NURS230 EXAM GUIDE PHYSIOLOGIC CHANGES DURING
PREGNANCY
Chap 11
Physiologic changes during pregnancy
• Uterus:
o enlargement due to hypertrophy, thickening of walls, increase in vascular and
lymphatic system, Braxton hicks
• Cervix:
o estrogen stimulates glandular tissue, development of mucous plug, Goodell
and Chadwick sign
• Ovaries:
o ovum production stops, HcG maintains corpus luteum, secretes progesterone
• Vagina:
o hypertrophy, increased vascularity, hyperplasia from estrogen, increased
secretions, loosening of connective tissues, increased blood flow
• Breasts:
o glandular hyperplasia and hypertrophy, darkened areolas, prominent veins,
striae, colostrum (antibody rich yellow secretion that converts to milk following
birth)
• GI:
o nausea and vomiting, hyperemia (bleeding of the gums), many symptoms related
to uterine pressure, liver changes, slow gallbladder emptying
• Urinary:
o pressure on the bladder causes frequent urination, dilation of kidneys, increased
GFR and renal plasma flow, possible glycosuria
• Skin:
o hyperpigmentation, facial chloasma (melasma gravidarum), striae, vascular spider
nevi, decreased hair growth, hyperactive sweat glands
• Musculoskeletal:
o pelvic joints relax (waddling gait), center of gravity changes, separation of
rectus abdomen
• Eyes:
o decreased intraocular pressure, thickening of cornea, may affect contact lenses
• CNS:
o decreased attention span, concentration, and memory, sleep problems
• Metabolism:
o weight gain (25-35lb above pre-pregnancy weight recommended), nutrient
metabolism (increased protein retention, fetal demands high during 2nd half of
pregnancy, higher rate of fat absorption, fat deposits increase from 2-12%, body
switches from glucose to lipid metabolism), carbohydrate demand increases,
gestational diabetes, increased demand for iron, retention of calcium
• Endocrine:
o thyroid: serum thyroxine and BMR increase, TSH decreases
o parathyroid: concentration of PTH increases, parallels fetal Ca requirements
o pituitary: thyrotropin and adrenotropin alter metabolism, prolactin (lactation).
oxytocin and vasopressin
o adrenal: increased aldosterone
o pancreas: increased insulin needs
, NURS230 EXAM GUIDE PHYSIOLOGIC CHANGES DURING
PREGNANCY
Supine Hypotension
• AKA vena caval syndrome, aortocaval compression
• the growing uterus compresses the inferior vena cava, leading to decreased venous
return (when the pt is in supine position)
Goodell’s Sign
• softening of the cervix
Hegar’s Sign
• softening of the uterus
Cardiac changes
• uterus puts pressure on diaphragm, BV increases 40-50%, cardiac output increases, decrease
in systemic and pulmonary vascular resistance, pulse increases, BP decreases slightly, femoral
venous pressure rises, supine hypotensive syndrome, erythrocyte volume increases, leukocyte
and platelet production, plasma fibrinogen increases, anemia
Respiratory changes
• TV increases, O2 consumption increases, breathing changes from abdominal to thoracic,
vascular congestion of nasal mucosa
Physiologic anemia
• Plasma volume increases more than RBC’s during pregnancy, resulting in lowered Hgb and
Hct levels.
• Decreased Hgb leads to decreased iron, resulting in physiologic
anemia. Presumptive, Probable and Positive Signs of Pregnancy
1. Presumptive: amenorrhea (no period), nausea and vomiting (morning sickness),
fatigue, frequent urination, breast changes, quickening (mothers perception of fetal
movement)
2. Probable: changes in pelvic organs, Hegar’s sign, Ladin sign, McDonald sign, Braun von
Fernwald sign, Piskacek sign, enlargement of abdomen, braxton hicks, striae, uterine souffle,
skin pigmentation, fetal outline (Ballottement), pregnancy tests of blood or urine
1. B subunit radioimmunoassay (RIA)
2. Enzyme linked immunosorbent assay (ELISA)
3. Fluoroimmunoassay (FIA)
b. Positive: auscultation of fetal heartbeat using Doppler, fetal movement (palpable at 20wks),
visualization of the fetus via ultrasound
Psycho-social adjustment- Maternal and Paternal
• Maternal:
o intendedness
o ambivalence
o acceptance (1st- baby does not seem real, 2nd- quickening, pregnancy glow,
3rd- physical discomfort and nesting)
o introversion
o mood swings
o body image changes
o ensuring a safe passage through birth, pregnancy, labor
o seeking of acceptance of the child from others
o seeking of commitment and acceptance of oneself as a mother
o learning to give oneself on behalf of one’s child
• Paternal:
o view of role has changed (nurturing, caring parent and provider)
o benefit of being involved decreases maternal stress levels
