CONCEPT OF PREGNANCY
PHYSIOLOGY OF PREGNANCYBYTIYAS KDEPARTMENT OF CHILD &
MATERNITY NURSING, AIRLANGGA UNIVERSITY, 2013Definition of
pregnancyThe period from conception to birth
(wordnet.princeton.edu/perl/webwn )
Pregnancy is a state in which a woman carries a fertilized egg
inside her body
(medical-dictionary.thefreedictionary.com/pregnancy)Conception
Fertilization of an ovum by a spermatozoon
Cell division
Chromosome exchange
Normal PregnancySpans 40 weeks without any complication in
either mother & fetus
Trimesters:First: weeks 1 through 13 Second: weeks 14 through 26
Third: weeks 27 through 40
Fetal Growth
Signs and symptomsPresumptive indicators Missed menstrual period
Home pregnancy test positive Amenorrhea, nausea, vomiting, breast
tenderness, urinary frequency, fatigue (morning sickness)
Quickening (perception of fetal movement)
Probable indicatorsUterine enlargement Braxton Hicks
contractions Uterine souffle Ballotement Positive pregnancy
test
Positive indicatorsPresence of fetal heartbeat distinct from
mothers Fetal movement felt by someone other than mother
Visualization (e.g., ultrasound examination)
Diagnosis of Pregnancy USGDoppler ExaminationEstimated date of
birth (EDB)Ngeles rule Determine first day of LMP(Last Menstrual
Period), subtract 3 months, add 7 days plus 1 year Alternatively,
add 7 days to LMP and count forward 9 months
Adaptation of PregnancyPsychosocial adaptation:Maternal
adaptation Accepting pregnancy Identifying with mother role
Reordering personal relationships Establishing relationship with
fetus Emotional attachment Preparing for childbirth
Adaptation of PregnancyPsychosocial adaptation:Paternal
adaptation Accepting pregnancy Identifying with father role
Reordering personal relationships Establishing relationship with
fetus Emotional attachment Preparing for childbirth Sibling
adaptation Grandparent adaptation
Physical ChangesHormonesEndocrine systemReproduction
systemHematology systemRespiratory systemUrinary
systemGastrointestinal systemBone and integument system
Pregnancy HormonesHuman Chorionic Gonadotropin(hCG)glicoprotein
lutein hormone like structure Produce by trophoblast. Rising level
to 9th WOP. To maintain corpus luteum wich produce oestrogen &
proqesteron before placenta is available Change in smell &
taste nauseaDecreasing immunosupresan reduce mother rejection to
placenta15Pregnancy HormonesHuman Placental
Lactogen(hPL)Polipeptide produce by syntiotrophoblastProduce time
510days after implantation Reduce mother responds to insulin sugar
intake on mother > extra cell matrix water water retention
edemaPregnancy HormonesProgesteroneProduce by
syntiotrophoblastLowering excitability of white muscle (myometrium,
ureter, usus)Increasing sensitivity of chemoreceptor on
CO2Increasing temperature 0,51,0Cinduce varicose & hemorrhoids
cause by dilatation of vein on lower extremity & rectal
Hormone level during pregnancy
Endocrine system>> sekresi ACTH>> Beta endorfin on
3rd trimester >> oxytocin sekretion > corticosteroid
@cortisol higher level in morning , induce striae >> T3 &
T4 intestine calcium absorbtion >>, excretion by the renal
> contraction frequency (5% per week) especially nocturnal
CERVIXCervix thickness & soften start at 2nd trimestercervix
Mucus sticky to avoid infection
VAGINA>> blood flow vena enlargement >> mucus +
normal bacteria vagina >acid
UTERUS
Hematology systemHemodilutionIncreased blood volume 3050% from
week 734 Hemoglobin, immunoglobulin, platelet & protein
>hyperventilationSnoring especially women with preeclampsia
(Izci etal,2005)
Urinary systemIncreased GFR 4050% on 1st trimesterActivity of
Reninangiotensinaldosterone system
increaseelektrolitGlycosuriaUrinate frequencies >>
Gastrointestinal systemSlow gastric emptyingNausea, vomiting
constipation
Mother Weight DistributionFetal weight : 28%Plasenta :
5,7%amnion : 4,1%uterus : 8%breast : 6,5%Blood volume : 13,1%Body
fat : 33,6%(Neil, 1995)Increase Body WeightBMI PRENATALNormal
Increase of body weight (Kg)Underweight ( Melanocyte stimulating
