SYSTEMIC CHANGES

CIRCULATORY/CARDIOVASCULAR GASTROINTESTINAL RESPIRATORY URINARY MUSCULOSKELETAL TEMPERATUR ENDOCRINE CHANGES WEIGHT Emotional responses
CHANGES CHANGES CHANGES CHANGES E

30%-50% ↑ Urinary frequency, lordotic position (“pride of slight increase in placenta as an endocrine First trimester= gain of First trimester: the fetus is
Total cardiac volume Morning sickness Shortness of breath seen during the first pregnancy”) body temperature organ, producing large amounts 1.5 – 3 lbs an unidentified concept with
↓ Due to: increased Due to: trimester -makes ambulation easier by progesterone, but of estrogen, progesterone, HCG great future implications but
a drop in  human chorionic  Increased oxygen standing more straight and the body adapts and HPL 2nd trimester and 3rd without tangible evidence of
hemoglobin and hematocrit genadotropin (HCG) consumption and taller after the 4th month trimesters= gain of 10-11 reality. Some degree of
↓  acidity production of pounds per rejection, denial and
Physiologic anemia  emotional factors carbon dioxide trimester disbelief, even
during the first repression.
Consequences: Management: trimester Total allowable weight
Nosebleeds Eat dry toast or crackers  Increased uterine gain during entire period
Easy fatigability 30minutes before arising size causes of pregnancy is
Shortness of breath diaphragm to be 20 - 25 lbs ( = 10 – 12 kgs)
Slight hypertrophy pushed
Systolic murmurs Management: Lateral
expansion of the chest

Palpitations Heartburn Decreased renal pelvic bones Moderate enlargement of the Pattern of weight gain is Second trimester: fetus is
Management: threshold for sugar become more supple and thyroid gland due to more important than the perceived as a separate
due to:  Pats of butter before ue to increased movable, wobbly gait. hyperplasia of the amount of weight entity. Fantasizes
 Sympathetic nervous system meals production of glandular tissues and increased appearance of the
stimulation during first half of  Avoid fried, fatty foods glucocorticoids Implication: Advise use of vascularity. baby
pregnancy  Sips of milk at frequent which cause lactose low-heeled shoes after the first
 Increased pressure of uterus intervals and dextrose trimester
against the diaphragm during 2nd  Small, frequent meals
half of pregnancy taken slowly
 Bend at the knees, not at
the waist

Poor circulation →Edema of the lower Constipation and flatulence Leg cramps are caused by: Increased size of the
extremities occurs. Management: Increased pressure of gravid parathyroids, probably to
 Increase fluids uterus on lower extremities satisfy the increased need
Managements:  Avoid harsh laxatives Fatigue of the fetus for calcium
 Wear support hose  Regular elimination time Chills
 Apply elastic bandage  Increase exercise Muscle tenseness
 Avoid use of constricting garters  Avoid enemas Low calcium high phosphorus
intake
Poor circulation in the blood vessels of Leg cramps Increased size and activity of Third trimester: has
the genitalia→varicosities of the vulva Hemorrhoids caused by: the adrenal cortex→ personal identification with
and rectum Management:  Increased pressure of increasing the a real baby about to be born
Cold compress with witch gravid uterus on lower amount of circulating cortisol, and
Management: hazel extremities aldosterone and ADH, (all of realistic plans for future
 Side-lying position with hips  Fatigue which affect child care responsibilities.
elevated on pillows  Chills carbohydrate and fat Best time to talk about
 Advise modified knee-chest position  Muscle tenseness metabolism) preparation of
 Low calcium high layette and infant feeding
phosphorus intake method. Fear of death,
Most effective relief: Press though, is prominent
knee of the affected leg and
dorsiflex the foot

increased level of circulating fibrinogen Hyperemesis gravidarum –

excessive nausea and Gradual increase in insulin
vomiting which persists production
beyond 3 months;
↓
dehydration,
starvation and acidosis
Management:
 D10 NSS 3000 ml in 24
hours
 Complete bed rest
LOCAL CHANGES
Uterus Weight increase to about 1,000 grams at full term

Change in shape from pear like to avoid

Hegar’s sign, seen at about the 6th week

Mucous plugs in the cervix, called operculum, are produced to seal out bacteria

Goodell’s sign

Vagina Chadwick’s sign

Increasing amount of vaginal discharges called leukorrhea.

Management: Maintain or increase cleanliness by taking twice daily shower baths usingcoolwater.

pH of vagina changes from the normally acidic (because of the presence of the
Doderlein bacilli) to alkaline (because of increased estrogen)
*two microorganisms which love to thrive in an alkaline environment:
DISEASE SYMPTOMS TREATMENTS
Trichomoniasis. Frothy, cream-colored, irritatingly Flagyl for 10 days p.o. or vaginal
itchy, foul-smelling discharges suppositories of Trichomonicidal
compounds (e.g.,
Tricefuron, Vagisec, Devegan).

Acidic vaginal douche (1 tbsp.

white vinegar to 1 quart of water or
15
ml white vinegar in 1000 ml water)
to counteract alkaline-preferred
environment of the protozoa.

Avoid intercourse to prevent re-

infection.
Moniliasis or White, patchy, cheese-like particles Mycostatin/Nystatin p.o. or vaginal
Candidiasis. that adhere to vaginal walls. suppositories/pessaries (100,000 U)
Irritatingly itchy and twice a day
foul-smelling vaginal discharges for 15 days

Gentian violet swab to vagina (use

panty shields to prevent staining of
clothes or
underwear)

Correct diabetes

Avoid intercourse

Acidic vaginal douche

Abdominal Wall Striae gravidarum – increased uterine size results in rupture and atrophy of the
connective tissue layers, seen as pink or reddish streak

Umbilicus pushed out

Skin Linea nigra – brown line running from umbilicus to symphysis pubis

Melasma or chloasma – extra pigmentation on cheeks and across the nose due to the
increased production of melanocytes

Sweat glands unduly activated

Breasts All changes due to increased estrogen

Increase in size due to hyperplasia of mammary alveoli and fat deposits.

Feeling of fullness and tingling sensation in the breasts

Nipples more erect

Montgomery glands become bigger

Areolae become darker and diameter increase

Skin surrounding areolas turns dark

a thin, watery, high-protein fluid, called colostrums, is formed. It

is the precursor of breast milk.

Ovaries no activity