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 systems Reproductive system

oCardiovascularoRespiratoryoUrinaryoGastrointestinaloMusculoskeletaloIntegumentaryoMetabolic changesoEndocrineoImmunological

oUterusoCervixoOvaries and fallopian TubesovaginaoVulvaoBreast

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-Cervix:

1. Goodell’s sign; softening of cervix2. 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 vascularityFat deposition causes labia majora to

close and partially cover introitus.

Breasts:3-4 weeks: prickling, tingling sensation6 weeks: developing ducts and glands8 weeks: bluish surface veins are visible8-12 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 myocardiumShift in chest contents:

- Heart is displaced upwards and to the leftHeart rate increases by 10 to 15 b/mBlood volume increases 40-50%

physiological anemiaHemoglobin and hematocrit decrease in

relation to increased plasma volumeCardiac 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.(morning sickness).

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 vomitingUrinary frequencyWeight gainConstipationFatigueQuickeningBreast tenderness, tingling, and

heaviness.

2.Probable evidence : Noted by examiner

Goodell’s sign - softening of cervixChadwick’s sign - bluish color, cervix, vaginaHegar’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 testPalpation 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

examinerFetal parts felt by examiners.Visualization of the fetus by

ultrasound.

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