PSYCHOLOGICAL CHANGES OF PREGNANCY E.

PARTNER’S ADAPTATION
- Intensity of emotional attachment with the mother will
A. SOCIAL INFLUENCES affect the partner’s attachment with the child.
- Viewed as a healthy span of time best shared w/a - A close relationship with each other may affect the
supportive family/partner woman’s decision-making (i.e. cultural background,
- Women bring families for prenatal visits and to watch past experience, relationship with family)
the birth - Conveying emotional factors through physical touch
- Pain management is chosen by the woman for labor (i.e. caress or touch during a prenatal visit or during
and birth birth)
Nursing Role: to teach women about their healthcare PSYCHOLOGICAL TASKS OF PREGNANCY
options and to work with other healthcare providers to
humanize childbirth. FIRST TRIMESTER: Accepting the Pregnancy

B. CULTURAL INFLUENCES Task: Accepting the Reality of Pregnancy

- Ask the people if there are things that need to be
done or to be avoided - The couple both need to recover from the initial
- Beware of myths such as lifting arms during surprise of learning about the pregnancy.
pregnancy (it can cause cord coiling) - Most common reaction is being Ambivalent (feeling of
- Watching a lunar eclipse can cause birth deformity both pleasure and anxiety with regards to the
(refer to sources if it is true or not) pregnancy; wanting and not wanting the baby)

