Physiologic Changes in Pregnancy

Prepared by:
ERLINDA M. BARONDA, RN,Ph.D.

PHYSIOLOGIC
CHANGES in
PREGNANCY
Pregnancy:
Normal Physical Changes
 Vagina
 Increased vascularity produces deep violet
or bluish color (Chadwick’s sign)
 Epithelium hypertrophies and is enriched
with glycogen due to the influence of
glycogen
 they loosen from their connective tissue
attachment in preparation for great

distention at birth
 produces white vaginal discharge
throughout pregnancy
Pregnancy:
 Uterus
Normal size = 2 x 3 inches
Increases dramatically in size and weight
By week 20 – 22 Umbilical level

By week 30 Midway between umbilicus
and xiphoid process
By week 36 At the xiphoid process
Pregnancy:
 Uterus…
 Braxton Hicks contractions
 Rhythmic, painless contractions of the uterus;
initially become noticeable and sometimes

uncomfortable toward the end of the pregnancy
(“false labor”)
 Begin by the end of the first trimester
 Hegar’s sign: softening of the lower

uterine segment of the cervix
 Occurs about 6th week of pregnancy
Pregnancy:
 Cervix
 Glandular tissue increases in number
and becomes hyperactive

 Mucous plug is formed and acts as
barrier to prevent ascending infection

 Increased blood flow to cervix leads
to softening (Goodell’s sign)

Pregnancy:
 Ovaries
 Ovum production ceases (due to high
estrogen and progesterone which

inhibits FSH and LH from pituitary
stimulation)
 Corpus luteum persists and secretes
progesterone until weeks 6-8 until

the placenta is developed
Pregnancy:
 Breasts
 changes are brought about by estrogen and
progesterone
 increased tenderness, feeling of fullness, or
tingling
 superficial veins are prominent
 increased pigmentation and increase in
diameter of areola and nipple

 Montgomery’s tubercules (sebaceous glands of
the areola) enlarge and become protuberant
Pregnancy:
 Breasts…
 Colostrum produced by week
12
 The antibody-rich forerunner of
mature breast milk

 Pre-colostrum can be expelled by
the 16th week

Reproductive Changes
1. Amenorrhea occurs because the
corpus luteum persists;
- ovulation inhibited by the high
levels of estrogen and
progesterone
2. Uterine Changes (due to circulatory,

hormonal and related to fetal growth)):
a) Chadwick’s sign: purplish hue to the

cervix and vaginal mucosa
> Leukorrhea-whitish, gray, moderate
in amount with a musty or mousy odor
discharge
b) Goodell’s sign- softening of the cervix
> Operculum- mucus plug to seal off
bacteria, hormone responsible is
progesterone
c) Hegar’s sign- softening of the lower uterine
segment
d) Uterus enlarges in size
e) Changes in position of the uterus:

> 1st trimester: uterus in pelvic cavity
> 2nd & 3rd trimester: uterus is in abdominal cavity
before lightening occurs
3. Ovaries- pregnancy is the rest period for

the ovaries
4. Breast changes: fullness, tingling,

soreness, and darkening of the areola and
nipples occur due to increase in hormonal
level
Respiratory System
Shortness of breath because of enlarging uterus and
increased oxygen demand
Management:
- Position mother on the left lateral side-lying
to promote expansion of the lungs
Hyperventilation occurs due to the mother’s need to
blow-off increased carbon dioxide transferred to her
from the fetus
Nasal congestion occurs as a
response to increased estrogen
levels
Pregnancy:
 Cardiovascular System
 Blood volume increases about 40-45%
 By weeks 20-24, cardiac output increases 30-

50% over pre-pregnant levels; remains
elevated for the duration of the pregnancy
 Pulse rate increases
 BP decreases slightly by 2nd trimester
- RBCs, hemoglobin and plasma levels increase

 Hematocrit levels of 32% to 44% considered
normal
 Leukocyte production increases
Pregnancy:
 Cardiovascular System…
 Pressure of enlarging uterus on vena cava
can interfere with blood return to the

heart
 Can cause dizziness, pallor, clamminess
and lowered BP (supine hypotensive

syndrome/ vena caval syndrome/
aortocaval compression)
Supine Hypotensive Syndrome/
vena caval syndrome….
-weight of enlarged uterus obstructs vena cava,
which decreases blood return to heart therefore
decreasing cardiac output resulting to
hypotension, lightheadedness, faintness and
palpitations
- corrected: by having the woman lie on

her side (left lateral position)
 Lateral position
 Rationale:
It helps relieve pressure
on the sacrum and
heels in person who
sit for much of the day
or who are confined to
bed and rest in the
fowler’s/supine
positions.
Area of support: the

