Psychological and Physiological Changes of Pregnancy

 Pregnancy brings both psychological and physical changes to the woman

and her partner.

 Physiologic changes occur gradually but eventually affect all organ

systems of a woman’s body.

 Psychological changes occur in response to physiologic alterations.

 Pregnancy represents wellness not illness.

Changes in Pregnancy

 The nurse will help the family maintain a state of wellness throughout the

pregnancy and into early parenthood.

 Nursing Process:

 Assessment begins before pregnancy

 Plan-women are often surprised to see the changes occurring in herself

 Implementation-women need help in voicing their concerns about the

physiologic changes of pregnancy.

 Evaluation

 Evaluation-determined if the woman has really “heard” your teaching.

Diagnosis of Pregnancy
 Marks a major milestone.

 Presumptive Signs of Pregnancy:

 least indicative of pregnancy, could indicate other conditions

 subjective-experienced by the woman

 breast changes, nausea, vomiting, amenorrhea, frequent urination,

fatigue, uterine enlargement, quickening, linea nigra, melasma, stria gravidarum.

Probable Signs of Pregnancy

 Signs that can be documented by the examiner

 Serum laboratory tests:

 hCG in urine or blood serum of the women.

 accurate 95% to 98 % of the time.

 home pregnancy tests are 97% accurate.

 women taking psychotropic drugs may have a false positive result on

pregnancy test.

 discontinue oral contraceptives 5 days before the test.

 Chadwick’s sign

 Goodell’s sign

 Hegar’s sign

 Sonographic evidence of gestational sac

 Ballottement
 Braxton Hicks sign

 Fetal outline felt by examiner

 Sonographic evidence of fetal outline

 week 6-8

 Fetal heart audible

 week 18-20

 Fetal movement felt by examiner

 week 20-24

 Psychological Changes of Pregnancy:

 The woman’s attitude toward the pregnancy depends on the environment

in which she is raised.

Psychological Changes of Pregnancy

 Social influences

 Pregnancy is not an illness, now the family is included.

 Use of birthing centers has increased.

 Demedicalize childbirth.

 Cultural influences

 How active a role she wants to take.

 Certain beliefs and taboos may place restrictions on her behaviors and

activities.

 Family influences
 Viewed in a positive or negative light.

 Stories about pain and endless suffering in labor.

 People love as they have been loved.

 Individual influences

 Ability to cope with or adapt to stress.

 Secure in her relationship.

 Pregnancy takes away her freedom.

Psychological Tasks of Pregnancy

 1st Trimester:

 Accepting the Pregnancy

 50% of all pregnancies are unintended, unwanted or mistimed. Surprise!

 Women sometimes experience disappointment, anxiety or ambivalence.

 Partner may go through some changes also.

 Partner should give emotional support.

 May feel proud, happy, jealous or loss.

 2nd Trimester

 Accepting the Baby:

 Second turning point is often quickening.

 Proof of the child’s existence.

 Anticipatory role playing.

 May accept at conception, at birth or later.

 How well she follows prenatal instructions.

 Partner may feel left out, he may increase his work, he has

misinformation.

 Educate both partners.

 3rd Trimester:

 Preparing for Parenthood

 “nest building”

 attending prenatal classes or parenting classes.

 Reworking Developmental Tasks

 working through previous life experiences.

 woman’s relationship with her parents, particularly her mother.

 fear of dying.

 Needs confidence in health care providers.

 Men may need to reconcile feelings toward fathers and learn a new

pattern of behavior.

 Role-playing and Fantasizing:

 Second step in preparing of parenthood.

 Spend time with other mothers to learn how to be a mother. Needs good

role models.
 Father may need to change his carefree individual to a member of a

family unit.

 Nurturing roles.

Emotional Responses to Pregnancy

 Ambivalence

 Grief

 Narcissism

 Introversion versus Extroversion

 Body Image and Boundary

 Stress

 Couvade Syndrome

 Emotional Lability

 Changes in Sexual Desire

 Changes in the Expectant Family

 Local changes - confined to the reproductive organs.

