Lowdermilk, Perry: Maternity Nursing, 7/e Copyright © 2006 by Mosby, Inc. All rights reserved. 1 of...

Copyright © 2006 by Mosby, Inc. All rights reserved.Lowdermilk, Perry: Maternity Nursing, 7/e1 of 24

Chapter 8Chapter 8

Anatomy and PhysiologyAnatomy and Physiologyof Pregnancyof Pregnancy

Copyright © 2006 by Mosby, Inc. All rights reserved.2 of 24 Lowdermilk, Perry: Maternity Nursing, 7/e

Gravidity and ParityGravidity and Parity

Understanding of following terms is essential Understanding of following terms is essential to study of maternity care:to study of maternity care:■ Gravida: a woman who is pregnantGravida: a woman who is pregnant■ Gravidity: pregnancyGravidity: pregnancy■ Multigravida: woman who has had two or more Multigravida: woman who has had two or more

pregnanciespregnancies



■ Multipara: woman who has completed two or Multipara: woman who has completed two or more pregnancies to stage of fetal viabilitymore pregnancies to stage of fetal viability

■ Nulligravida: woman who has never been Nulligravida: woman who has never been pregnantpregnant

■ Nullipara: woman who has not completed Nullipara: woman who has not completed pregnancy with fetus or fetuses who have pregnancy with fetus or fetuses who have reached stage of fetal viabilityreached stage of fetal viability



■ Parity: number of pregnancies in which fetus Parity: number of pregnancies in which fetus or fetuses have reached viability, not number or fetuses have reached viability, not number of fetuses (e.g., twins) born. Whether fetus is of fetuses (e.g., twins) born. Whether fetus is born alive or stillborn (fetus who shows no born alive or stillborn (fetus who shows no signs of life at birth) after viability is reached signs of life at birth) after viability is reached does not affect paritydoes not affect parity

■ Postdate or postterm: pregnancy that goes Postdate or postterm: pregnancy that goes beyond 42 weeks of gestationbeyond 42 weeks of gestation



■ Preterm: pregnancy that has reached 20 Preterm: pregnancy that has reached 20 weeks of gestation but before completion of 37 weeks of gestation but before completion of 37 weeks of gestationweeks of gestation

■ Primigravida: woman who is pregnant for first Primigravida: woman who is pregnant for first timetime

■ Primipara: woman who has completed one Primipara: woman who has completed one pregnancy with fetus or fetuses who have pregnancy with fetus or fetuses who have reached stage of fetal viabilityreached stage of fetal viability



■ Term: pregnancy from beginning of week 38 of Term: pregnancy from beginning of week 38 of gestation to end of week 42 of gestationgestation to end of week 42 of gestation

■ Viability: capacity to live outside uterus; about Viability: capacity to live outside uterus; about 22 to 24 weeks since last menstrual period, or 22 to 24 weeks since last menstrual period, or fetal weight greater than 500 gfetal weight greater than 500 g


Pregnancy TestsPregnancy Tests

Human chorionic gonadotropin (hCG) is Human chorionic gonadotropin (hCG) is earliest biochemical marker for pregnancy; earliest biochemical marker for pregnancy; pregnancy tests are based on recognition of pregnancy tests are based on recognition of hCG or beta subunit of hCGhCG or beta subunit of hCG


Pregnancy TestsPregnancy Tests

Many different pregnancy tests availableMany different pregnancy tests available■ ImmunoassayImmunoassay■ RadioimmunoassayRadioimmunoassay■ Radioreceptor assayRadioreceptor assay■ Enzyme-linked immunosorbent assay (ELISA)Enzyme-linked immunosorbent assay (ELISA)

testing is most popular method of testing for testing is most popular method of testing for pregnancypregnancyELISA technology is basis for most OTC ELISA technology is basis for most OTC

home pregnancy tests home pregnancy tests


Adaptations to PregnancyAdaptations to Pregnancy

Signs of pregnancySigns of pregnancy Reproductive system and breastsReproductive system and breasts

■ UterusUterusChanges in size, shape, and positionChanges in size, shape, and positionChanges in contractilityChanges in contractility

● Braxton Hicks signBraxton Hicks signUteroplacental blood flowUteroplacental blood flowCervical changesCervical changes

● Goodell signGoodell sign


Displacement of internal abdominal structures and diaphragm by the enlarging uterus at 4, 6, and 9 months of gestation


Displacement of internal abdominal structures and diaphragm by the enlarging uterus at 4, 6, and 9 months of gestation

