Maternal and Newborn Health Nursing Course Physiology of Normal Pregnancy Part 2 PDF

 Physiology of Normal Pregnancy part 2 Dr. Ahlam Goda  Outline III. Physiological adaptation during pregnancy Changes in the reproductive system Changes in the urinary tract. Changes in the alimentary tract. Weight gain. ...

 Physiology of Normal Pregnancy part 2 Dr. Ahlam Goda  Outline III. Physiological adaptation during pregnancy Changes in the reproductive system Changes in the urinary tract. Changes in the alimentary tract. Weight gain.  Outline  Changes in the respiratory system.  Changes in the skin.  Changes in the skeleton and joints.  Changes in the cardiovascular system.  Endocrine changes.  IV. Calculation of the expected date of delivery  Lecture expectation  Signs & symptoms of pregnancy Presumptive Probable Positive Signs and Symptoms of Pregnancy. Presumptive signs and symptoms Presumptive signs of pregnancy refers to changes felt by the woman that may resemble pregnancy signs and symptoms, but may in fact be caused by something else. These signs and symptoms include:  Presumptive Signs and Symptoms. Amenorrhea. Morning sickness Unexplained fatigue. Frequent urination. Breast tenderness and changes. Excessive salivation (Ptyalism). Skin changes.  Probable Signs and Symptoms Probable signs of pregnancy are changes observed by an examiner that indicate pregnancy the majority of the time. However, there is still the chance they can be false or caused by something other than pregnancy, like presumptive signs.  Probable Signs and Symptoms Hegar sign. Abdominal ballottement Positive pregnancy test. Dr.Samia.I.O.Hassan  Positive Signs and Symptoms 1. Hearing fetal heart sounds by a Doppler. 2. Visualization of the fetus by ultrasound. 3. Movement of the fetus seen by a doctor.  Physiological Adaptation During Pregnancy  Changes in the Uterus Shape : Non -pregnant Pear Pregnant Globular Weight: Non -pregnant 60g Pregnant 1 kg Professional Midwifery Professional Midwifery  Changes in the uterus The muscle fibers of the uterus multiply, grow large & stretch due to the stimulus of estrogens and progesterone. The uterine wall gets thinner and softer as the uterus enlarges. Changes in the uterus At term the wall is less than 0.5 cm thick. Uterine blood vessels dilate to supply a greatly increased volume of blood to the placenta. Irregular uterine contractions (Braxton Hick’s contraction) Professional Midwifery 19  Changes in the Cervix Hypertrophy and increased vascularity The cervix is mainly fibrous. In preparation for labor, estrogens and the placental hormone relaxin cause it to become softer (Goodell's Sign).  A plug of mucus, the operculum, is formed by the 8th week from the secretions of the cervical glands. It remains in the cervix until labor commences, when cervical dilatation causes it to dislodge. ('show' of cervical mucus can be one of the early signs of labor. The operculum acts as a physical barrier, sealing off the uterus from ascending organisms. Professional Midwifery  Changes in the Vagina Early in pregnancy the vagina and cervix become almost blue color (Chadwick's Sign) (they are normally a pink color in the non-pregnant woman). This blueness is caused by venous dilatation due to the action of progesterone. Increase of vaginal discharge (leukorrhea) which is in response to the estrogen-induced hypertrophy of the vaginal glands. The normal acidic vaginal secretions increase significantly Professional Midwifery  Changes in the Breast The breasts grow throughout pregnancy, increasing in size and weight by about 500 g each. Surface veins are visible at about 8 weeks. The nipples become larger, more erect and darker in colour. The areolae become darker and are surrounded by prominent sebaceous glands (Montgomery's tubercles), which appear at about 12 weeks. Professional Midwifery Changes in the Breast Professional Midwifery  Changes in the Skin 1-Pigmentation Darker pigmentation occurs: In the nipples and areolae. On the face (Melasma (chloasma)-the 'mask of pregnancy') On the abdominal midline (from above the umbilicus to the pubic hair)-the linea nigra. Professional Midwifery  Changes in the Skin 2- Stretch marks Pigmentation usually fades following delivery, but the nipples of a parous woman always remain brown. Striae gravidarum Professional Midwifery  Changes in the Skin 3- Spider naevi Spider naevi (Angiomas) is a bright red lesion with a central arteriole with tiny radiating branches. Professional Midwifery Changes in the Skin Professional Midwifery  Changes in the Urinary Tract Changes in the urinary tract have both hormonal and mechanical causes, and give rise to urinary problems. Frequency of micturition Stress incontinence  Changes in the Alimentary Tract The changes in the alimentary tract are also due to both hormonal and mechanical causes 1- Morning sickness 2-Gastric acid reflux 3-Constipation  Weight Gain The average total weight gain during a normal pregnancy is between 9 and 12 kilograms also, may be reach to17kg Increase in the result of : 1. Water retention. 2. Anabolic effect of hormones. 3. Products of conception. The breasts 1.0 kg Maternal storage of fats and protein 3.0 kg Increase in maternal blood volume and interstitial fluid 2.0 kg  Changes in the Respiratory System The enlarging uterus pushes the diaphragm up-wards, changing the shape of the thorax, but not reducing lung capacity. The woman may feel short of breath, so the respiratory rate is increased in order to obtain the higher amount of oxygen necessary; this can result in slight hyper-ventilation.  Changes in the Skeleton and Joints The weight of the uterus and its contents causes an alteration in the centre of gravity and in the contour of the body. The spinal curvature is changed to compensate for the abdominal enlargement and, towards the end of pregnancy, many women adopt a typical posture (called lordosis).  Changes in the Cardiovascular System 1- Haemodilution The blood volume increases during pregnancy by about 40-50% to meet the requirements of the placental circulation. The plasma volume is increased more than the red cell volume (which increases by approximately 30%); therefore there is a state of haemodilution, with the haemoglobin lowered to about 80% of its normal level. This situation is called physiological anemia of pregnancy. 2- Blood Pressure Cardiac output is increased because of the increased blood volume. The heart has to pump with more force, especially near term, and it dilates slightly. Progesterone relaxes the smooth muscles and causes dilatation of the blood vessel walls which compensates for the increased force from the heart; so the blood pressure should remain at, or close to, the prepregnant reading. 3- Blood Coagulability The coagulability of blood is slightly increased during pregnancy. If it failed to increase, there would be danger of excessive bleeding at the time of delivery. Because coagulability does increase, the danger of venous thrombosis is present. Therefore careful observation and education are important aspects of preventive care during pregnancy, labor and the postnatal period.  Endocrine Changes The pituitary gland secretions are generally increased, and this in turn causes increased secretion from all endocrine glands (especially the thyroid, parathyroid and adrenal glands). Levels of the pituitary hormone, prolactin, increase gradually towards the end of pregnancy, but prolactin's function of initiation of lactation is suppressed until after the placenta is delivered and the level of oestrogen has fallen.  Calculation of Expected Date of Delivery 1- Calculating by dates The average duration of pregnancy is 266 days after fertilization of the ovum or (in a 28-day cycle) 280 days, or 40 weeks, or 9 months and 7 days, from the first day of the last normal menstrual period (LNMP). 2- Quickening 3- Fundal Height Professional Midwifery 4- Ultrasound The fetal sac can be seen as early as 6-7 weeks and the fetal head measured by 13 weeks using ultrasound-high frequency, short wavelength, sound wave reflections. Ultrasound is a non-invasive method of investigation. Ultrasound has now virtually replaced X-rays in the assessment of fetal maturity. Professional Midwifery 4- Ultrasound