Normal Pregnancy


Contractionexhibits wavelike pattern that begins slowly climbing (increment) to a peak (acme) and decreases (decrement)
Durationbeginning of one contraction to the end of the same contraction
Frequencybeginning on one to the beginning of ANOTHER contraction
Intervalresting time BETWEEN contractions allows for placental perfusion
Probable signs of pregnancypositive pregnancy test (HCG), uterine and cervical changes (ballottement (palpate and bounce floating area and feel its rebound), Braxton-hicks, palpation of fetal parts, uterine souffle
hCG (human chorionic gonadotropin)This stimulates the corpus luteum to produce estrogen & progesterone. Secreted by the placenta and presents in blood and urine pregnancy tests
uterine soufflesoft, blowing sound made by the blood in the arteries of the pregnant uterus and synchronous with the maternal pulse
GravidaThe number of times the woman has been pregnant, regardless of whether these pregnancies were carried to term. A current pregnancy, if any, is included in this count.
Paranumber of deliveries at 20+ weeks (not # of babies delivered but the # of deliveries)
primigravidaa woman who is pregnant for the first time
multigravidaa woman who has been pregnant more than once
nulliparano births (a woman who has not given birth to a viable offspring) none maintained past 20 weeks
Primiparafirst sustained birth past 20 weeks
Multiparamultiple births past 20 weeks
TPALTerm, preterm, abortion, living children
Term(38-42 weeks)
Preterm(20-38 weeks)
AbortionAbortions (induced & spontaneous SAB)
(less than 20 weeks)
Living childrenLiving children (currently living)
Nagele’s Rule1st day of last period – 3 months + 7 days = estimated date of birth


Chadwick’s signBluish purple discoloration of the cervix, vagina, and labia during pregnancy as a result of increased vascularity of the pelvic organs
Goodell’s signsoftening of the cervix caused by pelvic vasoconstriction
Hegar’s signSoftening of the isthmus of the cervix


advantages of home pregnancy testreadily available, uncomplicated, convenient, 97% accurate, min time, cost-effective
Disadvantages of home pregnancy testmust be able to follow directions or can lead to improper collection or errors in performing and reading
false positiveshematuria and proteinuria, anticonvulsants, ASA, tranquilizers, MJ
false negativediuretics and promethazine
Positive signs of pregnancyaudible fetal heartbeat, fetal movement felt by examiner, ultrasound visualization of a fetus (may be visible as early as 3 weeks)
Normal aches of pregnancyN/V, back pain, round ligament pain, UA frequency, varicosities, constipation, hemorrhoids, leg cramps, heartburn
Warning signs of pregnancyvaginal bleeding, fluid gushing or leaking from vagina, persistent vomiting, , visual disturbances, dizziness, persistent headache, abdominal pain, edema, dysuria, oliguria and a notable decrease in fetal movement

Physiological Changes

  • Heart
    • – VERY Increased Preload
    • – Increased HR
    • – Decreased SVR
  • Pulmonary
    • – Increased total volume
    • – Decreased functional residual capacity
  • Clotting
    • – Increased adhesion (due to increased vWf)
    • – Increase in factors 7,8,and 10
    • – Decrease in protein C and S
  • Renal
    • – Increased GFR
    • – Decreased Creatitine
    • – Obstructive uropathy usually occurs at pelvic brim
  • Gastrointestinal
    • – GERD
    • – Nausea
    • – Constipation
    • – Iron Deficiency
    • – Gallbladder dx

Pregnancy Weight Gain

Danger Signs!



First Trimester

  • Uncertainty
    • —-Incorporation and integration of the fetus as an integral part of the woman.
  • Ambivalence
    • —–emotions that come with early pregnancy
  • Self as the primary focus
    • —-Baby not perceived as a reality.
    • —-Fetus is not perceived as a separate object
    • —-Interest and concern about their bodily and emotional changes.
  • Psychological Task
    • – Needs to be able to say “I am Pregnant”

Second Trimester

  • Fetus as the primary focus
    • —Sees fetus as a separate object and not an extension of self.
    • —Picture the fetus as a newborn infant.
    • —Assign sex and describe with specific characteristics.
  • Narcissism and Introversion
    • —Wants to do the right things to protect herself and her baby
  • Body Image
  • Psychological Task
    • – Needs to be able to say “I am going to have a baby”

Third Trimester

  • Vulnerability
    • —Worry that baby may be lost or harmed
  • Increasing dependence
  • Preparation for birth
    • —Planning baby’s arrival at home.
    • —Decide on the method of feeding.
    • —Acceptance of demands baby will make on parents.
    • —More confident in knowledge about labor and delivery.
    • —Interest in child care and planning for the future.
  • Psychological Task
    • – Needs to be able to say “I am going to be a parent.”

Changes in Sexuality


Nutritional Requirements

Food Precautions

Nutritional Risk Factors