Physical Changes During Pregnancy PDF

PT 704 GROWTH AND FUNCTIONAL DEVELOPMENT OF THE FETUS Gestation period 40was or 9months  Divided into three trimesters.  Embryonic phase of development lasts from fertilization until the 8th week of gestation, when it becomes a fetus.  By day 35 the heart is beating, an...

PT 704 GROWTH AND FUNCTIONAL DEVELOPMENT OF THE FETUS Gestation period 40was or 9months  Divided into three trimesters.  Embryonic phase of development lasts from fertilization until the 8th week of gestation, when it becomes a fetus.  By day 35 the heart is beating, and eye and limb buds are present. embryothe first 8Whs fetusfrom month 3 andforward  TRIMESTERS Trimester 1st = week’s 1-13 2nd = week’s 14 - 26 3rd = week’s 27 and on (38-40 WEEKS)  GESTATIONAL AGE  Gestational age=Time since last menstrual period (LMP)  EDC, EDD, EDB (Estimated Date of Confinement; Delivery; Birth) 1914.9 delivery  266 Days after fertilization period is usually28days mother culates at day14andthat's  280 Days after onset of LMP when eggis fertilized Fertilization LMP Days 266 280 Weeks 38 40 Calendar Months 8 3/4 9 Lunar Months 9 1/2 10  Embryo at Eight Weeks  End of eighth week marks end of embryonic period  GESTATIONAL AGE Nagele’s Rule  Add 7 days to the first day of the last normal menstrual period, subtract 3 months and add 1 year.  Example:  1st day of LNMP=November 16 2012  add 7 days = Nov 23 2012  subtract 3 months = Sept 23 2012  add 1 year =Sept 23 2013, estimated due date (EDD) Month 5  Second Trimester At the end of 5 months:  Baby is 8 to 10 inches long  Weight is about 1 pound  Hair begins to grow on baby's head  Soft woolly hair called lanugo will cover its body. Some may remain until a week after birth, when it is shed.  Mother begins to feel fetal movement  Internal organs are maturing  Eyebrows, eyelids and eyelashes appear Month 7 Duringthistimethebabygoing Significantheight  Third Trimester At the end of 7 months:  Baby is 14 to 16 inches long  Weight is about 2 1/2 to 3 pounds  Taste buds have developed  Fat layers are forming  Organs are maturing  Skin is still wrinkled and red  If born at this time, baby will be considered a premature baby and require special care  premobabyis skinny Month 8  Third Trimester At the end of 8 months:  Baby is 16 1/2 to 18 inches long  Weight is about 4.5 pounds  Overall growth is rapid this month  Tremendous brain growth occurs at this time  Most body organs are now developed with the exception of the lungs  Movements or "kicks" are strong enough to be visible from the outside  Kidneys are mature urinatinginfero  Skin is less wrinkled  Fingernails now extend beyond fingertips Month 9 lungs take a longtime to develop Third Trimester At the end of 9 months:  Baby is 19 to 20 inches long  Weight is about 7 pounds  The lungs are mature  Baby is now fully developed and can survive outside the mother's body  Skin is pink and smooth  Baby settles down lower in the abdomen in preparation for birth and may seem less active normal weight is 4.5 11lbs If babyatbirthheighsmorethan9tbsmom is more at riskforgestationaldiabetesinnextpregnancy  Embryonic Membranes As the amnion develops, it surrounds the embryo, and the umbilical cord begins to form from structures in the connecting stalk DEVELOPMENT OF THE ORGAN SYSTEMS  CARDIOVASCULAR SYSTEM  1st System to function  Fetal Heart Rate 120-160/Min  Begins beating during the 4th week following fertilization 6waspregnant  Blood cells form 3rd week beforestartstobeat when Infant in distress Hisstartsto fall  NEUROLOGICAL SYSTEM  Formed from the ectoderm during the 3rd week all afterfertilization  Swallowing 12 1/2 WKS  Fetal movement felt 16-20 WKS (Quickening)  Respiratory effort 18 1/2 WKS  Sucking thumb 29 WKS  Some mylinization 1 year of age nervoussystemtakestime movement developBabieshavejerky  GASTROINTESTINAL SYSTEM  Forms during 4th week babiesbornpestterm  Meconium – Dark green to black tarry waste accumulated in the fetal intestine near term babycanaspiratethe meconium labor is inducedto prevent this  RENAL SYSTEM defeats canbedetected in utero surgery bedonetoo can  Kidneys form in 5th week and begin to function 4 weeks later.  Voiding into amniotic fluid  Renal malformation can be diagnosed in utero.  