Mrs.

Ashwini Sutar
Lecturer
Mksss Btine Pune
CHANGES OF THE REPRODUCTIVE
SYSTEM DURING PREGNANCY
 Uterus
• At term, the uterus will have increased five times its
normal size:
(a) In length from 7.5 to 35 cm
(b) In depth from 2.5 to 22 cm
(c) In width from 4 to 24 cm
(d) In weight from 50 to 1000 grams.
(e) In thickness of the walls from 1 to 0.5 cm

The capacity of the uterus must expand to

normally accommodate a seven-pound(3500gm) fetus
and the placenta, the umbilical cord, 500 ml to 1000 ml
of amniotic fluid and the fetal membranes.
• Shape- Non pregnant uterus- pyriform shape
At 12 week- globular
At 28 week- oval
At 36 week- spherical

• Position- Non pregnant uterus- Anteverted

After 8 week- it becomes erect in position

• Contractions- from the early weeks of pregnancy uterus

undergoes spontaneous contraction, i.e. Braxton’s hicks
contraction.
The contractions are irregular, infrequent, spasmodic &
painless without any effect on dilatation of the cervix.
• Growth of the uterus -occurs at a steady, predictable
pace.
- Measurement of the fundal height during pregnancy is
an important factor.
- Growth that occurs too fast or too slow could be an
indication of problems.
- The size of the uterus usually reaches its peak at 38
weeks gestation.
- The uterus may drop slightly as the fetal head settles
into the pelvis, preparing for delivery. This dropping is
called as "lightening."
This is more noticeable in a primigravida than a
multigravida.
Fundal height during pregnancy
 Cervix
* There is hypertrophy & hyperplasia of the elastic &
connective tissue, cervix undergoes a marked softening which
is called as the Goodell's sign.
It is seen within 6 wks of pregnancy.
* Secretions- becomes copious & tenacious, called as
physiological leucorrhea.
Secretion forms thick mucus plug, which is known as
"operculum" is formed in the cervical canal. This is due to
effect of estrogens & result of enlarged and active mucus
glands of the cervix.
It serves to seal the uterus and to protect the fetus and
fetal membranes from infection. The mucus plug is expelled
at the onset of labor or during labor called as show. When the
mucus is blood-tinged, it is referred to as a "bloody show.
 Vagina
• Wall becomes hypertrophied, edematous & more
vascular.
• Vaginal mucosa become bluish in colour due to increased
blood supply, known as Jacquemier’s sign.
• Increased circulation to the vagina early in pregnancy
changes the color from normal light pink to a purple hue
which is known as the Chadwick's sign.
• Secretion – becomes copious, thin & curdy white, pH
becomes acidic for prevention of multiplication of
pathogenic organism.

 Vulva - becomes edematous & hyperemic

Labia minora are pigmented & hypertrophied.
 Ovaries
 The follicle-stimulating hormone (FSH) ceases its
activity due to the increased levels of estrogen and
progesterone secreted by the ovaries and corpus luteum. The
FSH prevents ovulation and menstruation.
 The corpus luteum enlarges during early pregnancy, it
produces progesterone to help maintain the lining of the
endometrium in early pregnancy.
 It functions until about the 10th to 12th week of pregnancy
when the placenta is incapable of producing adequate
amounts of progesterone and estrogen.
 It slowly decreases in size and function after the 10 th to
12th week.
 CHANGES OF THE BREASTS
 In early pregnancy, the breast may feel full or tingle, and
increase in size (due to hypertrophy & proliferation of ducts &
alveoli) as pregnancy progresses.
 The areola of the nipples darken and the diameter increases
& the sebaceous glands of the areola enlarge and tend to
protrude, called as Montgomery's tubercles.
 Appearance of primary and secondary areola.
 The surface vessels of the breast may become visible &
bluish tint due to increased vascularity.
 By the 16th week (2nd trimester) the breasts begin to
produce colostrum (It is a thin, watery, yellowish secretion
that thickens as pregnancy progresses. It is extremely high in
protein)
Nursing implication: Inform the pregnant patient to
wear a good, supporting bra.
Changes in breast
 CHANGES OF THE SKIN
Alterations in hormonal balance and mechanical stretching
are responsible for several changes in the integumentary system.
a. Linea Nigra- This is a dark line that runs from the umbilicus
to the symphysis pubis and may extend as high as the sternum. It
is a hormone- induced pigmentation.
After delivery, the line begins to fade, though it may not ever
completely disappear.

