PSYCHOLOGICAL TASK OF PREGNANCY

1. First Trimester: Accepting the Pregnancy

2. Second Trimester: Accepting the Baby
3. Third Trimester: Preparing for Parenthood
PHYSIOLOGIC CHANGES OF PREGNANCY
1. Reproductive System Changes
• Uterine Changes
❖ Over the 10 lunar months of pregnancy, the uterus increases in length, depth, width, weight, wall
thickness, and volume
o Length increases from approximately 6.5 to 32 cm.
o Depth increases from 2.5 to 22 cm.
o Width expands from 4 to 24 cm.
o Weight increases from 50 to 1000 g.
o Early in pregnancy, the uterine wall thickens from about 1 cm to about 2 cm; toward the end of
pregnancy, the
o wall thins to become supple and only about 0.5 cm thick. The volume of the uterus increases from
about 2 mL to
o more than 1000 mL. The uterus can hold a 7-lb (3175-g)
o fetus plus 1000 mL of amniotic fluid for a total of about
o 4000 g at term.
❖ by the end of the 12th week, the uterus is large enough to be palpated as a firm globe under the
abdominal wall, just above the symphysis pubis
❖ By the 20th or 22nd week of pregnancy, reach the level of the umbilicus.
❖ By the 36th week, it should touch the xiphoid process and can make breathing difficult.
❖ About 2 weeks before term (the 38th week) for a primigravida, a woman in her first pregnancy, the
fetal head settles into the pelvis to prepare for birth, and the uterus returns to the height it was at 36
weeks
❖ This event is termed lightening, because a woman’s breathing is so much easier it seems to lighten a
woman’s load. multipara (a woman who has had one or more children) it may not occur until labor
begins.
❖ Braxton Hicks contractions, serve as warm-up exercises for labor and also increase placental
perfusion. 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.
❖ Hegar’s sign extreme softening of the lower uterine segment; It is a probable sign of pregnancy
• Amenorrhea
❖ occurs with pregnancy because of the suppression of follicle-stimulating hormone (FSH) by rising
estrogen levels.
❖ A presumptive sign of pregnancy.
• Cervical Changes
❖ A tenacious coating of mucus fills the cervical canal
❖ operculum, acts to seal out bacteria during pregnancy and therefore helps prevent infection in the
fetus and membranes
❖ Goodell’s sign - Softening of the cervix in pregnancy is marked. probable diagnostic of pregnancy.
• Vaginal Changes
❖ increase in the activity of the epithelial cells results in a white vaginal discharge throughout pregnancy
(a presumptive sign).
❖ increase in the vascularity of the vagina, beginning early in pregnancy,
❖ Chadwick’s sign - resulting increase in circulation changes the color of the vaginal walls from the
normal light pink to a deep violet a probable sign of pregnancy.
❖ Vaginal secretions during pregnancy fall from a pH of sgreater than 7 (an alkaline pH) to 4 or 5 (an acid
pH).
• 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.
2. Changes in the Breasts
• Subtle changes in the breasts may be one of the first physiologic changes of pregnancy notices (at
about 6 weeks)
• because of the increased stimulation of breast tissue by the high estrogen level The women
experienced a feeling of
❖ fullness
❖ tingling,
❖ tenderness

3. Systemic Changes
• Integumentary System
As the uterus increases in size, the abdominal wall must stretch
to accommodate it. This stretching (plus possibly increased adrenal cortex activity) can cause rupture
and atrophy of small segments of the connective layer of the skin. This leads to pink or reddish streaks
(striae gravidarum) appearing on the sides of the abdominal wall and sometimes on the thighs .

During the weeks after birth, striae gravidarum lighten to a silvery-

white color (striae albicantes or atrophicae), and, although permanent, they become barely noticeable.

Extra pigmentation generally appears on the abdominal wall. A narrow, brown line (linea nigra) may
form, running from the umbilicus to the symphysis pubis and separating the abdomen into right and left
hemispheres

Darkened areas may appear on the face as well, particularly on the cheeks and across the nose. This is
known as melisma (chloasma), or the “mask of pregnancy.” These increases in pigmentation are caused
by melanocyte-stimulating hormone, which is secreted by the pituitary. With the decrease in the level of
the hormone after pregnancy, these areas lighten and again disappear.

Vascular spiders or telangiectasis (small, fiery-red branching

spots) are sometimes seen on the skin of pregnant women,
particularly on the thighs. These probably result from the increased level of estrogen in the body. They
may fade but not completely disappear after pregnancy.

• 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.

