The Montgomery's glands (the sebaceous glands of the areola) enlarge and tend to
protrude. The surface vessels of the breast may become visible due to increased
circulation and turns to a bluish tint to the breasts.
b. By the 16th week (2nd trimester) the breasts begin to produce colostrum.
This is the precursor of breast milk. It is a thin, watery, yellowish secretion that thickens
as pregnancy progresses. It is extremely high in protein.
c. Nursing implication: Inform the pregnant patient to wear a good, supporting
CHANGES OF THE CIRCULATORY SYSTEM DURING PREGNANCY
a. Blood Volume.
(1) Blood volume increases gradually by 30 to 50 percent (1500 ml to
3 units). This results in decrease concentration of red blood cells and hemoglobin. This
explains why the need for iron is so important during pregnancy.
(2) By the time pregnancy reaches term, the body has usually compensated
for the decrease resulting in an essentially normal blood count.
(3) Blood count is interpreted as anemia by the physician if the hemoglobin
falls below 10.5 grams per 100 ml and the hematocrit drops below 30 percent.
(4) Increased blood volume compensates for hypertrophied vascular system
of enlarged uterus. It improves the placental performance. Blood lost during delivery,
less than 500 cc is normal (300 to 400 cc is average).
b. Cardiac Output.
(1) Cardiac output increases about 30 percent during the first and second
trimester to accommodate for hypervolemia. This is not a problem for patients with a
normal heart. A patient with a diseased heart is especially at risk for cardiac
decompensation 28 to 35 weeks of pregnancy when the blood volume and cardiac load
are at their peak; also, during labor and immediately after delivery when rapid
hemodynamic changes occur.
(2) Change in output is reflected in the heart rate. It usually increases by 10
beats per minute.
(3) Nursing implication. Patients with a diseased heart need to be advised
to get plenty of rest and to report any shortness of breath or unusual symptoms to their