MATERNAL ADAPTATIONS

QKCC 1
 Breast
– estrogen causes
hyperplasia,
engorgement, feelings of
fullness, tingling
sensation, tenderness
 nipple & areola
become larger &
darker in color
 blood vessels
enlarge & become more
prominent
 proper breast support
with well fitting
brassiere
QKCC 2
Body Mass

– weight gain 25-30lbs

 first trimester : wt gain 3 – 4 lbs
 2nd trimester: wt gain 12 – 14 lbs
 3rd trimesters : wt gain of 10-12 lbs /

QKCC 3
 Skin
– pigmentations
 Striae gravidarum – pink or reddish streaks
on thigh, breasts, abdomen as result of fat
deposits (stretch)
 Chloasma (mask of pregnancy) – blotchy
brown areas on face, forehead, cheeks
 Linea Nigra – dark pigmented line on
abdomen
 vasodilation of veins – minute vesicular
spiders
 umbilicus pushed outward
 sweat & sebaceous glands are more active
QKCC 4
QKCC 5
 REPRODUCTIVE SYSTEM

UTERUS
•Enlarges, irregular painless contractions occur
OVARY
• ovulation stops
VAGINA
• becomes softer, mucosa thickens
•vaginal discharge increases
•More acidic

QKCC 6
 REPRODUCTIVE SYSTEM

BREAST

•Increases in size
•Areola darken
•Colostrum is excreted

CERVIX
•Softens
•Forms mucus plug

QKCC 7
 Musculoskeletal

Lordosis ( Pride of Pregnancy)

Backache

 Occasional cramps in calf

Widening of symphisis pubis

Waddling gait

QKCC 8
 Hormonal
 Estrogen – enlargement of uterus, breasts, genitals,
fat deposition, increased elasticity, sodium &
water retention, vascular changes
 Progesterone – maintains pregnancy state, decrease
contractility of uterus,  gastric motility, relaxed
sphincters
 Human chorionic somatomammotropin & Human
placental lactogen – anabolic effect - insulin antagonist
 Prolactin – by anterior pituitary for milk secretion
after placental delivery
Oxytocin – by posterior pituitary for labor
&lactation
QKCC 9
 Blood & Respiration

BLOOD – increased by 50%. Normal BP maintained

by peripheral vasodilation
  RBC & WBC, clotting factors
 hemoglobin & hematocrit slightly decreases
in response to hemodilution; physiologic
anemia

RESPIRATION – enlarged uterus causes the

diaphragm to be displaced upward putting
pressure on lungs and causes shortness of
breath QKCC 10
 Digestion and Urinary System
DIGESTION
 Nausea & vomiting occurs during 1st trimester
 Hyperemesis gravidarum - excessive / persistent
 Progesterone – induce relaxation of muscle tone
causes constipation, flatulence, heartburn
 Cravings for certain foods. Pica

URINARY SYSTEM – urine output & low specific gravity.

  1st and 3rd trimester
1st – increased blood supply to kidneys & uterus
rising out of pelvic cavity
3rd – pressure on enlarged uterus
 2nd trimester – decreased output & reabsorption – to
maintain increased bloodQKCC volume 11
 Endocrine
ENDOCRINE – Placenta also considered as an
endocrine gland;
• additional
 moderate enlargement of thyroid gland;
hyperplasia due to increased vascularity & basal
metabolic rate
 gradual increase in insulin production but the
body sensitivity to insulin is decreased during
pregnancy

QKCC 12
MATERNAL ADAPTATIONS

PSYCHOLOGICAL
QKCC 13
FIRST TRIMESTER
 Maternal ambivalence
 some degree of rejection, disbelief, denial and
repression

SECOND TRIMESTER
 Mother is self absorbed and introverted
 usually increased maternal feelings of physical
and emotional well being
 fetus is perceived as a separate entity.
 Fantasize appearance of the baby
THIRD TRIMESTER
 Fears related to labor and delivery
 feelings of awkwardness clumsiness & decreased
femininity related to changes in body image
QKCC 14
PSYCHOSOCIAL
ADAPTATIONS TO
PREGNANCY

QKCC 15
 DEVELOPMENTAL TASKS OF
PREGNANCY
“I AM PREGNANT”
acceptance of the biological fact of pregnancy

“I AM GOING TO HAVE A BABY”

acceptance of the fetus as a distinct individual and a person to care for.

