PHYSIOLOGICAL CHANGES (LOCAL: REPRODUCTIVE SYSTEM)

1. Uterus – Uterine changes (increase in size); 20th week AOG in umbilical level; “Hegar’s
sign” (softening of the lower uterine segment.); ballottement (bouncing of the fetus
when examined); Braxton Hicks contraction (“practice contractions” / false labor)

2. Amenorrhea – absence of menstruation.

3. Cervical changes - Hypertrophy and Hyperplasia; Operculum (mucus plug); Goodell’s sign
(softening of the cervix – like an earlobe but it is like a butter during birth due to ripening)

4. Vagina – vaginal discharges; Chadwick’s sign (increased vascularity – from light pink to deep
purple color); Vaginal wall secretions increased acid pH.

5. Ovaries – feedback sent to Hypothalamus due to the presence of the Estrogen and
Progesterone; Corpus Luteum increase in size and produces estrogen and progesterone until
16th week of pregnancy, afterwards, estrogen and progesterone will be produced by the
placenta.

6. Breasts - Feeling of fullness, tingling, or tenderness in her breasts due to increased Estrogen;
Montgomery’s tubercles is enlarged and become protuberant; at 16th week AOG colostrum can
be expelled from nipples.

PHYSIOLOGICAL CHANGES (SYSTEMIC: OTHER BODY SYSTEMS)

1. Integumentary System - Striae gravidarum (Pregnancy stretch marks); diastasis recti (separation
of the rectus abdominis); Umbilical depression becomes obliterated and smooth by 28th week
AOG; linea nigra (narrow, brown line running from the umbilicus to the symphysis pubis);
Melasma / Chloasma (mask of pregnancy); Vascular spiders or telangiectases, Increased
perspiration, palmar erythema, and increased hair growth.

2. Respiratory System - Marked congestion, or “stuffiness,” of the nasopharynx

3. Temperature - Early in pregnancy, body temperature increases slightly and at 16 weeks AOG,
temperature slightly decreases (Progesterone).

4. Cardiovascular system - Total circulatory blood increased by 30%-50%, which begins at the end
of 1st trimester, then gradually up to the 3rd trimester; Iron, Folic Acid, and Vitamin Needs; Blood
loss NSVD: 300 to 400 mL; Blood loss CS: 800 to 1000 mL; Pseudoanemia in early pregnancy;
Increased HR by additional 10bpm; the blood pressure does not normally rise; Supine
Hypotension Syndrome.
5. GIT System - nausea and vomiting (due to increased levels of hCG and progesterone.); Ovaries
produces an enzyme “relaxin” which relaxes the cardioesophageal sphincter; heartburn; Relaxin
and Progesterone also slows GIT motility; Hemorrhoids can happen if there is impaired venous
return; Gingival hypertrophy; hyperptyalism (increased saliva).

6. Urinary System - Compression of the bladder and ureters by the growing uterus; increased
blood volume; Progesterone stimulates response of the angiotensinrenin system.

7. Skeletal system - Calcium and phosphorus needs are increased during pregnancy; Gradual
softening of a woman’s pelvic ligaments and joints; Gradual softening is caused by relaxin and
placental progesterone; wide separation of the symphysis pubis at 32 weeks AOG; Lordosis
(pride of pregnancy);

8. Endocrine system – increased metabolism and it affects other endocrine glands and hormones.

9. Immune System - Immunologic competency during pregnancy apparently decreases, probably to

prevent a woman’s body from rejecting the fetus.

DIAGNOSIS OF PREGNANCY

1. Presumptive – “Subjective” / majority are felt by pregnant client.

2. Probable – “Objective” / observe by the examiner but not necessarily confirms the
pregnancy.
3. Positive – confirmatory diagnosis of pregnancy / all diagnosis confirmed by the presence of
“fetus / fetal” on diagnostic exams such as UTZ.