NCM 107 MIDTERM by Loise Anne Jarylle Soller

LESSON 2: PHYSIOLOGIC & PSYCHOLOGICAL CHANGES IN PREGNANCY

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Pregnancy hormones

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1. HCG (Human chorionic gonadoprotin)
- secreted during first trimester
- sustaining the corpus luteum
*corpus lutuem: secretes estrogens & progesterone during first 2 months of pregnancy

2. Estrogen
- comes from the androgens inside the adrenal cortex that comes from the fetus

3. Progesterone
- comes from the mother
- inhibits GnRH, LH, FSH, release, preventing LH surge

PLACENTA: hormone secreting organ

Pregnancy Tests

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1. Laboratory tests - detects HCG

* HcG - found in blood or urine
- important in secreting estrogen and progesteron

2. Home pregnancy tests - 97% accuracy if done properly
* medications such as anti-depressants can give false positive result

Cryptic pregnancy
- unconsciously aware of pregnancy

3F's Positive Signs

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Fetal Outline in UTZ
Fetal heart tone
Fetal movement felt by examiner

*note- Fetal Outline is only a probable sign if it's only felt by examiner

Importance of hormones during pregnancy

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- to support fetal growth
- maternal health

SIGNS

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PHYSICAL CHANGES

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Presumptive Signs

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NOTES
• breast changes is one of the earliest signs of pregnancy apart from amenorrhea
• By the 12th week, the uterus rises above the
symphysis pubis.
• On the 18th week, quickening, a term used to describe fetal movement felt by the mother is present at this time.
• all the signs under presumptive may be signs of other conditions aside from pregnancy and are highly subjective.

MsH promotes lung maturity

Probable Signs

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NOTES:
• Ballottement is done by tapping the lower uterine segment
• Braxton-Hicks contraction are also known as practice contractions (not a true contraction)
- prepares for labor contraction

TRUE CONTRACTION
- cervix opens

Positive Signs

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NOTES:

The fetal heart is audible by the 10th to 12th week using a doppler

The fetal heart is audible by by
the 18-20th week using a ordinary stethoscope

• 120-160 bpm: normal FHT
• fetal back: where FHT is best heard at and determined by performing the Leopold’s maneuver

UTERUS

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• ↑ size (volume, length, width, depth, wall thickness)
•↑ uterine blood flow
• decidua: endometrium of pregnant woman (thick, highly vascularized)
• hegar's sign
• ballottement
• braxton hicks
• amenorrhea

OVARY

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• ovulation stops
• ↑ corpus luteum

OPERCULUM: mucus plug; coating of mucus fills the cervical canal: prevents ascending infection to uterus/vagina

VAGINA

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• chadwick's sign
• vaginal secretion changes (from alakaline (7 pH) to acidic (4-5 pH))

LEUKORRHEA: white vaginal discharge
abnormal: change in color and odor, and excessive amount

BREAST

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• colostrum: earliest breastmilk production; happens at 12th to 18th weeks

MONTGOMERY'S TUBERCLE: small bumps around dark area of nipple
: lubricates and keeps germs from breast

Local Changes (Reproductive System)

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Consistency of Vaginal Discharge

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Nonpregnant - tip of nose
Pregnant - earlobe
Term - soft as butter; "ripening"

Systemic Changes

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INTEGUMENTARY

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• striae
• melasma

RESPIRATORY

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there is an increased amount of oxygen needed, and an increased amount of CO2 to be eliminated

• ↑ increased RR
• ↑ increased tidal volume
• no change vital capacity
• ↓ by 20% residual volum
• ↓ to about 27-32 mmHg plasma CO2
- to allow movement of CO2 from fetus to mom through diffusion
• ↑ plasma pH
• ↑ plasma PO2

FETAL: 40-45 mmHg
MOTHER: 20-30 mmHg

CARDIOVASCULAR

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↑ increased by 30-50% blood volume
----may cause pseudo-anemia (false OR physiologic anemia)

• pseudo-anemia
- compensated by increased RBC
- near levels by 2nd trimester

• anemia
- low hemoglobin
- low RBC to carry oxygen

PSEUDO-ANEMIA: anemia during late 1st trimester to early 2nd trimester

ANEMIA: early 1st and late 2nd-3rd trimester
- (Hgb < 11.5g/100mL)/Hct < 300%

PSYCHOLOGICAL CHANGES

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SOCIAL CHANGES

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- knowledge
- personal experiences
- cultural experiences

pregnancy is viewed as:
before: 9-month long illness
present: a time of health

ATTITUDE TOWARDS PREGNANCY

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A WOMAN’S ATTITUDE TOWARD A PREGNANCY DEPENDS A GREAT DEAL ON PSYCHOLOGICAL ASPECTS:

• the environment in which she was raised
• 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 or less than a good time in her life

Influences in Pregancy

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•Cultural Influences: beliefs and practices
• Family Influences: positive or negative influence
• Individual Influences: coping mechanism, social relationships

Common Psychological Effects

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1st trimester: ambivalence
2nd trimester: narcism and introversion; role playing and day dreaming
3rd trimester: clothes preparation and arrangement of sleep; being ready for birth

Tasks during pregnancy

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1st trimester: Accepting the pregnancy
2nd trimester: Accepting the baby
3rd trimester: Preparing for the baby and end of pregnancy

Changes in Sexual Desire

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1st trimester: decreased in libido due to nausea, vomiting
2nd trimester: libido and sexual enjoyment rise markedly
3rd trimester: sexual desire may remain high or may decrease due to uncomfortabileness

Emotional responses

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ambivalence
grief
narcissism
introversion
body image and boundary
stress
emotional lability

COUVADE SYNDROME
- men are experiencing physical
symptoms like N & V, backache to some degree or more
intensely than partner
- due to stress, anxiety and empathy