Physiological Changes During

Pregnancy
1. Circulatory/Cardiovascular
a. Beginning the end of the first trimester, there is
gradual increase of about 30%-50% in total
cardiac volume, reaching its peak during the 6th
month. This causes a drop in hemoglobin and
hematocrit values since the increase is only in the
plasma volume=physiologic anemia of
pregnancy. Consequences of increased total
cardiac volume are:
Easy fatigability and shortness of breath
because of increased workload of the heart
Slight hypertrophy of the heart, causing it
to be displaced to the left, resulting in
torsion on the great vessels (the aorta and
pulmonary artery)
b. Palpitations due to:
Sympathetic nervous system
stimulation during first half of
pregnancy
Increased pressure of uterus against
the diaphragm during 2nd half of
pregnancy
c. Because of poor circulation resulting from
pressure of the gravid uterus on the blood
vessels of the lower extremities:
Edema of the lower extremities occurs.

Management: raise legs above hip level

Important: Edema of the lower extremities
is NOT a sign of toxemia.
Varicosities of the lower extremities can also
occur.
Management:
 Use/wear support hose or elastic stocking to promote
venous flow, thus preventive stasis in the lower
extremities
 Apply elastic bandage – start at the distal end of the
extremity and work toward the trunk to avoid
congestionand impaired circulation in the distal part;
do not wrap toes so as to be able to determine the
adequacy of circulation (Principle behind bandaging:
blood flow thru tissues is decreased by applying
excessive pressure on blood vessels)
 Avoid use of constricting garters, e.g., knee-high
socks
d. Because of poor circulation in the blood vessels
of the genitalia due to pressure of the gravid
uterus, varicosities of the vulva and rectum can
occur. Management:
 Side-lying position with hips elevated on pillows
 Advise modified knee-chest position
e. There is increased level of circulating
fibrinogen, that is why pregnant women are
normally safeguarded against undue
bleeding. However, this also predisposes
them to formation of blood clots (thrombi).
The implication is that pregnant women
should not be massaged since blood clots
can be released an cause
thromboembolism.
2. Gastrointestinal changes
a. Morning sickness (-nausea and vomiting
during the first trimester) is due to
increased human chorionic gonadotropin
(HCG). It may also be due to increased
acidity or even to emotional factors.
Management:
Eat dry toast or crackers 30 minutes before
arising in the morning (or dry, high
carbohydrate, low fat and low spices in the
diet).
Hyperemesis gravidarum – excessive nausea and vomiting
which persists beyond 3 months; will result in
dehydration, starvation and acidosis. Management
D10 NSS 3000 ml in 24 hours is the
priority of treatment
Complete bed rest is also an important
Constipation and flatulence are due to
the displacement of the stomach and
intestines, thus slowing peristalsis and
gastric-emptying time; may also be due
to increased progesterone during
pregnancy.
Management: vitamins, Increase fluids
and roughage in the diet
Establish regular elimination time
Increase exercise
Avoid enemas
Avoid harsh laxatives like Dulcolax; stool
softeners, e.g. Colace, are better
Mineral oil should not be taken because it
interferes with absorption of fat-soluble
b. Hemorrhoids are due to pressure
of enlarged uterus. Management:
Cold compress with witch hazel or
Epsom salts.
c. Heartburn, especially during the last
trimester, is due to increased
progesterone which decreases gastric
motility, thereby causing reverse
peristaltic waves which lead to
regurgitation of stomach contents
through the cardiac sphincter into the
esophagus, causing irritation.
Management:
 Pats of butter before meals
 Avoid fried, fatty foods
