adaptation of the body
TRANSCRIPT
Adaptation of the body during pregnancy
By
Dr. Ahmed
Adaptations to pregnancy
These adaptations are attributed to;
The hormones of pregnancy
Mechanical pressures arising from the enlarging uterus
Other issues.
These adaptations; Protect the woman`s normal physiologic
functioning
Meet the metabolic demands pregnancy imposes on her body
Provide a nurturing environment for fetal development and growth.
The pregnant woman, her partner and
family must all adjust to the reality of
pregnancy and anticipated new roles as
mother, father, grandparent or sibling.
Body systems affected by pregnancy
Other body systemsReproductive system
oCardiovascular
oRespiratory
oUrinary
oGastrointestinal
oMusculoskeletal
oIntegumentary
oMetabolic changes
oEndocrine
oImmunological
oUterus
oCervix
oOvaries and fallopian
Tubes
ovagina
oVulva
oBreast
Uterus:The phenomenal uterine growth in the first trimester
is simulated by high levels of estrogen and progesterone.
Size: increase to 20 times of its non-pregnant size due to increased vasculariy, hyperplasia and hypertrophy.
Weight: increase from 50 grams – 1000 grams.
Volume: increases from less than 10 ml to 5000 ml.
Contraction: Braxton Hicks sign ( irregular, painless intermittent uterine contraction).
Shape: changes from that of an inverted pear to that of soft globular or spherical. Later it become ovoid and rises out of the pelvis into the abdominal cavity.
Uterus: continue-
Endometrium : consists of 3 layers:
1. Decidua basalis
2. Decidua capsularis
3. Decidua vera
Cervix: 1. Goodell’s sign; softening of cervix
2. Operculum ( mucus plug)
Ovaries and fallopian tubes:
Involution due to suppression of FSH
Vagina:
Chadwick’s sign; bluish color, cervix,
vagina
Hypertrophy and hyperplasia
Leukorrhea , acid pH 3.5 to 6 (a
whitish or yellowish discharge of
mucus from the vagina).
Vulva:
Increased vascularity
Fat deposition causes labia majora to
close and partially cover introitus.
Breasts:
3-4 weeks: prickling, tingling sensation
6 weeks: developing ducts and glands
8 weeks: bluish surface veins are visible
8-12 weeks: Montgomery’s glands become
more prominent, primary areola become
darker.
16-18 weeks: colostrum expresses.
Secondary areola appears.
Adaptation of other body systems
Cardiovascular system:
Slight enlargement of myocardium
Shift in chest contents:
- Heart is displaced upwards and to the left
Heart rate increases by 10 to 15 b/m
Blood volume increases 40-50% physiological anemia
Hemoglobin and hematocrit decrease in relation to increased plasma volume
Cardiac output increases by 30% during the 1st and 2nd trimesters.
Respiratory system:
The upper respiratory tract becomes more vascular in response to estrogen that can result in nasal stuffiness, epistaxis, voice changes, impaired hearing and a sensation of fullness in the ears..
Enlarged uterus prevent the lungs from expanding shortness of breath.
Basal metabolic rate increases and oxygen requirement increases by 30 to 40 ml\min.
Urinary system:
Frequency of micturition due to pressure
of the growing uterus.
Decreased bladder capacity and bladder
tone.
Renal functions changes:
Changes occur to accommodate an increased
workload while maintaining stable electrolyte
balance.
Increased glomerular filtration rate.
Glucosuria may occur.
Gastrointestinal system:
Gums become hyperemic and have a tendency to bleed.
Ptyalism is seen in some women.
Smooth muscle relaxation occurs related to increased progesterone production; this can cause:
Decreased peristalsis and constipation.
Heartburn, slowed gastric emptying and esophageal regurgitation.
Hemorrhoid from the pressure of the gravid uterus.
Appetite usually increases, after a temporary decrease due to nausea and vomiting.
Musculoskeletal system:
Alteration in posture can result in lordosis
( waddling gait due to increased level of
progesterone and relaxing hormone).
Diastasis recti is associated with enlarged
uterus in some women.
Relaxation and increased mobility of
joints occur because of the relaxing
hormone.
A, Normal position in no pregnant woman. B,
Diastasis recti abdominis in pregnant woman.
Integumentary system (cutaneous changes)
Chloasma is the brownish “ mask of
pregnancy”.
Nipples, areolae, axilae, vulva and
perineum all darken.
Striae graviderium ( stretch marks)
appear on the breasts and abdomen.
Striae gravidarum,
Metabolic changes:
Increase metabolic rate.
Increase the demands for carbohydrate,
protein and minerals.
Weight gain of 9-11 kg.
Water requirement is increased to supply
fetus, placenta and amniotic fluid.
Endocrine system: FSH and LH production is suppressed.
Thyroid gland enlarges, resulting in increased iodine metabolism.
Pancreas: Insulin production is increased throughout pregnancy to compensate for placental hormone insulin antagonism.
Ovaries produce: Estrogen
Progesterone
Relaxing hormone.
- Relaxing can regulate the mother’s cardiovascular and renal systems to help them adapt to the increase in demand for oxygen and nutrients for the foetus.
Immunological system:
Resistance to infection is decreased.
Maternal IgG levels are decreased.
Maternal IgM levels remain unchanged.
Pregnancy signs and symptoms
Presumptive evidence: woman
reports
Signs:Amenorrhea.
Breast changes.
Chloasma and lina nigra.
Chadwick’s sign; bluish color of the
cervix during pregnancy.
Abdominal enlargement and striae.
1.Presumptive evidence: continued-Symptoms:Nausea and vomiting
Urinary frequency
Weight gain
Constipation
Fatigue
Quickening
Breast tenderness, tingling, and heaviness.
2.Probable evidence : Noted by examiner
Goodell’s sign - softening of cervix
Chadwick’s sign - bluish color, cervix, vagina
Hegar’s sign - softening of lower uterine segment
◦ Enlarged abdomen
◦ Pigmentation changes
◦ Stretch marks
Ballottement- A method of diagnosing pregnancy, in which the uterus is pushed with a finger to feel whether a fetus moves away and returns again.
Positive pregnancy test
Palpation of fetal outline
Figure 7–4 Hegar’s sign, a softening of the isthmus of the uterus, can be determined by the examiner during a vaginal examination.
3. Positive ; Noted by examiner - only
caused by pregnancy;
Hearing of fetal heart rate.
Fetal movement palpable by the
examiner
Fetal parts felt by examiners.
Visualization of the fetus by
ultrasound.
Positive evidence:
.