“I AM GOING TO BE A MOTHER”
prepare realistically for the birth and parenting of the
child.

QKCC 16
Question:
It is characterized
by psychological &
behavioral
manifestation
experienced by
the husband?
Answer:
Couvade
syndrome
QKCC 17
 PSYCHOLOGICAL

PATERNAL REACTIONS –
may parallel those of
mother; some may
experience physical
symptoms of pregnancy
( couvade syndrome )

ADAPTATION OF SIBLING –
Preparation QKCC 18
DETERMINATION OF PREGNANCY

QKCC 19
PRESUMPTIVE SIGNS & SYMPTOMS

•Amenorrhea
•Nausea and vomiting
•Breast increase in fullness and color
•Weight changes
•Fatigue
•Urinary frequency
QKCC 20
PRESUMPTIVE SIGNS & SYMPTOMS

• Skin Pigmentation changes

• Vaginal Changes
• Leukorrhea
• Quickening

These signs are NOT conclusive for pregnancy.......!

QKCC 21
PROBABLE SIGNS AND SYMPTOMS
(OBJECTIVE)
Not conclusive for pregnancy.
Uterine enlargement Changes in pelvic organs

GOODELL sign – softening of the cervix.

HEGAR sign – softening of the lower uterine segment.

PISKACEK sign – enlargement of the uterus.

QKCC 22
QKCC 23
 PROBABLE SIGNS AND SYMPTOMS
(OBJECTIVE)
BALLOTTEMENT
– fetus rebounds against the examiner’s hand when pushed gently
upwards.
BRAXTON HICK’S CONTRACTIONS
– intermittent contractions of the uterus occurring throughout
pregnancy; generally painless but may cause discomfort late in
pregnancy can be felt by the 4th month of pregnancy.
Changes in skin pigmentation

(+) hCG tests

QKCC 24
 POSITIVE SIGNS AND
SYMPTOMS
These signs emanate from the fetus, are noted by the health
care provider, and are conclusive for pregnancy.

Fetal heartbeat – audible at 10 – 12 weeks’ gestation by Doppler

ultrasound, and 10-20 weeks’ gestation with a
fetoscope. The normal fetal heart rate is 120-160
bpm.
Fetal movements palpable by examiner.
Palpation of fetal outline
Demonstration of fetal outline by either ultrasound

QKCC 25
 CLASSIFICATIONS OF
PREGNANCY
GRAVIDA
- number of times pregnant, regardless of duration, including
the present pregnancy.

PRIMIGRAVIDA
- pregnant for the first time.

MULTIGRAVIDA
- pregnant for second or subsequent time.

QKCC 26
 CLASSIFICATIONS OF
PREGNANCY
PARA
- number of pregnancies that lasted more than 20
weeks, regardless of outcome.
• NULLIPARA
- a woman who has not given birth to a baby beyond
20 weeks gestation.
• PRIMIPARA
- a woman who has given birth to one baby more than
20 weeks gestation.
• MULTIPARA
- a woman who has had two or more births at more
than 20 weeks gestation.
Note: Twins or triplets counted as 1 para.
QKCC 27
 CLASSIFICATIONS OF
PREGNANCY
TPAL
- Para subdivided to reflect births that went to Term,
Premature births, Abortions, and Living children.

• PRETERM
- newborn born before 37 weeks of gestation.

• TERM
- newborn born after 37 weeks to 40 weeks of
gestation.

• POST-TERM
- newborn born after 40 QKCC
weeks of gestation. 28
PRENATAL CARE

SCHEDULE OF VISITS

• Every 4 weeks, up to 32 weeks

Every 2 weeks from 32-36 weeks

(more frequently if problems exist)
• Every week from 36-40 weeks

QKCC 29
FETOSCOPE

QKCC 30
FUNDAL MEASUREMENT

QKCC 31
FUNDAL
HEIGHT

QKCC 32
 EVALUATION OF FETAL
WELL-BEING
ULTRASONOGRAPHY
Transducer on abdomen transmits sound waves that show fetal
image on screen.
Provide useful information when assessing fetal growth and well-
being. It provides direct information about the fetus during each
trimester.
FIRST TRIMESTER
 Assessment of gestational age.
 Evaluation for congenital anomalies.
 Diagnostic evaluation of vaginal bleeding.
 Confirmation of suspected multiple gestation.
 Evaluation of fetal growth.
 Adjunct to prenatal testing (Amniocentesis or chorionic villi sampling)
QKCC 33
 EVALUATION OF FETAL WELL-
BEING
ULTRASONOGRAPHY
SECOND TRIMESTER
Assessment of gestational age.