 Sips of milk at frequent intervals
 Small, frequent meals taken slowly
 Bend at the knees, not at the waist
 Take antacids (e.g. Milk of Magnesia) but NEVER sodium
bicarbonate (e.g. Alka Seltzer or baking soda) because it
promotes fluid retention.
3. Respiratory changes – there is shortness of
breath
Causes
 Increased oxygen consumption and production of
carbon dioxide during the first trimester
 Increased uterine size causes diaphragm to be
pushed or displaced, thus crowding chest cavity
b. Management: Lateral expansion of the chest to
compensate for shortness of breath increases
oxygen supply and vital lung capacity.
4. Urinary changes
a. Urinary frequency, the only sign in
pregnancy seen during the first
trimester, disappear during the second
and reappear during the third trimester,
is due to increased blood supply in the
kidneys and to the uterus rising out of
the pelvic cavity; on the last trimester,
is due to pressure of enlarged uterus on
the bladder, especially with lightening.
b. Decreased renal threshold for sugar due to
increased production of glucocorticoids which
cause lactose and dextrose to spill into the urine;
also an effect of the increase in progesterone.
(Implication: It would be difficult to diagnose
diabetes in pregnancy based on the urine sample
alone because all pregnant women have sugar in
their urine)
5. Musculoskeletal changes
a. Because of the pregnant woman’s attempt
to change her center of gravity, she makes
ambulation easier by standing more straight
and taller, resulting in a lordotic position
(“pride of pregnancy”)
b. Due to increased production of the hormone
relaxin, pelvic bones become more supple and
movable, increasing the incidence of accidental
falls due to the wobbly gait.
Implication: Advise use of low-heeled shoes
after the first trimester.
c. Leg cramps are caused by:
Increased pressure of gravid uterus on
lower extremities
Fatigue
Chills
Muscle tenseness
Low calcium high phosphorus intake
Management:
Frequent rest periods with feet elevated
Wear warm, more comfortable clothing
Increase calcium intake (calcium tablets and
diet)
Do not massage – blood clots can cause
embolism
Most effective relief: Press knee of the
affected leg and dorsiflex the foot
6. Temperature – slight increase in
body temperature due to increased
progesterone, but the body adapts
after the 4th month
7. Endocrine changes
a. Addition of the placenta as an endocrine organ,
producing large amounts of estrogen,
progesterone, HCG and HPL
b. Moderate enlargement of the thyroid gland due to
hyperplasia of the glandular tissues and increased
vascularity. Could also be due to increased basal
metabolic activity of the products of conception.
c. Increased size of the parathyroids, probably to
satisfy the increased need of the fetus for calcium
d. Increased size and activity of the adrenal cortex,
thus increasing the amount of circulating cortisol,
aldosterone and ADH, all of which affect
carbohydrate and fat metabolism
e. Gradual increase in insulin production but the
body’s sensitivity to insulin is decreased during
pregnancy
8. Weight
a. During first trimester, weight gain of 1.5 – 3 lbs
b. On 2nd trimester and 3rd trimesters, weight gain
of 10-11 pounds per trimester is recommended
c. Total allowable weight gain during entire period
of pregnancy is 20 - 25 lb. (10 – 12 kg.)
d. Pattern of weight gain is more important than the
amount of weight gained
9. Emotional responses
a. First trimester: the fetus is an unidentified concept
with great future implications but without tangible
evidence of reality. Some degree of rejection, denial
and disbelief, even repression. (Implication: when
giving health teachings, be sure to emphasize the
bodily changes in pregnancy)
b. Second trimester: fetus is perceived as a separate
entity. Fantasizes appearance of the baby
