Anatomy & Physiology of Pregnancy

What is gravid and para?

Gravida – # of pregnancies including the present pregnancy (not # of children ie twins = 1 gravida).

Para – a woman who has produced an infant, whether the child was alive or stillborn. # of pregnancies not fetuses.

T – indicates term births past 37 weeks.

P – preterm births (total babies) below 37 weeks gestation and above age of viability.

A – abortions, including miscarriages. Loss of fetus before viability.

L – children living now.

G – 3 P-3 T-2 P-1 A-0 L-3 would indicate a woman who has had two term children one preterm, no abortions, and all three children are living.

What is measured in pregnancy tests? Why is this an indicator?

hCG (human chorionic gonadotropin) – earliest marker of pregnancy.  Can be detected as early as 7-10 days after conception.  High levels may indicate ectopic, abnormalities, or multiple gestation. Low levels may indicate miscarriage. Production of b-hCG begins on the day of implantation.

Signs of pregnancy:

  1. What are the presumptive signs?
    1. felt by the women
      1. amenorrhea
      2. fatigue
      3. N/V
      4. breast changes
  2. What are the probable signs?
    1. observed by an examiner
      1. Hegar sign
      2. ballottement
      3. pregnancy tests
      4. braxton hicks
  3. What are the diagnostic (positive) signs?
    1. signs attributed only to the presence of the fetus
      1. visualization of fetus
      2. fetal heart tones
      3. fetal movement – palpated
      4. visualization of fetal movement

What are the following?

  1. Lightening
    1. drop of fundal height between weeks 38-40 as the fetus descends into the pelvis.
  2. Hegar sign
    1. softening and compressibility of the lower uterine segment – causing urinary frequency.
  3. Braxton Hicks
    1. uterine contractions felt after the fourth month, irregular and painless, facilitate blood flow and oxygen delivery to fetus.
  4. Uterine soufflé
    1. sound of synchronous blood in the the uterine arteries with maternal pulse.
  5. Ballottement
    1. passive movement of the fetus week 16-18. Technique of bouncing the floating fetus to feel the rebound.
  6. Quickening
    1. fetal movements felt as early as 14-16 week.  Described as flutter but gradually increase in intensity and frequency.
  7. Chadwick
    1. violet-bluish color of the vaginal mucosa and cervix.
  8. Leukorrhea
    1. white or light gray discharge with musty odor.
  9. Montgomery tubercles
    1. sebaceous glands around the areolae.  Thought to lubricate the breast for breast feeding.
  10. Colostrum
    1. creamy discharge from the nipples as early as 16 weeks.  Lactation is inhibited during pregnancy until estrogen levels drop post partum.

Physiological changes during pregnancy:


  • What are the changes in blood pressure/pulse?
    • Systolic pressure usually remains the same but may decrease as pregnancy advances.
    • Diastolic pressure begins to decrease in the first trimester and will continue to drop until 24-32 wks.  It will return to normal by term.
    • BP cuff should be 20% wider than diameter of the arm.
  • Why is a pregnant woman at greater risk for DVTs?
    • Compression of the vena cava as the woman lies flat.
    • Compression of the iliac veins and inferior vena cava by the uterus.
    • The uterus impedes blood return to the heart.
    • Increase in clotting factors to prevent hemorrhage.
    • Fibrinolytic activity is depressed.
  • What position promotes optimal maternal/fetal nutrition?
    • left lateral
  • What is physiological anemia of pregnancy?
    • Hemodilution due to significant increase in blood volume with greater increase in plasma than RBCs.
    • Blood volume increases by as much as 40-45%.
    • Cardiac output increases from 30% to 50% and declines to about a 20% increase at 40 weeks.
    • Hmg should not go below 11


  • Why do some woman experience SOB while pregnant?
    • Diaphragm is displaced making it harder to descend.
    • thoracic breathing replaces abdominal breathing.
    • Upper airway congestion occurs.
    • Decreased threshold to CO2.
    • Pregnant women are more aware of the NEED to breath.
    • BMR increases.
    • Compensatory respiratory alkalosis.
  • Why are pregnant woman in a mild hyperventilative state during pregnancy?
    • Respiratory alkalosis combined with increased NEED to breath.

Are these normal or not in pregnancy? What would be nursing implications and/or teaching for each?

  • Nose Bleeds (epistaxis)
    • normal due to respiratory congestion and other respiratory changes.
  • Back pain
    • normal due to musculoskeletal changes.
    • center of gravity changes, larger breasts
    • lordosis (curvature of the spine) back exercises can help decrease this
  • Clear vaginal discharge (leukorrhea)
    • normal as long as there is no ferning on dried mucus smear.  Ferning would indicate amniotic fluid.
  • Vaginal Bleeding
    • slight vaginal bleeding can be normal, but all bleeding should be reported and evaluated.
  • Nausea and vomiting (hyperemisis gravidarum)
    • normal during first trimester due to increasing levels of hCG.
    • eat foods as tolerated, insure adequate intake of fluids.
  • Constipation
    • normal due to decreases in BM and displacement of abdominal organs.
    • Increase movement when possible and drink fluids.
  • Bladder infections
    • normal due to increase in glycogen making them more susceptible to candida
    • drink plenty of fluids, cranberry juice, void when needed.
  • Striae
    • normal stretch marks as abdomen grows.
  • Cholasma
    • normal look of being pregnant.
  • Linea Nigra
    • normal line from pubis to top of fundus.
  • Carpal Tunnel
    • parethesia of unknown cause during first trimester.