Evaluation for congenital anomalies

(hydrocephaly)
Assessment for fetal growth.
Guidance of procedures (Amniocentesis and
fetoscopy)
Assessment of placental location.
Diagnosis of multiple gestation.
THIRD TRIMESTER
Determination of fetal position.
Estimation of fetal size.
QKCC 34
QKCC 35
Amniocentesis

QKCC 36
 EVALUATION OF FETAL
WELL-BEING
AMNIOCENTESIS
Used to determine fetal maturity and detect certain birth defects such as
DOWN SYNDROME, SPINAL BIFIDA, HEMOLYTIC DISEASE OF
THE NEWBORN, SEX AND CHROMOSOMAL ABNORMALITIES.

Amniotic fluid is aspirated by a needle which is inserted through the

abdominal wall and uterine walls.

Done at 16 weeks to assess L/S ratio and detect genetic disorder. Possible
after week 14.
QKCC 37
Amniocentesis

QKCC 38
 EVALUATION OF FETAL
WELL-BEING
AMNIOCENTESIS
PREPARATION:
Prior to procedure, the patient’s bladder should be emptied.
Ultrasound used prior to procedure to guide needle to prevent fetal and
placental trauma.
TEST RESULTS: within 2-4 weeks
COMPLICATIONS:

Premature labor, infection, Rh isoimmunization

Monitor fetus and uterine contractions after procedure.
Teach client to report decreased fetal movement or increased
abdominal discomfort. QKCC 39
Amniocentesis results
Normal Abnormal
L/S 2:1 (mature) 1:1 (immature)
-Prone to RDS
-Bethamethasone/Dexametha
sone at least 24 hours before
delivery
AFP 2-4 g/L or -Increase in neural tube
(13wks) 2.5MOMS defects
-(spina bifida, meningocele)
QKCC 40
QKCC 41
Chorionic Villus Sampling

QKCC 42
CVS

QKCC 43
QKCC 44
QKCC 45
 EVALUATION OF FETAL WELL-BEING
CHORIONIC VILLI SAMPLING

Earliest test possible on fetal cells alternative to amniocentesis to diagnose

fetal karyotype and genetic anomalies (sickle-cell anemia, PKU, Down
syndrome, Duchenne muscular dystrophy).
Done between 9-12 weeks;

Complications: Bleeding, spontaneous abortion, premature rupture

of membranes.

Rh(-) mother receive RhoGAM after test to prevent Rh isoimmunization.

Ultrasound used to guide.

QKCC 46
TEST RESULTS: Within 2-10 days.
Percutaneous Umbilical Blood Sampling

QKCC 47
PUBS (CORDOCENTESIS)

QKCC 48
 EVALUATION OF FETAL
WELL-BEING
PERCUTANEOUS
UMBILICAL BLOOD
SAMPLING

• Involves inserting a needle into the fetal umbilical cord and

aspirating blood for analysis.

• The procedure is guided by U/S and is used to screen karyotypes

(chromosomes), examine antibodies for teratogenic viruses and
provide assess for fetal blood transfusions..

QKCC 49
QKCC 50
 EVALUATION OF FETAL WELL-
BEING
Biophysical Profile: data on fetal
breathing movements, body movements,
muscle tone, reactive heart rate, and
amniotic fluid volume
Electronic Monitoring:
1. Non stress Test (NST): accelerations in heart rate accompany
normal fetal movement
RESULT:REACTIVE, 2 or more
accelerations of 15 beats/min. Lasting
15 sec or more in 20-min period
Nonreactive- presence of less than two fetal heart rate
accelerations within a 20-minute period over a 40-minute testing
period
QKCC 51
QKCC 52
QKCC 53
EVALUATION OF FETAL WELL-BEING
2. Contraction Stress Test (CST ):
Types
a. Nipple Stimulated CST
b. Oxytocin Challenge Test
,

*CST is NEVER DONE unless WILLING to DELIVER*

QKCC 54
DANGER SIGNS OF PREGNANCY
 Any bleeding from vagina.
 Gush of fluid from vagina

 Regular contractions occurring before due date.