c. Third trimester: has personal identification
with a real baby about to be born and
realistic plans for future child care
responsibilities. Best time to talk about
preparation of layette and infant feeding
method. Fear of death, though, is
prominent (To allay fears, let pregnant
woman listen to the fetal heart tones).
B. Local Changes
1. Uterus
a. Weight increase to about 1,000 grams at full
term; due to increase in the amount of fibrous and
elastic tissues.
b. Change in shape from pear-like to ovoid
c. Change in consistency of the lower uterine
segment causes extreme softening, known as
Hegar’s sign, seen at about the 6th week
d. Mucous plugs in the cervix, called
operculum, are produced to seal out
bacteria
e. Cervix becomes more vascular and
edematous, resembling the consistency of
an earlobe, known as Goodell’s sign
2. Vagina
a. Increased vascularity causes change in
color from light pink to deep purple or
violet known as Chadwick’s sign
To prevent confusion as to pregnancy signs
arrange the body “outer to inner” and the
different signs alphabetically.
Thus:
Vagina - Chadwick’s sign
Cervix - Goodell’s sign
Uterus - Hegar’s sign
 Abdominal Wall
a. Striae gravidarum – increased uterine size
results in rupture and atrophy of the
connective tissue layers, seen as pink or
reddish streaks (gently rubbing oil on the skin
helps prevent diastasis)
b. Umbilicus pushed out
Skin
a. Linea nigra – brown line running from
umbilicus to symphysis pubis
b. Melasma or chloasma – extra pigmentation
on cheeks and across the nose due to the
increased production of melanocytes by the
pituitary gland
c. Sweat glands unduly activated
5. Breasts
a. All changes due to increased estrogen
b. Increase in size due to hyperplasia of mammary
alveoli and fat deposits. Proper breast support
with well-fitting brassiere necessary to prevent
sagging
c. By the fourth month, a thin, watery, high-protein
fluid, called colostrums, is formed. It is the
precursor of breast milk.
b. Due to increase estrogen, activity of the
epithelial cells increases, thus increasing
amount of vaginal discharges called
leukorrhea. As long as the discharges are
not smelling or irritatingly itchy, it is
normal.
Management: Maintain or increase
cleanliness by taking twice daily shower
baths using cool water.
c. pH of vagina changes from the normally
acidic (because of the presence of the
Doderlein bacilli) to alkaline (because of
increased estrogen). Alkaline vaginal
environment is supposed to protect against
bacterial infection, however, there are two
microorganisms which love to thrive in an
alkaline environment
 Trichomonas, a protozoa or flagellate. The condition is
called trichomonas vaginalis or trichomonas vaginitis or
trichomoniasis. Symptoms are:
 Frothy, cream-colored, irritatingly itchy, foul-smelling
discharges
 Vulvar edema and hyperemia due to irritation from the
discharges
 Psychological
changes of pregnancy
 Pregnancy is maturational and developmental crisis.
MCN CONCEPT
 It should be an emotionally satisfying experience. (the
nurse should help or assist the mother to express her
feelings and emotions)
 Pregnancy is a crisis because it involves physiologic change
and adjustment to change.
 Nursing care should focus on the family because MCN is
family-centered.
Pregnancy is such a huge
change in a woman’s life that it
brings about more
psychological changes than any
other life event besides puberty.
A woman’s attitude toward a
pregnancy depends a great deal on
psychological aspects such as the
environment in which she was raised,
the messages about pregnancy her
family communicated to her as a child,
the society and culture in which she
lives as an adult, and whether the
pregnancy has come at a good time in
her life.
The ability of a woman to accept her
pregnancy depends on social,
cultural, family, and individual
influences.