SECOND TRIMESTER: Accepting the Baby

C. FAMILY INFLUENCES
- A woman that view mothering as positive is more Task: Accepting she is having a baby
likely to be pleased to be pregnant (influenced by the
- Usually occurs during Quickening (first moment she
positivity the woman saw her siblings or herself were
feels fetal movement)
loved during their mother’s pregnancy and birth)
- Might occur fast if the pregnancy was planned.
- Might occur during the announcement to the parents,
D. INDIVIDUAL DIFFERENCES
if the pregnancy was not planned.
- Woman’s ability to cope with stress
- The partner or the man might feel as if he is left
- Feeling of security with her relationship esp with the
standing and waiting to take part in the event and may
father of her child
have difficulty enjoying the pregnancy due to
- Negative/Positive Experiences
misinformation.
THIRD TRIMESTER: Preparing for Parenthood - The woman beings to envision herself as getting
bigger and avoiding objects or tables to avoid
Task: Nest-building bumping against it.
- Nest-building is planning for a sleeping arrangement
and choosing a name for the baby. B. GRIEF
- Attending prenatal classes or childbirth education. - The woman might feel like she is giving up or altering
her present role as she will never be the woman she
ASSESSING EVENTS THAT COULD CONTRIBUTE has been.
TO DIFFICULTY ACCEPTING THE PREGNANCY - She will never be carefree and could never sleep
soundly for the next few years.
• Pregnancy is unintended C. NARCISSISM
• Learning the pregnancy is a multiple, not a single one - Self-centeredness may be an early reaction to
• Learning the fetus has a developmental abnormality
pregnancy
• Pregnancy is less than one year from the previous
one - Dresses to show or not show her pregnancy.
• Family has to relocate during pregnancy (involves a - Loses interest in job or social events
need to find new support people) - May resent obvious casual remarks regarding her
• The woman has a role reversal (a previously weight or appearance
supporting person becomes dependent or vice versa) D. INTROVERSION vs EXTROVERSION
• The main family support person suffers a job loss - Introversion (turning inward to concentrate on oneself)
• Relationships end due to infidelity
- Extroversion (the woman becoming more active and
• There is a major illness in self, partner or relative
• Loss of significant other more outgoing)
• Complications of pregnancy occur E. STRESS
• The woman has a series of devaluing experiences - Can make it difficult for a woman to make decisions or
such as failure in school or work manage their time
- Most common in women who did not plan for
EMOTIONAL RESPONSES THAT CAN CAUSE
pregnancy.
CONCERN IN PREGNANCY
F. DEPRESSION
A. BODY IMAGE BOUNDARY - A feeling of sadness marked by loss of interest (low
self-worth, disturbed sleep, low energy, and poor
Body Image- the way your body appears to yourself concentration)
Body Boundary- zone of separation you perceive between - Can occur when they lack a meaningful support
yourself and objects and other people. person.
 - Can also occur for women who begins the pregnancy
with a strong support person and loses them along
the way.
G. COUVADE SYNDROME
- French word for “to hatch”
- Also called sympathetic pregnancy
- Proposed condition in which a partner experiences
the same symptoms and behavior as the expectant
mother.
- Some of them begin to gain weight along with their
partners.
H. EMOTIONAL LIABILITY
- Mood changes frequently A. PRESUMPTIVE SIGNS OF PREGNANCY (2-24 weeks
- Feelings are easily hurt (due to sustained increase in AOG)
estrogen and progesterone) 1. Breast Changes
I. CHANGES IN SEXUAL DESIRE - Increase in breast size
- Some women may enjoy sexual relations during - Tenderness, fullness, tingling, and darkening of areola
pregnancy while some lose the desire. - Marked hypertrophy and proliferation of the ducts
- 1st Trimester: decrease in libido (due to - Vascularity is increased
nausea/fatigue) 2. Nausea and Vomiting
- 2nd Trimester: libido and sexual enjoyment may rise - “morning sickness”
(increase blood flow to the pelvic area) - Linked to the production of the human chorionic
- 3rd Trimester: sexual desire may remain high gonadotrophin (HCG) hormone. Commonly referred to
J. CHANGES IN THE EXPECTANT FAMILY as the pregnancy hormone.
- Pre-school and school-aged children need to be 3. Amenorrhea
assured periodically that a new baby will be coming - Absence of menstruation
but will not interfere with their parent’s affection for 4. Frequent Urination
them. - 3 weeks AOG
- Sense of having to void more often
SYMPTOMS OF PREGNANCY BEFORE MISSING PERIOD
- Caused by an increase of the hormone progesterone
A. Presumptive Signs 5. Fatigue
B. Probable Signs - 12 weeks AOG
C. Positive Signs
 6. Uterine Enlargement - HCG is released by a fertilized egg that attaches to
