ANATOMY & PHYSIOLOGY

OF PREGNANCY
Buah kandungan adalah tenunan
tangan Tuhan
Maz 139: 13
Orang-orang Israel beranak cucu
dan tak terbilang jumlahnya;
mereka bertambah banyak dan
dengan dahsyat berlipat ganda,
sehingga negeri itu dipenuhi
mereka. Keluaran 1:7
Pregnancy is a normal life event that
involves considerable physical and
psychological adjustments for
mother.
• A pregnancy is divided into three
semester of 13 weeks each, within
each semester, numerous
adaptations take place that
facilitate the growth of the fetus.
• The most obvious are physical
changes to accommodate the
growing fetus, but pregnant
woman also undergo psychological
changes as they prepare for
parenthood.
 Gravidity & Parity
• Is information is obtained during
history taking interview. Obtaining
and documenting this information
accurately is important in making a
plan of care for the pregnant
woman.
• With 2 digits
G1P1 ( first digit represents the number of
pregnancies the woman had, second digit is the
number pregnancies that have reached 20 0r
more weeks of gestation before the birth.
• With 5 digits
This provide more specific information
about the woman's obstetric history
G : Gravidity ( Jumlah kehamilan)
T : Term ( jumlah kehamilan cukup bulan)
P : Preterm ( Jumlah lahir prematur)
A : Arbotion ( Jumlah yang arbosi)
L : Living children ( Anak lahir dan hidup)
 Pregnancy Test
• Human chorionic gonadotropin
(hCG) –is the earliest
biochemical marker for
pregnancy
• Production of hCG begins as
early as the day of implantation
and can be detected 7-10 after
conception.
• In urine, about 26 days after
conception
• Level of hCG increases until it
peaks at about 60 to 70 days of
gestation and decline until 80
days of pregnancy.
 Adaptation of Pregnancy
Signs of Pregnancy
• Presumptive (Changes felt by the woman)
• Probable (Changes observed by an examiner)
• Positive (Those signs that are attributed only to
the presence of the fetus)
 Reproduction System and Breasts

Uterus
Changes in Size, Shape, and
Position
• Phenomenal uterine
growth in the first
trimester is stimulated by
high levels of estrogen and
progesterone
• 7 weeks of gestation is the
size of a large hen’s Egg
• 10 weeks gestation-is the
size of an orange (twice
nonpregnant size)
• 12 weeks of gestation-is
the size of a grapefruit
• Pregnancy may “show”
after 14 weeks
• 22-24 weeks nearly
reached the umbilicus
• Lightening between 38
and 40 weeks the fundal
height drops
• Hegar Sign (At
approximately 6 weeks of
gestation, softening and
comprehension of the
lower uterine segment)
• Uterine fundus presses on
the urinary bladder
causing the woman to
have urinary frequency
Changes in Contractility
Braxton Hicks sign
• Soon after the fourth month of pregnancy,
uterine contractions can be felt through the
abdominal wall
• Contractions are irregular, painless, and occur
intermittently throughout pregnancy
• Contractions facilitate
uterine blood flow through
the intervillous space of the
placenta
• Contractions are not painful,
but some women complain
that they are annoying
• After the 28th week, these
contractions become more
definite
Cervical Changes
• Softening of the cervical
may be observed about
the beginning of the
sixth week
• Goodell's sign is brought
about by the increase
vascularity, slight
hypertrophy, and
hyperplasia (increase in
number of cells)
• Friability is increased; that is the cervix bleeds
easily when scraped or touched
Changes related to the presence of the fetus
• Ballottement- passive movement of the
unengaged fetus, can be identified generally
between the sixteenth and eighteenth week
Technique of palpating a floating structure by
bouncing it gently and feeling it rebound
• Palpate the fetus examiner places a finger
within the vagina and taps gently upward
causing the fetus to rise fetus sinks and a
gentle tap is felt on the finger
Vagina and Vulva
• Chadwick sign-increased
vascularity results in a
violet-bluish color of the
vagina mucosa and cervix
• Leukorrhea- is a white or
slightly gray mucoid fluid
occurs in response to
cervical stimulation by
estrogen and progesterone
• pH of vaginal secretions is more