hormone hyper pigmented skin
Striae
Linea nigra
Care ManagementPurpose of prenatal care is to identify existing
risk factors and other deviations from normal Emphasis on
preventive care and optimal self-care
AssessmentInitial visit: interview Reason for seeking care
Current pregnancy Obstetric and gynecologic history Medical history
Nutritional history History of drug use Family history Social and
experiential history History of physical abuse Review of systems
Physical examination Laboratory tests
Follow-up visits Interview Physical examination Fetal assessment
Fundal height Gestational age Health status Laboratory tests
Multiple-marker or triple-screen blood test Other blood tests
(RPR/VDRL, CBC, anti-Rh) Other tests Ultrasonography
Amniocentesis
Obstetric History TerminologyG (gravida): the current pregnancyT
(term births): the number of pregnancies ending >37 weeks
gestation, at termP (preterm births): the number of preterm
pregnancies ending >20 weeks or viability but before completion
of 37 weeksA (abortions): the number of pregnancies ending before
20 weeks or viabilityL (living children): number of children
currently living
36Physical ExaminationPelvic examinationExamination of external
and internal genitaliaBimanual examinationPelvic shape: gynecoid,
android, anthropoid, platypelloidPelvic measurements: diagonal
conjugate, true (obstetric) conjugate, and ischial tuberosity
37Abdomen Leopolds maneuvers
Fundal height (FH) and age of gestation by Mc Donalds
Months of gestation = FH ( cm ) X 2/7weeks of gestation = FH (
cm ) X 8/7
Estimated Fetal Weight (EFW) based onJohnson Tausack formula
EBW = [FH(cm) N ] X 155
N = 13 if fetal head have not pass the pelvic inlet yetN = 12 if
fetal head is above the spina iskhiadika.N = 11 if fetal head is
below the spina iskhiadika.AuscultationNormal Fetal Heart Beat(FHB)
= 120160 times/ min Follow-up VisitsVisit schedule: Every 4 weeks
up to 28 weeksEvery 2 weeks from 29 to 36 weeksEvery week from 37
weeks to birth
421st Trimester DiscomfortsUrinary frequency or incontinence
(see Teaching Guidelines 12-1)FatigueNausea and vomitingBreast
tendernessConstipationNasal stuffiness, bleeding gums,
epistaxisCravingsLeukorrhea432nd Trimester
DiscomfortsBackacheVaricosities of the vulva and
legsHemorrhoidsFlatulence with bloating443rd Trimester
DiscomfortsReturn of 1st trimester discomfortsShortness of breath
and dyspneaHeartburn and indigestionDependent edemaBraxton Hicks
contractions
45Intervention Education on:Nutrition Personal hygiene
Prevention of urinary tract infections Kegel exercises Preparation
for breastfeeding newborn Dental health Physical activity Posture
and body mechanics Rest and relaxation Employment and travel
Clothing
Medications Immunizations Alcohol, cigarettes, and other
substances Normal discomforts Recognizing potential complications
Printed list of signs and symptoms Emergency telephone numbers
Recognizing preterm labor After the 20th week Before 37th week of
pregnancy Uterine contractions, if untreated, cause cervix to open
earlier, with resulting preterm birth
Sexual counseling Permission Countering misinformation
Suggesting alternative behaviors Psychosocial support Cultural
influences Emotional response Clothing Physical activity and rest
Sexual activity Diet
Childbirth and Perinatal EducationBirth setting choices Labor,
delivery, recovery, postpartum (birthing) rooms Birth centers Home
birth Factors increasing the safety of birth at home Pain
management
Key Points Maternal physical and familial adaptations to
pregnancy generate needs that nurse can anticipate and meet Nurse
must be alert to hazards such as supine hypotension, warning signs
and symptoms, and signs of family maladaptation Each pregnant woman
needs to know how to recognize and report preterm labor Cultural
prescriptions and proscriptions influence responses to pregnancy
and health care Childbirth education helps parents make transition
from role of expectant parents to role and responsibilities of
parents