- Uterus can be palpated over symphysis pubis the lining of the uterus.
7. Quickening 3. Chadwick Sign
- Fetal movement felt by woman - 6 weeks AOG
- Often feels like flutters/bubbles. - Bluish discoloration of the cervix, vagina, and labia.
8. Linea Negra - Caused by coloration due to increased blood flow
- Line of dark pigment forms on the abdomen leading to engorgement.
- Latin for “black line” - Operculum (a mucous plug forms to seal out bacteria
- Linea Alba (longitudinal, fibrous median raphe along and help prevent infection in the fetus and
the rectus sheath formed by the fusion of the anterior membranes)
and posterior walls of the sheath) 4. Godell’s Sign
9. Melasma or Chloasma - Significant softening of the vaginal portion of the
- “mask of pregnancy” cervix from increased vascularization.
- Dark pigment forms on face - Vascularization is a result of hypertrophy and
- Spots usually show up on the person’s cheek and engorgement of the vessels below the growing uterus.
forehead. 5. Hegar’s Sign
- Hormones temporarily stimulate an increased - Non-sensitive indication of pregnancy in women,
production of melanin, the substance which gives although its absence does not exclude the pregnancy.
color to your skin, hair, and eyes. - Pertains to the features of the cervix and the uterine
10. Striae Gravidarum isthmus.
- Red streaks form on abdomen - Softening consistency of the uterus.
- Appear initially over the abdomen, and then on breast, 6. Sonographic Evidence of Gestational Sac
thighs and inguinal area. - Characteristic ring is evident
- Marks usually fade after pregnancy - Gestational sac is fluid-filled structure that surrounds
the embryo in the womb.
B. PROBABLE SIGNS OF PREGNANCY - Diameter is only 2-3 mm.
- Can be observed and verified by an examiner. 7. Ballotement
1. Maternal Serum Test - French word for “to quake”
- A venipuncture of blood serum reveals the presence - Lower uterine segment is tapped on bimanual
of HCG. examination
2. Home Pregnancy Test 8. Braxton Hicks Contractons
- 1 week AOG - Periodic uterine tightening occurs
- Works by checking urine that detects the levels of 9. Fetal Outline Felt by Examiner
HCG in the urine. - Fetal outline can be palpated through abdomen
 C. POSITIVE SIGNS OF PREGNANCY - Counsel women on the importance of a diet rich in
-positive signs are the definitely confirmed as pregnancy. protein, folic acid, iron and vitamins.
Includes fetal heart sounds, ultrasound, palpation, x-ray - Hemoglobin level, blood type, and pap smear may be
and actual delivery of infant. determined.
1. Sonographic Evidence of Fetal Outline - The main purpose of the preconceptual visit is to
- 8 weeks AOG confirm pregnancy.
- Fetal outline can be seen and measured by sonogram
2. Fetal Heart Tone Audible PRENATAL CARE
- 10-12 weeks AOG - Essential for ensuring the overall health of newborns
- Doppler ultrasound reveals heartbeat and their mothers.
3. Fetal Movement felt by Examiner - Major strategy for helping to reduce complications of
- 20 weeks AOG pregnancy.
- Fetal movement can be palpated through abdomen - Purpose:
a. Establish a baseline of present health
PRENATAL CARE
b. Determine the gestational age of fetus
• Lifetime adequate intake of Calcium c. Monitor fetal development and maternal well-being
• Vitamin D to prevent rickets (which can disrupt pelvic d. Identify women at risk for complications
size) e. Minimize risk of possible complications
• Adequate immunizations for protection against viruses f. Provide education about pregnancy, lactation, and
during pregnancy newborn care.
• Overall healthy lifestyle - Goals:
1. Safe birth
• Positive attitude about sexuality, womanhood and
2. Health Promotion
childbearing.
3. Self-care
“Once a woman becomes sexually active, preparation for a 4. Provide physical care
successful pregnancy includes practicing safer sex, regular 5. Provide anticipatory guidance
pelvic examination, and prompt treatment of any sexually
Nursing Role
transmitted infection to prevent complications that could lead to
subfertility” (Ray, Shah, Gudi, et al., 2012) 1. Physical Assessment
2. Identify and reevaluate risk factors
PRECONCEPTUAL VISIT
3. Teach self-care
- usually done before planning a pregnancy to obtain 4. Nutrition counseling
accurate reproductive life planning information. 5. Promote family’s adaptation to pregnancy
 PRENATAL VISIT B. Components of Health History
- includes both present and past history
- Pregnant women engage themselves of having an 1. Demographic Data
appointment check-up with her doctor to obtain and - Name
maintain healthy pregnancy. - Age
- Provides a greater advantage in pregnancy whether - Address
the baby or the mother will encounter any problems - Contact number
during or after pregnancy. - Religion
FREQUENCY OF PRENATAL VISITS - Ethnicity
Weeks 4 to 28 1 prenatal visit per month - Type and place of employment
