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Questions and Answers
What causes the slight decrease in blood pressure during the first two trimesters of pregnancy?
What causes the slight decrease in blood pressure during the first two trimesters of pregnancy?
What percentage does plasma volume increase during the 32nd week of pregnancy?
What percentage does plasma volume increase during the 32nd week of pregnancy?
What condition may occur if a pregnant woman lies supine due to uterine weight?
What condition may occur if a pregnant woman lies supine due to uterine weight?
How much does blood pressure typically drop during the first two trimesters of pregnancy?
How much does blood pressure typically drop during the first two trimesters of pregnancy?
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What hematologic change is typically observed during pregnancy due to hemodilution?
What hematologic change is typically observed during pregnancy due to hemodilution?
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What is one of the primary aims of physiological changes during pregnancy?
What is one of the primary aims of physiological changes during pregnancy?
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What is the normal change in size of the uterus during pregnancy compared to its non-pregnant size?
What is the normal change in size of the uterus during pregnancy compared to its non-pregnant size?
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Which hormone is NOT primarily involved in the physiological changes during pregnancy?
Which hormone is NOT primarily involved in the physiological changes during pregnancy?
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Which physiological change occurs in the uterine wall thickness during the first trimester of pregnancy?
Which physiological change occurs in the uterine wall thickness during the first trimester of pregnancy?
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What position does the uterus take after the first trimester of pregnancy?
What position does the uterus take after the first trimester of pregnancy?
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What is a common reason for urinary incontinence during pregnancy?
What is a common reason for urinary incontinence during pregnancy?
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Which trimester is associated with improvement in urinary-related symptoms?
Which trimester is associated with improvement in urinary-related symptoms?
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What is an advised action to manage edema in pregnant women?
What is an advised action to manage edema in pregnant women?
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What should be limited to manage urinary frequency during pregnancy?
What should be limited to manage urinary frequency during pregnancy?
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Which symptom is NOT typically associated with mild kidney-related discomfort during pregnancy?
Which symptom is NOT typically associated with mild kidney-related discomfort during pregnancy?
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What percentage of pregnant women experience ankle swelling?
What percentage of pregnant women experience ankle swelling?
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When should a woman consult a doctor regarding constipation during pregnancy?
When should a woman consult a doctor regarding constipation during pregnancy?
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What exercise is recommended to enhance urinary control during pregnancy?
What exercise is recommended to enhance urinary control during pregnancy?
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What is primarily causing heartburn in pregnant women?
What is primarily causing heartburn in pregnant women?
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Which factor is likely NOT a cause of constipation in pregnant women?
Which factor is likely NOT a cause of constipation in pregnant women?
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What advice should be followed to help manage heartburn during pregnancy?
What advice should be followed to help manage heartburn during pregnancy?
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What symptoms should be assessed when evaluating heartburn?
What symptoms should be assessed when evaluating heartburn?
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What is the recommended daily fluid intake for managing constipation during pregnancy?
What is the recommended daily fluid intake for managing constipation during pregnancy?
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What should be avoided to reduce the risk of heartburn?
What should be avoided to reduce the risk of heartburn?
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Which lifestyle change would best help in managing constipation during pregnancy?
Which lifestyle change would best help in managing constipation during pregnancy?
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What is a recommended practice after eating to manage heartburn effectively?
What is a recommended practice after eating to manage heartburn effectively?
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What is a common cause of backache during pregnancy?
What is a common cause of backache during pregnancy?
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When may haemorrhoids subside after delivery?
When may haemorrhoids subside after delivery?
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Which of the following is an advised posture-related recommendation for managing backache?
Which of the following is an advised posture-related recommendation for managing backache?
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What should be avoided to manage back discomfort?
What should be avoided to manage back discomfort?
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What is a typical characteristic of pelvic girdle pain during pregnancy?
What is a typical characteristic of pelvic girdle pain during pregnancy?
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What role does relaxin play during pregnancy?
What role does relaxin play during pregnancy?
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Which of the following is NOT a recommended strategy for back pain relief?
Which of the following is NOT a recommended strategy for back pain relief?
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What kind of footwear is recommended for managing back pain during pregnancy?
What kind of footwear is recommended for managing back pain during pregnancy?
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Which of these actions is suggested to alleviate pelvic and pubic joint pain?
Which of these actions is suggested to alleviate pelvic and pubic joint pain?
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What is a beneficial exercise to relieve back pain during pregnancy?
What is a beneficial exercise to relieve back pain during pregnancy?
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What is one effective method to manage leg cramping during pregnancy?
What is one effective method to manage leg cramping during pregnancy?