head, across the chest
and in between the
thigh
Cardiovascular system…
Heart rate increases 10-15 beats per min. in the

latter half of pregnancy
Palpitation is common
Physiologic Anemia:
- due to hemodilution of the
blood
- 45-50% increase in blood
volume expansion, of which
about 75% is plasma and
25% is RBC
Pathologic Anemia
Iron deficiency anemia:
- most common hematologic disorder
- affects roughly 20% of pregnant women
Assessment:
- pallor, concave fingernails (late sign of
progressive anemia) caused by chronic
tissue hypoxia, listlessness
Pathologic Anemia….:
Management:
- increased iron in diet
- Oral iron supplements (ferrous
sulfate 0.3 g, 3x a day): best given
before meals or with an empty stomach
for better absorption, however can
lead to GI irritation, hence given
on full stomach
Best sources of Iron:

liver, lean or red meat,
legumes: Monggo, green leafy
vegetables such as kangkong,
ampalaya, spinach, and malungay.
Iron Preparation…
> Iron is better absorbed when taken
with foods rich in Vitamin C such as
orange juice
Side effects: constipation, black tarry

stools
>Monitor for hemorrhage
Cardiovascular system
Normal Values in Pregnancy
Hct: 32-42 %
Hgb: 10.5-14 g/dL
Criteria: Hct and Hgb should not fall:

>1st & 3rd Trimester:
Hct <33%
Hgb<11 g/dl
>2nd trimester:
Hct<32%
Hgb<10.5
Gastrointestinal System…
Morning Sickness:
- characterized by early morning nausea

and vomiting due to increased HCG
and reduction in hydrochloric acid
secretion that
interferes with gastric motility
Morning Sickness…:
Management:
1st trimester:
Getting out of bed slowly after
eating a few crackers
Eating frequent, small meals
(afternoon nausea)
Avoiding spicy or greasy foods
Hyperemesis Gravidarum:
- excessive vomiting during
pregnancy
Emesis Gravidarum:
- vomiting during pregnancy
Heartburn or Pyrosis:
- reflux of stomach content to the
esophagus
Prevention:
Eating small frequent meals
Avoiding fatty and spicy foods
Proper body mechanics
Taking sips of milk
Food cravings may occur:
only significant if substance craved is
unusual (pica) – Example: clay, starch, dirt
Ptyalism:
- increased salivation caused by elevated
estrogen levels
Nursing Care: Offer mouthwash
Flatulence:
- presence of excessive amount of
gas in the stomach and intestines due
to increased progesterone
Prevention:
- voiding intake of gas-forming foods
(i.e. root crops, beans)
Constipation:
- a condition in which bowel movements are
infrequent or incomplete
Causes:
Hypoperistalsis
Lack of fluids
Poor dietary habits
Pressure of the enlarged uterus on internal
organs
Effects of progesterone on
muscle and hemorrhoids
Constipation:
Management:
Increase oral fluid intake
Eat high-fiber foods: oatmeal,
papaya, pineapple, grapes, apple,
watermelon, cantaloupe
Regular exercise
Hemorrhoids:
- a varicose condition of the external
hemorrhoidal veins causing painful
swellings at the anus
Cause: due to the gravid uterus
Nursing Interventions:
Warm sitz bath
Sit on soft pillows
High fiber diet
Increased fluid intake
Renal System
Urinary Frequency:
- due to increased pressure on the bladder from
the growing uterus
- due to proximity of the uterus and bladder in
early and late pregnancy
1st trimester - frequent urination
2nd trimester - normal as bladder is already
adjusted
3rd trimester - increase in frequency of
urination due to pressure of the gravid
uterus on urinary bladder
Renal System
Glysosuria:
- Increased excretion of sugar caused by
lowered renal threshold
- Determined by Benedict’s test
Nocturia: is the need to get up during the night in order to

urinate, thus interrupting sleep
Management:
a) Decreased oral fluid intake at least two
hours before bedtime
b) Side lying or lateral position
Pregnancy:
 Skin (Integumentary) and Hair
 Pigmentation of areolae, nipples, vulva, and
linea nigra increases

 Facial chloasma or melasma gravidarum:
a butterfly-shaped area of pigmentation over

the face
 Called the “mask of pregnancy”
 Usually fades after childbirth
 Striae or stretch marks may develop on the
abdomen, breasts and thighs

Melasma
Striae gravidarum
Linea nigra
Integumentary System…
Striae Gravidarum or Stretch marks:
- caused by enlarging uterus which causes
destruction of connective tissue resulting from
separation of underlying collagen which
appears as irregular scars
- Do not scratch instead apply lotion or oil
Linea Nigra:
- brownish-pinkish line running from symphysis
pubis to the umbilicus due to increased melanin
Protruding umbilicus.
Musculoskeletal System
1. Lordosis:
- Accentuation of the lumbar
curvature of the spine
- Known as ”Pride of Pregnancy”