Weeks 28 to 36 1 prenatal visit every 2 weeks - Health insurance information
Weeks 36 to 40 1 prenatal visit per week 2. Chief concern
- The reason why the patient has come to the
healthcare setting
What is Trimester? A period of 3 months; division of duration of
- Document the date of her LMP
the pregnancy.
- Elicit the signs that occur in early pregnancy
First Trimester 1st -3rd month - Ask if she is feeling discomfort and danger signs of
Second Trimester 4th -6th month pregnancy
Third Trimester 7th -9th month - Ask if the pregnancy was intended
3. Family Profile
- Obtain information about family structure (may help
HEALTH ASSESSMENT DURING FIRST PRENATAL you get to know her and identify important support
VISIT persons)
- Foundation for Health Teaching
A. Initial Interview
- Areas to include (marital status, support people,
- Appropriate interviewing techniques (to obtain
educational level of the couple, size and structure of
meaningful health history)
the house, and lifestyle)
- Best accomplished in a private, quiet setting
4. History of Past Illness
- Ask the patient how they want to addressed (Miss,
- Important because it may become active during
Ma’am, first name or last name)
pregnancy
- Give them your name and make her understand your
- Example diseases:
role (Hello, my name is Ella, I’ll be your nurse today
a. Kidney Disease
and I will be asking you a few questions)
b. Heart Disease
c. Hypertension
 d. STDs 9. Reproductive Planning
e. Diabetes - Ask about what reproductive planning method has
f. Thyroid Disease been used
g. Gallbladder Disease 10. Sexual History
h. UTI - Number of sexual partners
i. Varicosities - the use of safe sex practices (to establish risk of STD)
j. PKU 11. Stress Incontinence
k. TB - Incontinence of urine while laughing, coughing, etc.
l. Asthma - Relieved through Kegel Exercises
5. History of Family Illnesses 12. Obstetrical History
- Identify illness that occur frequently to help identify - Do not assume current pregnancy is the woman’s first
potential problems that the infant or the woman might pregnancy
experience during or after pregnancy - Document the sex, weight, place and date of birth of
- Ask about cardiovascular and renal disease, cognitive each previous pregnancy.
impairment and blood disorders. - Ask about miscarriages or abortions and other
6. Day History/Social Profile complications
- Information abour current nutrition, elimination,sleep, - Rate GTPALM
recreation, exercise, hobbies, and interpersonal
interactions DEFINITION OF TERMS RELATED TO PREGNANCY
- Ask about Tobacco, Alcohol and Drug Consumption
a. Para – number of pregnancies that have reached
7. Gynecological History
viability, regardless of infant death
- Menstrual History
b. Gravida – number of times that the woman got pregnant
a. Age of menarche
c. Primigravida – first time pregnancy
b. Usual cycle (interval, duration, amount of flow and
d. Primipara – the woman that has given birth to one child
any discomfort)
past age of viability
- Perineal and Breast Self-Examination
e. Multigravida – the woman who has been pregnant
a. Inspecting the external genitalia monthly for
previously
infections or lesions.
f. Multipara – a woman has carried two or more
b. Women should be alerted with normal breast
pregnancies towards viability
changes
g. Grand Multigravida – a woman has been pregnant
8. Past Surgery
many times
- Any type of surgery on the reproductive tract as it will
h. Nulligravida – a woman has never been pregnant and is
affect the ability to conceive and give birth
not currently pregnant.
 i. Age of Viability – 20 weeks gestation 8. Respiratory System- cough, wheezing, asthma, SOB, TB,
j. Preterm – less than 37 weeks or Pneumonia
k. Post-term – more than 37 weeks 9. Cardiovascular System- heart murmur, heart disease,
palpitations, hypertension, normal blood pressure
l. Full-term – born at 37 weeks
10. Gastrointestinal System- pregnancy weight, vomiting,
diarrhea, constipation, hemorrhoids, hepatitis,
OBSTETRIC SCORING
appendicitis
G= number of pregnancies including current pregnancy 11. Genitourinary System- UTI, Hematuria, Polyuria, STD,
pregnancy complications
P= number of deliveries includes live and stillbirths 12. Extremities- varicosities, pain or stiff joints, carpal tunnel
syndrome
T= number of term deliveries born at or after 37 weeks 13. Skin- acne, rashes, psoriasis
P= number of preterm deliveries born before 37 weeks BASELINE DATA (height, weight, vital signs)
A= number of abortions spontaneous or therapeutic abortions - To serve as baseline for future comparison
- BP, HR, and RR
L= number of living children count twins as separate children - Determine BMI
M= number of multiple births count twins as one pair
Note: the scores should be in subscripts after the letters in
GP. TPALM scores are enclosed in parentheses.