Glomerular Filtration Rate is low at birth  ENDOCRINE SYSTEM  Thyroid gland 1st to develop  Insulin produced at 20 weeks INTEGUMENTARY SYSTEM  7th week – Two layers of cells  Vernix caseosa –Protects skin  Lanugo – Fine hair  10th week – Fingernails, toenails RESPONSE OF THE MOTHER’S BODY TO PREGNANCY  Where does the extra weight go? avg mom weight gain is 24 lbs Mostlyfromlast 2  Baby: 7pds trimesters  Placenta: 2 pds  Amniotic Fluid: 2 pds  Uterus: 2 pds  Maternal breast tissue: 2 pds  Maternal blood: 4 pds  Her blood volume will have increased as much as 40% net for childbirth Safety  Fluids in maternal tissue: 2 pds  Maternal fat and nutrient stores: 3 pds  Nutrients stored for breastfeeding the baby after delivery  Rate of weight gain  Also depends on prepregnancy weight and goal should be to keep weight gain as steady as possible bcuz mom is noteatingfor 2 adults  Healthy weight before pregnancy  3-5 pds during the first trimester  1-2 pds/ week second and third trimester  Underweight before pregnancy  5-6 pds or more first trimester, depending on medical eval  1-2 pds/week second and third trimester  Overweight before pregnancy shouldn'tlose it  1-2 pds first trimester  1 pd/week during last six months  Gregwomen feel moreheated basometabile rate 15 bour there's more thyroxineadrenalcatene steroidsestrogenprostegore  Nutrition During Pregnancy  Calories- recommended intake is increase in daily caloric intake:  340 kcal/day in the second trimester I  452 kcal/day in the third trimester baby to Mara sing  Vitamin K so baby has sufficient prothrombin forclotting  Nutrition During Pregnancy man is givenprenatalvitamins  Iron- recommended intake is 30 g/day, almost double.  This means 2-3 servings of green leafy vegetables, 3 servings of whole grains, and 2-3 servings of lean protein.  Necessary for fetal/placental development and to expand the maternal blood volume.  Calcium- recommended intake is 1000 mg/day.  For fetal skeletal development, especially in third trimester.  This means 3-4 servings of dairy products.  Folic acid- recommended 600-800 mcg daily.  Preconception recommendation to all fertile females of 400mcg, because the neural tube closes between 18-26 enceptionfertilization days after conception so folic acid supplementation after the diagnosis of pregnancy is usually too late to reduce the effects of neural tube defects. iii in It leadstospinalbifida  Risks of gaining too much weight  These are potential medical problems with gaining too much weight:  Gestational diabetes- high blood sugar  Backaches clempsiccan  Preeclempsia- high blood pressure spikes in last Essean  Leg pain trimester  Increased fatigue  Varicose veins  Increased risk of cesarean deliveryis Eisation Anatomical Changes  Pelvis  Pelvic Floor Muscles  Uterus  Uterine Ligaments  Cervix  Placenta  Amniotic Fluid Pelvis  Pelvic Floor Muscles If pplbecomeincontinet pelvicflow musclesbecometightend can heavenduringpregnancy  I Pelvic Floor Muscle Functions  Maintain alignment and support of internal organs  Control of urine flow  Sexual enhancement  Eliminate waste from rectum a  Improve recovery from episiotomy iii Uterus & Uterine Ligaments Uterus attached topelvis bythoseligaments Broad ligament Round ligament ligs can causepain whenstretched Diastasis Recti Abdominal Diastasis Tocheck liesonback Pt Midland abdominal from bulge contents Normal Diastasis  Cervix  Becomes softer  Has more blood supply  Forms a mucus plug  Becomes about 12 X weaker by term  Placenta baby Ghet to Eater.it ss aisipathfirulatio card obabyviaUmb alcohol e.gdrugs Amniotic Sac & Fluid waterbreak L released Ifbrothenbeforeinlabor dangerousdue tochanceof infyn  Physiological Changes  Circulatory  Urinary  Thermoregulation  Skin  Metabolic  Breasts  Respiratory  Biomechanical  Digestive  Cardiovascular Changes INCREASE DECREASE  Blood volume  Hematocrit  Cardiac (heart)  Blood pressure output  Blood supply to uterus  Stroke volume  Cardiac reserve  End diastolic  Vascular resistance volume So BP islower  Resting pulse metafinish  % of blood plasma Hematocrit is lower  Orthostatic Hypotensive Syndromes  Avoid supine position  Do strength exercises prior to aerobic exercise  Limit aerobic exercise to 20 - 45 minutes  Do thorough cool-down  Rest daily in the side-lying position  WATER, WATER, WATER Hydration is a major concern during maternal exercise.  