Chapter 7 Anatomy and Physiology of Pregnancy Copyright © 2018 by Elsevier Inc. All rights reserved. Gravidity and Parity Understanding of following terms is essential to study of maternity care: Gravidity Gravida: Woman who is pregnant Gravidity: Pregnancy Nulligravida: Woman who has never been pregnant Primigravida: Woman pregnant for first time Multigravida: Woman who has had two or more pregnancies Copyright © 2018 by Elsevier Inc. All rights reserved. 2 Gravidity and Parity (Cont.) Parity Parity: Number of pregnancies in which fetus or fetuses have reached viability, not number of fetuses (e.g., twins) born. Whether the fetus is born alive or is stillborn (fetus who shows no signs of life at birth) after viability is reached does not affect parity Nullipara: Woman who has not completed a pregnancy with fetus or fetuses who have reached stage of fetal viability Copyright © 2018 by Elsevier Inc. All rights reserved. 3 Gravidity and Parity (Cont.) Parity (Cont.) Primipara: Woman who has completed one pregnancy with fetus or fetuses Multipara: Woman who has completed two or more pregnancies grandmultipara: Woman who has given birth 5 or more times (birth must occur at 20 weeks gestation or more for counting as “birth” weather live or stillborn) Copyright © 2018 by Elsevier Inc. All rights reserved. 4 Gravidity and Parity (Cont.) Term Preterm: Pregnancy that has reached 20 weeks of gestation but before completion of 37 weeks of gestation Late preterm: Pregnancy that has reached between 34 weeks 0 days and 36 weeks 6 days gestation Early term: Pregnancy that has reached between 37 weeks 0 days and 38 weeks 6 days gestation Copyright © 2018 by Elsevier Inc. All rights reserved. 5 Gravidity and Parity (Cont.) Term (Cont.) Full term: Pregnancy that has reached between 39 weeks 0 days and 40 weeks 6 days Late term: Pregnancy that has reached between 41 weeks 0 days and 41 weeks 6 days Postterm: Pregnancy that has reached 42 weeks 0 days and beyond gestation Viability: Capacity to live outside the uterus; about 22 to 25 weeks gestation are on the threshold of viability These very premature infants are vulnerable to brain injury Copyright © 2018 by Elsevier Inc. All rights reserved. 6 25 week infant: Bella Torkington Bella with her parents today Summarizing Obstetric History Two digits G—Gravida P—Para Five digits GPTAL Gravidity, preterm, term, abortions, living children Copyright © 2018 by Elsevier Inc. All rights reserved. 9 Pregnancy Tests Human chorionic gonadotropin (hCG) is earliest biochemical marker of pregnancy Pregnancy tests based on recognition of hCG or β subunit of hCG Can be detected in serum or urine as early as 7 to 8 days after ovulation Copyright © 2018 by Elsevier Inc. All rights reserved. 10 Adaptations to Pregnancy Copyright © 2018 by Elsevier Inc. All rights reserved. Signs of pregnancy Presumptive Probable Those changes felt by the woman that makes her think she might be pregnant (N/V, amenorrhea, breast changes) Those changes observed by an examiner that might make them think the woman is pregnant (positive pregnancy test, Hagar's sign-softening of the lower uterine segment, Chadwick's sign-bluish discoloration of the cervix and vagina due to increased vascularity) Positive Those signs attributed only to the presence of the fetus that can only be explained by pregnancy (fetal movement, fetus on US, fetal heart tones) 11 Chadwicks sign Hegar's sign Adaptations to Pregnancy (Cont.) Reproductive system and breasts Uterus Changes in size, shape, and position-grapefruit size by 12wks Changes in contractility-Braxton Hicks (contractions that do not change the cervix) Uteroplacental blood flow-increased vascularity Cervical changes-firm, collagen rich connective tissue Changes related to the presence of the fetus Ballottement-bouncing and rebound Quickening-first recognition of movement Vagina and vulva Leukorrhea-whitish mucoid discharge Operculum-cervical mucous plug 14 Copyright © 2018 by Elsevier Inc. All rights reserved. Copyright © 2018 by Elsevier Inc. All rights reserved. 15 Copyright © 2018 by Elsevier Inc. All rights reserved. 16 Copyright © 2018 by Elsevier Inc. All rights reserved. 17 Copyright © 2018 by Elsevier Inc. All rights reserved. 18 Adaptations to Pregnancy (Cont.) Breasts Fullness, heaviness Heightened sensitivity from tingling to sharp pain Areolae become more pigmented Montgomery tubercles-lubricate/anti-infective Colostrum-produced by end of first trimester Copyright © 2018 by Elsevier Inc. All rights reserved. 19 Adaptations to Pregnancy (Cont.) General body systems Cardiovascular system Blood pressure-systolic: slight to no increase, diastolic: slight decrease around 24-32 weeks Supine hypotensive syndrome-pregnant women lying supine, gravid uterus compresses inferior vena cava causing decrease in maternal blood pressure (maternal hypotension and fetal hypoxia). Also affects fetus by decreasing perfusion to placenta and fetus. Turning patient to left lateral position will correct the issue. Blood volume and composition Cardiac output- increase of 30-50%, inc stroke volume and heart rate (pulse increases 10-15BPM around 32 wks gestation and remains elevated for remainder of pregnancy) Circulation and coagulation times Increases in various clotting factors-hypercoagulable state (inc in clotting factors- XII, XIII,IX< X; decrease in inhibiting factors, depressed fibrolynitic activity) 5-6 fold increase for thromboembolic disease 20 Copyright © 2018 by Elsevier Inc. All rights reserved. Copyright © 2018 by Elsevier Inc. All rights reserved. 21 Adaptations to Pregnancy (Cont.) General body systems Respiratory system Pulmonary function-state of chronic mild hyperventilation Basal metabolism rate-increases Renal system Anatomic changes-dilation of renal pelvis and ureters Functional changes-due to inc in blood volume, preg. Hormones, left lateral recumbent Fluid and electrolyte balance-inc tubular reabsorption Copyright © 2018 by Elsevier Inc. All rights reserved. 22 Adaptations to Pregnancy (Cont.) General body systems Integumentary system Chloasma (mask of pregnancy) Linea nigra Striae gravidarum Angiomas Palmar erythema Musculoskeletal system-lordosis (increases with gestation) Neurologic system-compression of nerves Copyright © 2018 by Elsevier Inc. All rights reserved. 23 Copyright © 2018 by Elsevier Inc. All rights reserved. 24 Copyright © 2018 by Elsevier Inc. All rights reserved. 25 Adaptations to Pregnancy (Cont.) General body systems Gastrointestinal system Appetite PICA-ingestion of non nutritive substances (clay, chalk, ice, etc) Mouth and teeth-oral hygiene linked to preterm labor, emphasize good dental practices Esophagus, stomach, and intestines-GI discomforts due to gravid uterus, effects of estrogen Gallbladder and liver-distension, gallstones Abdominal discomfort-gas, nausea/vomiting, constipation Endocrine system-pg.164 table7.6 Copyright © 2018 by Elsevier Inc. All rights reserved. 26 Question Probable signs of pregnancy are which of the following? a. Determined by ultrasound b. Observed by the health care provider c. Reported by the patient d. Diagnostic tests Copyright © 2018 by Elsevier Inc. All rights reserved. 27