REVIEW OF SYSTEMS
1. Head – headache, head injury, seizures, dizziness,
fainting
2. Eyes – vision, glasses needed, double vision, glaucoma,
cataract, pain
3. Ears – infection, discharge, earache, hearing loss,
tinnitus, vertigo
4. Nose – epistaxis, sinus pain, allergies, how many colds a
year
5. Mouth and Pharynx- dentures, condition of teeth,
toothaches, bleeding gums, difficulty in swallowing,
tonsillitis
6. Neck- stiffness, masses
7. Breast- lumps, pain, tenderness, secretions
UTERINE GROWTH DURING PREGNANCY Determination of Estimated Birth Date

McDonalds Rule EDC/EDB = Estimated Date of Confinement or Estimated Date

of Birth
- A measure of the size of the uterus used to assess
fetal growth and development during pregnancy. 1. Naegele’s Rule
- Measured from the top of the woman’s uterus to the - Standard method used to calculate the due date of
top of the woman’s pubic symphysis. pregnancies
- Count backwards 3 calendar months from the first day
of the woman’s LMP and add 7 days.
- Rule estimates the expected date of birth by adding a
year, subtracting three months, and adding 7 days to
the origin of gestational age.

LMP (APRIL TO DECEMBER)

Formula: (-3 months, +7days, +1 year)

LMP (JANUARY TO MARCH)

Formula: (+9 months, +7 days)

Measurement of Fundal Height and Fetal Heart Sounds
AGE OF GESTATION
- Can be palpable at 12-14 weeks of pregnancy.
Gestational Age – common term used to describe how far
- Characterizes as a firm globular sphere over the
along the pregnancy is. Measured in weeks from first day of
symphysis pubis.
LMP to current date.
- From symphysis pubis to the superior fundus.
- Fetal Heart sounds (normal rate of 110 to 160 bpm)

Last Menstrual Period

- Pregnancies are dated weeks starting from the first

day of the woman’s first day of her last menstrual
period.
 Nausea, Vomiting, Constipation, and Pyrosis

- Gastrointestinal symptoms are related to nutrition

- Morning sickness during pregnancy
- Pyrosis (technical term for heartburn or burning
sensation of the upper abdomen)

Fatigue

- Extremely common in early pregnancy (due to

increased metabolic requirements)
- Increase sleep and rest
MINOR BODY CHANGES OF PREGNANCY (1st
Trimester)
Breast Tenderness Muscle Cramps

- One of the first symptoms noticed in early pregnancy - Decreased serum calcium levels; increased serum
- Most noticeable when exposed to cold air phosphorus levels, and possible interference with
- Minimal and transient circulation
- Encourage wearing of bra with good bra strap support - Advise to take magnesium lactate or citrate once in
- Rule out pain brought by nipple fissures or breast the morning
abscess - Elevate lower extremities during the day to improve
- Dress warmly circulation
- Breasts may feel sore, sensitive or tender to touch, - Avoid full-leg extension
fuller and heavier - How to relieve leg cramp: 1) straighten leg, 2) flex
- Occurs 1-2 weeks after conception your toes back and toward the shin, 3) massage
muscle and warm with heating pad
Palmar Erythema
Hypotension
- Palmar pruritus (palm itch) caused by increase in
estrogen levels. - Symptom that occurs when a woman lies on her back
- After the woman’s body adjusts to these increase, it and the uterus presses on the inferior vena cava
will disappear. impairing blood return to the heart
- Irregular heart rate and feeling of apprehension
- Turn the woman to the left side to relieve pressure
 - Sitting position after being on a lying position in a - Use stool softener (docusate sodium or colace) to
warm crowded area women who already have hemorrhoids
- Apply witch hazel, cold compress, and OTC
hemorrhoid cream
- Hydrocortisone-pramoxine (Proctofoam-HC)
prescribed and safe for fetus

