PHYSIOLOGIC CHANGES OF PREGNANCY
● All maternal body systems are altered, these changes are
normal and inevitable.
● Pregnancy is a state of wellness, not an illness.
● It’s important to encourage independence of the woman
during her pregnancy (taking care of herself, physically).
● Can be categorized as:
A. Local - reproductive organs only.
B. Systemic - the whole body.
PHYSIOLOGIC CHANGES OF PREGNANCY
● All maternal body systems are altered, these changes are
normal and inevitable.
● Pregnancy is a state of wellness, not an illness.
● It’s important to encourage independence of the woman
during her pregnancy (taking care of herself, physically).
● Can be categorized as:
A. Local - reproductive organs only.
B. Systemic - the whole body.
● The following are the changes seen through different
systems:
- Reproductive System Changes
- Breast Changes
- Endocrine Changes
- Cardiovascular Changes
- Gastrointestinal System
- Urinary System
- Immune System
- Integumentary System
- Muscular System
- Skeletal System
● Recommended weight during pregnancy:
Weight gain in pregnancy is at approximately 0.4 kg (1lb) per month during the first trimester, and then 0.4 kg (1lb) per week during the 2nd & 3rd trimesters (a trimester pattern of 3-12-12).
● 25-35 lbs, average of 27 lbs.; Multiple babies: 40-45 lbs.
● Total energy cost in the duration of pregnancy:
85,000 calories (take note of the image above).
- Increase of thyroid and parathyroid
hormones. Insulin requirements increase in the 2nd
trimester because of the human placental lactogen (HPL).
Melanocyte-stimulating hormones are also increased.
Endocrine Changes
- There is an increase of size, but it varies
from woman to woman. Assure that the woman can
provide milk regardless of her body size. Production of
immunoglobulin A (igA) for breast milk.
Breast Changes
- Growth of uterus, it is
going to accommodate the fetus. A uterus can carry more
than 4000 grams on its overstretching. Increased
hormones can be observed as well, such as estrogen and
progesterone.
Reproductive System Changes
● Task is accepting the pregnancy.
● The woman and the partner should both spend
time recovering from the shock of learning that
they are pregnant, and concentrate on what it
feels like to be pregnant.
● A common reaction is ambivalence, or feeling
both pleased and not pleased about the
pregnancy.
- FIRST TRIMESTER: ACCEPTING THE PREGNANCY
- 30-50% increase in total cardiac
volume. Physiologic anemia is also seen due to the fetus’
need for hemoglobin and iron. Heart rate also increases.
Women may also experience edema on the lower
extremities, varicose veins on the legs, and epistaxis.
Cardiovascular Changes
- Slow-emptying of stomach,
feeling of bloatedness, heartburn, nausea and vomiting
due to the human chorionic gonadotropin (hCG). pH level
of saliva decreases, gum tissues soften and is at risk of bleeding, constipation. Give increased fluid intake,
encourage soft-bristle brush for teeth.
Gastrointestinal System
- Production of immunoglobulin G (igG)
for the placenta. WBC increases and it is normal.
Immune System
- Glomerular filtration rate (GFR) is
increased, while blood urea nitrogen (BUN) and plasma
creatinine is decreased. Renal system has decreased
measurement for sugar. Frequent urination.
Urinary System
- Hyperpigmentation of areola,
Linea Nigra, Melasma or mask of pregnancy, active
sebaceous sweat glands.
Integumentary System
- Remember the balance of calcium and
phosphate intake.
Muscular System
- A woman’s ability to cope
with or adapt to stress plays a major role in how she can
resolve any conflict and adapt:
a. To being a mother without needing mothering,
to loving a child as well as a partner;
b. To becoming a mother for each new child
depends on her basic temperament on whether
she adapts to new situations quickly or slowly,
whether she faces them with intensity or
maintain a low-key approach, and whether she
had experience coping with change and stress;
c. The extent to which a woman feels secure in her
relationship with the people around her;
d. Past experiences influence how a woman
perceives pregnancy as a positive or negative
experience;
e. To being concerned about her appearance;
f. To worry that pregnancy will rob her financially
and ruin her chances of job promotion.
● INDIVIDUAL DIFFERENCES
- The woman and her partner feel
during pregnancy and prepared to meet the challenges
related to them:
a. Cultural background
b. Personal beliefs
c. Experiences reported by friends and relatives
d. Current plethora of information available
● CULTURAL INFLUENCES
- Gradual softening of pelvic ligaments
and pubic joints. Lumbosacral spinal curve, lordotic
posture of the patient and causes low back pain.
Skeletal System
- The family in which the woman is
raised can be influential to her beliefs about pregnancy:
a. The woman and her siblings were loved and
seen as a pleasant outcome is more likely to
have a positive attitude towards her pregnancy.
b. A woman who views mothering a positive
activity is more likely to be pleased when she
becomes pregnant than one who does not value
mothering.
c. Negative influences - The woman and her
siblings were blamed for the breakup of a
marriage or a relationship.
● FAMILY INFLUENCES
- Refers to the interwoven feelings
of wanting and not wanting feelings, which can
be confusing to an ordinarily organized woman.
Ambivalence
- provides an outlet
for both the male and female partners to discuss
concerns and offer parenting information.
Prenatal visit or fetal testing
- assesses both anomalies
and can be a major step in promoting
acceptance because the woman can see a
beating heart, fetal outline, or learn the sex of
the fetus.
Routine sonogram
● Task is preparing for the baby and the end of
the pregnancy - The woman and the partner
prepare clothing and sleeping arrangements for
the baby but also grow impatient with
pregnancy as they prepare themselves for birth.
- THIRD TRIMESTER: PREPARING FOR PARENTHOOD
● Task is accepting the baby - The woman and the
partner move through emotions such as
narcissism and introversion as they concentrate
on what it will feel like to be a parent.
Roleplaying and increased dreaming are
common.
- SECOND TRIMESTER: ACCEPTING THE BABY
- hearing their pregnancy is
officially diagnosed at a first prenatal visit is
another step towards accepting a pregnancy.
First prenatal visits
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LESSON 1: MALE AND FEMALE REPRODUCTIVE ANATOMY116
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LESSON 2.1: BREAST, PELVIS, AND FETAL SKULL63
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LESSON 2.2: MENSTRUATION61
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LESSON 2.3: HUMAN GENETICS43
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LESSON 4.1: CARE OF THE MOTHER AND FETUS DURING THE PERINATAL PERIOD93
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LESSON 4: NORMAL CHANGES DURING PREGNANCY32
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LESSON 4.3: PRENATAL CARE7
