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Anatomy and Physiology of Pregnancy 209 208-230_CH08_Lowdermilk.qxd 11/1/05 5:26 PM Page 208 Chapter Anatomy and Physiology8 of Pregnancy DEITRA LEONARD LOWDERMILK LEARNING OBJECTIVES • Determine gravidity and parity by using the five- • Compare normal adult laboratory values with and four-digit systems. values for pregnant women. • Describe the various types of pregnancy tests • Identify the maternal hormones produced during including the timing of tests and interpretation pregnancy, their target organs, and their major of results. effects on pregnancy. • Explain the expected maternal anatomic and • Compare the characteristics of the abdomen, physiologic adaptations to pregnancy for each vulva, and cervix of the nullipara and multipara. body system. • Differentiate among presumptive, probable, and positive signs of pregnancy. KEY TERMS AND DEFINITIONS ballottement Diagnostic technique using palpation: diastasis recti abdominis Separation of the two rec- a floating fetus, when tapped or pushed, moves tus muscles along the median line of the abdom- away and then returns to touch the examiner’s inal wall; often seen in women with repeated child- hand births or with a multiple gestation (e.g., triplets) Braxton Hicks sign Mild, intermittent, painless uter- epulis Tumorlike benign lesion of the gingiva seen ine contractions that occur during pregnancy; oc- in pregnant women cur more frequently as pregnancy advances but do funic souffle Soft, muffled, blowing sound pro- not represent true labor; however, they should be duced by blood rushing through the umbilical ves- distinguished from preterm labor sels and synchronous with the fetal heart sounds carpal tunnel syndrome Pressure on the median Goodell sign Softening of the cervix, a probable sign nerve at the point at which it goes through the of pregnancy, occurring during the second month carpal tunnel of the wrist; causes soreness, ten- Hegar sign Softening of the lower uterine segment derness, and weakness of the muscles of the that is classified as a probable sign of pregnancy, thumb may be present during the second and third Chadwick sign Violet color of vaginal mucous mem- months of pregnancy, and is palpated during bi- brane that is visible from approximately the fourth manual examination week of pregnancy; caused by increased vascu- human chorionic gonadotropin (hCG) Hormone that larity is produced by chorionic villi; the biologic marker chloasma Increased pigmentation over bridge of in pregnancy tests nose and cheeks of pregnant women and some leukorrhea White or yellowish mucus discharge women taking oral contraceptives; also known as from the cervical canal or the vagina that may be “mask of pregnancy” normal physiologically or caused by pathologic colostrum Fluid in the acini cells of the breasts pres- states of the vagina and endocervix ent from early pregnancy into the early postpartal lightening Sensation of decreased abdominal dis- period; rich in antibodies, which provide protection tention produced by uterine descent into the pelvic to the breastfed newborn from many diseases; cavity as the fetal presenting part settles into the high in protein, which binds bilirubin; and laxative pelvis; usually occurs 2 weeks before the onset of acting, which speeds the elimination of meconium labor in nulliparas and helps loosen mucus 208 208-230_CH08_Lowdermilk.qxd 11/1/05 5:26 PM Page 209 C HAPTER 8 Anatomy and Physiology of Pregnancy 209 KEY TERMS AND DEFINITIONS—cont’d linea nigra Line of darker pigmentation seen in some pyrosis Burning sensation in the epigastric and ster- women during the latter part of pregnancy that nal region from stomach acid (heartburn) appears on the middle of the abdomen and ex- quickening Maternal perception of fetal movement; tends from the symphysis pubis toward the um- usually occurs between weeks 16 and 20 of ges- bilicus tation Montgomery tubercles Small, nodular promi- striae gravidarum “Stretch marks”; shining reddish nences (sebaceous glands) on the areolas around lines caused by stretching of the skin, often found the nipples of the breasts that enlarge during preg- on the abdomen, thighs, and breasts during preg- nancy and lactation nancy; these streaks turn to a fine pinkish white operculum Plug of mucus that fills the cervical canal or silver tone in time in fair-skinned women and during pregnancy brownish in darker-skinned women palmar erythema Rash on the surface of the palms uterine souffle Soft, blowing sound made by the sometimes seen in pregnancy blood in the arteries of the pregnant uterus and ptyalism Excessive salivation synchronous with the maternal pulse ELECTRONIC RESOURCES Additional information related to the content in Chapter 8 can be found on the companion website at or on the interactive companion CD http://evolve.elsevier.com/Lowdermilk/Maternity/ • NCLEX Review Questions • NCLEX Review Questions • WebLinks he goal of maternity care is a healthy • parity: the number of