MATERNAL ADAPTIONS TO PREGNANCY What is PREGNANCY? y y Condition of carrying an offspring within the body.

A form of reproduction that unites the cells of 2 individuals to form a unique new individual who embodies characteristics of both parents.

OVERVIEW OF PREGNANCY FIRST TRIMESTER y y y y y Lasts from weeks 1 through 12 Critical time in pregnancy Rapid cellular differentiation makes the embryo susceptible to teratogens Woman experiences physical changes 7 to 10 days fertilization, serum HCG is present

SECOND TRIMESTER y y Lasts from 13 weeks through 27 Uterine and fetal size increase substantially

THIRD TRIMESTER y y Lasts from weeks 28 through 40 Increasing uterine size may displace pelvic and intestinal structures causing indigestion, protrusion of the umbilicus, shortness of breath and insomnia

PHYSIOLOGIC CHANGES OF PREGNANCY What are the reproductive system changes of pregnancy? a. Uterus y At the end of pregnancy, uterus is large, thin-walled organ, weighing 1,000 g; from pear shape-spherical and later on ovoid shape y Capacity has increased from 10 mL to 5 L. y Irregular painless uterine contractions occur (Braxton-hicks contractions) y Hegar s sign-softening of the uterine isthmus about the 6th week. b. Cervix y Increase in cell numbers due to estrogen y Secretes a thick, sticky mucus that forms a plug in the cervix (operculum). y Goodell s sign-purplish-blue color of the cervix and vagina due to an increased vascularity noted at 8 weeks. c. Ovaries

y y y d. Vagina y y y y

Follicles do not mature Ovulation does not occur Corpus luteum produces progesterone and estrogen for about 12 weeeks. Increase in vaginal secretions called leucorrhea Increased levels of glycogen in cells may enhance growth of organisms such as Trichomonas vaginalis or Candida albicans. Increase in vascularity change in violet color (Chadwick s sign) pH of vagina changes from the normally acidic to alkaline (due to increased levels of estrogen).

e. Breast y Enlargement, nipples erect, areolas darken, production of colostrums (4th month), Montgomery s tubercles enlarge What are the cardiovascular system changes of pregnancy? a. Blood volume y 45% to 50% increase in blood volume y Unequal proportion results in hemodilution that lowers hematocrit (physiologic anemia) y Increase BV leads to increased CO by 25% to 50% y Increased blood supply to other parts of the body (kidney and skin) Consequences of increased total cardiac blood volume? 1. 2. 3. 4. b. Easy fatigability and shortness of breath Slight hypertrophy of heart causing it to be displaced to the left Systolic murmurs are common due to lowered blood viscosity Nosebleeds may occur because of marked congestion of the nasopharynx Blood constituents y Increased production of RBC to compensate y Hemodilution of bood occurs y Increased protein requirement of the fetus and hemodilution contributes to the reduction of maternal plasma protein levels y This leads to normal ankle and foot edema of pregnancy due to fluid shifting y Blood lipids and cholesterol levels increase y Increased level of clotting factors making woman prone to thrombus formation c. Heart y Heart displaced to the left and upward y Slight cardiac enlargement by 10% due to increased blood volume y Palpitations; PR may increase slightly to 10-15 bpm y CO increased when in left lateral position d. Blood pressure

y y y

BP remains the same as pre-pregnancy level May drop slightly on the second trimester but returns to normal levels on the third trimester BP highest in sitting; intermediate in supine and lowest in left-lateral

What are the gastrointestinal system changes of pregnancy? a. Nausea and vomiting y morning sickness y Occurs on the first trimester y Causes: 1. Increased HCG levels 2. Increased estrogen and progesterone levels 3. Decreased maternal glucose levels as glucose is utilized by fetus REMEMBER! Hyperemesis gravidarum is excessive vomiting in pregnancy persisting beyond 3 months. b. Constipation and flatulence y Due to the displacement of the stomach and intestines; thus slowing peristalsis and gastric emptying time y Due to increased progesterone (sluggish peristalsis) y Oral iron supplements c. Hemorrhoids y Due to pressure on the pelvic veins by the enlarging uterus y Due to increased pressure secondary to constipation d. Heartburn y Due to relaxation of esophageal sphincter caused by high levels of progesterone e. Changes in the oral cavity y Ptyalism- increased salivation y Epulis- gums usually become soft and edematous and may bleed with brushing; tooth decay f. Changes in appetite y Increased in appetite to compensate for the growing needs of the fetus y Pica describes dietary cravings or aversions for nonnutritional substances. y Ex: clay, starch, coal, soap, toothpaste, ice and newspaper. g. Generalized itching and predisposition to gallstone formation What are the respiratory changes of pregnancy? a. Increased tidal volume b. Upward displacement of diaphragm

