Physiological Changes During Pregnancy PDF

Physiological Changes During Pregnancy Outlines of content 1. Changes during first trimester...

Physiological Changes During Pregnancy Outlines of content 1. Changes during first trimester 2. Changes during second trimester 3. Changes during third trimester 4. Factors affecting psychological adaptations 5. Minor discomforts PREPARED BY: TYSEER MARZOUK I. Reproductive System Pattern of Uterine Growth 1. Uterus o At 12 weeks of gestation, fundus can be palpated at or above the symphysis pubis. Uterine growth o At 16 weeks, the fundus reaches midway between symphysis pubis and umbilicus. Before conception the uterus is a small, pear-shaped organ entirely o It is located at the umbilicus at 20 weeks. contained in the pelvic cavity. The non-pregnant uterus weighs up to o The fundus reaches its highest level at the xiphoid process at 36 weeks of gestation. 50-70 g and has a capacity of about 10 mL. By term, the uterus weighs o By 40 weeks, the fetal head descends into the pelvic cavity, and the uterus sinks to a lower level. 1100 to 1200 g and has a capacity of 5 L.  Contractility Throughout pregnancy Braxton Hicks contractions occur, where uterus temporarily tightens and then returns to its original relaxed state. During the first two trimesters, the contractions are infrequent and usually not felt by the woman. Contractions occur more frequently during the third trimester and may cause some discomfort. They are called false labor when they are mistaken for the onset of early labor. 2. Cervix 1. Chadwick sign: the cervix, vagina, and labia change colour from pink to a dark bluish purple. It is due to increased vascularity of the pelvic organs. It present by 8 3. Vagina and Vulva weeks of pregnancy.  Increased vascularity causes the vaginal walls to appear bluish purple. 2. Formation of the mucus plug: It blocks the ascent of bacteria from the vagina into the uterus and protect the fetus and uterine membranes from infection.  The pH of the vaginal discharge is acidic (3.5 to 6). The acidic 3. Goodell sign indicates to softening of the cervix due to pelvic vasocongestion. condition helps prevent growth of harmful bacteria in the vagina. 4. Hegar’s sign: indicates to softening of the lower uterine segment. It presents about 6-8 weeks from the last menstrual period.  4. Ovaries 5. Breast o After conception, the corpus luteum of the ovaries secretes 1. During pregnancy the breasts change in both size and appearance. progesterone, mainly during the first 6 to 7 weeks of pregnancy. 2. The nipples increase in size and become darker and more erect, and o Between 6 and 10 weeks of gestation, the corpus luteum produces a the areolae become larger and more pigmented. smaller amount of progesterone as the placenta takes over production. 3. A thick, yellowish fluid; colostrum, is secreted as early as 16 weeks o The corpus luteum then regresses because it is no longer needed. of gestation. Secretion of milk is suppressed during pregnancy by the high levels of estrogen and progesterone. o Ovulation ceases during pregnancy. II. Cardiovascular system RBC volume increases by 20% to 30% above pre pregnancy values. Physiologic anemia of pregnancy occurs. From 5% to 10% of women develop a drop in BP known as supine hypotensive syndrome, with symptoms of lightheadedness, dizziness, nausea, or syncope.  III. Respiratory system IV. Gastrointestinal system Appetite is increased during pregnancy; unless woman is nauseated. Nasal and sinus stuffiness, epistaxis, and deepening of the voice. Reduced gallbladder tone also leads to a tendency to retain bile salts, Increased vascularity also causes edema of the eardrum and Eustachian which can cause itching (pruritus). tubes and may result in a sense of fullness in the ears. Gastro-esophageal reflux of acidic stomach contents into the esophagus Dyspnea affects 60% to 70% of women experience beginning in the and produces heartburn (pyrosis). first or second trimester. Gingivitis and bleeding gums. V. Urinary system Bladder Decreased motility in the large intestine leading to constipation. 1. The woman experiences frequency and urgency of urination in pregnancy. Constipation may cause or exacerbate hemorrhoids. 