Provide a ready source of water  Encourage frequent water breaks HelpsbringBP up  Metabolic Changes INCREASES IN:  Insulin level  Carbohydrate utilization during exercise as weight increases  Estrogen  Progesterone  Relaxin  Caloric requirements by ~ 300 calories/day  Protein and fluid requirements  Respiratory Changes morepressurein abdominalcavity  Respiratory capacity decreases  Shortness of breath  Pulmonary reserve decreases  Increased risk of muscle soreness  Tendency to hyperventilate RESULT adjust the intensity level and duration of exercise  Digestive Changes  Digestive system slows  Intestines are pushed up and to the sides  Smooth muscle of the stomach relaxes and can cause heartburn  Constipation and hemorrhoids are common during pregnancy  Morning sickness  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 bcuz of babyresting on bladder  Skin Changes  Stretch marks  Dark pigmented line on abdomen which is called Linea Nigra  Pigment changes on face and neck  Small blood vessels in the face, neck and upper chest  MOST OF THESE RESOLVE AFTER PREGNANCY  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 milk  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  Postural Dynamics ppltendtobecomelordotic levercrosssyndrome  Increased curve of the waist  Top of pelvis tilts forward Aut  More flexion in the hip joint  Increased hunching in the upper back and neck thypothic  Tailbone is pushed back pelvicfloormusclesweather overstretch of glte tis absppr back  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  Changes to Body System  First Trimester  Third Trimester  Baby begins to grow  Baby has more rapid  Increased urination growth & weight gain  Changes with skin and  Backaches redflagfor hair  Swelling of the hands,  Thickening waistline legs, and feet  Nausea/fatigue  Breathlessness  Second Trimester  More frequent urination  Baby’s weight increases  Energy level improves  Heartburn  Leg cramps  Pelvis relaxes causing SI discomfort ligsand muscles  Healthyformom andbaby Exercise and Pregnancy  How much total weight should I gain?  This all depends on your prepregnancy wt:  28-40 pounds for underweight women  BMI25-29.9  15 pounds for obese women  BMI>30 ACSM Position  Current Comment  Safety concerns—avoid activities that can injure abdomen or cause fatigue rather than feeling of well being  Environment—hydrate and avoid heat stress  Growth and development—monitor proper weight gain  Mode—swimming and cycling; walking, jogging and low impact aerobics  Intensity—”probably” should not seriously compete  Exercise is encouraged by this statement  Exercise and Pregnancy After 4 monthsdon'twanttodosupinestufflike crunches  Years ago it was discouraged  ACOG now actively encourages it  Concerns included:  increases in body temperature,  stress hormones,  caloric expenditure,  biomechanical stresses  Medical literature does not support these concerns  Exercise and Pregnancy  Benefits of exercise during pregnancy:  Reduces musculoskeletal complaints  Enhances feeling of well-being  Improves body image  Decreases maternal weight gain and fat deposition  Less likelihood of developing pre- eclampsia Hypertensivecrisis  May make labor and delivery easier  Less infant fat deposition  Exercise and Pregnancy  Common beneficial activities in pregnancy  Stationary cycling and swimming-- considered safest  Walking is the most common  Improves sense of well-being, but did not decrease maternal weight gain  Weight training—not studied; but heavy lifting is discouraged  Increased injuries not reported  Exercise and Pregnancy  Benefits for perinatal period intermsof wt  Infants of exercising mothers are smaller  Gestation tends to be shorter in exercising women than in their sedentary counterparts  Expulsion is usually shorter labormaybe aslongbutactualbirth painful is shorter  Exercise and Pregnancy  Some evidence that babies may be healthier  Leaner body mass at age 5  Better motor skills  Higher intelligence  Less insulin resistance as adults (?), better CV profile, athletic proficiency (?)  Exercise and Pregnancy  Cardiovascular and fitness benefits  Exercise increases plasma volume which is additive to the increase in pregnancy  Effect of increased cardiac output may persist postpartum (up to a year)  Ninety percent of women who exercise in pregnancy, continue after the birth and 70% reach or exceed their pre-pregnancy fitness level  Exercise and Pregnancy  Other benefits to women:  Exercising women are more likely to to achieve their pre-pregnancy weight within a year  Increase abdominal tone more rapidly  Much less incidence of loss of bladder control at 1 year postpartum