vision
• Facial and hand edema, epigastric pain

Active Learning Scenarios

• Encourage practices to prevent UTIs such as wiping front to back, avoiding bubble baths, maintaining hydration, and urinating post-intercourse.

Application Exercises Overview

• Initial laboratory testing includes CBC, Rubella titer, and blood type/Rh factor.
• Common first trimester discomforts encompass breast tenderness and urinary frequency.
• Measures to relieve backache include pelvic tilts and proper body mechanics.
• Immediate reporting of vaginal bleeding is crucial; other symptoms can be more typical occurrences.

This quiz covers the expected physiological changes during pregnancy, including the classification of pregnancy signs into presumptive, probable, and positive categories. Understanding these changes is crucial for both healthcare providers and clients during prenatal visits.