PREGNANCY
Chap 11
Physiologic changes during pregnancy
• Uterus:
o enlargement due to hypertrophy, thickening of walls, increase in vascular and
lymphatic system, Braxton hicks
• Cervix:
o estrogen stimulates glandular tissue, development of mucous plug, Goodell
and Chadwick sign
• Ovaries:
o ovum production stops, HcG maintains corpus luteum, secretes progesterone
• Vagina:
o hypertrophy, increased vascularity, hyperplasia from estrogen, increased
secretions, loosening of connective tissues, increased blood flow
• Breasts:
o glandular hyperplasia and hypertrophy, darkened areolas, prominent veins,
striae, colostrum (antibody rich yellow secretion that converts to milk following
birth)
• GI:
o nausea and vomiting, hyperemia (bleeding of the gums), many symptoms related
to uterine pressure, liver changes, slow gallbladder emptying
• Urinary:
o pressure on the bladder causes frequent urination, dilation of kidneys, increased
GFR and renal plasma flow, possible glycosuria
• Skin:
o hyperpigmentation, facial chloasma (melasma gravidarum), striae, vascular spider
nevi, decreased hair growth, hyperactive sweat glands
• Musculoskeletal:
o pelvic joints relax (waddling gait), center of gravity changes, separation of
rectus abdomen
• Eyes:
o decreased intraocular pressure, thickening of cornea, may affect contact lenses
• CNS:
o decreased attention span, concentration, and memory, sleep problems
• Metabolism:
o weight gain (25-35lb above pre-pregnancy weight recommended), nutrient
metabolism (increased protein retention, fetal demands high during 2nd half of
pregnancy, higher rate of fat absorption, fat deposits increase from 2-12%, body
switches from glucose to lipid metabolism), carbohydrate demand increases,
gestational diabetes, increased demand for iron, retention of calcium
• Endocrine:
o thyroid: serum thyroxine and BMR increase, TSH decreases
o parathyroid: concentration of PTH increases, parallels fetal Ca requirements
o pituitary: thyrotropin and adrenotropin alter metabolism, prolactin (lactation).
oxytocin and vasopressin
o adrenal: increased aldosterone
o pancreas: increased insulin needs
, NURS230 EXAM GUIDE PHYSIOLOGIC CHANGES DURING
PREGNANCY
Supine Hypotension
• AKA vena caval syndrome, aortocaval compression
• the growing uterus compresses the inferior vena cava, leading to decreased venous
return (when the pt is in supine position)
Goodell’s Sign
• softening of the cervix
Hegar’s Sign
• softening of the uterus
Cardiac changes
• uterus puts pressure on diaphragm, BV increases 40-50%, cardiac output increases, decrease
in systemic and pulmonary vascular resistance, pulse increases, BP decreases slightly, femoral
venous pressure rises, supine hypotensive syndrome, erythrocyte volume increases, leukocyte
and platelet production, plasma fibrinogen increases, anemia
Respiratory changes
• TV increases, O2 consumption increases, breathing changes from abdominal to thoracic,
vascular congestion of nasal mucosa
Physiologic anemia
• Plasma volume increases more than RBC’s during pregnancy, resulting in lowered Hgb and
Hct levels.
• Decreased Hgb leads to decreased iron, resulting in physiologic
anemia. Presumptive, Probable and Positive Signs of Pregnancy
1. Presumptive: amenorrhea (no period), nausea and vomiting (morning sickness),
fatigue, frequent urination, breast changes, quickening (mothers perception of fetal
movement)
2. Probable: changes in pelvic organs, Hegar’s sign, Ladin sign, McDonald sign, Braun von
Fernwald sign, Piskacek sign, enlargement of abdomen, braxton hicks, striae, uterine souffle,
skin pigmentation, fetal outline (Ballottement), pregnancy tests of blood or urine
1. B subunit radioimmunoassay (RIA)
2. Enzyme linked immunosorbent assay (ELISA)
3. Fluoroimmunoassay (FIA)
b. Positive: auscultation of fetal heartbeat using Doppler, fetal movement (palpable at 20wks),
visualization of the fetus via ultrasound
Psycho-social adjustment- Maternal and Paternal
• Maternal:
o intendedness
o ambivalence
o acceptance (1st- baby does not seem real, 2nd- quickening, pregnancy glow,
3rd- physical discomfort and nesting)
o introversion
o mood swings
o body image changes
o ensuring a safe passage through birth, pregnancy, labor
o seeking of acceptance of the child from others
o seeking of commitment and acceptance of oneself as a mother
o learning to give oneself on behalf of one’s child
• Paternal:
o view of role has changed (nurturing, caring parent and provider)
o benefit of being involved decreases maternal stress levels
