- If they are not well prepared for parenthood or have had little experience with children.

- Unwed father may have great deal of difficulty accepting a pregnancy unless he is actively
involved in prenatal care. He tries to picture himself as a father but then realize if he does not
marry his partner, he may never play a full father role to this child, so image disappears again.

SECOND TRIMESTER: ACCEPTING THE BABY

- Accept she is having a baby. This change usually happens at QUICKENING, or first moment when
woman feels fetal movement.
- Proof of child’s existence, she may think life inside of her.
- Anticipatory role playing is an important activity for MIDPREGNANCY. Not only she is pregnant
but also there is a child inside her.
- Accepting baby as a welcome family addition might not come until labor has begun or after
several hours of labor. It might even be the moment a woman first hears her.
- Good way to measure level of woman begins to actively prepare for the coming baby, partner
may feel as if he is left standing in wings, waiting to be asked to take part in the event.
- Some men may have difficulty enjoying the pregnancy because they have been misinformed
about sexuality pregnancy, and woman’s health.
- A man might believe. The changes in appearance of the woman or his wife that will no longer
enjoyable.

THIRD TRIMESTER: PREPARING FOR PARENTHOOD

- Couples usually begin “NESTBUILDING” such as planning infant’s sleeping arrangements, buying
clothes, choosing a name, and “ensuring safe passage” by learning about birth.
- Couples invested in attending prenatal classes or preparation for childbirth classes.

EMOTIONAL RESPONSE TO PREGNANCY

GRIEF

- Before woman can take in mother role, she has to give up or alter her present roles. She will
never be a daughter in exactly same way again. She will never be irresponsible and carefree.
- She must incorporate her new role as a mother

NARCISSISM

- Self-centeredness is an early reaction to pregnancy. Woman who previously was barely

conscious of her body, dressed or what to wear, who was unconcerned about her posture or her
weight suddenly begins to concentrate.
- Manifested by change in activity. Woman may stop playing tennis.

INTROVERSION VERSUS EXTROVERSION

- Introversion, or turning inward to concentrate on oneself and one’s body. Common finding
during pregnancy. Some women react in an entirely opposite fashion and become more
extroverted.
- Become more active, healthier that ever before and are more outgoing.
- Body image (way your body appears to yourself) and Body boundary (zone of separation you
perceive between yourself and objects or other people). Woman begins to envision herself as a
mother. She begins to see herself becoming “Bigger”

STRESS

- Difficult for a woman to make decisions, be aware of her surroundings as usual, or maintain
time management with her usual degree of skill
- Women that is dependent feel neglected
 COUVADE SYNDROME

- Many men experience physical symptoms such as nausea, vomiting, and backache to same
degree or even more intensely than their partners.
- The more partner is involved in or attuned to changes of pregnancy, more symptoms a
woman’s partner may experience.

EMOTIONAL LABILITY

- Mood changes frequently in pregnant woman, partly manifestation of narcissism and partly
because of hormonal changes.
- Mood swings may be common.

CHANGES IN SEXUAL DESIRE

- Women decreases sexual desire

- Others might feel loss of desire because of their estrogen increase, or they might
unconsciously view sexual relations as threat to fetus
- First trimester, woman decrease in libido
- Second trimester, blood flow to pelvic area increases to supply the placenta, libido and
sexual enjoyment rise markedly
- Third trimester, sexual desire may remain high or it may decrease because of difficulty
finding a comfortable position and increasing abdominal size.
- Changes in expectant family
- Couples appreciate suggestions from health care personnel regarding how this task can be
accomplished.
- Medical Diagnosis of pregnancy serves to date when birth will occur and also helps predict
existence of high-risk status.
- Most women who come to health care have already guessed that they are pregnant.

PRESUMPTIVE SIGNS OF PREGNANCY

- Are least indicative of pregnancy, taken as single entities

- (MACFUQ) – signs of pregnancy

PROBABLE SIGNS OF PREGNANCY

- In contrast to presumptive signs, are objective so can be documented by an examiner

- More reliable , they still are not positive or true diagnostic findings.

DIAGNOSIS OF PREGNANCY

 C-hadwicks sign
 H-egar’s sign
 U-terine Enlargement (12 weeks)
 P-ositive pregnancy test
 B-allotement
 O-utlining of fetal body
 G-oodells sign
 S-ouffle, contraction and Braxton hicks (28 weeks, painless contraction)

LABORATORY TEST

- Common used based on HUMAN CHORIONIC GONADOTROPIN (hCG), hormone created by

chorionic villi of the placenta, in the urine or blood serum of pregnant woman.
- 95%-98% are considered probable rather than positive signs
- Performed bt RADIOIMMUNOASSAY(RIA), ENZYME-LINKED IMMUNOSORBENT ESSAY
(ELISA), or RADIORECEPTOR ASSAY (RRA) techniques.
- For these tests, hCG is measured in international units. In nonpregnant woman, no units are
detectable because there is no trophoblast cells producing hCG
 - URINE used extensively for pregnancy testing. Blood serum test give earlier results.