 Systemic changes - affecting the entire body.

 Both subjective (symptoms) and objective (signs) findings are used to

diagnose and mark the progress of the pregnancy.

 Reproductive System Changes: (table 9.3)

 Uterine changes:

 Increase in size, length, depth, width, weight, wall thickness and volume.
 Length-from 6.5 to 32 cm.

 Depth-increases from 2.5 to 22 cm.

 Width-expands from 4 to 24 cm.

 Weight-increases from 50 to 1,000 g.

 Uterine wall thickens from 1 cm to 2 cm by the end of pregnancy, the wall

thins so it is supple and 0.5 cm thick.

 Volume of uterus increases from 2 mL to 1,000 mL. It can hold a 7 lb.

fetus plus 1,000 mL of amniotic fluid. Total 4,000 g.

 Uterine growth is due to formation of a few new muscle fibers and

stretching of existing muscle fibers (2 to 7 times longer).

 Week 12 the fetus is palpated just above the symphysis pubis.

 Week 20 or 22 the fetus is at the umbilicus.

 Week 36 should touch the xiphoid process which causes some SOB.

 Primigravida - woman in her 1st pregnancy.

 Multipara - a woman who has had 1 or more children.

 Lightening - 2 weeks before term (week 38) the fetal head settles into the

pelvis to prepare for birth and the uterus returns to the height it was at on the

36 week.

 This permits better lung expansion and easier breathing.

 This is predictable in 1st birth but not others.

 Uterine growth is a presumptive sign of pregnancy.

 As the uterus increases in size it:

 pushes the intestines to the side

 elevates the diaphragm and liver

 puts pressure on the bladder

 Uterine blood flow increases:

 before pregnancy - 15 to 20 mL/ min.

 by the end of pregnancy - 500 to 750 mL/min. with 75% going to the

placenta.

 Uterine bleeding can be a major blood loss.

 Uterus is anteflexed, larger and softer.

 Hegar’s sign - extreme softening of the lower uterine segment. The wall

can not be felt or it feels as thin as tissue paper with bimanual exam.

 Ballottement - on bimanual exam, tapping of lower segment the fetus is

felt to bounced or rise in the amniotic fluid up against the to top examining hand

(week 16 to 20).

 Braxton Hicks contractions - practice contractions. Week 12 until term.

Waves of hardness or tightening across the abdomen.

 They serve as warm-up exercise and increase placental perfusion.

 False labor, the do not cause cervical dilation.

 Amenorrhea - absence of menstruation due to suppression of FSH.

 Presumptive sign.
 Cervical changes:

 Cervix more vascular and edematous.

 Increased fluid between the cells causes the cervix to soften and

increased vascularity causes it to darken from pale pink to a violet hue.

 A tenacious coating of mucus fills the cervical canal.

 Operculum - mucous plug - seals out bacteria during pregnancy.

 Goodell’s sign - softening of the cervix.

 Nonpregnant cervix is like the nose.

 Pregnant is like earlobe.

 Just before labor the cervix becomes soft like butter and is “ripe” for birth.

 Vaginal changes:

 vaginal epithelium become hypertrophic and enriched with glycogen which

results in white vaginal discharge throughout pregnancy.

 Chadwick’s sign - vaginal walls are deep violet color due to increased

circulation.

 pH 4 to 5 (from pH over 7) favors growth of Candida albicans (yeast like

fungi).

 due to Lactobacillus acidophilus a bacteria that grows freely in glycogen

environment, so this increases the lactic acid content.

 Ovarian changes:

 ovulation stops.
 Corpus luteum increases in size until week 16 and then the placenta has

taken over as provider of progesterone and estrogen.

 Changes in the breasts:

 result of estrogen and progesterone production. (1st change)

 feeling of fullness, tingling or tenderness.