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Which statement accurately describes leucorrhoea during pregnancy?
Which statement accurately describes leucorrhoea during pregnancy?
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What is a hallmark physical change of the musculoskeletal system during pregnancy?
What is a hallmark physical change of the musculoskeletal system during pregnancy?
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Which of the following is NOT a recommended management for managing pelvic pain?
Which of the following is NOT a recommended management for managing pelvic pain?
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How should one manage dehydration as a cause of leg cramps?
How should one manage dehydration as a cause of leg cramps?
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What is one physiological change in the respiratory system during pregnancy?
What is one physiological change in the respiratory system during pregnancy?
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What measure should be taken if leg cramps persist despite management strategies?
What measure should be taken if leg cramps persist despite management strategies?
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What is a common symptom associated with pelvic girdle pain during pregnancy?
What is a common symptom associated with pelvic girdle pain during pregnancy?
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Which statement accurately reflects management advice for leucorrhoea?
Which statement accurately reflects management advice for leucorrhoea?
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What is a psychological change observed during the third trimester of pregnancy?
What is a psychological change observed during the third trimester of pregnancy?
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Study Notes
Physiologic & Psychosocial Adaptation during Pregnancy
- This lecture covers physiological and psychosocial changes during pregnancy.
- Learning outcomes include describing maternal physiological, emotional, and psychological changes, and pregnancy-induced discomforts along with nursing management.
- Pregnancy causes profound physiological changes in almost every organ system.
- These changes are necessary to support and nourish the fetus, prepare the mother for childbirth, and preparation for lactation.
- Physiological changes are mainly due to hormonal influences (estrogen and progesterone) and fetal growth.
Reproductive System
-
Uterus:
- Size increases significantly, approximately 20 times its non-pregnant size.
- Weight increases from 60g to 1100g.
- Capacity increases from 10ml to 5000ml.
- Blood supply increases.
- Shape transitions from pear-shaped to ovoid.
- Ascends into the abdominal cavity after the first trimester.
- Uterine wall thickness is 8mm at 12 weeks and 10mm at term during the pregnancy,
- Traditional method to assess gestational age is based on fundal height.
- Braxton Hicks contractions start around the 20th week, promoting blood circulation to the placenta.
- Isthmus of uterus forms the lower uterine segment from 26-32 weeks
-
Cervix:
- Vascularity increases (Chadwick's sign).
- Softening occurs (Goodell's sign).
- Mucus plug forms in the cervical canal to protect the fetus.
- "Show" occurs as cervix begins to dilate, often accompanied by slight bleeding.
-
Vagina:
- Vascularity increases due to estrogen.
- Vaginal secretions increase, becoming more acidic.
- Risk of vulvovaginal candidiasis (VVC) increases due to higher estrogen levels. This often presents with itching, irritation, and erythema.
-
Ovaries:
- Ovulation ceases during pregnancy due to increased estrogen and progesterone levels.
- Corpus luteum secretes estrogen and progesterone during the first 6-8 weeks until placenta development.
Breasts
- Weight increases by 500-800g.
- Tenderness is common.
- Glandular tissue and ducts grow.
- Nipples and areola darken.
- Increased blood flow to breasts, with visible dilated veins.
- Montgomery's tubercles become prominent in the third trimester.
- Colostrum (creamy, yellowish fluid) is produced, providing nourishment for the newborn during the first few days.
Cardiovascular System
- Profound but reversible changes to the cardiovascular system.
- Cardiac output increases by 20% at 8 weeks and continues to increase to 50% above baseline at 32 weeks.
- Stroke volume rises by 30% in late pregnancy,
- Maternal heart rate increases by 15 to 20 beats per minute.
- Blood pressure may slightly decrease in the first two trimesters but gradually increases to pre-pregnant levels at term, due to peripheral vasodilation from progesterone.
- Hemodynamics show physiological anemia, with plasma volume increasing 40-50% at 32 weeks but red blood cell volume increasing only 20-30%.
- This results in mild white blood cell increase and slight increase in plasma fibrinogen, platelets, and other clotting factors.
- Supine hypotension syndrome is a concern due to the weight of the uterus potentially compressing the inferior vena cava, reducing blood flow and impacting fetal oxygen supply.
Respiratory System
- Generalized vasodilation and edema increase mucosal edema and nasal congestion, this may result in epistaxis.
- Oxygen consumption increases by 20-30% due to fetal needs.
- Lung volume increases in the third trimester due to elevation of the diaphragm by roughly 4cm.
- Pregnant women have a higher risk of hypoxia, hyperventilation, and dyspnea.