b. Striae Gravidarum ( )- These are slightly

depressed linear marks with different length & breadth found in
pregnancy.
This may be due to the action of the adrenocorticosteroids.
This occurs on the abdomen, thighs and breasts.
It will usually fade after delivery although they never
completely disappear.
Linea Nigra
On either side of abdominal wall are other striae; both
pinkish and whitish in color
c. Mask of Pregnancy (Chloasma)-
This is the brownish hyper pigmentation of the
skin over the cheek, forehead & around the eye.
It begins about the 16th week of pregnancy and
gradually increases, then it usually fades after delivery.

d. Sweat Glands-
Activity of the sweat glands throughout the body
usually increases which causes the woman to perspire
more profusely during pregnancy.
Chloasma
Itching, sweating & excretion of sebum increases
Erythematic rash
 CHANGES IN BODY WEIGHT
Normal weight gain is about 24 to 30 pounds (11kg-
13kg) during pregnancy.
Weight gain in pregnancy-
1. A slight loss of wt during early pregnancy due nausea and
vomiting.
2. Woman gains 1kg by the end of the first trimester.
3. A gain of appro. 5kg each during the second and third trimesters.
4. A lack of significant weight gain may be an indication of
intrauterine growth retardation (IUGR) of the infant.
Adequate protein intake should be emphasized to the
patient for development of the healthy fetus.
periodical & regular weight checking is of importance to
detect abnormality.
WEIGHT GAIN
Changes in cardiovascular system
A. Blood Volume.
 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.
 By the time pregnancy reaches term, the body has
usually compensated for the decrease resulting in an
essentially normal blood count.
Total blood volume during pregnancy is about 5 liters
Cont….

Uterine blood flow increased from 50ml/min.

in non pregnant state to about 750ml/min. near
term, due to utero-placental & feto-placental
vasodilatation.
 Blood count is interpreted as anemia by the
physician if the hemoglobin falls below
10.5gms per 100ml and the hematocrit drops
below 30 %.
B. Cardiac Output
It start to increase from 5th wk of pregnancy
• Cardiac output increases about 30% during
the first and second trimester to accommodate
for hypervolemia.
• Change in output is reflected in the heart rate.
It usually increases by 10 beats per minute.

Nursing implication- Patients with a heart

diseased need to be advised to get plenty of rest and
to report any shortness of breath or unusual
symptoms to their physician.
c. Blood Pressure
Normally, the patient's blood pressure will not
rise.
Nursing implications.
a. The patient's blood pressure should be checked
carefully and often since a significant increase is
one of the indicators of toxemia of pregnancy.
b. When monitoring the blood pressure, be sure it
is done under the same circumstances (i.e. Patient
sitting and left arm).
D. Venous Return.
• The lower extremities are hampered in the last
months of pregnancy due to the enlarged uterus
restricting physical movement and interfering with the
return blood flow of common illiac vein.
This results in swelling of the feet and legs & also
develops varicose veins, piles & DVT.
Nursing implications
• Advise the patient to rest frequently to improve venous
return and decrease edema.
• To elevate legs while sitting.
• Not to lie in a supine position since this inhibits return
blood flow as the heavy uterus presses on the vessels.
This leads to the vena cava syndrome or supine
hypotension. The patient may complain of feeling dizzy,
nauseated or weak.
Vena cava syndrome
Abnormal clinical finding
• Apex beat is shifted to 4th intercostal space above
• Palpitation
• Slightly increased pulse rate 2.5cm outside the
midclavicular line.
• Continuous hissing murmur (mammary murmur)
• Increased in the left ventricular end diastolic diameter &
left & right atrial diameter also.
The physician should be familiar with these
physiological finding.
 CHANGES OF BODY TEMPERATURE

• A slight increase in body temperature in early

pregnancy. The temperature returns to normal at
about the 16th week of gestation.

• The patient may feel warmer or experience "hot

flashes" caused by increased hormonal level and
basal metabolic rate.
Changes of RESPIRATORY SYSTEM
Cont…..

• The respiratory rate rises to 18 to 20 to compensate

for increased maternal oxygen consumption, which is
needed for demands of the uterus, placenta and fetus.
• Breathing become diaphragmatic due to elevation of
the diaphragm (4cm).
• Chest circum. increases by 5-7cm.
• Maternal oxygen consumption is increased by 20-
40%
• State of hyperventilation occurs.
 CHANGES OF URINARY SYSTEM

• Kidney- enlarge in length by 1cm, renal plasma flow

is increased by 50-70% from 16th wk to 34th wk.
- GFR is increases by 50% all through out
pregnancy.
- The kidneys must work extra hard excreting the
mother's own waste products plus those of the fetus.
- There is an increase in urinary output and a
decrease in the specific gravity.