 Severe headaches or changes in vision.
 Epigastric pain.
 Vomiting that persists and is severe.
 Change in fetal activity pattern.
 Temperature elevation, chills or “sick” feeling
 Swelling in upper body, especially face and fingers.
QKCC 55
COMMON DISCOMFORTS
OF PREGNANCY

QKCC 56
 RELIEVING THE COMMON
DISCOMFORTS OF PREGNANCY
ANKLE EDEMA

• Rest with your feet elevated.

• Avoid standing for long periods of time.
• Avoid restrictive garments on the lower half
of your body.

QKCC 57
RELIEVING THE COMMON
DISCOMFORTS OF PREGNANCY
BACKACHE
• Apply local heat.
• Avoid long periods of standing.
• Stoop to pick up objects.
• Tylenol in usual adult dose may help.
• Wear low-heeled shoes.
• Maintain correct posture.
QKCC 58
Birth ball

QKCC 59
RELIEVING THE COMMON
DISCOMFORTS OF PREGNANCY
BREAST TENDERNESS

Wear a supportive bra.

Decrease the amount of caffeine and

carbonated beverages ingested.
QKCC 60
RELIEVING THE COMMON
DISCOMFORTS OF PREGNANCY
CONSTIPATION
• Increase fiber in your diet.
• Drink additional fluids.
• Have a regular time for bowel movements.

QKCC 61
 RELIEVING THE COMMON
DISCOMFORTS OF PREGNANCY
DIFFICULTY SLEEPING
 Drink a warm, caffeine-free
drink before bed and practice
relaxation techniques.

QKCC 62
 RELIEVING THE COMMON
DISCOMFORTS OF PREGNANCY
FATIGUE

• Schedule rest periods daily. Have a

regular bedtime routine.

• Use extra pillow for comfort.

QKCC 63
RELIEVING THE COMMON DISCOMFORTS OF
PREGNANCY
FAINTNESS

• Move slowly.
• Avoid crowds.
• Remain in a cool environment.
• Lie on your left side when at rest.

QKCC 64
RELIEVING THE COMMON DISCOMFORTS OF
PREGNANCY

HEADACHE

• Avoid eye strain.

• Rest with a cool cloth

on your forehead.

QKCC 65
 RELIEVING THE COMMON
DISCOMFORTS OF PREGNANCY
HEARTBURN

• Eat small, frequent meals each

day.

• Avoid overeating, as well as

spicy, fatty and fried foods.

QKCC 66
RELIEVING THE COMMON DISCOMFORTS OF
PREGNANCY

HEMORRHOIDS

• Avoid
constipation and straining with a
bowel movement.
• Take a sitz bath. Apply a witch hazel
compress.
QKCC 67
RELIEVING THE
COMMON DISCOMFORTS
OF PREGNANCY

LEG CRAMPS

• Avoid pointing your toes.

• Straighten your leg and dorsiflex your

ankle.

QKCC 68
RELIEVING THE COMMON
DISCOMFORTS OF PREGNANCY
SHORTNESS OF BREATH

• Use proper posture.

• Use pillows behind head and shoulders
at night.

QKCC 69
RELIEVING THE COMMON
DISCOMFORTS OF PREGNANCY

URINARY FREQUENCY
• Void as necessary, at least every 2 hours.
• Increase fluid intake.
• Avoid caffeine.
• Practice Kegel exercises

QKCC 70
RELIEVING THE COMMON
DISCOMFORTS OF PREGNANCY

VAGINAL DISCHARGE

• Wear cotton underwear.

• Bathe daily.
• Avoid tight pantyhose.