2. Stress and urge incontinence are experienced by 30% to 50% of pregnant Flatulence may be a problem. women. If accompanied by burning sensation or pain, may indicate urinary Bloating and abdominal distention. tract infection. 3. Nocturia is common because sodium and water are retained during the day and excreted during the night when the woman is lying down.  V. Urinary system VI. Integumentary system Kidneys and ureters Skin The risk of bacteriuria, which may be asymptomatic, is increased and I. Melasma means areas of pigmentation include brownish patches pyelonephritis results in 25% to 35% of these women. involves the forehead, cheeks, and bridge of the nose and occurs in about 70% of pregnant. It known as chloasma or pregnancy mask. VI. Integumentary system VI. Integumentary system II. Linea nigra is the line that marks the longitudinal division of the III. Striae gravidarum “stretch marks” is the linear tears that occur on abdomen, breasts, and buttocks, appearing as slightly depressed, pink to midline of the abdomen. It extends from the symphysis pubis to the top purple streaks. They occur in 50% to 80% of pregnant women, and 10% of the fundus. have severe striae.  VI. Integumentary system VII. Musculoskeletal system 1. At 28 to 30 weeks, the symphysis pubis separates. The Hair and nails increased mobility of the pelvic joints causes the pregnant 1. Hair grows more rapidly and less hair falls during pregnancy. After woman to assume a wide stance with the “waddling” gait childbirth, hair loss occurs 2 to 4 months following childbirth. Hair of pregnancy. growth returns to normal within 6 to 12 months after childbirth. 2. During the third trimester, as the uterus increases in size, 2. The nails may become brittle or softer. the expectant mother must lean backward to maintain her balance. This posture creates a progressive Lordosis or curvature of the lower spine and often leads to backache. VII. Musculoskeletal system VII. Endocrine system Pituitary Gland 3. The abdominal muscles may be stretched beyond their capacity during Serum prolactin levels increase tenfold by term to prepare the breasts for the third trimester, causing diastasis recti, separation of the rectus lactation. The hormones FSH and LH are not needed to stimulate ovulation abdominis muscles. during pregnancy and are suppressed by high levels of estrogen and progesterone. The posterior pituitary releases oxytocin, which stimulates contractions of the uterus. This action is inhibited by progesterone, produced by the placenta during pregnancy. In the second half of pregnancy, estrogen causes a gradual rise of oxytocin receptors in the uterus.  VII. Endocrine system ii. Pancreas IV. Weight gain Blood glucose levels are 10% to 20% lower than before pregnancy, and Most women should gain between 25 and 35 pounds (11.5 to 16 hypoglycemia may develop between meals and at night as the fetus kilograms) during pregnancy. Most will gain 2 to 4 pounds (1 to 2 continuously draws glucose from the mother. kilograms) during the first trimester, and then 1 pound (0.5 kilogram) a week for the rest of pregnancy. VIII. Sensory Organs Eye Consider these general guidelines for single pregnancy Consider these general guidelines for twin pregnancy weight gain weight gain Intraocular pressure decreases, which may cause improvement and a Recommended Pre-pregnancy Pre-pregnancy weight weight gain weight Recommended weight gain need for less medication in women with glaucoma. Ear Underweight 28 to 40 lbs. (about 13 Underweight 50 to 62 lbs. (about 23 to 28 (BMI below 18.5) to 18 kg) (BMI below 18.5) kg) Healthy weight 25 to 35 lbs. (about 11 Healthy weight 37 to 54 lbs. (about 17 to 25 Changes in the mucous membranes of the Eustachian tube from (BMI 18.5 to 24.9) to 16 kg) (BMI 18.5 to 24.9) kg) Overweight (BMI 25 to 15 to 25 lbs. (about 7 Overweight (BMI 25 31 to 50 lbs. (about 14 to 23 increased levels of estrogen may cause women to have blocked ears and 29.9) to 11 kg) to 29.9) kg) Obese (BMI 30 or 11 to 20 lbs. (about 5 Obese (BMI 30 or 25 to 42 lbs. (about 11 to 19 a mild, temporary hearing loss. more) to 9 kg) more) kg)  IX. Immune System Hormones related to pregnancy 1. Immune function is altered during pregnancy to allow the fetus, which is foreign tissue for the mother, to grow undisturbed without being rejected by the woman’s body. 2. Resistance to some infections is decreased. Confirmation of pregnancy Confirmation of pregnancy The signs and symptoms of pregnancy are grouped into three classifications: presumptive, probable, and positive indications. A diagnosis of pregnancy cannot be made solely on the presumptive or probable signs because they may have other causes.  