Muskuloskeletal System…
3. Leg cramps:
- may occur from an imbalance of calcium
(hypocalcemia) in the body and from
pressure of the gravid uterus on nerves
supplying the lower extremities
Management:
Put the affected leg in a flat
surface then do dorsiflexion
Milk: 1 pint or 4 cups/day
or 3-4 servings.
Muskuloskeletal System…
Leg Cramps…
Calcium-rich foods:
Anchovies
Sardines (specifically the head of the fish)
Sea foods
Mussels
Cheese
Yogurts
Broccoli
Dairy products
Endocrine System
1. Elevated HCG levels which reaches peak at third
month then drops.
2. Estrogen and progesterone increases and continue to
be secreted from the placenta during the last 6
months of pregnancy.
a) Progesterone acts to inhibit uterine
contractions.
b) Increase in both hormones leads
to sodium and water retention
and muscle relaxation which
leads to fatigue.
Endocrine System
3. Thyroid activity is increased; normal

pregnancy may emulate a mild
hyperthyroid state.
4. Estriol levels increased; sometimes

used as an indicator of fetal well-
being
Nutrition & Metabolic Changes
1. All pregnant women should be
encouraged to eat a well-balanced
diet.
2. Folic acid: Prevent neural tube

defects (NTD’s)
Prenatal multivitamin
Nutrition & Metabolic Changes
3. Nutritional recommendations for
pregnant women are based upon the
prepregnancy body mass index (BMI).
A weight gain of 12.5 to 18 kg (28 to 40
lb) for Underweight women (BMI<19.8)
7 to 11.5 kg. (15to 25 lb.) for

overweight women (BMI>26)
11.5 to 16 kg. (25-35 lb.) for women of

average weight (BMI 19.8 to 26.0)
4. Conduct nutritional assessment and
emphasize knowledge on the food guide
pyramid especially on the following high risk
mothers:
Pregnant teenagers: low compliance to
health regimen
Extremes in weight:
Underweight: malnourished
Overweight : pre-eclampsia, DM
Mothers with low socio-economic status:
refer to Social Worker
Vegetarian mothers:
4 Types:
 Strict vegetarian: No meat, fish, eggs and dairy, rigid personality
- most prone to anemia
 Lactovegetarian:
Eats dairy products and vegetable
 Ovo-vegetarian:
Eats eggs and vegetables
 Lacto-ovovegetarian:
Eats eggs, milk and vegetables
Least prone to anemia
5. Calories
a) Non pregnant: 2, 200
b) Pregnant: +300=2,500
c) Lactation: +500=2, 700
5. Calories:
Non pregnant: 2, 200
Pregnant: +300=2,500
Lactation: +500=2, 700

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Prepared by:

ERLINDA M. BARONDA, RN,Ph.D.

attachment in preparation for great

By week 20 – 22 Umbilical level

 Rhythmic, painless contractions of the uterus;

initially become noticeable and sometimes

 Hegar’s sign: softening of the lower

and becomes hyperactive

barrier to prevent ascending infection

to softening (Goodell’s sign)

estrogen and progesterone which

progesterone until weeks 6-8 until

 increased pigmentation and increase in

diameter of areola and nipple

mature breast milk

the 16th week

2. Uterine Changes (due to circulatory,

a) Chadwick’s sign: purplish hue to the

e) Changes in position of the uterus:

3. Ovaries- pregnancy is the rest period for

4. Breast changes: fullness, tingling,

 By weeks 20-24, cardiac output increases 30-

 BP decreases slightly by 2nd trimester

- RBCs, hemoglobin and plasma levels increase

can interfere with blood return to the

and lowered BP (supine hypotensive

- corrected: by having the woman lie on

Area of support: the

Heart rate increases 10-15 beats per min. in the

Best sources of Iron:

Side effects: constipation, black tarry

Criteria: Hct and Hgb should not fall:

- characterized by early morning nausea

Nocturia: is the need to get up during the night in order to

linea nigra increases

a butterfly-shaped area of pigmentation over

 Usually fades after childbirth

 Striae or stretch marks may develop on the

abdomen, breasts and thighs

- Known as ”Pride of Pregnancy”

3. Thyroid activity is increased; normal

4. Estriol levels increased; sometimes

2. Folic acid: Prevent neural tube

7 to 11.5 kg. (15to 25 lb.) for

11.5 to 16 kg. (25-35 lb.) for women of

- most prone to anemia

Non pregnant: 2, 200

Lactation: +500=2, 700

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