2.1. Physiological and Psychological changes of pregnancy- B.pdf

Course Code : NS MTN 401 Lecture No : L2.1 Title of the lecture : Physiological and Psychological changes of Normal pregnancy Dr. Masani Abdelbagi A. Elmahdy...

Course Code : NS MTN 401 Lecture No : L2.1 Title of the lecture : Physiological and Psychological changes of Normal pregnancy Dr. Masani Abdelbagi A. Elmahdy Assistant Professor September 5, 2024 College of Nursing www.gmu.ac.ae Learning Objectives Define Concepts : Menstrual / Gestational age, Fertilization / Ovulatory age , Antepartum period and Normal pregnancy. Explain physiological and Psychological changes of normal pregnancy. 1.Normal Pregnancy: Normal Pregnancy: A pregnancy that progresses without significant complications and is characterized by the typical physiological changes expected during pregnancy. It includes a full-term duration 40 weeks (usually between 37 and 42 weeks gestation) and is associated with normal fetal growth, maternal health, and no significant deviations from expected prenatal development or care. 3. Gestational Age: Gestational Age: The age of the pregnancy calculated from the first day of the last menstrual period (LMP). For example, if a woman is 8 weeks pregnant, this means it has been 8 weeks since the start of her last menstrual period. 2. Antepartum Period: Antepartum Period: The period of time during pregnancy before labor begins. It encompasses the entire duration of the pregnancy from conception to the onset of labor. Pregnancy Pregnancy is the period of time between conception and birth, during which time the fertilized ovum matures and grows in the uterus. Pregnancy is divided into three trimesters each consisting of 3 calendar months First Trimester :up to 12th week Second Trimester :13th - 28th week Third Trimester :29th-40th week Physiological changes in Pregnancy Physiological changes in Pregnancy During pregnancy progressive anatomical & physiological changes takes place in all the systems of the body which is a phenomenon of maternal adaptation to the increasing demands of the growing fetus The changes during pregnancy are brought about by specific hormones. The psychological state of the mother is also affected by the harmones.These changes interact with other external factors and influence her transition to motherhood 1, Reproductive system External Genitalia Vulva (Pudendum ) - Oedamatous & hyperaemic and Superficial varicosities appear Labia minora (smaller lips )- Pigmented & hypertrophied Vaginal walls hypertrophied,oedematous and more vascular Increased blood supply surrounding the vaginal walls gives the bluish discoloration of the vaginal mucosa (Jacquemiers ) Vaginal secretions increase and become more thin & curdy white (Leucorrhea ) due to marked exfoliated cells & bacteria B ) Internal Genitalia 1.Uterus Changes occur in all parts of the uterus ie body, isthmus and cervix Uterus increases in weight from 60 to 900 Hypertrophy & hyperplasia The individual muscle fibers increase in length and breadth and there is addition of new muscle fibers under the influence of estrogen & progesterone Vascular system Uterine blood supply increases  Position of the uterus Normal position is anteverted and anteflexed. The anteverted position is exaggerated up to 8 weeks causing frequency of micturition. Contractions ( Braxton-Hicks ) Spontaneous, irregular, infrequent & painless without any effect in cervix Intra-uterine pressure remains < 8mmHg  Isthmus First trimester-hypertrophies & elongates 3 times its normal length ( N-0.5cms ) & gets softer Cervix Increased vascularity gives a bluish purple discoloration- Chadwicks sign brought about by increased oestrogen hypertrophy & hyperplasia of the glands leads to marked softening of the cervix ( Goodells sign ) Fallopian tubes and Ovaries Increased blood supply Corpusluteum in the ovaries enlarges and produces large amounts of estrogen & progesterone in the early 10-12 weeks of pregnancy, after which the placenta matures and takes over the hormone production. Corpusluteum completely regresses by mid – pregnancy Breasts- Accessory reproductive organs Size Breast enlarges Prominent Montgomery's tubercles on areola 2.CIRCULATORY SYSTEM SYSTEMIC CHANGES Blood volume increases by 30 % Cardiac output increases from 5-7 litres per minute by late pregnancy Plasma volume increases by 50 % ( 1.25 liters ) RBC volume increases by 18-20 % ( 250ml ) Disproportionate increase in plasma & RBC volume(haemodilution)is characterized by lowered hemoglobin ,haematocrit & red cell count leads to physiological anemia Leucocytes-Neutrophilic leucocytosis. Immunoglobulin levels-IgA,IgG & igM Iron Metabolism-Iron requirements increases significantly in the last trimester, during which time iron absorption from gut is enhanced Plasma Proteins Total plasma proteins increase reduces viscosity of blood & osmotic pressure and results in moderate oedema ( physiological oedema).  