THANK YOU Importance of antenatal care 1.To ensure that the pregnant woman and her fetus are in their best health. Antenatal care: 2.To detect early and treat properly complicated conditions. Means comprehensive health supervision of a pregnant woman before 3.Offering education for parents within a planned program or individually. delivery. It is a planned examination, observation & guidance (comprehensive care given to pregnant women from conception till the 4.Exchanging information with the woman and her family. time of labor. It also includes medical activities, education and provision 5.Helping the woman and family in preparations of birth demands. of dietary & social condition. 6.To prepare the woman for labor, lactation and care of her infant  Schedule for Antenatal Visits The first visit or initial visit should be made as early in pregnancy as possible. Activities during antenatal visit Return Visits: 1. Screen and assess the maternal & fetal health condition. Once every month till 7th month. 2. Identify the high risk group. Once every 2 weeks till the 9th month 3. Plan for the follow up visits. Once every week during the 9th month, till labor. These can be achieved through taking woman’s history, perform Note: When there is a problem, the pregnant woman may have a visit. assessment, and diagnose abnormal cases Antenatal Advice 4. Care of weight: Health Teaching During the First Trimester Regular weighing is important 1. Physiological changes during pregnancy : The changes that affect all Excessive weight gain: indicate occult oedema and it may indicate Preeclampsia. systems during pregnancy should be explained to the pregnant woman in a Poor weight gain: may caused by placental insufficiency. simple way. Note: Components of weight gain: Fetus=3.5Kg placenta=0.5Kg Amniotic 2. Fresh air and sunshine: The pregnant woman should be advised to spend Fluid=1.5Kg Uterine growth=0.5Kg Breast growth=0.5Kg ↑ blood volume 1.5Kg 2 hours a day in the fresh air away from the busy streets and preferably Protein retention 2Kg water retention 2Kg fat is variable. walking or sitting in the garden or park. 3. Rest and sleep: The pregnant woman should be advised to sleep 8 hours by night and 2 hours by day that increase near term.  5.Exercise and relaxation Exercise should be simple and mild; Consider these general guidelines for single pregnancy Consider these general guidelines for twin pregnancy weight gain weight gain walking is ideal, but long periods of Pre-pregnancy weight Recommended Pre-pregnancy Recommended weight gain walking should be avoided. weight gain weight Importance of exercise; woman who Underweight 28 to 40 lbs. (about 13 Underweight 50 to 62 lbs. (about 23 to 28 (BMI below 18.5) to 18 kg) (BMI below 18.5) kg) exercise during pregnancy: Healthy weight 25 to 35 lbs. (about 11 Healthy weight 37 to 54 lbs. (about 17 to 25 Experience shorter labor (BMI 18.5 to 24.9) to 16 kg) (BMI 18.5 to 24.9) kg) Overweight (BMI 25 to 15 to 25 lbs. (about 7 Overweight (BMI 25 31 to 50 lbs. (about 14 to 23 Have fewer cesarean deliveries 29.9) to 11 kg) to 29.9) kg) Have fetuses that experience fewer % of fetal distress. Obese (BMI 30 or 11 to 20 lbs. (about 5 Obese (BMI 30 or 25 to 42 lbs. (about 11 to 19 more) to 9 kg) more) kg) 7. Hygiene 6. Diet : Daily bath with water and soap Diet during pregnancy should be light, easily digestible, balanced and contain Regular and frequent washing of genital area, axilla and breasts due to increased discharge essential elements. and sweating. Diet should be discussed in terms of food groups rather than in terms of 8. Teeth protein, fat and carbohydrates, fibers, vitamins and minerals. The teeth should be brushed carefully in the morning, after each meal and at night.  2-3 glasses of milk  Liver twice weekly The pregnant woman should visit the dentist twice during pregnancy.  