y Shortness of breath y Decreased residual volume y Chest crowding c. Slightly hyperventilization What are the unitary changes of pregnancy? a. Increased urinary output/ urinary frequency Causes: y Uterus exerts pressure on the bladder as it enlarges ( first trimester) y Relieved in the second trimester by the uterus moving into the abdominal area y Pressures of the presenting part on the bladder after lightening (third trimester) y Increased blood flow to the kidney which increases glomerular filtration rate, thus urinary output b. Glycosuria y Glucose spills in urine y Increase in glomerular filtration without an increase in tubular reabsorptive capacity c. Increased aldosterone production resulting in sodium and water retention d. Dilated ureters and renal pelvis due to progesterone and pressure from enlarging uterus e. Nocturia What are the integumentary changes of pregnancy? a. Increased melanin production y Anterior pituitary gland produces more melanotropin stimulating hormone 1. Chloasma (mask of pregnancy) - An increase in pigmentation on the forehead and around the eyes - Aggravated by sun exposure - Due to increase production of melanocytes 2. Striae gravidarum or stretch marks - Appear as reddish streaks on trunk and thighs. These generally change to a shiny gray-white color after delivery - They do not disappear 3. Linear nigra - Brown line running from umbilicus to symphysis pubis b. Estrogen effects 1. Palmar erythema- redness and itching of the hands 2. Vascular spider nevi- prominent capillaries under the skin 3. Activation of sweat gland and sebaceous gland What are the musculoskeletal changes of preganancy? a. Relaxation of the pelvic joints results in the classis waddling gait seen in pregnancy

b. Physiologic lordosis ( pride of pregnancy ) - Curvature of the lumbar spine increases to compensate for the weight of the gravid uterus. - Results in low back pain c. Leg cramps - Increased pressure of gravid uterus on lower extremities - Poor circulation - Fatigue - Low calcium, high phosphorus intake Remember! The most effective relief for leg cramps is press knee of the affected extremity and dorsiflex the foot. What are the endocrine system changes of pregnancy? a. Increased basal metabolic rate - Average weight gain is 3 to 5 pounds in the first trimester and 12 to 15 pounds in each of the following trimester. - Increase in total weight is 22-25 lbs - Water retention occurs during pregnancy due to increased sex hormone and decreased serum protein. b. Increased production of prolactin c. Increased estrogen levels d. Increased cortisol levels e. Thyroid Gland- slight enlargement f. Pancreas-increased glucocorticoid levels- increased insulin production g. Parathyroid Glands- to meet increase need for calcium h. Adrenal glands- increased corticosteroid production and aldosterone promote water and sodium reabsorption i. Pituitary gland-enlarges j. Increased secretion of growth hormone and melanocyte stimulating hormone k. Posterior pituitary secrete increasing amount as of oxytocin and prolactin

Psychological / emotional adaptations to pregnancy First trimester (acceptance of pregnancy) y I am pregnant

Second trimester ( acceptance of the Fetus as a separate individual)

I am going to have a baby!

Third trimester ( acceptance of motherhood/ the woman prepares for the birth of the baby and her Role as a Mother) y I am going to be a mother

Signs and symptoms of pregnancy What are the presumptive signs of pregnancy? Something observed and felt by the woman Changes that a woman experiences and reports which may not be associated with pregnancy Amenorrhea Breast changes Urinary frequency Quickening Easy fatigability Leucorrhea Nausea and vomiting Chadwick s sign Skin changes - Striae gravidarum - Linea nigra - Increased perspiration y y

1. 2. 3. 4. 5. 6. 7. 8. 9.

What are the probable signs of pregnancy? y 1. 2. 3. 4. 5. 6. 7. 8. Something observed by the examiner Hegar s sign- 6-8 weeks after LMP Uterine growth Ballotement Uterine shuffle Goodell s sign Braxton-hicks contraction Fetal outline Positive pregnancy tests

Remember! The earliest time that hcg can be detected in maternal serum is 8 days after ovulation, 23 days after LMP; 5 days before the expected menstrual period What are the positive signs of pregnancy?

y Noted by the examiner and can only be caused by pregnancy y Proves conclusively that the woman is pregnant 1. Hearing the fetal heartbeat y At 12 weeks by Doppler y At 16 weeks by a fetoscope y At 20 weeks by a stethoscope 2. Visualization of the fetus ( ultrasound at 6 weeks) 3. Examiner feeling fetal movement from 20 weeks onward