- Compensatory mechanisms include relaxation of thoracic muscles, widening of the chest circumference, and decreased airway resistance for breathing.
Gastrointestinal System
-
Mouth:
- Gums may swell due to estrogen, increasing the risk of gingivitis.
- Saliva production increases, and taste may change.
-
Oesophagus:
- Progesterone relaxes the cardiac sphincter, leading to reflux of gastric contents.
- Heartburn is a common complaint.
-
Stomach:
- Progesterone decreases gastric acid production.
-
Intestines:
- Progesterone reduces intestinal motility, leading to constipation.
- Increased pressure on the intestines from the growing uterus further contributes to this.
- Haemorrhoids are prevalent
Integumentary System
- Hyperpigmentation: Melanocyte-stimulating hormone (MSH) increases, causing linea nigra (dark line from the symphysis pubis to umbilicus) pigmentation, chloasma (pigment on the face), and pigmentation of areola and vulva.
- Striae gravidarum: Stretching of the skin results in bluish-pink lines (stretch marks) on the abdomen, breasts, thighs, and buttocks. This is most notable during weeks 6-7.
Musculoskeletal System
- Pelvic ligaments soften and stretch due to progesterone and relaxin.
- Pelvic and pubic joints loosen, potentially leading to a "waddling gait."
- Pelvic girdle pain frequently arises in the advanced stages of pregnancy.
- Lordosis, an increased curvature of the spine, compensates for the shift in the center of gravity.
- Leg cramps may occur due to calcium, potassium, electrolyte imbalances, or dehydration.
Renal System/Urinary System
- Blood flow to the kidneys increase by 50-80%.
- Glomerular filtration rate (GFR) also increases by 50%.
- Increased urine flow and volume ensue.
- Increased micturition frequency results from urinary bladder compression.
Endocrine System
-
Placenta:
- Produces human chorionic gonadotropin (hCG) to prevent corpus luteum involution and potentially spontaneous abortion
- Human placental lactogen (hPL) is released to support fetal nutrition by increasing maternal glucose levels and mobilizing maternal fatty acid stores. Relaxin is produced for muscle, ligaments, and joint relaxation.
- Progesterone: Prevents uterine contractions.
- Estrogen: Promotes uterine lining and breast development and growth.
- Thyroid and Pituitary: Thyroid enlarges and basal metabolic rate increases, while pituitary gland activity rises and produces prolactin (breast development), MSH (skin pigmentation), and oxytocin (uterine contractions).
Psychological Changes
- Hormonal changes significantly influence emotional fluctuations during pregnancy.
- First trimester often includes emotional lability, uncertainty, and anxiety about pregnancy, miscarriage, or childbirth.
- Second trimester often brings more emotional stability and growing excitement about the pregnancy & increased confidence.
- Third trimester sometimes features heightened anxiety about childbirth, health of the baby, and worries around labor.
Common Pregnancy-Induced Discomforts & Nursing Management
- Discomforts are due to rapid hormonal changes (estrogen, progesterone, relaxin, prolactin).
- Most discomforts resolve after delivery.
- Nursing management focuses on symptom improvement and minimizing risk to mother and fetus. Reassurance, assessment, and proper advice concerning diet, posture, exercise.
Minor Discomfort Details (Examples)
- Nausea and vomiting (morning sickness): Affects 70-80% of pregnant women. Causes are often unknown; possibly related to hCG, estrogen, hypoglycemia and tiredness, but resolves by the end of the first trimester.
- Heartburn: Affects 70% of pregnant women. Caused by progesterone relaxing the esophageal sphincter, leading to gastric acid reflux. Often worsens as pregnancy progresses.
- Constipation: Affects 10-40% of women. Due to progesterone reducing intestinal motility & estrogen increasing water reabsorption, leading to decreased bowel movements and harder stools.
- Urinary frequency and incontinence: Increased blood flow to kidneys and progesterone's effect on urinary tract smooth muscle increase urinary frequency and possible incontinence; less prominent during 2nd trimester.
- Edema: Swelling in the extremities, especially ankles. Caused by water retention from rising estrogen levels.
- Dizziness: Lightheadedness, weakness, fainting. Often caused by blood pooling in the legs from dilated blood vessels due to progesterone or orthostatic hypotension.
- Backache: Very common in later stages. Caused by shifted center of gravity (enlarged uterus) and joint laxity from progesterone and relaxin.
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Description
This quiz explores the physiological and psychosocial adaptations that occur during pregnancy. You will learn about the significant changes in the maternal body, emotional adjustments, and how these impact nursing management. Understand the profound physiological alterations necessary for fetal nourishment and childbirth preparation.
