Physical and Psychologic
Changes of Pregnancy
Chapter 10
1
Learning Outcomes
10.1 Identify the anatomic and physiologic changes that
occur during pregnancy.
10.2 Relate the physiologic and anatomic changes that
occur in the body systems during pregnancy to the signs
and symptoms of pregnancy.
10.3 Compare subjective (presumptive), objective
(probable), and diagnostic (positive) changes of
pregnancy.
10.4 Contrast the various types of pregnancy tests.
Learning Outcomes
10.3 Compare subjective (presumptive), objective
(probable), and diagnostic (positive) changes of
pregnancy.
10.4 Contrast the various types of pregnancy tests.
10.5 Examine the emotional and psychological changes
that commonly occur in a woman, her partner, and her
family during pregnancy.
10.6 Summarize cultural factors that may influence a
family’s response to pregnancy.
Hormonal influences
Anatomy
and
Physiology
of
Pregnancy
Growth of fetus inside
uterus
Mother’s physical
adaptation to changes
• Uterus
• Enlargement due to hypertrophy
• Thickening of walls
• Estrogen
Reproductive
• Progesterone
System
• Increase in vascular and lymphatic
system
• Braxton Hicks contractions
• Irregular, throughout
pregnancy
Reproductive System
• Cervix
• Estrogen stimulates glandular tissue
• Development of mucous plug
• Goodell sign
•Softening
• Chadwick sign
•Bluish-purple discoloration
Reproductive System
•Ovaries
• Cease ovum production during
pregnancy
• Human chorionic gonadotropin (h
C G) maintains corpus luteum
• Secretes progesterone until
placental production sufficient
Reproductive System
•Vagina
• Hypertrophy, increased
vascularization, hyperplasia due to
estrogen
• Increase in secretions, loosening of
connective tissue
• Increased blood flow
Reproductive System
• Breasts
• Glandular hyperplasia and hypertrophy
• Darkened areolae, superficial veins
prominent
• Striae may develop
• Colostrum
• Antibody-rich yellow secretion
• Converts to mature milk following
childbirth
Respiratory System
• Tidal volume increases
• Oxygen consumption increases
• Breathing changes from abdominal to
thoracic
• Vascular congestion of nasal mucosa
Cardiovascular System
• Uterus exerts pressure on diaphragm
• Blood volume increases 40–50%
• Decrease in systemic and pulmonary
vascular resistance
• Increase in cardiac output
• Pulse frequently increases during
pregnancy
• Blood pressure (BP) decreases slightly
Cardiovascular System
• Femoral venous pressure slowly rises
• Supine hypotensive syndrome
• Vena caval syndrome, aortocaval
compression
• Total erythrocyte volume increases
• Leukocyte and platelet production
• Plasma fibrinogen increases
• Physiologic anemia of pregnancy
Figure 10–1 Vena
Caval Syndrome.
The Gravid Uterus
Compresses the
Vena Cava when the
Patient Is Supine.
This Reduces the
Blood Flow
Returning to the
Heart and May
Cause Maternal
Hypotension
Gastrointestinal System
• Nausea and vomiting
• Hyperemia, softening and bleeding of
gums
• Numerous symptoms related to uterine
pressure
• Mild liver changes
• Gallbladder emptying may be slow
Urinary Tract
•Pressure on bladder causes
frequency
•Dilatation of kidneys and urine
•Increased glomerular filtration
rate (GFR) and renal plasma
flow
•Glycosuria is not uncommon
Skin and Hair
• Hyperpigmentation
• Facial chloasma (melasma
gravidarum)
• Striae
• Vascular spider nevi
• Decreased hair growth
• Hyperactive sweat and sebaceous
glands
Linea Nigra
Musculoskeletal System
• Pelvic joints relax
• Waddling gait
• Center of gravity changes
• Lumbodorsal spinal curve
accentuates
• Separation of rectus abdominis
Postural Changes During Pregnancy. Note the
Increasing Lordosis of the Lumbosacral Spine and the
Increasing Curvature of the Thoracic Area
Central
Nervous
System
Reports of decreased
attention, concentration,
and memory
Sleep problems common
in pregnancy
Decreased intraocular
pressure
Eyes
Thickening of cornea
May affect fit of contacts
Metabolism
• Weight gain in Pregnancy
• Recommendations
• Underweight- 28-40 lbs
• Normal Pregnancy- 25-35 lbs
• Overweight Pregnancy- 15-25lbs
• Obese- 11-20 lbs
Metabolism
• Nutrient metabolism
• Carbohydrate demand increases
• Diabetes during pregnancy
• Demand for iron accelerated
• Progressive absorption, retention of
calcium
Subjective
Signs of
Pregnancy
Objective
Diagnostic
• Amenorrhea
• Nausea and vomiting of pregnancy
• N V P, morning sickness
Subjective
• Excessive fatigue
(Presumptive) • Urinary frequency
Changes
• Breast changes
• Quickening
• Mother’s perception of fetal
movement
Subjective Changes
Possible Alternative Causes
Amenorrhea
•
•
•
Endocrine factors: Early menopause; lactation; thyroid, pituitary, adrenal, ovarian
dysfunction
Metabolic factors: Malnutrition, anemia, climatic changes, diabetes mellitus,
degenerative disorders, long-distance running
Psychologic factors: Emotional shock, fear of pregnancy or sexually transmitted
infection, intense desire for pregnancy (pseudocyesis), stress
Obliteration of endometrial cavity by infection or curettage
Systemic disease (acute or chronic), such as tuberculosis or malignancy
Nausea and vomiting
•
•
•
Gastrointestinal disorders
Acute infections such as encephalitis
Emotional disorders such as pseudocyesis or anorexia nervosa
Urinary frequency
•
•
•
•
•
Urinary tract infection
Cystocele
Pelvic tumors
Urethral diverticula