• Ureter- The patient may develop urine stasis and

pylonephritis in the right kidney due to pressure on
the right ureter resulting from dextrorotation.
Cont….
•Bladder- Frequent urination is a complaint during the
first & third trimester.
As the uterus rises out of the pelvic cavity in
early pregnancy, pressure on the bladder decreases and
frequency diminishes.
When lightening occurs during the final weeks
of pregnancy, pressure on the bladder returns to cause
frequency.
Bladder mucosa becomes edematous due to
venous & lymphatic obstruction.
 CHANGES OF SKELETAL SYSTEM

 There is a realignment of the spinal curvatures during

pregnancy to maintain balance. It is due to the
increase in size of the uterus and pressure on the
abdominal wall.
 The patient walks with head and shoulders thrust
backward and chest protruding outward to
compensate. This gives the patient a "waddling" gait.
 There is a slight relaxation and increased mobility of
the pelvic joints, which allows stretching at the time
of delivery of the infant.
LORDOSIS
 CHANGES OF THE GI SYSTEM

 Gum becomes congested & spongy,

Peristalsis is slowed because of the production
of the progesterone, which decreases tone and
mobility of smooth muscles.
 Slow emptying may increase nausea and
heartburn (pyrosis).
 Relaxation of the cardiac sphincter may
increase regurgitation and chance for
heartburn.
 Atonicity of guts leads to constipation.
Cont….

Nursing implications.
 For nausea and/or heartburn, advise her to eat
small, frequent meals.
 The patient should eat a well- balanced diet high
in protein, iron and calcium for fetal growth; high
fiber and fluids to prevent constipation.
 The mother should not lie flat for 1 to 2 hours
after eating.
 METABOLIC CHANGES
• Basal metabolic rate is increased
• Protein metabolism
• Carbohydrate metabolism: insulin secretion is
increased
• Fat metabolism: 3-4kg fat stored in abdominal
wall, breast, hips & thighs.
• Plasma lipids & lipoproteins increases
• Iron metabolism
• Calcium metabolism
 CHANGES OF SELECTED GLANDS OF THE
ENDOCRINE SYSTEM DURING PREGNANCY

Parathyroid Gland.- This gland increases

in size slightly. It meets the increased
requirements for calcium needed for fetal growth.

Posterior Pituitary.- Near the end of term,

the posterior pituitary will begin to secrete
oxytocin that was produced in the hypothalamus
and stored there. It will serve to initiate labor.
 Anterior Pituitary.- At birth, the anterior
pituitary will begin to secrete prolactin. This
stimulates the production of breast milk.

Placenta.- The placenta acts as a temporary

endocrine gland during pregnancy. It produces
large amounts of estrogen and progesterone by 10
to 12 weeks of pregnancy. It serves to maintain
the growth of the uterus, helps to control uterine
activity and is responsible for many of the
maternal changes in the body.
Psychological Consequences of Pregnancy
and Delivery

Among the major and recurring psychological themes

prevalent in pregnant and new mothers include feelings of
depression, emotional liability, self-esteem issues, body image
issues and personal feelings regarding control.

Emotional Toll of Pregnancy and Delivery

Hormone levels are constantly fluctuating during pregnancy
and in the post partum period.
This can lead to feelings of anxiety, depression, sadness,
elation and even confusion.
With adequate support most women will recover from
pregnancy and delivery very well on an emotional basis, if they
know what to expect and how to deal with it ahead of time.
Finding Time to Sleep

Sleep when your baby sleeps

If women are breastfeeding, it is vital that she get as
much sleep as possible to ensure an adequate milk supply
and energy to care for and feed to baby.
Dealing with Psychological Emotions
Improve the psychological and emotional impact of pregnancy and
delivery.
Women should accept these things:
Accept that mother will be tired during pregnancy and likely be
exhausted afterward.
In the post partum period need to spend a large portion of time
up at night feeding and caring for baby.
Should not expect to maintain a spotless home, cook meals and
other work as normal.
- So take the help of partner, family members, relatives or friends
maintain the house and cook meals.
- Limit the number of visitors, communicate with friends and
family members .
Body Image:
During pregnancy body will go through numerous
changes. gain weight, skin will be stretched out and may
change colors, hair may become fuller only to seem like it
is falling out after pregnancy.

It is vital for emotional well being, that you

realize that it took nine months for body to go through all
of the changes that it did during pregnancy, and it should
take at least nine months to recovery fully from the
changes that occur during pregnancy.
Conclusion:
The best thing women can do is love yourself and
appreciate the fact that your body has just completed
one of the most amazing and miraculous tasks known to
man - it has created life!
deserve to take the time necessary to recover, and
your body certainly deserves a break.
Return to the Facts on a Healthy, Happy Pregnancy.