Physiological adaptations and

changes after delivery

CVS,GIT and respiratory changes

AGABA ADAM
NIYIBIZI JOHNBOSCO
Introduction

In the postnatal period, all of the mother’s body systems have to adjust from the

pregnant state back to the pre pregnant state. Mothers go through a transitional period

Regardless of place of birth, the midwife is primarily concerned with the observation of

the health of the postpartum mother and the new baby.

As such, it has been common practice to have an overall framework upon which to base

the assessment of the mother’s state of health and for the observations contained within

the examination to link with pre-stated categories in the postnatal midwifery records.
 Cardio vascular changes in the mother

The body has to reabsorb a quantity of excess fluid following the birth and for
the majority of women this results in passing large quantities of urine,
particularly in the first day, as diuresis is increased (Cunningham et al 2005).

Women may also experience oedema of their ankles and feet and this swelling
may be greater than that experienced in pregnancy.

These are variations of normal physiological processes and should resolve

within the puerperal time scale as the woman’s activity levels also increase.
Advice should be related to taking reasonable exercise, avoiding long
periods of standing, and elevating the feet and legs when sitting
where possible.

Swollen ankles should be bilateral and not accompanied by pain; the

midwife should note particularly if this is present in one calf only as it
could indicate pathology associated with a deep vein thrombosis
Blood pressure

 Following the birth of the baby, a baseline recording of

the woman’s blood pressure will be made.

In the absence of any previous history of morbidity associated with

hypertension, it is usual for the blood pressure to return

to a normal range within 24 hours after the birth.

Routinely undertaking observations of blood pressure without

a clinical reason is therefore not required once a baseline

recording has been taken. NICE (2006) suggest this should

be within 6 hours of the birth.

Maternal circulation changes

Following the birth of the placenta and membranes, the uterine cavity
collapses inwards; the now opposed walls of the uterus compress the
newly exposed placental site and effectively seal the exposed ends of the
major blood vessels.

The muscle layers of the myometrium act like ligatures that compress
the large sinuses of the blood vessels exposed by placental separation.
These occlude the exposed ends of the large blood vessels and
contribute further to reducing blood loss. In addition,
vasoconstriction in the overall blood supply to the uterus results in
the tissues receiving a reduced blood supply; therefore,
deoxygenation and a state of ischemia arise.

Coagulation takes place through platelet aggregation and the release

of thromboplastin and fibrin (Cunningham et al 2005).
Fetal circulation changes

At birth, there is a dramatic alteration to the fetal circulation and an

almost immediate change occurs. The cessation of umbilical blood flow

causes a cessation of flow in the ductus venosus and a fall in pressure

in the right atrium.

As the baby takes its first breath, blood is drawn along the pulmonary
system via the pulmonary artery and as a consequence, pressure
increases in the left atrium due to the increased blood supply returning
to it via the pulmonary veins.

The alteration of pressures between the two atria causes a mechanical

closure of the foramen ovale.
In addition, as the baby takes its first breath, the lungs inflate, and
there is a rapid fall in pulmonary vascular resistance of approximately
80%, a slight reverse flow of oxygenated aortic blood along the ductus
arteriosus and a rise in the oxygen tension.

This causes the smooth muscle in the walls of the ductus arteriosus to
contract and constrict, usually within 24 hours following birth, though it
can remain patent for a few days
Respiratory changes
Respiratory changes
• There could be a transient temperature rise by 0.5 on the third or 4th
day due to breast engorgement .
• The respiratory rate also begins to fallback to the pre pregnancy level
with in 2 to 3 days
• Note
• A rise of temperature beyond the 3rd day or over the upper limit is
usually a sign of infection.
• Functional residue capacity return to normal 1to2 weeks postpartum,
accompanying the reduction in uterine size.
• All other respiratory parameters return to non pregnant values with
6to 12 weeks postpartum.
GIT IN PREGNANCY
 GIT changes
• Falling progesterone levels affect the alimentary tract so that the
smooth muscle tone gradually improves.

• Any symptoms of heartburn experienced by women should resolve.

• Constipation may, however, remain a common problem during the

postnatal period.