Emotional tension
•
•
Differential
Diagnosis of
Pregnancy—
Subjective
Changes
Differential Diagnosis of Pregnancy—Subjective
Changes
Subjective
Changes
Possible Alternative Causes
• Breast
tenderness
• Premenstrual tension
• Chronic cystic mastitis
• Pseudocyesis
• Hyperestrogenism
• Quickening
• Increased peristalsis
• Flatus (“gas”)
• Abdominal muscle contractions
• Shifting of abdominal contents
Objective (Probable) Changes
• Changes in pelvic organs
• Hegar’s sign
• Changes in the uterus
• Ladin sign
• McDonald sign
• Braun von Fernwald sign
• Piskacek sign
• Enlargement of abdomen
Objective (Probable) Changes
• Braxton Hicks contractions
• False labor near end of pregnancy
• Abdominal striae
• Uterine souffle
• Changes in skin pigmentation
• Fetal outline
• Ballottement
• Pregnancy tests of blood, urine
Differential Diagnosis of Pregnancy—Objective Changes
Objective Changes
Possible Alternative Causes
Changes in pelvic organs
Goodell sign
Chadwick sign
Hegar sign
Uterine enlargement
Braun von Fernwald sign
Piskacek sign
•
•
•
•
•
•
•
Increased vascular congestion
Estrogen–progestin oral contraceptives
Vulvar, vaginal, cervical hyperemia
Excessively soft walls of nonpregnant uterus
Uterine tumors
Uterine tumors
Uterine tumors
Enlargement of abdomen
•
Obesity, ascites, pelvic tumors
Braxton Hicks contractions
•
Hematometra; pedunculated, submucous, and soft myomas
Uterine souffle
•
Large uterine myomas, large ovarian tumors, or any condition with greatly increased
uterine blood flow
Differential Diagnosis of Pregnancy—Objective
Changes
Objective Changes
Possible Alternative Causes
Pigmentation of skin
Chloasma (melasma)
Linea nigra
Nipples/areola
•
•
Estrogen–progestin oral contraceptives
Melanocyte hormonal stimulation
Abdominal striae
•
Obesity, pelvic tumor
Ballottement
•
Uterine tumors/polyps, ascites
Pregnancy tests
•
Increased pituitary gonadotropins at menopause, choriocarcinoma,
hydatidiform mole
Palpation for fetal outline
•
Uterine myomas
Hegar Sign, a Softening of the Isthmus of the Uterus, Can
Be Determined by the Examiner During a Vaginal
Examination
A Early Uterine Changes of Pregnancy. Ladin Sign: A Soft
Spot Anteriorly in the Middle of the Uterus Near the
Junction of the Body of the Uterus and the Cervix
Early Uterine Changes of Pregnancy. Braun von Fernwald Sign:
Irregular Softening and Enlargement at the Site of Implantation
Early Uterine Changes of Pregnancy. Piskacek Sign: A
Tumor-like Asymmetric Enlargement
Approximate Height of the Fundus at Various Weeks
of Pregnancy
Objective (Probable) Changes
• Clinical pregnancy tests
• b - subunit radioimmunoassay (RIA)
• Enzyme-linked immunosorbent assay (ELISA)
• Fluoroimmunoassay (FIA)
• Over-the-counter pregnancy tests
• Variables may affect accuracy
• False negative
Diagnostic (Positive) Changes
• Auscultation of fetal heartbeat by Doppler
device
• Fetal movement
• Palpable after about 20 weeks’ gestation
• Visualization of the fetus by ultrasound
Psychologic Response of the Expectant Family
to Pregnancy
• Developmental challenges
• Transition period
• Roles
• Financial considerations
• Labor and birth
Mother / Pregnant Patient
• Intendedness
• Ambivalence
• Acceptance
• First trimester
• Baby may not seem real
• Second trimester
• Quickening, “glow” of pregnancy
• Third trimester
• Physical discomfort, nesting
Mother / Pregnant Patient
•Introversion
•Mood swings
•Changes in body image
•Psychologic tasks of the mother
• Ensuring safe passage
through pregnancy, labor, and
birth
Mother / Pregnant Patient
• Psychologic tasks of the mother
• Seeking of acceptance of this
child by others
• Seeking of commitment and
acceptance of self as mother to
the infant (binding-in)
• Learning to give of oneself on
behalf of one’s child
Father
• View of role has changed
• Nurturing, caring, involved parent as well as
provider
• Benefit of being involved is reduction of maternal
stress levels
• Paternal depression and anxiety
• First trimester
• Confused by partner’s mood changes
• May feel left out of pregnancy
Father
• Couvade
• Observance of rituals, taboos to signify
transition to fatherhood
• Unintentional development of physical
symptoms
• Indicates higher degree of parental
role preparation
Partners of Lesbian Mothers
• Motivations similar to heterosexual couples
• Language determination
• Legal options vary from state to state
• Can feel unwelcome and misunderstood by
their families and healthcare providers
Other Parental Models
• Gay couples and single fathers may achieve
parenthood through adoption or surrogacy
• Nonpartner coparent families
• Lesbian couples and gay couples have
formed partnerships to serve as coparents
• Transgender families
Siblings
• Introduction of older children to new
baby
• Family affair
• Older child should be informed
about baby before extended
family
Grandparents
• Usually first relatives told about a
pregnancy
• Responses can vary considerably
• Signals change in grandparents’ lives
• Advice versus criticism
• Clarify role of grandparent prior to
bringing baby home
Cultural Values and Pregnancy
• Ceremonial rituals, rites around life
events
• Identification of cultural values
• Generalization difficult
• Cultural assessment important
aspect of prenatal care
• Identify main beliefs
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