acidic during pregnancy, ranging
from 3.5 to 6.0
• Result of increased production of
lactic acid caused by Lactobacillus
acidophilus
Breast
• Fullness, heightened sensitivity, tingling, and
heaviness of the breasts
• Nipples and areolae become more pigmented,
secondary pinkish areolae develop
• Colostrum- the creamy, white-to-yellowish to
orange pre-milk fluid
General Body System
Cardiovascular System
• Slight cardiac hypertrophy
(enlargement) Heart returns
to normal after childbirth
• Diaphragm is displaced
upward by the enlarging
uterus
• Between 14 and 20 weeks
of gestation the pulse
increase about 10 to 15
beats/min
Blood Pressure
• Diastolic blood pressure usually remains the
same as the pre-pregnancy level but then
gradually decreases until 24 to 32 weeks
• After 32 weeks, the diastolic blood pressure
gradually returns to normal
Renal System
• Urine of pregnancy contains more nutrients,
including glucose
• Bladder irritability, nocturia, and urinary
frequency and urgency (without dysuria) are
commonly reported in early pregnancy
• Near term, bladder symptoms may return
• Bladder tone may decrease, which increases
the bladder capacity to 1500 ml
Fluid and Electrolyte Balance
• Pooling of blood in the lower legs is
sometimes referred as to physiologic edema
or dependent edema and requires no
treatment
• Proteinuria usually does not occur in normal
pregnancy except during labor or birth
Integumentary System
• Chloasma- facial melasma, usually fades after
birth
• Linea nigra- is a pigmented line extending
from the symphysis pubis to the top of the
fundus in the midline
• Striae gravidarum- or stretch marks seen over
the abdomen
• Birth they usually fade, although they never
disappear completely
Musculoskeletal System
• Walking is more difficult, and the waddling
gait of the pregnant woman called “the proud
walk of pregnancy”
• Ligamentous and muscular of the middle and
lower spine may be severely stressed
Neurologic System
• Edema involving the peripheral nerves, which
may result in carpal tunnel syndrome
• Tension headache is common when anxiety or
uncertainty complicates pregnancy
• “Light-headedness”, faintness, and even
syncope are common during early pregnancy
• Hypocalcemia may cause neuromuscular
problem such as muscle cramps or tetany
Gastrointestinal System
Appetite
• Morning sickness or nausea and vomiting of
pregnancy appears at about 4 to 6 weeks of
gestation and usually subsides by the end of the
third month
• Pica- nonfood cravings, such as for ice, clay, and
laundry starch
• Pytalism- excessive salivation, which may be
caused by the decrease in unconscious
swallowing by the woman when nauseated or
from stimulation of salivary glands by eating
starch
Esophagus, Stomach, Intestines,
• Pyrosis- “Acid Indigestion” or heartburn
• Constipation
• Pregnant woman has hemorrhoids and is
constipated, the hemorrhoids may become
bleed during straining at stool
Pituitary and Placental Hormones
• Oxytocin can stimulate uterine contractions
during pregnancy Oxytocin also stimulates the
let-down or milk-ejection reflex after birth in
response to the infant sucking at the mother’s
breast
 CONCLUSION
• Accuracy of results of home pregnancy tests
depends on following instructions correctly.
• Presumptive, probable, and positive signs of
pregnancy aid in the diagnosis of pregnancy;
only positive signs (identification of a fetal
heart tone, verification of fetal movements,
and visualization of the fetus) can establish
the diagnosis of pregnancy.
 CONCLUSION
• During pregnancy maternal blood pressure
remains the same or decreases slightly.
• Heart rate increases 10 to 15 beats/minute by
32 weeks of gestation and persists until term.
• Respiratory rate is unchanged during
pregnancy, although tidal volume and minute
ventilation increase by 30% to 50%.
 CONCLUSION
• Dilation of renal pelves and ureters during
pregnancy increases the risk of urinary tract
infection.
• Decreased muscle tone during pregnancy
contributes to heartburn, reflux, and
constipation.
• Endocrine changes are essential to
maintaining pregnancy and promoting fetal
growth.