As the uterus enlarges during pregnancy, a great deal of pressure is put on the diaphragm and,
ultimately, on the lungs. This can displace the diaphragm by as much as 4 cm upward. This crowding of
the chest cavity causes an acute sensation of shortness of breath late in pregnancy, until lightening
relieves the pressure.
The cumulative effect of these respiratory changes is often
experienced by a woman as chronic shortness of breath.
Although her breathing rate is more rapid than usual (18–20
breaths per minute), this is normal for pregnancy.

• Temperature
❖ Early in pregnancy, body temperature increases slightly because of the secretion of progesterone from
the corpus luteum (the temperature, which increased at ovulation, remains elevated). As the placenta
takes over the function of the corpus luteum at about 16 weeks, the temperature usually decreases to
normal.

• Cardiovascular System
❖ Blood Volume.
▪ Blood loss at a normal vaginal birth is about 300 to 400 mL; blood loss from a cesarean birth can be as
high as 800 to 1000 mL
❖ Iron, Folic Acid, and Vitamin Needs.
▪ The fetus requires a total of about 350 to 400 mg of iron to grow. The increases in the mother’s
circulatory red blood cell mass require an additional 400 mg of iron. This is a total increased need of
about 800 mg.
▪ The average woman’s store of iron is less than this amount (about 500 mg), and because iron
absorption may be impaired during pregnancy as a result of decreased gastric acidity
▪ Encourage women to eat foods that are high in folic acid (e.g., spinach, asparagus, legumes) both
during the pre-pregnancy period and during pregnancy.
▪ Prenatal vitamins that contain folic acid are routinely prescribed.
❖ Heart.
▪ To handle the increase in blood volume in the circulatory system, a woman’s cardiac output increases
significantly, by 25% to 50%; the heart rate increases by 10 beats per minute
▪ Palpitations in the early months of pregnancy are probably caused by sympathetic nervous system
stimulation; in later months, they may result from increased thoracic pressure caused by the pressure of
the uterus against the diaphragm.
▪ The nurse can caution women not to feel frightened if palpitations do occur
❖ Blood Pressure.
▪ Blood pressure actually decreases slightly during the second trimester because the peripheral
resistance to circulation is lowered as the placenta expands rapidly.
▪ During the third trimester, the blood pressure rises again to first-trimester levels
❖ Peripheral Blood Flow.
▪ During the third trimester of pregnancy, blood flow to the lower extremities is impaired by the pressure
of the expanding uterus on veins and arteries. This resistance to blood flow in the venous system can
lead to edema and varicosities of the vulva, rectum, and legs.

❖ Supine Hypotension Syndrome.

▪ When a pregnant woman lies supine, the weight of the growing uterus presses the vena cava against
the vertebrae, obstructing blood flow from the lower extremities. This causes a decrease in blood return
to the heart and, consequently, decreased cardiac output and hypotension
▪ A woman experiences this hypotension as lightheadedness, faintness, and palpitations
▪ The condition is potentially dangerous because it can cause fetal hypoxia.
▪ Supine hypotension syndrome can easily be corrected by
having a woman turn onto her side (preferably the left side), so that blood flow through the vena cava
increases again.
▪ Teach women always to rest on the left side rather than the back, because even with additional
collateral circulation, a supine position tends to lead to hypotension.
❖ Blood Constitution.
▪ The level of circulating fibrinogen, a constituent of the blood that is necessary for clotting, increases
probably because of the increased level of estrogen.
▪ clotting factors, such as factors VII, VIII, IX, and X, and the platelet count also increase.
▪ Total white blood cell count rises slightly, both as a protective mechanism and as a reflection of a
woman’s increased total blood volume
▪ The total protein level of blood decreases, perhaps indicating the amount of protein being used by the
fetus Because the circulating system has a lower total protein load and hypervolemia
▪ This causes the common ankle and foot edema of pregnancy (not to be confused with nondependent
or generalized edema, which is a symptom pregnancy induced hypertension).
▪ Blood lipids increase by one third, and the cholesterol serum level increases by 90% to 100%. These
increases provide a ready supply of available energy for the fetus.
• Gastrointestinal System
❖ At least 50% of women experience some nausea and vomiting
early in pregnancy.
❖ One of the first sensations a woman may experience with pregnancy (sometimes it is noticed even
before the first missed menstrual period).
❖ Common feeling of nausea usually subsides after the first 3 months, after which time a woman may
have a voracious appetite.
❖ Known as morning sickness, nausea and vomiting begin to be noticed at the same time levels of hCG
and progesterone begin to rise
❖ As the uterus increases in size, it pushes the stomach and intestines toward the back and sides of the
abdomen.
❖ At about the midpoint of pregnancy, this pressure may be sufficient to slow intestinal peristalsis and
the emptying time of the stomach, leading to increased heartburn, constipation, and flatulence.
❖ A lower than normal pH of saliva may lead to increased tooth decay if tooth brushing is not done
conscientiously.