POSITIVE SIGNS OF PREGNANCY

 Demonstration of fetal heart separate from mother’s heart

- Fetal heart can be shown to beating on ultrasound as early as 6th-7th week of pregnancy.
- Doppler Technique can detect fetal heart sounds as early as 10th-12th week of gestation.
- Echocardiography demonstrate heartbeat as early as 5 weeks.
- Fetal heart beating since 24th day after conception. Audible by auscultation of abdomen
with ordinary stethoscope only at 18-20 weeks of pregnancy. Difficult to hear if woman’s
abdomen has great deal of subcutaneous fat.
 Fetal movements felt by an examiner
- Felt as early as 16-20 weeks of pregnancy. More reliable.
- Fetal movements can be felt by an examiner at 20th-24th week of pregnancy unless woman is
extremely obese.
 Visualization of the fetus by ultrasound
- Characteristic ring, indication gestational sac, will revealed on OSCILLOSCOPE SCREEN as
early as 4th-6th week of pregnancy. Method gives information about site of implantation and
whether a multiple pregnancy exists. 8th week. Fetal outline can be seen so clearly within
the sac that the crown-to-rump length can be measured to establish gestational age of
pregnancy.

BIOPSYCHOSOCIAL ADAPTATION OF PREGNANCY

REPRODUCTIVE SYSTEM

1. UTERUS
- Enlargement and thickness of uterus, most marked in fundus.
- At level of Umbilicus by 20 weeks AOG, Xiphoid at 36 weeks due to fetal descent into the
pelvis.
- Mucus plugs of cervix are produced to seal out the bacteria.
- HEGAR’S SIGN- softening of the lower uterine segments.
- GOODELL’S SIGN- softening of the cervix

2. VAGINA
- Increased vascularity causes change of color from LIGHT PINK to DEEP PURPLE known as
CHADWICK’S SIGN.
- pH of the vagina changes ACIDIC to ALKALINE because of estrogen. It protects vaginal
environment from bacteria but it favors the growth of: TRICHOMONAS VAGINALIS and
CANDIDA ALBICANS OR CANDIDIASIS
- CANDIDAL INFECTION is manifested by itching, burning sensation in addition to
creamcheese-like discharge,
- THRUSH or ORAL MONILIA- candida infection in newborn

3. OVARY
- Ovulation ceases throughout pregnancy

4. BREAST
- Tender and tingle in early weeks of pregnancy
- Increases size, larger nipple, more pigmented
- Colostrum present by 2nd triemester
- Elevated gland or MONTGOMERY

INTEGUMENTRARY SYSTEM

1. STRIAE GRAVIDARUM
- Reddish slightly depressed streaks in abdominal wall, breast and thighs.
- Increased uterine size results in rupture and atrophy of connective tissue
 2. LINEA NIGRA
- Line of dark pigment extending from umbilicus down the midline to symphysis pubis

3. CHLOASMA
- “MASK OF PREGNANCY”
- Brownish patches of pigment of the face
- Pigmentary changes occur because of melanocyte stimulating hormone elevated from 2nd
month of pregnancy

METABOLIC CHANGES

1. WEIGHT GAIN
- ave. weight gain is -24-28 lbs.
- Fetus- 3400gm; Placenta- 450; Amniotic Fluid- 900; Uterus- 1100’ Breast Tissue- 1400;
Blood Volume- 1800; Maternal Stores- 1800-3600
- Average woman retains 6.5 L of extra water during pregnancy
- Fetus, uterus and maternal blood are rich in PROTEIN
- IRON reuqirements increases to 20-40 MG DAILY and DURING ON LAST HALF OF
PREGNANCY, IRON is transferred to fetus and stored to FETAL LIVER.

ENDOCRINE SYSTEM

1. PLACENTA
- Produces HCG, HPL, estrogen and progesterone
2. ADRENAL GLANDS
- Increase levels help reduce possibility of woman’s body rejecting foreign protein of
fetus.
- Help regulate glucose metabolism
3. PARATHYROID GLANDS
- For metabolism of calcium which is important for fetal growth.
4. PANCREAS
– increase production of insulin. Prevent fetal hypoglycaemia, which result of fetal
growth, maternal glucose level is usually at a higher than normal level.

CIRCULATORY SYSTEM

- Beginning at the end of 1st trimester, there is gradual increase of 30-50% in total cardiac
volume reaching its peak during 6th month of pregnancy. This causes physiologic anemia
of pregnancy.
- HR INCREASE by 10 BPM. Cardiac work increase on 2nd trimester
- Palpitations in early months are caused by SYMPATHETIC NS STIMULATION
- Heart murmurs are audible probable because of altered heart position
- Consequences of increased cardiac volume are easy fatigability or shortness of breah
and epistaxis.
- EDEMA on lower extremities because of poor circulation resulting from pressure of
gravid uterus on blood vessels of lower extremities. Management of edema- RAISE LEG
ABOVE HIP LEVEL
- VARISCOSITIES of lower extremities can occur. Management – WEAR STOCKINGS to
promote varicose flows thus preventing stasis on lower extremities. AVOID USE OD
CONSTRICTING GARTERS.
- PALPIATION can also occur due to pressure of uterus against the diaphragm