2-3 eggs  Fruits, green salads and vegetables The pregnant woman should avoid brushing her teeth for at least 1 hour after vomiting to  Meat or 1/4 chicken  Fluids, soups and fruit juices decrease the risk of enamel loss.  Fish twice weekly  Vitamins and minerals  9. Bladder and bowel care: 11. Smoking : Maintain regular habits of defecation and urination to avoid constipation and UTI. Effects on the fetus: This is attained through: Should be avoided , to avoid the dangers of nicotine that causes spasm of vessels leading Drinking plenty of fluids to: Eat plenty of firbers Fetal anoxia→ fetal death Avoid : catheterization, enema and laxative. Congenital anomalies Low birth weight 10. Sexual counselling: Premature labor Sexual intercourse is allowed, is absolutely safe and normal unless specific Effects on the mother: problem exists. Smoking may lead to ptyalism, It is avoided in case of: nervousness and hyper emesis and make pregnant woman at increased risk of chest Uterine bleeding Threatened abortion infections and thromboembolic disorders. 13. Environmental hazards: 12. Medications Pregnant woman should avoid exposure to infectious disease and X-ray. 14. Travel : o All pregnant woman should be taught the importance of taking daily dietary supplements such By car: better avoided in early and late pregnancy. as iron, folic acid and vitamins. By plane: allowed between 15-32 weeks. o Pregnant woman should avoid all unnecessary drugs By train: allowed any time unless there is tendency to abortion.  Health Education During the Second Trimester 15. Follow up: The pregnant woman should visit the antenatal clinic monthly, during the first trimester. 1. Physiological changes: The changes that occur during the second 16. Danger Signs trimester of pregnancy should be explained to the woman. Severe vomiting Chills, fever 2. Rest and sleep: Same as during 1st trimester Burning in urination Diarrhea 3. Exercise and relaxation: Same as during first trimester. Abdominal cramping; vaginal bleeding Vaginal discharge with odor or itching. 6. Clothing: Suitable cloths should be Loose and comfortable. 4. Diet: Shoes need to be comfortable. During the second trimester as the fetus develops rapidly, the woman’s High heels shoes should be avoided. blood volume increases, her basal metabolic rate rises. she needs the same 7. Immunization: type of nutrients in greater amounts. All pregnant women should be immunizing with toxoid vaccine in order to prevent neonatal tetanus. One dose of Tetanus vaccine is recommended during each pregnancy. 5. Breast care: Receiving the vaccine during pregnancy helps protect newborn from whooping cough Daily wash the breasts and nipples with clean water. To keep the breasts (pertussis). Ideally, the vaccine should be given between 27 and 36 weeks of pregnancy. clean and nipples free from cracking. 8. Follow up: The pregnant woman should visit the antenatal clinic monthly during the second trimester.  Health Education During the Third Trimester 9. Danger signs: 1. Rest and sleep 1.Persistent vomiting. In late pregnancy, the weight of the uterus may create discomfort and sleeplessness so adequate rest is important. 2.Chills or fever. 2. Diet 3.Marked changes of fetal movements. She needs adequate amounts of nutritious foods supplemented by concentrates of 4.Vaginal bleeding. protein, iron and calcium. 5.Vaginal discharge with odor or itching. 3.Exercise and relaxation 6.Dysuria or burning sensation. The pregnant woman should avoid long period of standing and avoid sitting with legs crossed. 4. Breast care: same as in 2nd trimester. 8. Follow up 5. Smoking: same as in 2nd trimester. Every 2 weeks during the 7th to 8th months 6. Travelling: same as in 2nd trimester. 7. Delivery: The woman should be encouraged to deliver in the Every week during the 9th month hospital. She should be taught the signs and symptoms of early labor, when to go to the hospital and what to take with her. After delivery counsel about family planning.  9. Danger signs Persistent, severe vomiting Sudden discharge of fluid from vagina before 37 weeks Vaginal bleeding, severe abdominal pain Chills, fever, burning on urination Severe backache or flank pain Change in fetal movements Uterine contraction before 37 week Signs and symptoms of severe PET