 Size increases due to hyperplasia of mammary alveoli and fat deposits.

 aerola darkens and diameter increases to 3.5 cm to 5 or 7.5 cm (1 1/2 to

3 inches)

 blue veins become prominent.

 Montgomery’s tubercles-sebaceous glands of the areola enlarge and

become protuberant.

 secretions keep the nipple supple and help prevent cracking and drying

during lactation

 week 16 colostrum-a thin, watery, high protein fluid can be expelled from

the breast

 Systemic Changes:

 Integumentary System

 Abdominal wall must stretch

 Striae gravidarum - pink or reddish streaks on sides of abdomen and

thighs.

Systemic Changes

 Caused by rupture and atrophy of the connective layer of the skin.

 After birth this lightens to silvery-white color. (permanent)

 Diastasis-rectus muscles separate, will appear after pregnancy as a bluish

groove.

 Umbilicus stretches until it is smooth.

 Extra pigmentation on abdominal wall.

 Linea nigra - brown line from umbilicus to symphysis pubis.

 Melasma - darkened areas on face due to melanocyte-stimulating

hormone secreted by the pituitary.

 Vascular spiders - small fiery-red branching spots on thighs, increases

estrogen.

 Palmar erythema - redness and itching.

 Increased sweat gland activity.

 Scalp hair growth increases.

 Respiratory System

 SOB

 Chronic respiratory alkalosis compensated by chronic metabolic acidosis.

 Diaphragm is displaced by 4 cm upward.

 Vital capacity does not decrease.

 Residual volume is decreased by 20%.

 Tidal volume is increased up to 40%

 Total O2 consumption is increased by 20%.

 Pco2 is 32 mm Hg
 Mild hyperventilation.

 Polyuria - increased urination due to plasma bicarbonate excreted by the

kidneys.

 respirations > 20/min.

 congestion of nasopharynx - increased estrogen levels.

 Temperature:

 increased for 16 weeks due to secretion of progesterone from the corpus

luteum, returns to normal once the placenta takes over.

 Cardiovascular System:

 Changes are extreme and significant to the health of the fetus.

 Blood volume

 increases by 30 to 50 %

 blood loss at birth-300 to 400 mL

 cesarean birth-800 to 1,000 mL

 increase blood volume peaks at week 28 to 32

 Pseudoanemia - concentration of hemoglobin and erythrocytes decline.

 Iron needs

 fetus requires 350 to 400 mg to grow.

 Mother has an increase in RBC needing an additional 400 mg of iron.

 Prenatal vitamins and foods supply needs.

 Heart

 cardiac output increases by 25 to 50 %

 heart rate increases by 10 beats/ min.

 heart is shifted more transverse

 Innocent heart murmurs due to positioning.

 Palpitations SNS

 Regional blood flow:

 3rd trimester blood flow to lower extremities is impaired due to pressure

on veins and arteries.

 leads to edema and varicoaities.

 Blood pressure:

 does not normally rise

 may decrease in 2nd trimester

 Supine hypotension syndrome:

 when woman lies supine the weight of the uterus presses on the vena

cava obstructing blood return to the heart.

 risk fetal hypoxia

 lightheadedness, faintness and palpitations.

 rest on left side.

 Blood constitution:

 level of circ. fibrinogen increases 50%.

 Factors VII, VIII, IX, X and platelets increase.

 Blood lipids increase by 1/3

 cholesterol level increase 90 to 100 %

 Gastrointestinal system

 Uterus displaces the stomach and intestines toward the back and sides of

the abdomen.

 Pressure slows peristalsis and the emptying time of the stomach.

 Leads to heartburn, constipation and flatulence.

 Nausea and vomiting in early morning.

 When hCG and progesterone begin to rise.

 May be a systemic reaction to increases estrogen or decreased glucose

levels.

 Subsides after 3 months

 Generalized itching due to reabsorption of bilirubin into the mother’s blood

stream due to decreased emptying of bile from the GB.

