Physiologic Changes of Pregnancy PDF

# Physiologic changes of pregnancy ## Combat Effects of Gravity/Hormones - Do pelvic tilts - Alter the stance - Shorten the jog stride - Lower or eliminate the step in aerobics - Avoid rapid leg abduction - Avoid breast stroke kick in swimming - Recognize tolerance for activities will vary - Do pe...

# Physiologic changes of pregnancy ## Combat Effects of Gravity/Hormones - Do pelvic tilts - Alter the stance - Shorten the jog stride - Lower or eliminate the step in aerobics - Avoid rapid leg abduction - Avoid breast stroke kick in swimming - Recognize tolerance for activities will vary - Do pelvic floor exercises to prevent trauma - Emphasize strengthening & stretching exercises - Wear abdominal support/sports bra when exercising for support ## Changes To Body System ### First Trimester - Baby begins to grow - Increased urination - Changes with skin and hair - Thickening waistline - Nausea/fatigue ### Second Trimester - Baby’s weight increases - Energy level improves - Heartburn - Leg cramps - Pelvis relaxes causing SI discomfort ### Third Trimester - Baby has more rapid growth & weight gain - Backaches - Swelling of the hands, legs, and feet - Breathlessness - More frequent urination ## Muscles Affected - Overstretching & weakening of gluteal muscles & hamstrings - Overstretching & weakening of abdominal muscles & pelvic floor - Overstretching & weakening of upper back muscles - Shortening and tightening of low back & hip flexors muscles - Shortening of upper back flexors & pectoral muscles ## Neurological and sensory - Decreased intraoccular pressure - Corneal thickening - Altered sense of smell - Decreased attention span - Problems with memory - Altered CNS physiology leading to mood disturbance. ## Biomechanical Changes - Weight distribution shifts - Joint movement - Balance of muscle strength - Spinal curves increase - Joint laxity becomes greater - More structural discomfort - Increased potential for nerve compression ## Potential for Injury - Nerve compression syndromes - Low back discomforts or pelvic pain - Upper back fatigue - Lower extremity - Pelvic floor function ## MS system - Joint relaxation - Posture changes - lordosis/ center of gravity Back ache - Diastasis recti: separation of rectus abdominous - Leg cramp due to calcium, and stretching ## Pelvic Floor Muscle Functions - Maintain alignment and support of internal organs - Control of urine flow - Sexual enhancement - Eliminate waste from rectum - Improve recovery from episiotomy ## Hyperpigmentation - Melasma and linea nigra - Estrogen and progesterone - Some melanocyte stimulating effect ## Breast Changes - Early in pregnancy, tenderness and tightness is common - After 8 weeks, breasts grow and blood vessels often are visible - Nipples become larger and darker - A thick yellowish fluid can be expressed from the nipple ## Striae - Reddish slightly depressed - Breasts, thighs, and abdomen - In future pregnancies they appear as glistening, silver lines ## Linea nigra A dark line that appears down the middle of a pregnant woman’s abdomen ## Melasma - Also known as the mask of pregnancy - More common in dark skin people - More pronounced in the summer - Fades a few months after delivery - Repeated pregnancy can intensify - Can occur in normal non-pregnant women with harmless hormonal imbalances or women on OCPs or depo ## Skin Changes - Stretch marks - Dark pigmented line on there abdomen which is called Linea Nigra - Pigment changes on their face and neck - Small blood vessels in the face, neck and upper chest - MOST OF THESE RESOLVE AFTER PREGNANCY ## Physiologic changes - INTEGUMENTARY SYSTEM - These result from stretching of the skin and hormonal changes - Linea nigra: pigmentation down middle line of abd - Chloasma – "mask of pregnancy" - Straie: stretch marks of abd, breasts, thighs and buttocks - Sweating ## Skin changes - Chloasma or melasma gravidarum - Striae - Linea nigra ## Liver - Liver morphology unchanged - Lab Tests similar to liver disease - Alkaline phosphatase doubles - AST, ALT, GGT and bilirubin are slightly lower - Decreased plasma albumin ## Gallbladder - Impaired contraction - High residual volumes - Promotion of stasis - Stasis associated with increased cholesterol saturation of pregnancy, supports predisposition of stones - Intrahepatic cholestasis - Retained bile salts-pruritus gravidarum ## Physiologic changes - INTEGUMENTARY SYSTEM - These result from stretching of the skin and hormonal changes - Linea nigra: pigmentation down middle line of abd - Chloasma – "mask of pregnancy" - Straie: stretch marks of abd, breasts, thighs and buttocks - Sweating ## Insulin resistance - Anti-insulin environment is aided by: - placental lactogen - Like growth hormone - Increases lipolysis and FFA - Increases tissue resistance to insulin - Increased unbound cortisol - Estrogen and Progesterone may also exert some anti-insulin effects ## Thyroid - Estrogen stimulates Increase in TBG - Total T3 and T4 are increased - However the active hormones remains unchanged - hCG stimulates thyroid - TSH is reduced - Iodine deficient state - Due to Increased renal clearance - To rule out pathologic changes - Early in pregnancy TSH can be used - Later free T4 is needed ## Thermoregulation - It is a major concern during maternal exercise - Provide a ready source of water - Encourage frequent water breaks ## Physiologic changes - URINARY TRACT - Increased glomerular filtration rate - Frequency - Infection: Smooth muscle of bladder relaxes/stasis ## Endocrine - Normal pregnancy physiology shows "lower lows and higher highs" - Postprandial hyperglycemia - To ensure sustained glucose levels for fetus - Accelerated starvation - Early switch from glucose to lipids for fuels - Insulin resistance promotes hyperglycemia - Resistance-Reduced peripheral uptake of glucose for a given dose of insulin - Mild fasting hypoglycemia occurs with elevated FFA, triglycerides,and cholesterol ## Thermoregulation - It is a major concern during maternal exercise - Provide a ready source of water - Encourage frequent water breaks ## RENAL SYSTEM - DILATION OF THE RENAL VESSELS DUE THE EFFECTS OF PROGESTERONE - INCREASED RENAL BLOOD FLOW - GFR INCREASES BY 60% IN EARLY PREGNANCY - SIZE OF PORES INCREASED ## Urinary Changes - Kidneys grow and filter more blood as the blood volume increases - Become more susceptible to bladder and kidney infections - Bladder becomes compressed causing frequent urination and incontinence ## Physiologic changes - - These result from stretching of the skin and hormonal changes - Linea nigra: pigmentation down middle line of abd - Chloasma – "mask of pregnancy" - Straie: stretch marks of abd, breasts, thighs and buttocks - Sweating ## PLASMA VOLUME - Increases from 10th week of pregnancy variable related to parity, fetal weight and number - Reaches maximum level approx 50% above non-pregnant levels at 32-34 weeks then maintained - 50% rise in plasma volume - 20% rise in red cell mass - Heamodilution: Physiological anaemia - Most apparent at 32-34 weeks ## BLOOD SUPPLY TO UTERUS - Blood supply pre pregnancy = 10mls/min - At 40weeks 800 - 900mls/min - 20% of cardiac output goes to uterus - Blood volume: from 5 litres to 7.5 total volume up by 40-50% - Red cell mass: rises constantly throughout pregancy - Up by 20% by end of pregnancy ## PLASMA VOLUME - Increases from 10th week of pregnancy variable related to parity, fetal weight and number - Reaches maximum level approx 50% above non-pregnant levels at 32-34 weeks then maintained - 50% rise in plasma volume - 20% rise in red cell mass - Heamodilution: Physiological anaemia - Most apparent at 32-34 weeks