QKCC 71
RELIEVING THE COMMON
DISCOMFORTS OF PREGNANCY
VARICOSE VEINS
• Walk regularly. Rest with feet
elevated.
• Avoid long periods of standing.
• Don’t cross your legs when
sitting.
• Avoid knee-high stockings. Wear
support hosiery.
QKCC 72
WEIGHT GAIN
 Variable but a total gain of 24-30 lbs. is
recommended.

a) 2-4 lbs. in the first trimester.

b) 11-14 lbs. in the second trimester.
c) 8-11 lbs. in the third trimester (i.e. 0.5lb
weekly)

 Gains mostly reflect maternal tissue in first half of

pregnancy, and fetal issue in second half of
pregnancy.

QKCC 73
DISCOMFORTS OF PREGNANCY
•FIRST TRIMESTER
 Nausea & vomiting – dry crackers before arising,
small feedings of bland food, milk
 Urinary frequency & urgency – do not restrict H2O
 vaginal discharge – good hygiene (no
douching), wear loose-fitting cotton underwear,
report signs & symptoms of vaginitis
 Breast soreness – well fitting, supportive brassiere
 Headache – due to tension. Relaxation techniques.
Report persistent or severe episodes

QKCC 74
 DISCOMFORTS OF PREGNANCY
•SECOND & THIRD TRIMESTER
 Constipation – fluid, fiber, exercise
 Braxton Hick’s – rest, change position or
activity
 Backache – good posture
 Faintness – gradual movement, no prolonged
standing & warm environment, elastic hose
 Leg cramp–calcium supplement, dorsiflexion of
feet
 Ankle edema – no constrictive clothing, elevate
legs, dorsiflex, BP assessment, limit Na
 Varicosities – elevate legs, no cross leg, use
stockings QKCC 75
  usually occur in the
Headaches 2nd or 3rd trimester
 Result from changes
in blood volume and
vascular tone
 Interventions:
 Changing position
slowly
 Applying a cool
cloth to the forehead
 Eating small snack
 Tylenol only if
prescribe by the MD
QKCC 76
  2nd & 3rd trimester
 Results from increased
Heartburn progesterone levels, dec. GI
motility & esophageal reflux &
displacement of the stomach by
the enlarging uterus

Interventions:
 Sitting upright for 30 min. after
meal
 Drinking between meals
 Avoid fatty & spicy food
 Tailor-sitting exercises
 Antacids per MD order
QKCC 77
 Interventions:
Hemorroids  Soaking in warm sitz bath
 Sitting on a soft pillow
 Eating high-fiber foods &
avoiding constipation
 Increase fluids
 Increase exercise
 Applying ointments,
suppositories or
compresses per MD order

QKCC 78
Skin Changes, Dryness, Itching

Interventions are symptomatic:

Cool baths

Lotions

Oils as Indicated

QKCC 79
A client arrives at a prenatal clinic for the first prenatal
assessment. The client tells a nurse that the first day
of her LMP was May.19, 2014. Using Nagele’s rule,
the nurse determines the EDC as

QKCC 80
A pregnant client asks the nurse in the clinic
when she will be able to start feeling the fetus
move. The nurse responds by telling the mother
that fetal movements will be noted between

a. 6 and 8 weeks of gestation

b. 8 and 10 weeks of gestation
c. 10 and 12 weeks of gestation
d. 14 and 16 weeks of gestation
QKCC 81
LEOPOLD’S
MANEUVER

QKCC 82
 1st maneuver
To determine fetal part lying in the fundus.
To determine presentation.

Using both hands, feel for the fetal part lying in the
fundus

Head is more firm, hard and round that moves independently

of the body.
Breech is less well defined that moves only in conjunction with
the body.

QKCC 83
 Leopold’s Maneuver
• L1 (Fundal Grip)

QKCC 84
 Second Maneuver:
Umbilical Grip
To identify location of fetal back.
To determine position
One hand is used to steady the uterus on one side of the
abdomen while the other hand moves slightly on a circular
motion from top to the lower segment of the uterus to feel for
the fetal back and small fetal parts. Use gentle but deep pressure

Fetal back is smooth, hard, and resistant surface

Knees and elbows of fetus feel with a number of angular
nodulation

QKCC 85
 Leopold’s Maneuver
• L2 (Umbilical Grip)

QKCC 86
 Third Maneuver:
Pawlik’s Grip
to determine engagement of presenting part

Using thumb and finger, grasp the lower portion of the

abdomen above symphisis pubis, press in slightly and make
gentle movements from side to side

The presenting part is engaged if it is not movable.

