According to Location

Physiolo
gic
Changes
 Uterus
• Increase growth
Length – 6.5 to 32 cm
Depth – 2.5 to 22 cm
Width – 4 to 24 cm
Weight – 50 to 1000g
• Formation of uterine muscles fibers
• Stretching of existing muscle fibers
• Growth – steady, constant and predictable
– 12th week – above symphysis pubis
th
– 16 week – midway between umbilicus and
symphysis pubis
nd
– 20-22 week – level of umbilicus
– 36th week – xiphoid process
• Hegar’s sign (6 weeks)
• Braxton-Hicks contractions (begins at 12wks,
occurs without cervical changes)
• Ballottment (16-20weeks)
 Cervix
• Cervix becomes vascular and edematous
(estrogen)
• Increased fluids between cells leads to
Goodell’s sign
“Nose” consistency – non pregnant
“Earlobe” consistency – pregnant
• Increased vascularity – pink to violet hue of the
cervix
• Increased mucus production – Operculum
* This prevents infection in fetus and membrane
 Vaginal
• Hypertrophic and enriched with glycogen
• Loosen connective tissues in preparation for
distention at birth
• Increased vascularity (Chadwick’s sign)
• Leukorrhea – increased white vaginal discharge
• pH – from 7 to 4 or 5 (Lactobacillus acidophilus)
• Candida albicans – fungi; Candidiasis or Moniliasis
Manifestations – itching, burning, cream-cheese like
discharge
Management - Nystatin
 Ovarian
• Ovulation stops
(estrogen & progesterone)
• Amenorrhea
 Breast
• Increased breast stimulation due to estrogen
*Fullness, tingling, or tenderness
• Hyperplasia of mammary alevoli and fat deposits
*Breast size increases
• Areola – darkens; increases in diameter (2-3 inches)
• Montgomery’s tubercles enlarge, become
protuberant and produce secretions (prevents
dryness)
• Blue veins become prominent over the surface
• Colostrum – expelled by 16th week
 Integumentary System
• Activation of melanocyte -stimulating hormone
by the pituitary gland
– Striae gravidarum – pink or reddish streaks on
abdominal wall
– Linea nigra – narrow brown line running from
umbilicus to the symphysis pubis
– Melasma /Chloasma – “mask of pregnancy”;
darkened areas on the cheeks and across the
nose
 Integumentary System
• Vascular spiders at thighs (estrogen) - small,
fiery-red branching spots
• Palmar erythema – redness and itchiness
(estrogen)
• Increased perspiration by the increased
activity of sweat glands
• Increased scalp hair growth
 Respiratory System
• Congestion or stuffiness of nasopharynx
• Shortness of breath – late pregnancy due to displacement
of the lungs by 4 cm upward
• Mild hyperventilation – progesterone decreased levels of
PCO2 at 27-32mmHg (more of fetal C02 than maternal)
* 40% increased in total ventilation capacity
• Chronic respiratory alkalosis fully compensated by a
chronic metabolic acidosis (plasma bicarbonate in urine is
excreted by the kidneys with excretion of additional sodium
and water)
• Polyuria – increased urination
 Respiratory Functions
• Unchanged vital capacity (maximum volume exhaled
after maximum inspiration)
• 20% decreased residual volume (amount of air
remaining after expiration)
• 30-40% increased tidal volume (amount of air expired)
• 20% increased total oxygen consumption
• RR increased at 1-2 /minute
• From 94 mmHg to 104 -108mmHg increased PO2
Temperatur
• Increases slightly e
due to progesterone
(CL) then decreases
back to normal after
16 weeks
 Cardiovascular System
st
• Blood volume is increase by 30-50% by 1
trimester to 28-32nd week
– Plasma volume : 3,600ml
– Blood volume: 5,250ml
– RBC mass: 4,650,000mm3
– Leukocytes: 20,500mm3
– Fibrinogen : 450mg/dl or increased at 50%
* Normal blood loss (300-500ml NSD;800-1000ml
CS)
 Cardiovascular System
• Pseudoanemia – faster increase of plasma volume
than RBC production (2nd trimester : RBC
increases)
• Decreased Iron
– Fetal iron requirements about 350-400mg of RBC
– Increased maternal RBC from 500 to 800mg
– Decreased iron absorption due to decreased
gastric acidity in pregnancy
• Anemia – hgb is less than 11.5g/100ml; hct is less
than 30%
 Cardiovascular System
• Increased need for folic acid
* Megalohemoglobinemia
– large nonfunctioning RBC
– Increased risk for neural tube defects
* Diet: Spinach, asparagus, legumes
* Prenatal vitamins
 Cardiovascular System
Heart
• 25-50% increased cardiac output
* increased blood volume increased cardiac workload
• Heart is shifted to a more transverse position
* presence of functional heart murmurs
• Palpitations are common due to sympathetic NS
stimulation (early pregnancy) and thoracic pressure of
the uterus against the diaphragm (late pregnancy)
 Cardiovascular System
• HR increased at 10bpm (80-90%)
• BP:
st
1 trimester – no change
2nd trimester – slight decrease
3rd trimester – return to pre-pregnancy
level
 Peripheral Blood Flow
• Decreased venous return due to pressure
of expanding uterus on blood vessels
• Leads to edema and varicosities of the
vulva, rectum and legs
– Hemorrhoids
– Varicose Veins
 Supine Hypotension Syndrome
• Pressure on the inferior vena cava
• Can cause fetal hypoxia
• Lightheadedness, faintness, palpitations
• Turn to left side
 Cardiovascular System
Blood Constitution:
3
• RBC – 4,200,000 to 4,650,000 mm
• Leukocytes – 7,000 to 20,500 mm3
• Fibrinogen, factor VII, VIII, IX, X and platelet
increases 50%
• Total protein level – decreases
• Blood lipids – increase by 1/3
• Cholesterol – increase by 90% to 100%
 Cardiac Classification in
Class I Pregnancy
• Asymptomatic with all activity
• No limitation of activity
Class II • Asymptomatic at rest
• Symptomatic with heavy physical activity
• Slight limitation of activity
Class III • Asymptomatic at rest
• Symptomatic with ordinary activity
• Able to handle physiologic demand of pregnancy
• Considerable limitation of activity
Class IV • Symptomatic with all activity and at rest
• High risk for pregnancy
 Gastrointestinal System
• Pressure of the uterus:
– slow peristalsis
– Decreased emptying time of the stomach
– heartburn (reflux of GI contents due to relax
cardiac sphincter by relaxin)
– constipation
– flatulence
– hemorrhoids
 Gastrointestinal System
• Relaxin produced by the ovary decreases gastric
motility together with progesterone
• Nausea and vomiting (increased estrogen and
decreased glucose levels) relieved after 3 months
• Decreased gastric motility Decreased emptying of
bile absorption of bilirubin to maternal blood
generalized itching and subclinical jaundice
• Increased plasma cholesterol and bile stone
formation
 Gastrointestinal System
• Hypertrophy of the
gum lines – gingival
bleeding
• Hyperptyalism –
increased saliva
formation
• Low pH of saliva lead
to tooth decay
 GI: Weight Gain Pattern
• First trimester – 1.5-3 lbs (.5-1lb/month)
• Second trimester – 10-12 lbs (1lb/week)
• Third trimester – 10-12 lbs (1lb/week)
• Minimum wt gain – 20-25 lbs
• Optimal wt gain – 25-35 lbs
GI: Metabolic
Changes (ULG,2008)
• 24-28 lbs/ 11-12 kgs weight gain
– 3,400gm fetus
– 450gm placenta
– 900gm amniotic fluid
– 1 gm uterus
– 1400gm breast
– 1800gm blood volume
– 1800-3600gms maternal
stores
 GI: Metabolic Changes (ULG,2008,p203)

