Maternal Adaptation To Pregnancy

MATERNAL ADAPTATION TO PREGNANCY

Nursing Process Overview For Healthy Adaptation to Pregnancy

Assessment Ideally, begins before the pregnancy. During a

preconception assessment Evaluate Woman's health status  Nutritional intake  Lifestyle  Identify any potential problems  Identify the woman's understanding and expectations of conception, pregnancy, and parenthood. 

Establish a trusting relationship Assess the woman's health and nutritional

status, as well as the well-being of the fetus, throughout pregnancy.  Document the woman's physiologic adaptations and the family's psychological adaptations to pregnancy Physical findings are gained through the health history, physical assessment, and laboratory tests. Assessment in psychological areas 

interviewing

Nursing Diagnosis Examples of nursing diagnoses Anxiety related to unexpected pregnancy  Altered breathing pattern related to respiratory system changes of pregnancy  Disturbed body image related to weight gain with pregnancy  Deficient knowledge related to normal changes of pregnancy  Imbalanced nutrition, less than body requirements, related to morning sickness 

 Outcome Identification and Planning Plan to review concerns of the woman as well as a plan to ask about the individual responses she is experiencing.

Implementation Help women at prenatal visits to voice their

concerns about either physiologic or psychological changes of pregnancy, May need suggestions on exercise and nutrition to prepare for pregnancy and to follow during pregnancy. Nursing interventions can be instrumental in not only guiding a woman safely through a pregnancy but also connecting her back with ongoing health care.

Outcome Evaluation Client states she is able to continue her usual lifestyle throughout pregnancy. Family members describe ways they have adjusted their lifestyles to accommodate the mother's fatigue. Couple states they accept the physiologic changes of pregnancy as normal.

Psychological Changes of Pregnancy Woman's attitude toward a pregnancy

depends a great deal on psychological aspects the environment the messages about pregnancy her family

communicated to her as a child the society and culture in which she lives as an adult whether the pregnancy has come at a good time in her life.

Social Influences cultural background their personal experiences the experiences of friends and relatives current public philosophy of childbirth. People's opinions about adolescent pregnancies, “late in life” pregnancies, or lesbian pregnancies have changed markedly.

Cultural Influences may strongly influence how active a role she wants to take in her pregnancy certain beliefs and taboos may place restrictions on her behavior and activities To learn about the beliefs of a particular woman and her partner, ask at prenatal visits if there is anything they believe should or should not be done to make the pregnancy successful and keep the baby healthy. Supporting these beliefs shows respect for the individuality of the woman and her knowledge

Family Influences Loving family: more likely to have a

positive attitude toward her pregnancy “People love as they have been loved” Woman who views mothering as a positive activity is more likely to be pleased when she becomes pregnant than one who devalues mothering

Individual Influences Woman's ability to cope with or adapt to stress Security in her relationship with the people around her, especially the father of her child, is usually also important to her acceptance of a pregnancy. A woman who thinks of brides as young but mothers as old may believe pregnancy will rob her of her youth.

The Psychological Tasks of Pregnancy First Trimester: Accepting the Pregnancy Accept the reality of the pregnancy. A diagnosis of pregnancy is a similar rite of passage. In reality, as many as 50% of pregnancies are still unintended, unwanted, or mistimed Often women immediately experience something less than pleasure and closer to disappointment or anxiety at the news that they are pregnant.

The Partner Partner may go through some of the same psychological changes. Accepting the woman in her changed state. A partner should try to give the woman emotional support while she is learning to accept the reality of pregnancy Often partners are proud and happy about the pregnancy, facilitating acceptance of it. An unwed father may have a great deal of difficulty accepting a pregnancy unless he is actively involved in prenatal care.

Second Trimester: Accepting the Baby The Woman Accept that she is having a baby, a separate

step from accepting the pregnancy. Second turning point in pregnancy : quickening, or the first moment a woman feels fetal movement. She begins to imagine herself as a mother Realize that not only is she pregnant but also there is a child inside her.

Second Trimester: Accepting the Baby The Partner Feeling of being left out Some men may have difficulty enjoying the pregnancy if they have been misinformed about sexuality, pregnancy, and women's health. Many men comment that the information they receive about childbirth and pregnancy is too concerned with their partner or the child and not enough with how they feel to be relevant to them.

Third Trimester: Preparing for Parenthood “nest-building” activities” It is helpful for couples to attend

childbirth education classes or classes on preparing for parenthood.

