NURSING CARE RELATED TO

PSYCHOLOGICAL AND PHYSIOLOGIC

CHANGES OF PREGNANCY
 TOPIC
§ Psychological Changes in Pregnancy

§ Psychological Task in Pregnancy

§ Emotional Responses

§ Events affecting pregnancy acceptance

§ Confirmation of Pregnancy

§ Positive Signs of Pregnancy

§ Physiologic Changes in Pregnancy

§ Reproductive System Changes

§ Sytematic Changes
PSYCHOLOGICAL CHANGES IN PREGNANCY
• It brings about more psychological change
than any other life event besides puberty.

• Adjustment to pregnancy depends on the

following factors:
ü Social Influences
ü Cultural Influences
ü Family Influences
ü Personal/Individual Influences
PSYCHOLOGICAL TASKS
OF PREGNANCY
- Accepting the Pregnancy
- Accepting the Baby
- Preparing for Parenthood
 Emotional responses that can cause
concern in pregnancy:
o Grief- change in roles
o Narcissism- self- centeredness
o Introversion Versus Extroversion
o Depression- a feeling of sadness
marked by loss if interest in usual
things, feeling of guilt or low self-worth,
disturbed sleep, low energy, and poor
concentration.
o Couvade syndrome (French word
“to hatch”)-result from stress, anxiety,
and empathy for the pregnant woman
o Body image and Boundary
o Stress
o Emotional lability
o Changes in sexual desire
o Changes in expectant family
 ASSESSING EVENTS THAT COULD CONTRIBUTE TO
DIFFiCULTY ACCEPTING PREGNANCY

PREGNANCY IS LEARNING THE LOSS OF

UNINTENDED PREGNACY IS MULTIPLE SIGNIFICANT OTHER

FETUS HAS A
COMPLICATIONS OF
DEVELOPMENT
PREGNANCY OCCUR
ABNORMALITY.
 ASSESSING EVENTS THAT COULD CONTRIBUTE TO
DIFFCIULTY ACCEPTING PREGNANCY (Cont..)

Pregnancy is less Family has to relocate Woman has a role

than 1 year after during pregnancy reversal
a previous one.

The woman’s relationship There is a major

The main family
ends because of partner illness in self,
support person
suffers a job loss. infidelity. partner, or a relative.
THE CONFIRMATION OF PREGNANCY

(subjective) experienced by the woman but

cannot be documented by an examiner
objective and can be verified by the examiner.

Laboratory Tests Home Pregnancy Tests

- uses venipuncture or a urine - high degree of accuracy (97%
specimento detect the presence to99%) since it can detect as
of human chorionic gonadotropin little as 35 milli-International
(hCG), a hormone created by the Unit/ml of hCG.
chorionic villi of the placenta, in
the urine or blood serum of the
pregnant woman
 POSITIVE SIGNS OF PREGNANCY

• Echocardiography- can demonstrate a heartbeat as early as 5

weeks.
• Ultrasound- can reveal a beating fetal heart as early as the 6
th to 7 th week
• Doppler instrumentation- able to detect fetal heart sounds
as early as the 11 th to 12 th week of gestation
• The fetal heart rate ranges between 120 and 160 beats/min.
PYSIOLOGICAL CHANGES IN PREGNANCY

- can be categorized as local (i.e., confines to

the reproductive organs) or systemic (i.e.,

affecting the entire body).

REPRODUCTIVE SYSTEM CHANGES

Ø increase in size of the uterus to accomodate the growing fetus.

Ø Lightening
ü settling of the fetus in the midpelvis
ü Occurs mainly 2 weeks before term
Ø Hegar’s sign - extreme softening of the lower uterine segment
Ø Ballottement (from the French word ballotter , meaning “to
quake”)- small fetus in amniotic fluid can be felt to bounce or rise
when the lower uterine segment is tapped during a pelvic exam.
Ø Braxton Hicks Contraction - “practice” contractions for labor,
ensuring adequate blood supply.
REPRODUCTIVE SYSTEM CHANGES

Ø Menstrual flow suppression due to estrogen-induced FSH suppression.

Ø Operculum (mucus plug ) – seals bacteria to prevent fetus and membrane

infections.
Ø Goodell’s sign - increased fluid cells soften, vascularity darkens it from
pale pink to violet.
ü nonpregnant cervix – compared to a nose
ü pregnant cervix – earlobe
ü just before labor – consistency of a “butter” (ripe for birth)
REPRODUCTIVE SYSTEM CHANGES

Ø Leukorrhea – white vaginal discharge

Ø Chadwick’s sign - increased vaginal vascularity causes uterine changes, causing
vaginal walls to change color from light pink to violet.
Ø Vaginal secretions pregnancy-induced pH levels increase to 4-5, making vaginal
walls resistant to bacterial invasion, reducing bacterial invasion.
Ø Lactobacillus acidophilus - bacteria grow freely in glycogen-rich environments,
causing increased lactic acid content.
no fraafian follicle develop and no ovulation occurs during
pregnancy.
REPRODUCTIVE SYSTEM CHANGES

Ø Increased breast size due to alveolar tissue growth, fat deposition and
increased vascularity
Ø Pregnancy causes breast changes like fullness, tingling, darkening,
Montgomery glands enlargement, and nipples prominence.
Ø By the 16th week, colostrum (thin, watery, high- protein fluid that is
the precursor of breast milk) can be expressed
Ø Montgomery’s tubercles - keep the nipple supple and help to prevent
nipples from crackingand drying during lactation
 SYSTEMATIC CHANGES
almost all aspects of the endocrine system increase
during pregnancy in order to support fetal growth.
o Placenta o Thyroid and parathyroid glands
o Pituitary gland o Adrenal glands
o Pancreas

Ø Immunoglobulin G (IgG) production is particularly decreased, which can

make a woman more prone to infection during pregnancy.
Ø A simultaneous increase in the white blood cell count may help to
counteract this decrease in the IgG response.
 SYSTEMATIC CHANGES

Ø Striae gravidarum - As the uterus grows, abdominal wall stretches,

potentially causing skin atrophy and rupture, causing streaks on sides and
thighs.
Ø Diastasis - rectus muscle underneath the skin separate. o Increased
melanin production
Ø Linea nigra – dark line from umbilicus to symphysis pubis separating the
abdomen into right and left halves
Ø Activation of sweat and sebaceous glands result in increased perspiration
and oily skin
 SYSTEMATIC CHANGES

Ø Melasma (chloasma) - aka “mask of pregnancy”

Ø Darker areola o Increased level of estrogen effects:
ü Palmar Erythema – redness and itching of hands
ü Vascular spider nevi (small, fiery-red branching spots) – prominent
capillaries in the skin
 SYSTEMATIC CHANGES

Ø Pregnancy brings hormonal changes that increase respiratory drive and

oxygen demand. The growing uterus can lead to breathlessness, while lung
function adjusts. Nasal congestion and exercise might be affected.

Ø Early pregnancy – increases

Ø About 16 weeks – decreases to normal
SYSTEMATIC CHANGES
SYSTEMATIC CHANGES
ASSESING PYSIOLOGIC CHANGES OF
PREGNANCY
ASSESING PYSIOLOGIC CHANGES OF
PREGNANCY
 Thank you
for listening :)