• Retains 6.5 L extra water

• Fetus, uterus and maternal blood rich in CHON
• May initiate DM or aggravate DM
• Fats are more absorbed during pregnancy
• Plasma lipid levels increased during second half
• Iron requirements increased to 20-40mg daily
* 2nd half – iron transfer to fetus (fetal liver)
Urinary System
Cause of Renal and
Urinary Changes:
• Effects of high estrogen
and progesterone
• Compression of the
bladder and ureters
• Increased blood volume
• Postural influences
 Urinary System
• Increased total body water by 7.5 L
• Increased sodium reabsorption
Progesterone
– potassium-sparing maintains potassium level
– increased response of angiotensin-renin
system increased aldosterone production
which aids in reabsorption of sodium
 Urinary System
• Increased size of the kidneys
• Increased urine output 60 to 80%
• Decreased specific gravity
• Increased GFR and renal plasma flow by 30 to 50%
(2nd trimester)
• Increased GFR Low BUN (15mg/100ml) and low
Creatinine (1mg/100mL)
• Creatinine level : 90-180ml/min (24hr urine sample)
• Traces of glucose in urine – lactose from the
mammary glands spilled into urine
 Urinary System
• Frequency of urination
– Increased in 1st trimester last 2 weeks of pregnancy (
10-12 times / day)
• Progesterone effect causes:
– Bladder capacity increased by 1,000-1,500ml
– Diameter of ureter increased by 25%
• Displacement of uterus at the right side pressure
on right ureter urinary stasis and pyelonephritis
• Pressure on urethra poor bladder emptying UTI –
preterm labor
 Skeletal System
• Increased calcium and phosphorus fetal skeleton
• Relaxin and Progesterone softening of pelvic
ligaments (birth preparation)
• Waddling gait
• Walks with difficulty (wide separation of symphysis
pubis by 3-4mm by 32nd week)
• Lordosis (“pride of pregnancy”)
to change center of gravity
makes ambulation easier
may also lead to backache
 Endocrine System
• Placenta – additional endocrine organ
• Pituitary gland
– FSH and LH production halted
– Increased growth hormone and melanocyte-stimulating
hormone
– Oxytocin by PPG (late in pregnancy)
– Prolactin late in pregnancy
• Thyroid gland
– enlarges as BMR increases by 20%
– Insufficient iodine thyroid hypertrophy (goiter)
 Endocrine System
• Parathyroid:
– Necessary for the metabolism of calcium
• Adrenal gland:
– Increased level of corticosteroids
– Suppress inflammatory reaction
– Reduce the possibility of rejection
– Regulate glucose metabolism
– Increased aldosterone
– Aid in sodium reabsorption
– Maintain osmolarity
 Endocrine System
• Pancreas:
– Increase production of insulin due to increased
glucocorticoids production by adrenals
– Progesterone, estrogen and HPL are antagonists
to insulin
– Increase insulin intake by diabetics
– To avoid hypoglycemia:
• high caloric diet
• never go 12 hours between meals
 Immune System
• Decreased immunologic competency
• Decreased IgG production susceptibility
to infection counteracts by increase in
WBC
• No to live vaccines to increase immunity