• Urinary System
❖ Fluid Retention.
▪ To provide sufficient fluid volume for effective
placental exchange, total body water increases to 7.5 L; this requires the body to increase its sodium
reabsorption in the tubules to maintain osmolarity
▪ Water is retained during pregnancy to aid the increase in blood volume and to serve as a ready source
of fluid for the fetus.
▪ A sodium restricted diet was also recommended. The excess fluid can serve to replenish the mother’s
own blood volume, should hemorrhage occur.
❖ Renal Function.
▪ During pregnancy, a woman’s kidneys must excrete not only the waste products from her body but also
those of the growing fetus. Also, her kidneys must be able to excrete additional fluid and manage the
demands of increased renal blood flow. The kidneys may increase in size, changing their structure and
ultimately affecting their unction.
▪ During pregnancy, urinary output gradually increases (by about 60% to 80%). The specific gravity of
urine decreases
▪ Creatinine clearance has become the standard test for renal function during pregnancy, because
creatinine is cleared from the body at a steady rate in relation to GFR. A normal pregnancy value is 90 to
180 mL/min. This is analyzed from a 24-hour urine sample.
❖ Ureter and Bladder Function.
▪ an increase in urinary frequency during the first
3 months of pregnancy, until the uterus rises out of the pelvis and relieves pressure on the bladder.
▪ Frequency of urination may return at the end of pregnancy, as lightening occurs and the fetal head
exerts renewed pressure on the bladder.
▪ Because of the increased level of progesterone during
▪ pregnancy, the ureters increase in diameter and the bladder
▪ capacity increases to about 1500 mL.
▪ The uterus tends to rise on the right side of the abdomen because it is pushed slightly in that direction
by the greater bulk of the sigmoid colon.
▪ As a result, pressure on the right ureter may lead to urinary stasis and pyelonephritis if not relieved.
Pressure on the urethra may lead to poor bladder emptying and bladder infection.
▪ Such infections are potentially dangerous to the pregnant woman, because they can ascend to become
kidney infections.
▪ They are potentially dangerous to the fetus, because
▪ urinary tract infections are associated with preterm labor
❖ Frequency of urination Increased first trimester,
▪ last 2 weeks of pregnancy to 10–12 times/day
• Skeletal System
❖ Calcium and phosphorus needs are increased during pregnancy, because the fetal skeleton must be
built.
❖ To change her center of gravity and make ambulation
easier, a pregnant woman tends to stand straighter and taller than usual. This stance is sometimes
referred to as the “pride of pregnancy.” Standing this way, with the shoulders back and the abdomen
forward, creates a lordosis (forward curve of the lumbar spine), which may lead to backache

Endocrine Gland Changes and Effects During Pregnancy

Gland Change Effect
Thyroid Slight enlargement Increased basal metabolism rate
gland Increased thyroid hormone production Increased oxygen consumption
Parathyroid Slight enlargement Better utilization of calcium and vitamin D
gland Increased parathyroid hormone production
Pancreas Early in pregnancy, decreased Additional glucose is available for fetal
insulin production because of heavy fetal growth
demand for glucose
 After first trimester, increased insulin
production because of insulin antagonist
properties of estrogen, progesterone,
and
human placental lactogen
FSH and LH decrease Anovulation
Pituitary Prolactin increases Breasts prepared for lactation
gland Melanocyte-stimulating hormone increases Increased skin pigment
Human growth hormone increases Aids fetal growth
Estrogen and progesterone produced Uterine and breast enlargement, fat
deposits Increased blood coagulation,
sodium and water retention

Softening of cervix and collagen of joints

Placenta
Relaxin increased Increases glucose available for fetus
Decreases utilization of protein for energy,
increasing availability for fetal growth

Human placental lactogen

• Immune System
❖ Immunologic competency during pregnancy apparently decreases, probably to prevent a woman’s
body from rejecting the fetus as if it were a transplanted organ.

Danger signs of Pregnancy

4. First Trimester
1. severe nausea, vomitting and diaherra for 24 hours
2. Fever greater than 100.4
3. Bleeding, pain with urination
4. Abdominal cramping
5. Bloody show

5. Second Trimester
1. nausea, vomitting, diaherra for 24 hours
2. abdominal cramping
3. pain with urination or blood
4. fever greater than 100.4
5. bloody show
6. severe continuous HA
7. change in vision, blurred or seeing spots
8. heartburn pain
9. sudden swelling in face and hands
10. decreased fetal movement
6. Third Trimester
1. Bloody show
2. Water breaking
3. Contractions (q 5 mins)