It is not yet engaged if it is still movable

QKCC 87
 Leopold’s Maneuver
• L3 (Pawlik’s Grip)

QKCC 88
 Fourth Maneuver:
Pelvic Grip
To determine the degree of flexion of fetal head.
To determine attitude or habitus.

Facing foot part of the woman, palpate fetal head pressing

downward about 2 inches above the inguinal ligament.
Use both hand

Good attitude – Poor attitude – if examining fingers

if brow correspond to the side will meet an obstruction on the
(2nd maneuver) that contained same side as fetal back
the elbows and knees. (hyperextended head)

QKCC 89
 Leopold’s Maneuver
• L4 (Pelvic Grip)

QKCC 90
NORMAL DIAGNOSTIC/LABORATORY FINDINGS
& DEVIATION

PREGNANCY TEST- (+) HCG

ULTRASOUND

QKCC 91
 PSYCHOLOGIC/ EMOTIONAL ADAPTATION
• 1st TRIM- ACCEPTANCE OF PREGNANCY
• “I am pregnant”- 1st psychologic task to face motherhood
• ACCEPTANCE –of the s/s of pregnancy as well as medical
confirmation of pregnancy helps the mother to accept that the
unborn child is incorporated as part of the woman’s body
image or part of herself

QKCC 92
• 2nd TRIM- ACCEPTANCE OF FETUS AS A SEPARATE INDIVIDUAL
• “ I am going to have a baby”
• QUICKENING - felt on 20 wks AOG, significantly help mother to
realize that the fetus is not just a part of her body but real &
separate individual to care for
• Begins to fantasize about child’s sex, appearance, gives fetus an
identity, introspective & preoccupied about the unborn child

QKCC 93
• 3rd TRIM- PREPARES FOR THE BIRTH OF THE BABY & ROLE AS A
MOTHER
• “I am going to be a mother”
• -plans about the birth, chooses name, layette, feeding sleeping
•

QKCC 94
 EMOTIONAL REACTION

• 1. AMBIVALENCE- simultaneous positive & negative response

to her pregnancy
• Negative- not as rejection but doubts about her capacity to
become a mother, parent readiness for a baby & how it will
affect her lifestyle
• Positive- joy & excitement, happiness & anticipation
• 2. FEAR & ANXIETY- mother’s concern about her own health &
baby’s health
• pregnant only after they felt the baby move or after quickening
QKCC 95
• 3. INTROVERSION & NARCISSISM- during pregnancy mother is
concerned about her welfare & effects of pregnancy to her
health
• Preoccupied w/ her own thoughts & feelings
• 4. UNCERTAINTY- still doubts she is pregnant despite + PT &
doctor’s confirmation
• - Not uncommon for the pregnant to believe that they are

QKCC 96
 CHARACTERISTIC AT DIFFERENT STAGES

• FIRST TRIMESTER
• 1. Sense of ambivalence
• 2. Fantasize about pregnancy
• 3. Role playing
• 4. Increase concern for financial & social
• problems
• 5. Decrease interest in sex due to bodily changes

QKCC 97
 SECOND TRIMESTER

• 1. Sense of well being as body becomes adjusted to changes

associated w/ pregnancy
• 2. Quickening felt
• 3. Heart beat is heard
• 4. Both parents increase interest in fetal growth &
development
• 5. Interest in the process of labor & delivery express

QKCC 98
• 6.Wide mood swings
• 7. Tendency to introversion & focus on self as center of
attention
• 8. Increase sexual interest, fantasies & dreams, increase vaginal
lubrication

QKCC 99
• 3rd TRIMESTER
• 1. Altered self image- vacillating from being special, beautiful
to ugly, awkward, unsexy & feels bad
• 2. Fear- about the infant & the future for the newborn, her
health & well being of her child, her own safety & performance
during labor & delivery

QKCC 100
• 3. Aggravation- over things she can’t do herself due to her size
• 4. Fatigue- tires easily
• 5. Obsession- concerned & preoccupied by events of labor &
delivery
• 6. Wondering- wonders what kind of parent she will be

QKCC 101