Normal Changes During Pregnancy

NORMAL
CHANGES
DURING
PREGNANCY
PHYSIOLOGIC CHANGES
1. ABDOMINAL ENLARGEMENT
- Uterus rises reaching the level or slightly above the umbilicus
- Umbilicus is slightly pushed outward.
2. BALLOTMENT
- From French word “balloter” meaning to toss about.
- Bouncing of the fetus felt when the lower uterine segment is
tapped by the lower hand during bimanual examination.
3. SKIN PIGMENTATION
- Cholasma/melasma – deposits of brownish pigments on the
forehead, nose, cheeks. Also called as “Mask of pregnancy”
CHANGES IN UTERINE MEASUREMENTS
PREPREGNANCY TERM PREGNANCY
WEIGHT 50 gm 1100 gm
THICKNESS 2 cm 0.5 cm
LENGTH 6.5 cm 32 cm
DEPTH 2.5 cm 20 cm
WIDTH 4 cm 24 cm
CAPACITY 10 mL 5000 mL
- Linea Nigra – narrow line of brown pigmentation from the
midline of the umbilicus to the symphysis pubis.
3. STRIAE GRAVIDARUM
- Pink or reddish streaks appearing on the sides of the abdominal
wall and thigh; may also appear on the breast.
- Caused by the stretching of the abdominal wall leading into the
rupture and atrophy of small segment of the connective layer of
the skin.
4. DIASTASIS RECTI
- Occurs when the abdominal wall has difficulty stretching
enough to accommodate the growing fetus, causing the rectus
muscle to separate.
- Appears as a bluish groove at the site of separation.
6. VASCULAR SPIDERS – (face, neck, chest)
- Small fiery red branching spots usually seen on the thighs.
- Results from the increase in estrogen level.
7. URINARY FREQUENCY
- Uterus exerts pressures on the bladder as it rises out the pelvic
cavity.
8. PALPITATION
- Increased thoracic pressure asserted by the uterus on the
diaphragm.
- Increase cardiac load, heart rate increase by 10b/min.
9. UTERUS (Changes)
- Becomes thin, soft walled muscular sac which yields to the
movement of the growing fetus.
PSYCHOLOGICAL/EMOTIONAL
CHANGES TO PREGNANCY
ACCEPTANCE OF PREGNANCY
“I am pregnant.” (First Trimester)
- Acceptance of the reality of pregnancy is the first psychological
task that the pregnant woman faces. Aside from the signs and
symptoms of pregnancy experienced, the doctor’s confirmation of
pregnancy often helps the woman accept the fact that she is
pregnant. At this stage, the unborn child is incorporated as part of
the woman’s body image or as part of herself.
ACCEPTANCE OF THE FETUS AS A SEPARATE INDIVIDUAL
“I am going to have a baby.” (Second Trimester)
- Quickening by 20 weeks gestation can be very significant in
helping the woman realize that the fetus inside her womb is not
a part of her body but a real and separate individual to care for.
As the woman realizes the individuality of her unborn child, she
begins to fantasize about the child’s sex and appearance. In this
manner she gives the fetus an identity.
THE WOMAN PREPARES FOR THE BIRTH OF THE BABY AND

HER ROLE AS A MOTHER
“I am going to be a mother.” (Third Trimester)
- The woman begins to plan about the birth of the baby.
EMOTIONAL REACTIONS
EXPERIENCED BY A NEWLY
PREGNANT WOMAN
1. AMBIVALENCE – refers to the simultaneous negative and
positive response of the woman to pregnancy.
2. FEAR AND ANXIETY – it is related to the woman’s concern
about her own health and the health of her baby.
3. INTROVERSION OR NARCISSISM – during pregnancy, the
woman may become concerned for her welfare and the effects
of pregnancy on her health and lifestyle. She may be occupied
with her own thoughts and feelings.
CHARACTERISTICS OF
PREGNANT WOMAN
FIRST TRIMESTER
1. Displays a sense of ambivalence of the pregnancy.
2. Fantasize about the pregnancy
3. Role playing
4. Increased concern for financial and social problems.
5. Decreased interest in sex due to body changes.
SECOND TRIMESTER
1. The patient develops a sense of well-being as her body
becomes adjusted to the changes associated with pregnancy.
2. “quickening” is experienced.
3. The fetus heartbeat is heard.
4. Both parents develop an interest in fetal growth and
development.
5. The interest in processes of labor and delivery is expressed.
6. The patients may have wide mood swings.
7. Tendency to introversion and to focus on herself as the center
of attention.
8. Changes in sexual behavior characterized by increased interest
in sex an decreased sexual fantasies and dreams.
THIRD TRIMESTER
1. Altered Self-image.
2. Fear. She dreams about the infant and what the future holds for
the new baby. She is also concerned for her own safety and
performance during labor and delivery.
3. Aggravation. The patient is aggravated over things she cant do
for herself due to her size.
4. Fatigue. She becomes tired easily.
5. Wondering. The patient wonders what kind of parent she will
be.
DISCOMFORTS DURING
PREGNANCY
1. NAUSEA AND VOMITING
- Also known as morning sickness.
- Hyperemesis Gravidarum - nausea accompanied by severe
vomiting.
Management:
• Eat dry toast or crackers before rising from bed.
• Eat small frequent meals rather than 3 large ones.
2. FREQUENT URINATION
- Due to the enlarging uterus exerts pressure on the bladder.
Management:
• Limit fluid intake before bedtime.
• Kegel exercise to improve tone of muscles that control
urination.
3. FATIGUE
- Due to the action of progesterone (first Trimester)
- Due to increased metabolic rate and increased weight of the
uterus (2nd and 3rd trimester.)
4. BREAST TENDERNESS AND NIPPLE IRRITATION
- Due to alveolar cells development as stimulated by increased
level of estrogen.
Management:
• Wash breast with water only, no soaps and alcohol to prevent
drying and irritation.
• Wear supportive maternity bra.
5. LEUKORRHEA
- Increase vaginal discharge. It is due to elevated level of estrogen
which causes hyperactivity of cervical gland
6. HEARTBURN/PYROSIS
- A burning discomfort located behind the lower part of the sternum.
- Progesterone slows down gastric motility resulting in reflux of gastric
contents into lower esophagus.
Management:
• Eat small frequent meals.
• Advise not to lie down immediately after eating
7. HEADACHE
- Expanding blood volume puts pressure on cerebral arteries.
Management:
• If intense or associated with hypertension call a physician
• Rest with cold towel on the forehead.
8. PICA and PTYALISM
- Craving for nonfood stuff or unusual food
• Geophagia – clay/soil eating
• Amylophagia – starch eating
• Ptyalism – profuse salivation
9. VARICOSITIES
- An enlargement in the diameter of the veins.
Management:
• Advise mother to assume Sim’s position when resting or on the back
with the legs elevated for 10-15 minutes.
• Avoid wearing tight clothes and garters that can constrict the blood
vessels.
• Use support stockings.
10. HEMORRHOIDS
- Varicosities of rectal veins
Management:
• Regular bowel movement
• Resting in a modified sim’s position
• Knee-chest for at least 10-15 minutes
• Use stool softeners
• Cold compress to affected area.
11. LEG CRAMPS
- Caused by the pressure of the uterus against the nerve
supplying the lower extremities.
12. EDEMA
- Swelling of the lower extremities due to pressure on the
lymphatics and blood vessels supplying the lower extremities.

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NORMAL

THE WOMAN PREPARES FOR THE BIRTH OF THE BABY AND

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