Emotional Responses to Pregnancy Ambivalence may want to be pregnant, and yet she may not

be enjoying it. This leads to some degree of ambivalence. refers to the interwoven feelings of wanting and not wanting that can exist at high levels. It is important to emphasize that this ambivalence is normal. Partners also experience ambivalence, sometimes more so than pregnant women. To help partners resolve some ambivalence, provide an outlet for them to discuss concerns,

Grief Before a woman can take on a

mothering role, she has to give up or alter her present roles. She must incorporate her new role as a mother into her other roles as a daughter, wife, or friend. Her partner must incorporate a new role as a father into his other roles of son, husband, or friend.

Narcissism Self-centeredness (narcissism) is generally an

early reaction to pregnancy. Dressing becomes a time-consuming, mirrorstudying procedure. She makes a ceremony out of fixing her meals. May lose interest in her job or community events Men may demonstrate the same behavior by reducing risky activities Need to protect her body has implications for nursing care.

Introversion Versus Extroversion Introversion, or turning inward to

concentrate on oneself and one's body, is a common finding during pregnancy. They become more active, appear healthier than ever before, and are more outgoing.

Stress Time of extreme stress for a woma May cause people who were dependent on

the woman before pregnancy to feel neglected To help families keep their perspective, remind them that a decrease in the responsibilities that a pregnant woman takes on is a reaction to the stress of pregnancy, not the pregnancy itself. A woman with few support people around her almost automatically has more difficulty

Couvade Syndrome Men experience physical symptoms such as

nausea, vomiting, and backache to the same degree or even more intensely than their partners do during a pregnancy. These symptoms apparently result from stress, anxiety, and empathy for the pregnant woman. The more the partner is involved in or attuned to the changes of the pregnancy, the more symptoms he may experience.  For the most part, these are healthy

Changes in Sexual Desire 1st Trimester: decrease in libido nausea, fatigue, and breast tenderness that accompany early pregnancy. 2nd trimester: libido and sexual enjoyment

rise markedly.  blood flow to the pelvic area increases to

supply the placenta

3rd trimester: sexual desire may remain high,

or it may decrease because of difficulty finding a comfortable

position and increasing abdominal size.

Reproductive System Uterus (UterineMeasurements) Uterine Wt. Thickness Length Depth Width Capacity

Pregnancy 50 gm. 2 cm 6.5 cm 2.5 cm 4 cm 10 ml

Term Pregnancy 1100 gm. 0.5 cm 32 cm 20 cm 24 cm 5000 ml

Reproductive System Blood Flow : Uterine blood flow increases

from 20 ml before pregnancy to 700 to 900 ml at the end of pregnancy. ¾ of the blood supply goes to the placenta.

Shape : From pear shape before

pregnancy to spherical and later on to ovoid shape in the last months of pregnancy

Position : After 12 weeks gestation, the

uterus loses its anteflexed position.

Reproductive System Location of the Fundus : 12 weeks - at the level of the symphisis 16 weeks – halfway between symphisis and

umbilicus 20 weeks – level of the umbilicus 24 weeks – 2 fingers above the umbilicus 30 weeks – midway between umbilicus and xiphoid process 36 weeks – level of the xiphoid process 40 weeks – 2 fingers below the umbilicus, drops at 34 weeks level because of lightening

Reproductive System Contractility : uterus is a highly contractile organ. Beginning on the first trimester,

the uterus undergoes irregular contractions. Late in pregnancy, these contractions, known as BraxtonHicks, becomes more intense and frequent causing some discomfort

Reproductive System Cervix Color : Change from pink to purplish due to

increase blood supply Leukorrhea : Estrogen stimulation results in

increase mucus production that leads to the formation of operculum, the mucus plug of the cervix that protects against bacteria and infection. Consistency: Softening of the cervix, known as Goodel’s sign, is observable by 6 to 8 weeks gestation.

Reproductive System Isthmus During pregnancy, the isthmus

softens and elongates up to 25 mm. It will later form the lower uterine segment, together with the cervix. Hegar’s sign – softening of the lower uterine segment begins as early as 5 week gestation

Reproductive System Vagina Increase blood supply results in:

Chadwick sign – change color from pinkish to purplish or dark-blue Increase sensitivity and heightened sexual responsiveness Vaginal ph 3.5 to 6, acidic 

Reproductive System Ovaries No Graafian follicle develop and no

ovulation occurs during pregnancy Corpus luteum is the chief source of hormone progesterone during the first 12 weeks gestation, it also produces estrogen, relaxin, inhibins and sometimes oxytocin.

