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Pregnancy and Maternal Physiologic Adaptations

Pregnancy and Maternal Physiologic Adaptations. Prepared by : Ayda khader. Feb.2017. Confirmation of pregnancy: Presumptive Indications of Pregnancy 1. Amenorrhea (cessation of menses) Pregnancy is suspected if more than 10 days elapsed since the time of the expected onset .

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Pregnancy and Maternal Physiologic Adaptations

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  1. Pregnancy and Maternal Physiologic Adaptations Prepared by : Ayda khader Feb.2017

  2. Confirmation of pregnancy: Presumptive Indications of Pregnancy 1. Amenorrhea (cessation of menses) • Pregnancy is suspected if more than 10 days elapsed since the time of the expected onset. 2. Breast and Skin Changes • Breast is enlarged and become tender • Nipple become larger and more pigmented • Secrete of colostrum in the 2nd half of pregnancy • Darkening of areola

  3. 3. Nausea and Vomiting (morning sickness) • Occur mainly in the morning • Usually disappear near the end of the first trimester 4. Vaginal and Cervical Color Changes • Chadwick’s signs = a bluish discoloration and congestion of vaginal wall 5. Abdominal Striae (striaegravidarum ) • Appears in abdomen and sometimes in breast, and thigh because of the stretch. 6. Fetal Movement (Quickening Sign) • occurs between 16th and 20th week after the onset of last menses

  4. 7. Frequency of Urination • Caused by pressure is exerted on the bladder by expanding uterus • Decrease when the uterus expands into the abdomen away from the pelvis • Reappear when the fetal head engages in the pelvis at the end of pregnancy. 8. Fatigue • Characteristic of early pregnancy that the direct cause unknown but may be related to hormones changes

  5. Probable Indications of Pregnancy 1. Abdominal Enlargement Slow gradual increase of the abdomen size 2. Braxton Hicks Contraction Irregular painless contractions of the uterus occurring throughout pregnancy. 3. Ballottement • Refers to sinking and rebounding of the fetus in its surrounding amniotic fluid when taping the uterus suddenly (occur at mid-pregnancy/ 16-28 weeks). • It’s a strong indication of pregnancy

  6. 4. Change in the shape, size and consistency of the uterus • Uterus enlarges, elongates and decrease in thickness as pregnancy progress • Hegar’s sign: softening of the lower uterine segment at 6-8 weeks. 5. Changes in the cervix • Goodell’s sign: softening of the cervix at 6-8 weeks • The cervix remains firm during pregnancy in case of cervical inflammation and carcinoma. 6. Pregnancy tests • Human Chorionic Gonadotrophin (HCG) hormone appears in the maternal serum and urine

  7. . Positive Indications of Pregnancy 1. Auscultation of fetal heart sounds • Fetal heart sounds can be heard with a fetoscope by 20to 24 weeks of gestation • Electronic Doppler can detect heart motion at 10 weeks of gestation. 2. Felt of fetal movement by the examiner • Should be careful to be not deceived by similar peristaltic movement of large intestine. 3. Visualization of the fetus The fetus can be detected by transvaginalultrasonography as early as 4 weeks after the last menstrual period and by transabdominalultrasonography at 6 weeks.

  8. . Maternal physiologic changes during pregnancy The changes that occur in the body system of the pregnant women caused by several factors: • Hormonal influences • Fetus growth inside the uterus • Maternal adaptation to physiological changes of pregnancy

  9. 1. Reproductive System • Uterus • The uterus develops to provide a nutritive and protective environment in which the fetus will develop and grow. • Progesterone and estrogen produced by the corpus lutium cause the decidua. • Become thicker, more vascular at the fundus. • The decidua provides a glycogen until to form placenta

  10. Increase in uterus weight and size. • The uterus can be palpated supra publically by the end of 3ed month that by 22 and 36 weeks of gestation the fundus has reached the umbilicus and xiphoid respectively. • The uterus descends slightly into the pelvis during the last 3 weeks • Painless irregular contraction (Braxton Hick’s Contraction) at the first two trimesters. During the last trimester become more frequent and cause some discomfort.