The psychological tasks of

pregnancy are centered on ensuring
safe passage for the fetus; these
consist of:
COMMON PSYCHOLOGICAL CHANGES
THAT OCCUR WITH PREGNANCY
 FIRST TRIMESTER
task: accepting the pregnancy
- woman and partner both spend time
recovering from shock of learning they are
pregnant and concentrate on what it feels like to
be pregnant.
- common reaction is ambivalence, or feeling
both pleased and not pleased about the pregnancy.
SECOND TRIMESTER
task: accepting the baby
- woman and partner move
through emotions such as narcissism
and introversion as they concentrate
on what it will feel like to be a parent.
- role playing and increased
dreaming are common.
THIRD TRIMESTER
task: preparing for the baby and
end of pregnancy
- woman and partner grow
impatient with pregnancy as they
ready themselves for birth.
EMOTIONAL RESPONSES TO
PREGNANCY
AMBIVALENCE

- occurs early in pregnancy, even

when the pregnancy is planned
- mother may experience
dependence-independent conflict and
ambivalence related to role changes.
 - father may experience ambivalence
related to the new role he is assuming,
the increased financial responsibilities,
and sharing the wife’s attention with
the child.
- to help partners resolve some
ambivalence, provide an outlet for
them to discuss concerns, and offer
parenting information at prenatal
visits.
ACCEPTANCE
- factors that may be related to
acceptance of the pregnancy are the
woman’s readiness for the experience and
her identification with the motherhood
role.
 grief
 narcissism
 introversion vs. extroversion
EMOTIONAL LABILITY
- may be manifested by frequency in the change
of emotional states or extremes in emotional states.
- these emotional changes are common, and the
mother may feel that these changes are abnormal.
- women and their partners and families need
to be cautioned that such mood swings occur,
beginning with early pregnancy, so that they can
accept them as part of pregnancy.
BODY IMAGE CHANGES
- the changes in a woman’s perception of
her image during pregnancy occurs
gradually and may be either positive or
negative.
- the physical changes and symptoms
that the woman experiences during
pregnancy contribute to her body image.
 COUVADE SYNDROME
- many men experience physical symptoms such
as nausea, vomiting, and backache to the same
degree or even more intensely than their partners
do during pregnancy.
- these symptoms apparently result from stress,
anxiety, and empathy for the pregnant woman.
- this is common enough that is has been given a
name: couvade syndrome
THE DIAGNOSIS OF
PREGNANCY
The medical diagnosis of
pregnancy serves to date the
expected birth and helps
predict the existence of a high-
risk status. It also marks a
major life milestone.
Ifpregnancy was planned, the
diagnosis produces a feeling of
intense fulfillment and achievement.

If it was not planned or not desired,

it can result in an equally extreme
crisis state.
Pregnancy is officially diagnosed on the
basis of the symptoms reported by the
woman and the signs elicited by a health
care provider.
These signs and symptoms are
traditionally divided into three
classifications:
Presumptive
Probable
positive
PRESUMPTIVE SIGNS OF
PREGNANCY
 are those that are least
indicative of pregnancy
 taken as single entities, they
could easily indicate other
conditions.
Time from
Implantation Presumptive Description
(weeks) findings

2 Breast changes Feeling of tenderness, fullness or

tingling; enlargement and
darkening of areola

2 Nausea, vomiting Nausea or vomiting on arising

Absence of menstruation
Amenorrhea
2
 3 Frequent Sense of having to void
urination frequently

12 Fatigue General feeling of tiredness

12 Uterine Uterus can be palpated over

enlargement symphysis pubis

18 Quickening Fetal movement felt by woman

Line of dark pigment on the

Linea nigra abdomen
24
24 Melasma Dark pigment on face

24 Striae Red streaks on abdomen

gravidarum
PROBABLE SIGNS OF
PREGNANCY
In contrast to presumptive signs,
probable signs of pregnancy can
be documented by the examiner.
Although they are more reliable
than the presumptive signs, they
are still not positive or true
diagnostic findings.
Time from Probable findings Description
implantation
(weeks)

1 Serum laboratory Tests of blood serum reveal the

tests presence of human chorionic
gonadotropin hormone

Color change of the vagina from

Chadwick’s sign pink to violet
6

Softening of the cervix

6 Goodell’s sign
6 Hegar’s sign Softening of the lower uterine
segment

6 Sonographic evidence Characteristic ring is evident

of gestational sac

Ballottement When lower uterine segment is

16 tapped on a bimanual
examination, the fetus can be felt
to rise against abdominal wall
20 Braxton Hicks Periodic uterine tightening
contractions occurs

20 Fetal outline felt by Fetal outline can be

examiner palpated through abdomen
POSITIVE SIGNS OF
PREGNANCY
There are only three positive signs
of pregnancy:
- demonstration of a fetal heart
separate from the mother’s
- fetal movements felt by the
examiner
- visualization of the fetus by
ultrasound
Time from Positive findings Description
implantation
(weeks)