4 Months 6 Months 9 Months



Reproductive system and breasts Reproductive system and breasts ■ Uterus—Uterus—cont’dcont’d

Changes related to presence of fetusChanges related to presence of fetusQuickeningQuickening

■ Vagina and vulvaVagina and vulvaChadwick signChadwick signLeukorrheaLeukorrhea

■ BreastsBreastsMontgomery’s tuberclesMontgomery’s tuberclesColostrumColostrum



General body systemsGeneral body systems■ Cardiovascular systemCardiovascular system

Blood pressureBlood pressureBlood volume and compositionBlood volume and compositionCardiac outputCardiac outputCirculation and coagulation timesCirculation and coagulation times



General body systems—General body systems—cont’dcont’d

■ Respiratory systemRespiratory systemPulmonary functionPulmonary functionBasal metabolism rateBasal metabolism rateAcid-base balanceAcid-base balance

■ Renal systemRenal systemAnatomic changesAnatomic changesFunctional changesFunctional changesFluid and electrolyte balanceFluid and electrolyte balance


Height of fundus by weeks of normal gestation with a single fetus. Dashed line, height after lightening




■ Integumentary systemIntegumentary systemChloasmaChloasmaLinea nigraLinea nigraStriae gravidarumStriae gravidarumPalmar erythemaPalmar erythema

■ Musculoskeletal systemMusculoskeletal system■ Neurologic systemNeurologic system




■ Gastrointestinal systemGastrointestinal systemAppetiteAppetiteMouthMouthEsophagus, stomach, and intestinesEsophagus, stomach, and intestinesGallbladder and liverGallbladder and liverAbdominal discomfortAbdominal discomfort




■ Endocrine systemEndocrine systemPituitary and placental hormonesPituitary and placental hormonesThyroid glandThyroid glandParathyroid glandParathyroid glandPancreasPancreasAdrenal glandsAdrenal glands


Key PointsKey Points

Biochemical, physiologic, and anatomic Biochemical, physiologic, and anatomic adaptations during pregnancy are profound adaptations during pregnancy are profound and revert back to nonpregnant state and revert back to nonpregnant state following birth and lactationfollowing birth and lactation

Maternal adaptations are attributed to Maternal adaptations are attributed to hormones of pregnancy and to mechanical hormones of pregnancy and to mechanical pressures exerted by enlarging uterus and pressures exerted by enlarging uterus and other tissuesother tissues



Ability to recognize beta subunit of hCG Ability to recognize beta subunit of hCG through use of monoclonal antibody through use of monoclonal antibody technology has revolutionized endocrine tests technology has revolutionized endocrine tests for pregnancyfor pregnancy

Presumptive, probable, and positive signs of Presumptive, probable, and positive signs of pregnancy aid in diagnosis of pregnancypregnancy aid in diagnosis of pregnancy



Positive signs of pregnancyPositive signs of pregnancy■ Identification of fetal heartbeat Identification of fetal heartbeat ■ Verification of fetal movementsVerification of fetal movements■ Visualization of fetus Visualization of fetus

Adaptations to pregnancy protect woman’s Adaptations to pregnancy protect woman’s normal physiologic functioning, meet normal physiologic functioning, meet metabolic demands of pregnancy, and metabolic demands of pregnancy, and provide for fetal growth and developmentprovide for fetal growth and development



Rise in pH of pregnant woman’s vaginal Rise in pH of pregnant woman’s vaginal secretions makes her more vulnerable to secretions makes her more vulnerable to vaginal infectionsvaginal infections

Increased vascularity and sensitivity of vagina Increased vascularity and sensitivity of vagina and other pelvic viscera may lead to high and other pelvic viscera may lead to high degree of sexual interest and arousaldegree of sexual interest and arousal

Some adaptations to pregnancy result in Some adaptations to pregnancy result in discomforts such as fatigue, urinary discomforts such as fatigue, urinary frequency, nausea, and breast sensitivityfrequency, nausea, and breast sensitivity



As pregnancy progresses, balance and As pregnancy progresses, balance and coordination are affected by changes in coordination are affected by changes in woman’s joints and center of gravitywoman’s joints and center of gravity

Lowdermilk, Perry: Maternity Nursing, 7/e Copyright © 2006 by Mosby, Inc. All rights reserved. 1 of...

Documents

Transcript of Lowdermilk, Perry: Maternity Nursing, 7/e Copyright © 2006 by Mosby, Inc. All rights reserved. 1 of...