Heart Palpitations

- Sudden movements may cause for heart palpitations

- Circulatory adjustments necessary to accommodate
increased blood supply
- Normal and to be expected on occasion
Varicosities - If it occurs frequently accompanied by pain, should be
- Development of torturous leg veins (due to the weight a cause for concern
of the distended uterus putting pressure on the veins Polyuria (Frequent Urination)
returning blood from the lower extremities)
- Blood pooling and vessel distention - The fetus presses on the anterior bladder
- Veins become enlarged, inflamed, and painful - Lasts about 3 months (the first trimester)
- Can extend up to the vulva - Disappears mid-pregnancy and then returns again in
- Occurs to women with a history of varicosities, late pregnancy as the head of the fetus presses
obesity, multiple pregnancy, or large fetus against the bladder
- How to prevent: 1) rest in sims position, 2) raise legs - Advise the woman to void as necessary and to not
on a footstool 2x a day, 3) do not sit with legs crossed delay. (Urine Stasis can cause infection)
or knees bent, 4) avoid garters/hoses, 5) use elastic - Kegel Exercises are also advised to strengthen
support stockings, 6) Vitamin C, A, and B complex for urinary control and to strengthen perineal muscles for
circulatory health, also important for blood vessel childbirth
collagen and endothelium
Abdominal Discomfort
Hemorrhoids
- Women with multiple pregnancy may notice this
- Varicosities of the rectal veins throughout pregnancy
- Daily bowel evacuation to prevent constipation, drink - Arms crossed in front relieves the weight of their
adequate fluid, eat adequate fiber, and rest in sims abdomen
position.
 - Sharp and pulling pain may be due to tension on a - Apply local heat from
round ligament heating pad to relieve
- Advise to rise slowly from a lying or sitting position backache
- Squat rather than crouch
Leukorrhea to pick up objects
- Whitish, viscous vaginal secretions (occurs in - Lift objects by holding
response to high estrogen level and increased blood them close to the body
supply to vaginal epithelium and cervix)
- Acetaminophen (Tylenol)
Vulvar Itching is considered safe and
effective for relieving this
- Accompanied with vaginal discharge (suggests
type of pain
infection)
- Acupuncture is also
- Can be Candidiasis
effective
- Advised to avoid tight underpants and pantyhose to
- Do not take herbal
avoid vaginal infections
remedies, muscle relaxants
- Bath Daily, wear cotton underpants, sleep without
or other analgesics
underwear
- Do not wear tampons and no douching Headache

- Usually occurs due to expanding blood volume which

nd
MINOR BODY CHANGES OF PREGNANCY (2 and puts pressure on cerebral arteries
3rd Trimester) - Reduce eye strain or tension to lessen headache
- Rest with an ice pack on the forehead
Muscular/Skeletal Discomfort - Do not take Ibuprofen
- Lumbar lordosis develops and Dyspnea
postural changes necessary to
maintain balance leads to - The expanding uterus places pressure on the
backache diaphragm which results to lung compression and
- Wear shoes with low-to- shortness of breath
moderate heels to reduce - Most noticeable at night
spinal curvature. - Advise women to sleep with their head and chest
- Encourage women to walk with elevated
pelvis tilted forward
Ankle Edema

- Swelling of ankles and feet (most noticeable at the

end of the day)
- Hypertension and Proteinuria should be absent.
- Caused by general fluid retention and reduced blood
circulation due to uterine pressure
- Can be relieved by resting in left side-lying position to
increase kidney glomerular filtration rate and also for
good venous return
- Avoid wearing constricting clothes

Braxton Hicks Contraction

- Tightening of the uterine muscles for 1-2 minutes,

considered as aid or preparatory for birth
- Begins during the 8th-12th week of pregnancy
- Contractions begin to get stronger during the middle
and late pregnancy. The woman may feel intense pain
sensation.