8 Sonographic evidence of Fetal outline can be seen and

fetal outline measured by sonogram

Fetal heart audible Doppler ultrasound reveals heartbeat

10 – 12
Fetal movement felt by Fetal movement can be palpated
examiner through abdomen
20
 PHYSIOLOGIC
Physiologic CHANGES
changes OFduring
that occur
PREGNANCY
pregnancy can be categorized as local
(confined to the reproductive organs)
or systemic (affecting the entire body).
Both symptoms (subjective findings)
and signs (objective findings) of the
physiologic changes of pregnancy are
used to diagnose and mark the
progress of pregnancy.
REPRODUCTIVE SYSTEM
CHANGES
Reproductive tract changes are
those involving the:
- uterus
- ovaries
- vagina
- breasts
UTERINE CHANGES
The most obvious alteration in the
woman’s body during pregnancy is
the increase in the size of the uterus
to accommodate the growing fetus.
Weight increases from 50 to 1000 g.
At about 6th week of pregnancy,
extreme softening of the lower
uterine segment is noted (Hegar’s
sign)
Ballottement may be
demonstrated during the 16th to
20th week of pregnancy.
Uterine contractions begin early in
pregnancy, at least by the 12th
week, and are present throughout
the rest of pregnancy, becoming
stronger and harder as the
pregnancy advances.
AMENORRHEA (absence of
menstruation)
- occurs with pregnancy
because of the suppression of
follicle-stimulating hormone
(FSH) by rising estrogen levels.
CERVICAL CHANGES
In response to the increased level
of circulating estrogen from the
placenta during pregnancy, the
cervix of the uterus becomes more
vascular and edematous.
Softening of the cervix in
pregnancy is marked (Goodell’s
sign)
Endocervical glands secrete a thick
mucus plug, which is expelled from
the canal when dilation begins.
- this mucous plug, called the
operculum, acts to seal out
bacteria during pregnancy and
therefore helps prevent infection in
the fetus and the membranes.
VAGINAL
 CHANGES
Hypertrophy and thickening of the muscle.
Increase in vaginal secretions, and
secretions are usually thick, white and
acidic.
Increase in the vascularity of the vagina;
the resulting increase in circulation
changes the color of the vaginal walls from
the normal light pink to a deep violet
(Chadwick’s sign).
OVARIAN CHANGES
Ovulation stops with pregnancy
because of the active feedback
mechanism of estrogen and
progesterone produced by the corpus
luteum early in pregnancy and by
the placenta later in pregnancy
Maturation of new follicles is
blocked.
CHANGES IN THE BREASTS
Subtle changes in the breasts that
occur as a result of estrogen and
progesterone production may be one
of the first physiologic changes of
pregnancy a woman notices (at
about 6 weeks).
Breast size increases.
Nipples become more pronounced.
Areola becomes darker in color.
Superficial veins become prominent.
Hypertrophy of the Montgomery
follicles occurs.
Early in pregnancy, the breast begin
readying themselves for the secretion
of milk. By the 16th week, colostrum,
the thin watery, high protein fluid that
is the precursor of breastmilk , can be
expelled from the nipples.
SYSTEMIC CHANGES
Although the physiologic
changes first noticed by a
woman are apt to be those of
the reproductive system and
breasts, changes occur in
almost all body systems.
INTEGUMENTARY SYSTEM
Pigmentation increases.
