Maternal Adaptations to Pregnancy PDF

Maternal Adaptations to Pregnancy  OB Hx – G P(TPAL) Gravida: number of times the client has been pregnant, regardless of the duration, including the present one Para: number of pregnancies that have reached 20 weeks gestation or more, regardless of the outcome (twins, tri...

Maternal Adaptations to Pregnancy  OB Hx – G P(TPAL) Gravida: number of times the client has been pregnant, regardless of the duration, including the present one Para: number of pregnancies that have reached 20 weeks gestation or more, regardless of the outcome (twins, triplets, etc. count as 1)  number of infants born after 38-42 weeks Term gestation number of infants born after 20 weeks, but Preterm before 38 weeks gestation Parity (TPAL) Abortio number of pregnancies ending in fetal loss ns before 20 weeks (spontaneous or elective) Living number of currently living children  May is 6-weeks pregnant. Her previous two pregnancies ended in a live birth at 41-weeks. What is her GP? G TPAL? Example 1  May is 6-weeks pregnant. Her previous two pregnancies ended in live births at 41-weeks. What is her GP? G TPAL? G3 P2 G3 P2002 Example 1  A pregnant woman comes to the clinic for a visit. This is her third pregnancy. She had a miscarriage at 12-weeks and gave birth to a son, now 3-years old, at 32-weeks. Using the GTPAL system, the nurse would document this woman’s obstetric history as what? Example 2  A pregnant woman comes to the clinic for a visit. This is her third pregnancy. She had a miscarriage at 12-weeks and gave birth to a son, now 3-years old, at 32-weeks. Using the GTPAL system, the nurse would document this woman’s obstetric history as what? G3 P0111 Example 2  Primigravida: client pregnant for the first time Multigravida: client who has been Other pregnant more than once Helpful Terms Primipara: client who has not delivered a pregnancy past 20 weeks **text is incorrect** Multipara: client who has delivered more than 1 pregnancy past 20 weeks  Presumptive signs: specific changes felt by the woman Amenorrhea, nausea, vomiting, excessive fatigue, urinary frequency, breast changes, quickening Probable signs: changes that can Am I be observed by the examiner Pregnant? Changes in pelvic organs, abdominal enlargement, Braxton Hicks contractions, positive HcG pregnancy test Positive signs: can ONLY be attributed to the presence of a fetus Fetal heartbeat, palpated fetal movements, ultrasound visualization of fetus Reproductive System Changes Uterus Hypertrophy and hyperplasia of myometrial cells Moves from being a pelvic organ to an abdominal organ By the end of pregnancy, 1/6th of maternal blood volume is here Cervix Mucous plug forms Increased vascularity/friability Reproductive System Changes, Cont. Vagina Increased vascularity Tissue loosens/vault lengthens Increased secretion amount and in acidity Ovaries Stop producing ova Corpus luteum secretes progesterone and estrogen until the placenta can take over Reproductive System Changes, Cont. Breasts The placenta’s release of estrogen and progesterone increases alveoli and ductal systems Prolactin is needed for milk production, but is inhibited by estrogen and progesterone  when placenta delivers, milk  Increased blood flow to the placenta, uterus, breasts Increased workload on the heart Cardiovascul Increased cardiac output by 30-50% from ar Changes pre-pregnant state Increased heart rate by 10-15 bpm from pre-pregnant state Blood pressure can decrease throughout the 1st and 2nd trimesters due to systemic vascular resistance, then gradually returns to normal by term  Uterus places pressure on the vena cava and iliac/femoral veins, especially when lying flat Cardiovascul Interferes with blood return to the heart ar Changes Supine hypotensive syndrome Supine Hypotensive Syndrome The gravid uterus compresses the vena cava when the woman is supine. This reduces the blood flow returning to the heart and may cause maternal hypotension. Results in dependent edema, varicose veins, hemorrhoids, and thrombophlebitis Hence, left lateral recumbent position is best  Rapid plasma increase to 40—45% above non-pregnant levels, peaking at 32-34 Hematological weeks Increased RBC production by approximately 20-30% (but slower than plasma increase)  hemodilution Changes WBCs increase during 2nd trimester and peak during 3rd trimester Fibrin/fibrinogen and clotting factors VII, VIII, IX, X increase  thrombosis risk  Increased oxygen requirements/lowered threshold for CO2 Ligaments relax and diaphragm Respirator displaced  increased chest y Changes expansion Upper respiratory more vascular Edema of nose, pharynx, trachea, and bronchi  Increased pressure from uterus results in GFR increased urinary frequency in 1st and 3rd trimesters Renal System Changes Proteinuria (trace amounts and +1 is normal, but >1 Possible glycosuria warrants close observation/intervent ions)  Increased MSH  darkening of areola, nipples, axilla, perianal area; causes Integument chloasma Linea nigra ary System Striae gravidarum Changes Vascular spiders Palmar erythema Potential mild pruritis Increased perspiration Gum hypertrophy Increased nail growth, decreased hair loss, and potential hirsutism Musculoskeletal Changes Center of Joints “relax” gravity shifts due to relaxin Diastasis recti forward   waddle, balance issues back pain  hCG and change in CHO metabolism  morning sickness Gums soften and bleed easily, saliva production may increase Gastrointesti nal Changes Progesterone (smooth muscle relaxer)  bloating, constipation, heartburn Delayed gallbladder emptying  stone formation