Assessing Childbearing Women (Ch.

29)
Structure & Function Pregnancy Changes
There are Physiologic & anatomic changes
Most of those changes are influenced by hormone changes related to
pregnancy. Hormone mainly include:
o Estrogen
o Progesterone
Skin, Hair, and Nails
Most changes resolve after pregnancy
Striae Gravidarum are pregnancy stretch marks; They typically never
completely resolve
Hyperpigmentation occurs. Linea Nigra is the dark line from umbilicus
to mons pubis; chloasma is the mask of pregnancy, which is the
darkening of skin on face
Areolae, nipples, axillae, umbilicus, & perineum darken
Vascular changes known as spider veins
Pruritic urticarial is common in the 3rd trimester. It is erythematous
papules, plaques, & urticarial that occurs with intense itching and
resolves few weeks post delivery
Acne may worsen or improve
There is an increased growth in hair & nails during pregnancy
Hirsutism may happen on face, abdomen, back in 2-3rd trimesters due
to androgens
Ears

& Hearing
Hearing may decrease
Sense of fullness in ears
Earache related to increase vascularity of Thematic Membrane &
blockage of eustachian tubes

Mouth-Throat-Sinuses
Women may have Gingival bleeding during brushing
The can have Hypertrophy of gums which increase gum bleeding
Epulis is a small, irritating nodules on gum line
Vocal changes related to edema of larynx
Women have Nasal stuffiness & epistaxis: elated to estrogen induced
edema & vascular congestion of nasal mucosa & sinuses
Thorax & Lungs
Progesterone causes relaxation of joints & ligaments
o Rib cage flare: increase in anteroposterior & transverse
diameters: required as pregnancy progresses

The Respiratory pattern changes, it moves from abdominal to costal

breathing
o Shortness of breath common in pregnant women
Oxygen requirements increase related to additional cellular growth of
body & fetus

Breasts
The breast enlarge related to the estrogen & progesterone surge
Mammary gland changes:
o Tingling sensation & tenderness in breast
o Enlargement of breast & nipple
o Hyperpigmentation of areola & nipple
o Enlargement of Montgomery tubercles
o Prominence of superficial veins
o Striae development
o Expression of colostrum 2nd & 3rd trimesters
Heart
Increased cardiac output & maternal blood
volume. Goes up 4050% during pregnancy
Heart size increases due to increase of blood volume being pumped
Position rotated up & left approximately 1-1.5 cm
Heart rate: increases 10-15 bpm
Murmur may be heard
Peripheral Vascular System
Physiologic anemia (pseudoanemia) because of disproportionate
increase in blood volume compared to increase in RBC production.
Plasma volume increases by 40-50%, RBC volume increase by 18-30%
Progesterone acts on vessels causing relaxation & dilation. This results
in dizziness, lightheadedness. Peaks at 32-34 weeks
Dependent edema & varicosities are common and happen usually later
in day
It is related to the expanding uterus pressure on femoral venous area,
resulting in stagnation of the lower extremity blood return
Varicose veins common in childbearing women
Thrombophlebitis is a vein inflammation & blood clot
Abdomen
Abdominal muscles stretch to accommodate uterus
Diastasis recti abdominis is permanent separation of abdominal
muscles that can occur in pregnancy
4 Paired ligaments: broad, uterosacral, cardinal, & round help support
uterus & position in pelvis

Women report pressure on bladder, kidney, ureters. This increases risk

of UTI
Urinary frequency common
Small intestine: in the increase pressure from the fetus and the uterus
help to decrease gastric motility & heartburn
Ptyalism is increase salivation; pica: crave non-nutritional items
Glucose may also increase. As glucose use increases, it may decrease
maternal glucose levels
Later in pregnancy the opposite occur. May have an increase risk to
hyperglycemia & hyperinsulinemia