A dark streak down the midline of
the abdomen may appear (linea
nigra).
Chloasma, or mask of pregnancy,
may occur over the forehead,
cheeks, and nose.
Reddish-purple stretch marks
(striae) may occur on the abdomen,
breasts, thighs, and upper arms.
Vascular spider nevi may occur on
the neck, chest, face, arms, and legs.
Rate of hair growth may decrease.
RESPIRATORY SYSTEM
A local change that often occurs in
the respiratory system is marked
congestion, or “stuffiness” of the
nasopharynx, a response to
increased estrogen levels.
Oxygen consumption increases by
15% to 20%
Diaphragm is elevated because
of the enlarged uterus.
Respiratory rate remains the
same.
Shortness of breath may
experienced.
TEMPERATURE
Slightincrease in body
temperature due to increased
progesterone, but the body
adapts after the 4th month.
CARDIOVASCULAR SYSTEM
Circulating blood volume increases,
plasma increases, total volume
increases by 40% to 50%
Total red cell volume increases
Physiological anemia occurs as the
plasma increase exceeds the increase
in the red blood cell production
Heart size increases with left
ventricle hypertrophy
Heart is elevated upward and to the
left because of displacement of the
diaphragm as the uterus enlarges
Pulse may increase about 10 beats
per minute
Blood pressure may decline in
the 2nd trimester
Iron requirements are
increased
Retention of sodium and water
may occur
GASTROINTESTINAL
SYSTEM
Nausea and vomiting may occur as
a result of the secretion of human
chorionic gonadotropin (hCG), and
subsides by the third month
Poor appetite may occur because of
the decreased gastric motility
Alterations in taste and smell
Constipation as a result of decreased
gastrointestinal motility or pressure of the
uterus
Flatulence and heartburn because of
decreased GI motility and slow emptying of
the stomach
Hemorrhoids as a result of increased venous
pressure
Gum tissue may become swollen and easily
bleed
Ptyalism (excessive secretion of saliva)
 Frequency of urination occurs in the first and third
RENAL SYSTEM
trimesters as a result of pressure of the enlarging uterus on
the bladder
 Decreased bladder tone is caused by hormonal changes
 Decreased bladder capacity
 Renal function increases
 Renal threshold for glucose may be reduced
SKELETAL SYSTEM
Center of gravity changes
Postural changes occur as the
increased weight of the uterus
causes a forward pull of the
bony pelvis
METABOLISM
 Metabolic function increases
 Body weight increases
 The average expected weight gain during
pregnancy is 2 to 4 pounds in the first trimester
and approximately 1 pound per week in the 2nd
and 3rd trimesters
 Water retention is increased, which can
contribute to weight gain
Addition of the placenta
ENDOCRINE CHANGES as an
endocrine organ, producing large
amounts of estrogen, progesterone,
HCG and HPL
Moderate enlargement of the thyroid
gland due to hyperplasia of the
glandular tissues and increased
vascularity
Increased size of the parathyroids,
probably to satisfy the increased
need of the fetus for calcium
Gradual increase in insulin
production but the body’s
sensitivity to insulin is decreased
during pregnancy
DISCOMFORTS OF
PREGNANCY
 Occur in the first trimester
NAUSEA AND VOMITING
 Due to elevated HCG levels and changes in carbohydrate
metabolism
 Implementation:

