PHYSIOLOGIC CHANGES DURING PREGNANCY increased difficulty with walking, stair climbing, and rapid

changes in position. Specific postural changes include:

 Endocrine System: The adrenal, thyroid, parathyroid, and
 Thoracic kyphosis with scapular retraction.
pituitary glands enlarge. Hormone levels increase to support the
 Increased cervical lordosis and forward head.
pregnancy and the placenta, and to prepare the body for labor.
 Increased lumbar lordosis.
Female hormone (relaxin) is released to assists in the softening
 Due to the alterations in ligament extensibility, postural
of the pubic symphysis so that the pelvis can stretch enough to
changes become more significant.
allow birth. Hormonal changes are also thought to induce a
 Neurologic System: Swelling and increased fluid volume can
greater laxity in all joints. This can result in: Joint
cause nerve compression of the thoracic outlet, wrists, or groin
hypermobility, especially throughout the pelvic ring, which
(brachial plexus, median nerve, and lateral (femoral) cutaneous
relies heavily on ligamentous support, Symphysis pubic
nerve of the thigh, respectively).
dysfunction, SIJ dysfunction and increased susceptibility to
 Gastrointestinal System: Nausea and vomiting may occur in
injury.
early pregnancy, and are generally confined to the first 16
 Musculoskeletal System: The average pregnancy weight gain
weeks of pregnancy but occasionally remain throughout the
is 20 to 30 pounds. This weight change can produce a number
entire 10 lunar months. Other changes include:
of changes within the musculoskeletal system:
 A slowing of intestinal motility.
 The abdominal muscles are stretched and weakened as
 The development of constipation, abdominal bloating, and
pregnancy develops.
hemorrhoids.
 The development of relative ligamentous laxity.
 Esophageal reflux.
 The rib cage circumference increases.
 Heartburn (pyrosis). Mostly in the third trimester.
 Pelvic floor weakness can develop with advanced
 An increase in the incidence and symptoms of gallbladder
pregnancy and childbirth. This can result in stress
disease.
incontinence
 Respiratory System: Adaptive changes include:
 Postural changes related to the weight of growing breasts,
 The diaphragm elevates with a widening of the thoracic
and the uterus and fetus, which can result in a shift in the
cage. This results in a predominance of costal versus
center of gravity in an anterior and superior direction,
abdominal breathing.
resulting in problems with balance. In advanced pregnancy,
 Mild increase in tidal volume and oxygen consumption,
the patient develops a wider base of support and has
which is caused by increased respiratory center sensitivity
 and drive due to the increased oxygen requirement of the  Increased cardiac output: increases to a similar degree as the
fetus. With mild exercise, pregnant women have a greater blood volume. During the first trimester, cardiac output is
increase in respiratory frequency and oxygen consumption 30% to 40% higher than in the nonpregnant state. 184
to meet their greater oxygen demand. As exercise increases During labor, further increases are seen. The heart is
to moderate and maximal levels, however, pregnant women enlarged by both chamber dilation and hypertrophy.
demonstrate decreased respiratory frequency, lower tidal
volume, and maximal oxygen consumption.
 A compensated respiratory alkalosis.
 A low expiratory reserve volume. The vital capacity and
measures of forced expiration are well preserved.
 Cardiovascular System: The pregnancy-induced changes
develop primarily to meet the increased metabolic demands of
the mother and fetus. These include:
 Increased blood volume: increases progressively from 6 to 8
weeks' gestation and reaches a maximum at approximately
32 to 34 weeks with linle change thereafter. The increased
blood volume serves two purposes:
 It facilitates maternal and fetal exchanges of
respiratory gases, nutrients, and metabolites.
 It reduces the impact of maternal blood loss at
delivery. Typical losses of 300 to 500 mL for vaginal
births and 750 to 1000 mL for cesarean sections are
thus compensated.
 Increased plasma volume (40-50%) is relatively greater than
that of red cell mass (20-30%), resulting in hemodilution
and a decrease in hemoglobin concentration (intake of
supplemental iron and folic acid is necessary to restore
hemoglobin levels to normal, which is 12 gldL).