 Hypertrophy of the gumlines and bleeding.

 Peptic ulcers improve.

 Urinary System

 Effects of estrogen and progesterone activity.

 Compression of the bladder and ureters.

 Increased blood volume

 Postural influences

 Fluid retention:

 total body water increases to 7.5 L

 increase sodium reabsorption

 Increased aldosterone production.

 Potassium remains adequate.

 Water retension increases blood volume to serve as a source of nutrients

to the fetus.

 Renal Function:

 Kidneys change size.

 Urinary output increases by 60 to 80 %.

 GFR and renal plasma flow increase.

 Creatinine clearance tests for renal function.

 Ureter and Bladder Function

 ureters increase in diameter due to increased progesterone.

 bladder capacity increases to 1,500 mL

 pressure on the urethra may lead to poor bladder emptying and

infections.

 May lead to kidney infection.

 Skeletal System

 Calcium and phosphorus increase for fetal skeleton.

 Softening of pelvic ligaments and joints.

 Relaxin (ovarian hormone) and placental progesterone.

 Separation of symphysis pubis-3 to 4 mm.

 Stand straighter and taller - lordosis

 Center of gravity is changed.

 Endocrine System

 Almost all aspects of the endocrine system increase.

 Placenta is an endocrine organ

 Produces estrogen, progesterone, hCG, human placental lactogen,relaxin,

prostaglandins.

 Pituitary Gland

 there is a halt to FSH and LH due to high estrogen and progesterone

levels.

 Increase in production of growth hormone and melanocyte-stimulating

hormone.

 Late in pregnancy it produces oxytocin and prolactin.

 Thyroid and Parathyroid Glands

 thyroid enlarges and BBM (metabolism) increases by 20%

 iodine and thyroxine are elevated.

 Parathyroid enlarges due to increased calcium requirements.

 Adrenal Gland

 Elevated levels of corticosteroids and aldosterone are produced.

 Aids in suppressing an inflammatory reaction or helps to reduce the

possibility of rejection of the fetus.

 Regulates glucose metabolism.

 Promotes sodium reabsorption and maintaining osmolarity in fluid

retained.

 Safeguards blood volume and perfusion

 Pancreas

 Increases insulin production in response to high glucocorticoid

production.insulin is less effective then normal because estrogen, progesterone

and hPL are antagonists to insulin.

 Diabetic needs more insulin.

 Maternal glucose levels are usually higher.

 Fat stores and available glucose are utilized.

 Immune System

 Competency decreases (IgG) to not reject the fetus.

 Increase in WBC to counteract the decrease.

KAFEIN SAAT HAMIL?

Beberapa minuman yang sudah sangat familiar menjadi minuman sehari-hari yang kita

minum seperti teh dan kopi. Kafein adalah salah satu zat yang terkandung pada kedua

minuman ini. Berbicara tentang kafein, konsumsi di saat kondisi hamil haruslah

diperhatikan karena kafein dalah jumlah banyak dapat berdampak negatif terhadap bayi

di dalam kandungan.

Kenapa dapat merugikan bagi kehamilan?

Ibu : menstimulasi peningkatana denyut jantung dan tekanan darah

Meningkatkan frekuensi berkemih sehingga bisa dehidrasi

Keguguran

Dampak negatif pada bayi

Denyut jantung meningkat

Gangguan pola tidur dan pola gerak janin

Bayi Berat Lahir rendah

Berapa batas berisiko kafein? 150 mg atau lebih per hari

Jumlah kafein pada beberapa minuman :

1 cangkir kopi instan : 100 mg

1 cangkir kopi saring : 140 mg

1 cangkir teh : 75 mg

1 kaleng minuman cola : 40 mg

250 ml minuman berenergi : 80 mg

50 g coklat murni : 25 mg

50 g coklat susu : 10 mg
Boleh mengonsumsi minuman mengandung kafein dalam jumlah aman yakni tidak lebih

dari 150 mg per hari.