M7

• 1st Trimester

  Accepting the pregnancy - "I am pregnant"
• 1st Trimester Tasks

  Accept the reality of the pregnancy
• Maladaptation

  Denial
• Initially, she feels ambivalence
• Sonogram is done between 18 - 22 weeks
• 2nd Trimester


  Accepting the baby - "I am going to have a baby!"
• 2nd Trimester Tasks

  Accept she is having a baby
• The change usually happens at quickening
• The partner and the woman feel narcissism and introversion
• 3rd Trimester

  Preparing for parenthood - "I am going to be a mother."
• 3rd Trimester Tasks

  Childbirth preparation
• Interested in attending prenatal and childbirth classes
• Emotional Responses to Pregnancy


  • Ambivalence
  • Grief
  • Narcissism
  • Introversion
  • Body Image and Boundary
  • Stress
  • Couvade Syndrome
  • Emotional Lability
  • Changes in Sexual Desire
  • Changes in Expectant Family
• Ambivalence


  Feeling of both pleased and not pleased
• Grief


  Give up or alter the present role
• Narcissism

  Self-centeredness
• Physiologic Changes Signs

  • Presumptive
  • Probable
  • Positive
• Presumptive Signs


  Subjective, least indicative of pregnancy
• Presumptive Signs


  • Amenorrhea
  • Nausea and vomiting
  • Breast Changes
  • Urinary Frequency
  • Skin changes: Chloasma, Linea Nigra, Striae Gravidarum
  • Diaphoresis
  • Leukorrhea
  • Weight Gain
  • Quickening
• Probable Signs


  Objective, can be documented by the examiner
• Probable Signs


  • Uterine enlargement
  • Goodell's Sign
  • Hegar's Sign
  • Chadwick's Sign
  • McDonald's Sign
  • Braxton-Hicks contractions
  • Ballotement
• Positive Signs


  Fetal parts on palpation by examiner<|>Fetal skeleton on X-ray<|>Fetal outline on ultrasonography<|>Fetal Heart Tone is audible
• Normal fetal heart rate range is 120-160 bpm
• FUNIC souffle


  Sound of blood in the cord
• Uterine souffle


  NOT a diagnostic sign
• Volume of uterus increases from 2 ml to >1000 ml
• Uterus can hold a 7 lb fetus plus 1000 ml of amniotic fluid totaling 4,000 g
• 12th week: palpated as a firm globe under the abdominal wall, under symphysis pubis
• 20th to 22nd week: palpated at the level of the umbilicus
• 36th week: should touch the xiphoid process making breathing difficult
• 38th week: for primigravida, fetal head settles into the pelvis, uterus returns to its height at 36 weeks (lightening)
• Uterus is pushed slightly to the right because of the bulk of the sigmoid colon on the left
• Toward the end of the pregnancy, 1/6th of the total body blood supply is circulating through the uterus
• Cardiovascular System Changes


  • Blood Volume
  • Heart Rate
  • Cardiac Output
  • Peripheral Blood Flow
  • Blood Constitution
• Blood volume increases by 30 to 50%
• Blood loss (NSD): 300-400 ml
• Blood loss (CS): 800-1000 ml
• Increase begins at the end of the 1st trimester & peaks at 28th-32nd week until term
• Pseudoanemia occurs as plasma volume increases faster than RBC's volume
• Fetus requires 350-400 mg of iron