- eating dry crackers before arising

- eating small, frequent, low-fat meals during the day
- drinking liquids between meals
- avoiding fried foods
- avoiding all antiemetics throughout pregnancy
Usually occurs in the first trimester
SYNCOPE
May be hormonal triggered or caused
by the increased blood volume, anemia,
fatigue, or sudden position changes
Implementation:

- sitting with the feet elevated

- changing positions slowly
- changing the position to the left side
to relieve the pressure of the uterus on
the inferior vena cava
URINARY URGENCY AND
FREQUENCY
 Usually occur in the 1st and 3rd trimesters
 Due to pressure of the uterus on the bladder
 Implementation:

- drinking 2 quarts of fluid per day

- limiting fluid intake in the evening
- voiding at regular intervals
- sleeping on the side at night
- wearing perineal pads if necessary
 Can occur from the 1st through the 3rd trimesters
BREAST TENDERNESS
 Due to increased levels of estrogen and progesterone
 Implementation:

- encouraging the use of a supportive bra with non-elastic

straps
- avoiding the use of soap on the nipples and areola area to
prevent drying
 INCREASED VAGINAL
DISCHARGE
 Can occur from the 1st through the 3rd trimesters
 Due to hyperplasia of vaginal mucosa and increased mucus
production
 Implementation:
- proper cleansing and hygiene
- wearing cotton underwear
- avoiding douching
- advising the client to consult the physician or health care
provider if infection is suspected
NASAL STUFFINESS
 Occurs during the 1st through the 3rd trimesters
 Occurs as a result of increased estrogen, which
causes swelling of the nasal tissues and dryness
 Implementation:

- encouraging the use of humidifier

- avoiding the use of nasal sprays or
antihistamines
FATIGUE
Occurs usually in the first and third
trimesters
Usually a result of hormonal changes
Implementation:

- arranging frequent rest periods

throughout the day
- obtaining regular exercise
- avoiding eating and drinking foods
containing stimulants throughout
pregnancy
HEARTBURN
Occurs in the 2nd and 3rd trimesters
Result from increased progesterone levels,
decreased GI motility and esophageal
reflux, and displacement of the stomach by
the enlarging uterus
Implementation:
- eating small, frequent meals
- sitting upright for 30 minutes following
a meal
 - drinking milk between meals
- avoiding fatty and spicy foods
- avoiding antacids and histamine
receptor antagonists throughout
pregnancy
- administering antacids only when
recommended by the physician
 ANKLE EDEMA
Usually occurs in the 2nd and the 3rd
trimesters
Occurs as a result of vasodilation,
venous stasis, and increased venous
pressure below the uterus
Implementation:
- elevating the legs at least twice a
day
- sleeping on the left side
 - wearing supportive stockings
- avoiding sitting or standing in
one position for long periods of
time
- avoiding the use of diuretics
during pregnancy
VARICOSE VEINS
Usually occur in the 2nd and the 3rd
trimesters
Occur as a result of weakening
walls of the veins or valves and
venous congestion
Implementation:
- wearing support hose
- elevating the feet when sitting
 - lying with the feet and hips elevated
- moving about while standing to
improve circulation
- avoiding pressure on the lower
thighs
- avoiding leg crossing
- avoiding long periods of standing or
sitting
- avoiding constricting articles of
clothing
Usually occur in the 2 nd
and 3 rd
HEADACHES
trimesters
Occur as a result of changes in blood
volume and vascular tone
Implementation:

- changing position slowly

- applying a cool cloth to the forehead
- eating a small snack
HEMORRHOIDS

Usually occur in the 2nd and 3rd

trimesters
Occur as a result of increased venous
pressure and/or constipation
Implementation:

- soaking in a warm sitz bath

- sitting in a soft pillow
 - eating high-fiber foods and
avoiding constipation
- drinking sufficient fluids
- increasing exercise, such as
walking
- applying ointments, suppositories,
or compresses as prescribed
CONSTIPATION
Usually occurs in the 2nd and 3rd
trimesters
Occurs as a result decreased
intestinal motility, the displacement
of the intestines, and taking iron
supplements
Implementation:
- eating high-fiber foods
- drinking plenty of fluids
 - exercising regularly
- avoiding mineral oil or castor oil
laxatives, only as prescribed by the
physician
BACKACHE
Usually occurs in the 2nd and 3rd
trimesters
Occurs from an exaggerated
lumbosacral curve resulting from the
enlarged uterus
Implementation:
- encouraging rest
- using good body mechanics and
improving posture
 - wearing low-heeled shoes
- performing pelvic lift
exercises and exercises such as
squatting, sitting, and pelvic
rocking
- sleeping on a firm mattress
 LEG CRAMPS
 Usually occur in the 2nd and 3rd trimesters
 Occur as a result of an altered calcium-phosphorous
balance and pressure of the uterus on nerves, or from
fatigue
 Implementation:

- getting regular exercise, especially walking

- elevating the feet and dorsiflexing the feet when resting
- increasing calcium intake
SHORTNESS OF BREATH
Can occur in the 2nd and 3rd trimesters
Occurs as a result of pressure on the
diaphragm
Implementation:

- allowing frequent rest periods

- sleeping with the head elevated or on
the side
- avoiding overexertion