Blood coagulation factors Coagulation time changed from 12 to 8 minutes (state of hyper coagubility ) at risk for thrombosis & embolism  Blood Pressure Arterial walls relax and dilate (progesteron) Mid pregnancy- fall in Bp, especially diastolic by 5-10Hg Late pregnancy- supine position Pressure on the inferior vena cava( enlarged uterus) reduced venous return & cardiac output Supine hypotensive syndrome Clinical manifestations of Supine Hypotensive Syndrome dizziness, light headedness, increased pulse, nausea & vomiting, drop in blood pressure Supine Hypotensive Syndrome 2. RESPIRATORY SYSYTEM Oxygen requirements increased by 20 % Pulmonary smooth muscles relax ( progesterone ) hyperventilation and shortness of breath in late pregnancy PCO2 rises from 95-105 mm Hg ( facilitates transfer of C02 from fetus to mother & oxygen from mother to fetus ) hyperemic & oedema of respiratory tract mucosa with hypersecretion of mucus (nasal stuffiness & epistaxis- oestrogen ) 3. GASTRO-INTESTINALSYSTEM hypertrophy of gingival tissues ( epulis ), sensitive gums and prone for bleeding ( estrogen ) ptyalism - Excessive salivation ( oestrogen) drying and cracking of lips ( depletion of vitamins ) morning sickness ( elevated HCG & progesterone ) heart burn (progesterone )relaxation of cardiac sphincter causes regurgitation of acid gastric content into the oesophagus flatulence due to increased intragastric pressure as a result of the heavy uterus on the stomach constipation ( decreased peristalsis and loss of muscle tone in the GI tract )due to progesterone gall bladder increases in size ,empties slowly leads to stasis of bile hence may cause pruritis or gall stone formation  changes in the sense of taste, dietary changes and food craving Pica ( craving for unnatural substances ) 4. URINARY SYSYTEM Kidneys dilatation of renal pelvis GFR increased by 50 % enhances glucose excretion ( glycosuria, UTI ). Ureters becomes atonic ( progesterone) dilatation of the ureters  Bladder Increased frequency of urine 6-8 weeks which subsides after 12 weeks ( anteverted uterus irritating the fundus of the bladder) Increased frequency in late pregnancy due to pressure of the presenting part on the bladder. 5.INTEGUMENTARY SYSTEM Increased blood supply to skin leads to sweating, women feel hotter in pregnancy ( progesterone ) which increases temperature by 0.5 degree C together due to vasodilatation Deep pigmentation due to increased activity of melanin stimulating hormone ( ant pituitary ) Face-chloasma/mask of pregnancy, deep patchy discoloration on face, around cheek, forehead and eyes http://www.hpathy.com/diseases/chloasma-melasma-symptoms-treatment-cure.asp Breast- Primary & Secondary areola Abdomen-Linea Nigra, pigmented line running from the pubis to the umbilicus Striae Gravidarum ( Striae albicans, after the stretch marks ) pinkish delivery the scar tissues in color on contract and obliterate the capillaries and become abdomen,breast,thighs glistening white in and buttocks. appearance. 6. ENDOCRINE SYSYTEM Thyroid Glands-enlarges Total T4 rises but levels of free T3 & T4 unaffected (euthyroid state maintained ). Pancreas-insulin resistance increases with advancing pregnancy mainly due to insulin antagonism by human placental lactogen ( HPL ). 7. MUSCULO SKELETAL SYSYTEM Relaxation of ligaments & muscles allowing the pelvis to increase capacity to accommodate fetal presenting part at the end of pregnancy and labour (progesterone & relaxin ) 8. NERVOUS SYSTEM Compression of median nerve under the carpal ligament over the wrist joint (carpal tunnel syndrome ) causing pain & par aesthesia in the hands & arms Temperamental changes noticed Mood changes & symptoms of psychosis may develop in those with a family history 9.METABOLIC CHANGES General metabolic changes BMR basal metabolic rate increases in the later half of pregnancy to the extent of 30 % higher than that for non-pregnant women Carbohydrate metabolism Total daily energy requirement increases by 300 k calories 10.Weight gain and Water metabolism Total weight gain during pregnancy is 12 kg, distributed as 1-2.5 kg in first trimester, thereafter 0.5 kg every week Distribution of weight gain PSYCHOLOGICAL CHANGES IN PREGNANCY Factors influencing the psychosocial effects of pregnancy 1. General physical health. 2. Age. 3. Emotional maturity. 4. Stability. 5. Educational background. 6. Working status. 7. Cultural consideration. 8. Financial consideration. 9. Timing of pregnancy. Phases of Psychological Adaptation First Trimester: Acceptance and Adjustment Focus: Pregnancy confirmation and adaptation. Common emotions: Shock, ambivalence, joy. Second Trimester: Connecting to the Fetus Focus: Fetal movement felt, stronger bonding. Common emotions: Calmness, anticipation. Third Trimester: Preparing for Birth Focus: Readiness for childbirth, nesting behavior. Common emotions: Increased anxiety, impatience, excitement. References 1. Konar H. DC Dutta’s Textbook of Obstetrics. 9th ed. India: Jaypee Brothers Medical Publishers; 2018. ISBN-13: 978-9352-702-428. Pg 42 -51, 60- 66. 2. Pillitteri A. Maternal and child health Nursing: care of childbearing &childrearing. 8th ed. Philadelphia: Lippincott Williams & Wilkins; 2017. ISBN-13: 978- 1496-348-135.Pg 203 – 207, 213 -220, 3. https://www.lecturio.com/nursing/free-cheat- sheet/physiology-of-pregnancy/ 4. https://www.youtube.com/watch?v=1ahxtcA5_3I