T2 Adaptations and Nursing Care During Pregnancy

• What happens to the uterus during pregnancy?

  Size increases from 10 mL to 5 L, becomes more ovoid, and moves from the pelvis up into the abdomen.
• When does the uterus start to move up into the abdomen?

  Around 12 weeks.
• When does the pregnancy begin to "show"?

  Around 14 weeks.
• When can the uterus be palpated above the pubic symphesis?

  Between weeks 12 to 14.
• When does the uterus reach the xyphoid process?

  36 weeks.
• What is the "lightening" that women feel after 36 weeks of pregnancy?

  The presenting part of the fetus settles into the pelvis.
• What sign of pregnancy occurs around 6 weeks that is shown by the softening of the lower uterus?

  Hegar's sign.
• What does Hegar's sign cause with pregnant women?

  Urinary frequency.
• What may the pregnant woman feel around the 4th month of pregnancy?

  Braxton Hicks contractions.
• What are Braxton Hicks contractions?

  Irregular and painless contractions to increase uterine blood flow.
• When do Braxton Hicks contractions become more pronounced?

  After 28 weeks.
• When do Braxton Hicks contractions usually stop?

  With activity such as walking.
• Do Braxton Hicks contractions cause cervical dilation?

  No.
• At term, how much of maternal blood volume is in the uterine vascular system?

  1/6.
• What factors can decrease uterine blood flow?

  • Maternal hypotension
  • Uterine contractions
  • Maternal supine hypotension
  • Decreased maternal blood volume
• What sound does uterine blood flow cause?

  A bruit called "uterine souffle" which can be heard using ultrasound, doppler or fetoscope.
• What does the funic souffle sound signify?

  Fetal heart rate caused by circulation of blood through the umbilical cord.
• What is ballottement?

  Passive movement of the fetus where the fetus "bounces" away from the examiners finger before it rebounds.
• What is quickening?

  Fetal movements felt by the mother during pregnancy that can be felt as early as 14 weeks but usually around 18 weeks or later.
• What is a softening of the cervix called?

  Goodell sign.
• What is friability?

  How cervical tissue is easily damaged which can lead to slight bleeding after examination or coitus.
• What is a mucous plug?

  Plug high in immunoglobulins in the cervical canal to help prevent infection during pregnancy.
• What is the corpus luteum?

  Site of egg release on the ovary.
• What else does the corpus luteum do until the placenta takes over?

  Produces estrogen and progesterone.
• What is it called when the vaginal mucous thickens with increased vascularity causing a violet or blueish color of the cervix and vaginal mucosa?

  Chadwick's sign.
• What kind of discharge may be noted with Chadwick sign?

  Whitish or grayish mucousy drainage.
• What happens to the vulva during pregnancy?

  Increased blood flow and hormonal changes can cause the vulva to become swollen and darker in color during pregnancy with heightened sensitivity.
• What becomes more pronounced on the breasts during pregnancy?

  Montgomery tubercules.
• What are striae gravidarum?

  Stretch marks.
• What may begin leaking during the second trimester?

  Colostrum.
• What happens to maternal blood volume during pregnancy?

  Increases by 40 - 45% by approximately 32 weeks.
• What function does an increase in maternal blood volume have during pregnancy?

  Protective mechanism to provide a fluid reserve for blood loss during childbirth.
• What happens to maternal cardiac output during pregnancy?

  Increases by 30 - 50% by 25 - 30 weeks and is related to increase volume and oxygen demand.
• What happens to maternal blood pressure during pregnancy?

  Systolic may decrease slightly and diastolic may decrease through 24 - 32 weeks before returning to pre-pregnancy levels.
• What happens to the heart during pregnancy?

  Slightly enlarges and is pushed up and to the left.
• What heart sounds may be heard from the mother during pregnancy?

  Splitting of S1 and S2 and may hear S3.
• What happens to the heart rate during pregnancy?

  Increases by 5 weeks, peaks by 15 - 20 bpm higher than pre-pregnancy rate by 32 weeks.
• Are the heart changes reversible after pregnancy?

  Yes.
• What happens to the blood during pregnancy?

  • Physiologic anemia
  • WBCs increase
  • Fibrinolytic activity is decreased
• What is physiologic anemia with pregnancy?

  Hemodilution leads to a decrease in H&H.