Pregnancy

• The body experiences many anatomical/physiologic changes during pregnancy. Findings in a physical assessment that would be considered abnormal in the nonpregnant client may be a result of pregnancy and not an abnormal state.
• In this chapter, the physical changes that occur in a woman as a result of pregnancy are identified as normal variations. Changes that are not a result of pregnancy or that represent an abnormal state during pregnancy are identified as deviations from normal.
• Prenatal maternal assessment


  1. Subjective data: Focus questions

  2. Objective data: Perform a general physical survey
• Subjective data: Focus questions

  • Past pregnancies
  • Current pregnancy
• Objective data: Perform a general physical survey

  • Age
  • Weight
  • Blood pressure
  • Pulse
  • Behavior
  • Skin color
  • Head and neck
  • Cardiovascular system
  • Respiratory system
  • Breast
  • Gastrointestinal system
  • Genitourinary-reproductive system
  • Musculoskeletal system
  • Neurologic system
• Ideal childbearing age


  16-35 years
• Advanced maternal age


  • Increases risk of genetic abnormalities such as Down Syndrome
  • Increased risk to mother and baby with age extremes
• Average total weight gain

  25-35 lb
• First trimester weight gain

  1. 4 lb
• Second trimester weight gain

  11 lb (1lb/wk)
• Third trimester weight gain

  11 lb (1lb/wk)
• Pre-pregnant weight


  • Sudden weight gain seen in pregnancy-induced hypertension (PIH)
  • Weight loss or failure to gain weight
• Normal blood pressure range

  90-130/60-89 mmHg
• Blood pressure changes during pregnancy


  Falls during second trimester, pre-pregnant level first and third trimesters
• Abnormal blood pressure


  • >140/90 mmHg or increase of 30 mmHg above baseline systolic or 15mmHg above baseline diastolic taken with client in side-lying position
  • Increased levels are seen with PIH
• Normal pulse range


  60-90 bpm: may increase 10-15 bpm higher than pre-pregnant levels
• Abnormal pulse


  • Irregularities: persistently <60 or >100 bpm at rest
• Behavior changes during pregnancy

  • First trimester: Tired, ambivalent
  • Second trimester: Introspective, energetic
  • Third trimester: Restless, preparing for baby, labile moods
• Abnormal behavior


  • Denial of pregnancy, withdrawal, depression, psychosis
• Normal skin changes


  Linea nigra, striae gravidarum, chloasma
• Abnormal skin changes


  • Pale, yellowish changes in color of the skin with liver diseases
• Head and neck changes

  • Nasal stuffiness, nosebleeds
  • Slight enlargement of thyroid
  • Blurred vision and visual spots are symptoms of PIH
• Abnormal head and neck changes

  • Nodules or marked enlargement, asymmetry of thyroid gland as seen with thyroid disease
• Cardiovascular changes


  • Short systolic blowing murmurs
  • Blood volume increases throughout pregnancy, peaks at 32-34 weeks, reaching 30-50% above prepregnancy levels
• Abnormal cardiovascular changes


  • Progressive dyspnea, palpitations, markedly decreased activity tolerance may be seen with cardiac diseases
• Peripheral vascular changes


  • Late pregnancy: dependent edema, varicose veins, supine hypotension
• Abnormal peripheral vascular changes

  • Perineal varicosities; calf pain may be related to deep vein thrombosis; generalized edema; diminished pedal pulses
• Respiratory changes


  Increased anteroposterior diameter, thoracic breathing, slight hyperventilation, shortness of breath in late pregnancy
• Abnormal respiratory changes


  • Dyspnea may be seen in patients with cardiac and/or lung diseases such as asthma
• Breast changes


  Increased size and nodularity, tenderness, prominent vascularization, darkening of nipples and areola, colostrum in third trimester
• Abnormal breast changes


  • Localized redness: localized pain and warmth; erythemic streaks are commonly seen with mastitis; inverted nipples may cause difficulty for breast-feeding infants
• Gastrointestinal changes


  Nausea and Vomiting, increased saliva, heartburn, bloating, constipation
• Abnormal gastrointestinal changes


  • Severe epigastric pain is seen with PIH; severe nausea & vomiting may be seen during the first trimester with hyperemesis gravidarum
• Genitourinary-reproductive changes


  • Urinary frequency in first and third trimesters, increased pigmentation of vulva and vagina, increased vaginal discharge
• Abnormal genitourinary-reproductive changes


  • Flank pain, dysuria, oliguria, proteinuria, purulent vaginal discharge, vaginal bleeding
• Musculoskeletal changes


  Relaxation of pelvic joints: "Waddling gait" increased lumbar curve, backache, leg cramps
• Abnormal neurologic changes


  • Hyperactive reflexes, positive seizure seen with PIH
• Slight dizziness during the early stage of pregnancy is a normal neurologic change
• Pregnancy history questions


  • Have you ever been pregnant?
  • What years did you give birth?
  • How many living children do you have?
  • Did you have any difficulties during pregnancy?
  • Have you ever had miscarriage? An abortion?
  • When did this occur?
  • What were the circumstances around miscarriage or abortion
  • How did you cope with these losses?
• Gravida-para notation


  • G = Gravida or total number of pregnancies
  • P = Para or outcomes of pregnancies
  • T = full Term
  • P = Premature
  • A = Abortion
  • L = Living children