pregnancies in which the fetus pregnancy with a physically safe and or fetuses have reached viability when they are born, emotionally satisfying outcome for not the number of fetuses (e.g., twins) born. Whether mother, infant, and family. Consistent the fetus is born alive or is stillborn (fetus who shows Thealth supervision and surveillance are of utmost importance no signs of life at birth) after viability is reached does in achieving this outcome. However, many maternal adap- not affect parity tations are unfamiliar to pregnant women and their families. • postdate or postterm: a pregnancy that goes beyond Helping the pregnant woman recognize the relation between 42 weeks of gestation her physical status and the plan for her care assists her in • preterm: a pregnancy that has reached 20 weeks of ges- making decisions and encourages her to participate in her tation but before completion of 37 weeks of gestation own care. • primigravida: a woman who is pregnant for the first time GRAVIDITY AND PARITY • primipara: a woman who has completed one preg- nancy with a fetus or fetuses who have reached the An understanding of the following terms used to describe stage of fetal viability pregnancy and the pregnant woman is essential to the study • term: a pregnancy from the beginning of week 38 of of maternity care. gestation to the end of week 42 of gestation • gravida: a woman who is pregnant • viability: capacity to live outside the uterus; about 22 • gravidity: pregnancy to 24 weeks since last menstrual period, or fetal weight • multigravida: a woman who has had two or more greater than 500 g pregnancies Gravidity and parity information is obtained during history- • multipara: a woman who has completed two or more taking interviews and may be recorded in patient records in pregnancies to the stage of fetal viability several ways. One way is to describe gravidity and parity • nulligravida: a woman who has never been pregnant with two numbers. For example 1/0 means that a woman • nullipara: a woman who has not completed a preg- is pregnant for the first time and has not yet carried a preg- nancy with a fetus or fetuses who have reached the nancy to viability. Another system commonly used in ma- stage of fetal viability ternity centers consists of five digits separated with hyphens. 208-230_CH08_Lowdermilk.qxd 11/1/05 5:26 PM Page 210 210 U NIT T HREE PREGNANCY TABLE 8-1 Gravidity and Parity Using Five-Digit (GTPAL) System TERM PRETERM ABORTIONS LIVING CONDITION PREGNANCIES BIRTHS BIRTHS AND MISCARRIAGES CHILDREN Jamilla is pregnant 100 0 0 for the first time. She carries the preg- 101 0 1 nancy to 35 weeks, and the neonate survives. She becomes preg- 201 0 1 nant again. Her second preg- 201 1 1 nancy ends in mis- carriage at 10 weeks. During her third preg- 311 1 2 nancy, she gives birth at 38 weeks. This system provides more specific information about par- and urine pregnancy tests may be performed at home. Both ity. The first digit represents the total number of pregnan- serum and urine tests can provide accurate results. A 7- to cies, including the present one (gravidity); the second digit 10-ml sample of venous blood is collected for serum testing. represents the total number of term births; the third indi- Most urine tests require a first-voided morning urine spec- cates the number of preterm births; the fourth identifies the imen because it contains levels of hCG approximately the number of abortions (miscarriage or elective termination of same as those in serum. Random urine samples usually have pregnancy before viability); and the fifth is the number of lower levels. Urine tests are less expensive and provide more children currently living. The acronym GTPAL (gravidity, immediate results than do serum tests (Stewart, 2004). term, preterm, abortions, living children) may be helpful in Many different pregnancy tests are available. The wide va- remembering this system of notation. For example, if a riety of tests precludes discussion of each; however, several woman pregnant only once gives birth at week 34 and the categories of tests are described here. The nurse should read infant survives, the abbreviation that represents this infor- the manufacturer’s directions for the test to be used. mation is “1-0-1-0-1.” During her next pregnancy, the ab- Radioimmunoassay (RIA) pregnancy tests for the beta breviation is “2-0-1-0-1.” Additional examples are given in subunit of hCG in serum or urine samples use radioactively Table 8-1. PREGNANCY TESTS Critical Thinking Exercise Early detection of pregnancy allows early initiation of care. Home Pregnancy Testing Human chorionic gonadotropin (hCG) is the earliest bio- Sylvia and her partner want to have a baby and have not chemical marker for pregnancy, and pregnancy tests are been using any contraception for 3 months. Sylvia’s pe- based on the recognition of hCG or a beta (␤) subunit of riod is now a week late. She uses a home pregnancy test hCG.
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