Genitalia
The Uterus dramatic increase in size & volume capacity
Growth size of uterus by week
McDonalds rule: fundal height in cm times 8/7 = fundal height
(approximately 1 cm per week of pregnancy)
As the Uterine wall thins closer to delivery, easy palpation of fetal
areas occurs
Cervix, vagina, & vulva also change. May see Goodells sign which is
the cervical softening, Chadwicks sign which is a bluish discoloration
or hypertrophy of cervical canal glands cause an increase in vaginal
discharge
Anus & Rectum
Constipation is common because of decreased gastric motility. There is
more time for absorption of nutrients
Iron supplements also related to constipation
Hemorrhoids are the varicose veins of rectum related to vascular
congestion, pressure on venous structures, & straining to have BM
Musculoskeletal
Uterine growth pulls pelvis forward resulting in curvature of spine
leading to lordosis
Shoulders droop R/T enlarging breasts
Progesterone & relaxin cause relaxation of pelvic joints & ligaments
Symphysis pubis, sacroiliac, & sacrococcygeal joints relax, increasing
flexibility and allowing pelvic outlet to increase for delivery usually
remains larger (doesnt go back to pre pregnancy size
Relaxin is a chemical produced in the body that also changes gait
during pregnancy which may lead to change in center of gravity, &
weight gain causing backaches which are common
Neurologic
Pain or thigh tingling due to pressure on lateral femoral cutaneous
nerve

Carpal Tunnel Syndrome where there is pressure on median nerve in

wrist
Leg cramps are common related to inadequate calcium intake
Dizziness & lightheadedness is related to BP changes, vasodilation,
decreased vascular resistance; later pregnancy, uterus compression on
vena cava & aorta worse when supine leading to supine hypotensive
syndrome

Collecting Subjective Data

History of present concern: Pre-pregnancy weight,
fever or
illness since Last Menstrual Period, nasal congestion, epistaxis, cough
or throat issues, N/V frequency, thirst level, bowel habits, bloody
stool, pain/burning on urination, vaginal bleeding-leakingdischarge, appetite, sleeping, breast pain-lumps-leakage, any other
concerns
Health history: include pt.'s age (older women have increased risk
complications), prenatal care, number of pregnancies & births,
previous pregnancy complications or issues, STI, vaginal infections,
blood type, medical conditions, medications, allergies, immunizations
Subjective Data Continues
Family History: any inherited birth defects, blood disorders, ethnic or
racial group, rheumatic fever or cardiac issues before age 50, lung
problems, chronic illnesses, cancer
Lifestyle: tobacco intake, alcohol intake, street drug use, food intake
amount & type, vitamins, exercise, ADLs, fatigue, exposure to
chemicals, radiation, or environmental risks, cat or cat liter exposure
(increases risk of toxoplasmosis), occupation, feeling about pregnancy,
support person, violence concern, any other children at home
Collecting Objective Data
Key points for examination
Accurate & complete prenatal history
Understand & recognize pregnancy Cardiovascular changes
Note skin changes
Identify common pregnancy complaints & the cause
Measure uterus growth
Demonstrate 4 Leopold maneuvers & significance
Collecting Objective Data
General Survey: ht, wt, temperature, P, BP, behavior
Skin, Hair, Nails: looking for hyperpigmentation, vascular markings,
inspect hair & nails
Head & Neck: looking for cervical lymph change, thyroid
Eyes: cornea, lens, iris, pupil, fundus

Ears: looking at Tympanic Membrane (TM). Women may have

decreased hearing due to increase vascularity of the TM
Mouth, Throat, Nose: teeth, gums, throat, nose
Lungs & Thorax: inspect, palpate, percuss,
auscultate: identify
abnormal respiratory sounds & any distress

Collecting Objective Data

Breasts: noting symmetry, color, inversion, pain, redness, tenderness,
warmth, discharge
Heart: rate, rhythm, regularity, murmurs, extra sounds
Peripheral Vascular: color, edema, reflexes
Abdomen: Inspection: notice striae, scars, size, shape;
Palpation: organs, masses, fetal movement, contractions (timing,
relaxation between); Measure fundal height; note Fetal position (using
Leopold); Fetal heart rate next slide

Collecting Objective Data, Look at:

External & Internal Genitalia
Anus & Rectum
Musculoskeletal
These will not be demonstrated or examined during your clinical lab &
will be presented in depth during your OB course
Textbook Pages 685-688
Summary
Critical to understand changes associated with pregnancy & why they occur
Identify critical information in subjective data placing mother & fetus at risk
Understand how to obtain objective data
Distinguish normal & abnormal findings
Understand significance of abnormal findings & those requiring immediate
attention