Reproductive System Breast

Increase breast size due to alveolar tissue

growth, fat deposition and increase vascularity. associated with pregnancy includes  feeling of fullness and tingling sensation  darkening of the skin around the areola.  Montgomery’s gland becomes prominent and nipples stand out.  A clear fluid called colustrum, can be expressed from it as early as the 4th month.

Cardiovascular System Blood Volume

Total volume increases by 45 to 50%

for which 75% is plasma and 25% is RBC. Increase volume leads to increase in cardiac output by 25 to 50% Increase in blood volume reaches its peak at about 24 weeks, cardiac workload also reaches its peak during the 2nd trimester.

Cardiovascular System Blood Constituents

Increase production of RBC by the bone marrow Hemodilution occurs causing pseudoanemia Increase protein requirement of the fetus and

hemodilution contribute to the reduction of maternal plasma protein level. Reduction of protein level lowers osmotic pressure within intravascular spaces which causes fluid shift from intravascular to interstitial space. This contributes to the normal ankle and foot edema of pregnancy. Blood lipid and cholosterol level increases to provide an available supply of energy for the fetus Increase level of clotting factor making woman prone to thrombus formation. Instruct to avoid massage

Cardiovascular System Heart

The heart is displaced to the left

and upward of the diaphragm Slight cardiac enlargement Palpitation during pregnancy. In the 1st trimester is due to

parasympathetic stimulation In the latter part of pregnancy, it is due to enlarged uterus.

Cardiovascular System Blood Pressure Blood pressure remains the same as

pre-pregnancy level. It may drop slightly on the 2nd trimester but returns to normal levels on the 3rd trimester. Arterial blood pressure is highest in sitting position, intermediate in supine and lowest in left lateral position.

Respiratory system

Increase oxygen requirement Effects of estrogen and progesterone Mechanical effect of the enlarge uterus Hyperventilation – in an effort to blow off

the extra CO2 from the fetus. Displacement of the diaphragm – because of the enlarged uterus  Chest crowding – compensate by expanding the lung horizontally  Decrease residual volume – less air is left in the lung after expiration Shortness of breath

Respiratory system Total body comsumption of O2 increase by 15 –

20%  Nasal congestion occurs due to estrogen stimulation.

Urinary System Urinary frequency during pregnancy is due to: 1st trimester – uterus exerts pressure on the

bladder as it rises out of the pelvic cavity 2nd trimester – pressure of the presenting part on the bladder after lightening Increase blood flow to the kidney which increases glomerular filtration rate and consequently, urinary output.

Lactosuria  presence of lactose in the urine is considered

normal.  Lactose is secreted by the mammary glands but since it is not yet used during pregnancy, it normally spills in the urine.

Nocturia – increase urination at night

System Nausea and vomiting on the 1st trimester is attributed to: increase HCG level Increase estrogen level decrease maternal glucose level is being

utilized for fetal brain development

Gastrointestinal System Effects of Progesterone Decrease GIT motility – constipation Pyrosis / Heartburn – relaxation of

cardiac sphincter Slowed bile movement from gall bladder result in reabsorption of bilirubin in the maternal blood stream – pruritus

Gastrointestinal System Effects of Estrogen  Ptyalism – increase salivation  Epulis – hypertrphy or swelling of the gums.

Intergumentary System Melasma – facial discoloration Linea Negra – dark line from the umbilicus

to the symphisis Darker areola

Increase melanin production

Striae gravidarum Palmar erythema Vascular Spider nevi Activation of sweat and oil glands



Endocrine System Thyroid glands – slightly enlarge due to

increase metabolic rate Pancreas – elevated glucocorticoid level increase insulin production Parathyroid gland – increase needs for calcium Adrenal gland – increased corticosteroid production and aldosterone promote sodium reabsorption and water retention.Posterior pituitary secretes increase amount of oxytocin and prolactin as pregnancy nears.

Skeletal System Softening of joints and ligaments,

especially symphisis and sacroiliac joint is caused by relaxin and estrogen Leg cramps is caused by pressure of

gravid uterus on nerves and imbalance of calcium in the body.

SIGNS AND SYMPTOMS OF PREGNANCY Pressumptive

Probable

Positive

Amenorrhea Breast change Urinary frequency Quickening Easy fatigability Leukorrhea Nausea and vomiting Chadwick sign Striae Linea negra Melasma

Hegar’s sign Uterine growth Ballotement Uterine Shuffle Goodel’s sign Braxton-Hicks Contraction Fetal outline Positive Pregnancy test

Positive FHT Funic Shuffle Fetal movement X-ray visualization Positive Ultrasound