  11. B. Cervix • The cervical glands proliferate with increase mucus production. The mucus form plug in the cervical canal and block ascending of bacteria from the vagina into the uterus. • The obvious cervical changes occur in color and consistency that the cervix becomes congested with blood (Chadwick’s sign) due to estrogen stimulation and soft (Goodell’s sign).

  12. C. Vagina and Vulva • Increase vascularity of the vagina cause vaginal wall to appear bluish (Chadwick’s sign). • Softening of vaginal tissue and loosens of connective tissue cause distend of vaginal wall to prepare for childbirth. • The subsequent breakdown of glycogen into lactic acid assists in producing a low vaginal pH which prevents infection

  13. D. Ovaries • Ovulation ceases during pregnancy because circulating estrogen and progesterone are high that inhibiting release of LH and FSH (these hormones are necessary for ovulation). • Progesterone produced in early pregnancy by special glandular structure of the ovaries called corpus luteum. Later the placenta produces it in increasing quantities

  14. 2. Integumentary System • Pigmentation changes occur ( increase of melanin). • Chloasma: patchy coloring on the face. • Linea nigra: pigmented line running from the pubis to the umbilicus. • Striaegravidarum: thin and stretch marks appear as red strips, its appers in the skin of the abdomen, breast and thighs. • Oily skin and acne may occur in pregnancy

  15. 3. Breast Changes • Some women may experience tender and tingle in the early weeks of pregnancy. • The breast size increased by 2ed month • Nipple becomes large, more deeply pigmented and more erectile, Areola becomes broader and more deeply pigmented. • Colostrum may be experienced in some women by 2ed trimester. It has protein and mineral but less sugar and fat compared to mature milk.

  16. 4. Metabolic System A. Weight Gain • Women are encouraged to gain an adequate amount of weight during pregnancy. • Expected increase: total weight gains are 7-18 kg for normal maternal pre-pregnancy weight, 12-18 kg for underweight women, 7-11.5 kg for overweight and at least 6-8 kg for obese women. Average weight gain for twines pregnancies is 16-20.5 kg.

  17. B. Water Metabolism • Average women retains 6.5 liter of extra water during pregnancy. • Many pregnant women experience edema in the legs and ankles. • Carpal tunnel syndrome (pain, burning and numbness of the hand and wrist) may be occurred in some women results from compress of edema in the median nerve.

  18. C. Carbohydrate Metabolism • Pregnancy is potentially diabetogenic. D. Iron Metabolism • Iron requirements increase that the needs for iron are often exceed the available amounts. • Supplementation of iron are necessary for several weeks after pregnancy.

  19. 5. Cardiovascular System A. Heart • Diaphragm is progressively elevated during pregnancy and displaced to the left and upward with moving the apex laterally. • Heart murmur is common and usually disappears after delivery. B. Circulation • Heart beat usually increases from 10-20 beat/minute during pregnancy. • Cardiac volume increase by 10% and increase cardiac output (reversed after childbirth).

  20. C. Blood pressure Blood pressure decreased slightly during first and second trimester and by the end of third trimester blood pressure return to pre-pregnancy state. D. Hematologic • hemoglobin concentration at term averages 11g/dl. • Leukocytes count is increased to 25.000 during labour with unknown causes.

  21. 6. Respiratory System • Maternal oxygen requirement increase by 15-20% during pregnancy to meet fetal needs for oxygen • Increase respiratory rate and reduce Pco2 • Diaphragm is elevated in the late of pregnancy due to enlarged uterus. 7. Urinary System • Glomerular filtration increases due to elevated level of human placental lactogen (HPL) hormone during pregnancy • Glycosuria and mild proteinuria may be evident during pregnancy. • Frequency of urination.

  22. 8. Gastrointestinal System • Stomach and intestine are displaced upward and laterally by enlarged uterus. • Heart burn is common • Hemorrhoid is common due to constipation resulted from decreases of intestinal motility.

  23. 9. Musculoskeletal System • Alteration in posture and walking due to increase in the maternal weight which result in back pain. • Increasing the mobility of pelvic joints and ligaments in the second trimester resulting from increases the relaxin and progesterone productions by the placenta. • Calcium absorption and storage is increased starting from the first trimester to meet fetal demands in the late of pregnancy,

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