Maternity - Pregnancy, part 1: Signs and Physiologic Changes of Pregnancy

by Meris Shuwarger August 30, 2021 Updated: September 05, 2021

Full Transcript

Hi, I'm Meris, and in this video, I'm going to be talking to you about the signs of pregnancy and the physiologic changes of pregnancy. I'm going to be following along using our maternity flashcards. These are available on our website, And if you already have a set of your own, I would absolutely invite you to follow along with me. So let's go ahead and get started. First up, we're talking about the signs of pregnancy. So you'll see here that we have three different ones. We have presumptive. We have probable. And we have positive. Presumptive means presuming. I can maybe kind of presume you're pregnant. Probable means you're probably pregnant. And positive means without a doubt, you are pregnant. So presumptive, these are going to be more like symptoms. I'm tired. I'm nauseated. I haven't had my period. That's called amenorrhea, amenorrhea without menstruation, breast changes, all of those sorts of things. They're presumptive because, yes, all of those may occur in pregnancy, but there are many other explanations for them. So they are just presumptive. Now, you'll see here on probable signs, we have some bold red tags and a cool chicken to help you to remember. So we have a few things here. Ballottement. Ballottement has to do with how the uterus feels to a healthcare provider. So ballottement is like moving, like it feels like fluid inside. A positive pregnancy test. You might think that's a positive sign, but it's not. A positive pregnancy test only indicates the presence of human chorionic gonadotropin, or the pregnancy hormone. There are actually other explanations for having HCG in one's system. So, although it is suggestive, although it is probable that a patient with a positive pregnancy test is pregnant, it's not guaranteed. Then you'll see we have Chadwick, Goodell, and Hegar's signs, three different signs. If your school makes you learn them, review them, but I'm not going to go into them. Three different signs that a healthcare provider may see, like the color of the cervix or the soft the softening of the cervix. All of the signs are probable signs. So all three of those, Chadwick, Goodell, and Hegar, all three of those you'll see here, our cool chick that says that all of the signs are probable signs. Okay. Now, positive signs. Positive signs means without a doubt, this patient is pregnant. So here they are. Fetal heart sounds. There's no other explanation. Seeing the fetus on ultrasound. No other explanation. If the healthcare provider feels fetal movement, that is considered a positive sign. Not if the patient does, because that could be gas or flutters in the belly or whatever from many other things. So if the healthcare provider feels it. So all of these are going to be definitive, meaning no other explanation. And you can see here we have a cool chicken that says baby can be heard, felt, or seen. If I can hear, feel,or see your baby, I am positive that you are pregnant.

Okay. So let's move on to physiologic changes in pregnancy. There's a lot, so we have two cards devoted to this. I'm not going to go super in-depth. I'm just going to point out a few things here. Cardiovascular status. The patient's blood volume is going to increase by almost 50%. So things that can come along with that are going to be things like edema. Right? We have more fluid. We can have swelling. A little bit of tachycardia is normal and expected because it's hard for that heart to pump fast enough to keep up with the cardiac output of all of this fluid. Right? I got to keep it moving. So that's where we're going to have that tachycardia. Now, because I have dilution of my red blood cells from the plasma volume, you're going to see dilutionally low levels in the lab work. So hemoglobin and hematocrit are going to drop slightly. That's normal. We don't consider a patient who is pregnant to have true anemia unless the hemoglobin is less than 11 grams per deciliter in the first and third trimesters, or less than 10.5 in the second. But point being, it is lower than a nonpregnant patient. And you'll see a lot of different things on this card. Musculoskeletal. The body is creating a hormone called relaxin, which thankfully, does what it sounds like. It helps to relax the ligaments and everything like that that are holding everything tightly so that when labor happens, there's enough relaxation in these joints to allow for this movement. But it can lead to things like clumsiness in coordination, which would be why when I was pregnant, I fell down the stairs three times because my body was very uncoordinated, thanks to all of that relaxin. So then on the second card here, are a few things that I want to point out. And there's a really, really big one here. It's that because this uterus is so big and so heavy, if I lay on my back, supine, what is underneath all of that? Think about it. It's going to be the inferior vena cava. And the inferior vena cava is where all of the blood from my lower extremities and everything is being returned back to my heart. If I lay on my back with a really heavy uterus, a gravid uterus, and put pressure on that vena cava, I'm going to cause a traffic jam, right, first of all. So that blood is not going to be getting back appropriately. But then, what else is going to happen? I'm going to have hypotension. My blood pressure is going to drop because I'm not getting enough blood back to my heart, and so I end up with this hypotension. This is called supine hypotension syndrome. And a very easy way to combat it is don't lay on your back when you're pregnant or, if you need to, put a pillow under one hip so that we are just slightly rotating to move that uterus to the side and make sure that we are getting that good blood return. Other things on here are going to be things like constipation, nausea, and vomiting, right. All of those things are going to be very common in pregnancy. And then under the integumentary heading, we have a few things here. Chloasma. This is oftentimes called the mask of pregnancy, and it's kind of a little discoloration of the face. Then we have striae gravidarum. Striae are stretch marks, and gravidarum means related to pregnancy. So those are just pregnancy-related stretch marks. And then, we have the linea [negrum?], or linea nigra, literally means black line. So this is going to be a darkening of the abdomen and it's a vertical line, usually running down the pregnant belly. Some people get it, some people don't. Same for all of these. It's not a good or a bad thing. It's just a thing that can happen. So it's good to be able to educate your patients.

Okay. That is it for the different physiologic changes in pregnancy and the signs of pregnancy. I hope that review was helpful. If it was, it would mean the world to me if you could like this video so that I know. If you have a really great way to remember something that I said in this video, I absolutely want to hear it. So please leave it in the comments below. And I know that somebody watching this video wants to hear it, too. Definitely be sure that you have subscribed to the channel because we have a lot more coming, and you want to be the first to know when the next video drops. This next video is actually a really great one, I think. It's going to be a comprehensive view of what happens in OB/GYN visits in the first, second, and third trimesters. It really helps you to get the timeline of prenatal care down. So I hope I will see you there. Thanks so much, and happy studying.

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