PHYSIOLOGIC ADAPTATIONS TO PREGNANCY

Developed by D. Ann Currie, R.N., M.S.N.

REPRODUCTIVE SYSTEM• UTERUS• CERVIX• VAGINA• BREASTS

REPRODUCTIVE SYSTEM• UTERUS-ENLAREMENT DUE TO

INCREASE ESTROGEN AND PROGESTERONE

• INCREASE VASCULARITY• HYPERPLASIA• HYPERTROPHY

Nonpregnant Uterus

UTERINE GROWTH• LENGTH:2 1/2 in. to 12 1/2 in(6.5cm-

32cm)• WIDTH:1 1/2in to 9 1/2 in(4cm-24cm)• DEPTH:1in to 8 1/2 in(2.5cm-22cm)• WEIGHT;2 1/2oz. to 2 1/2 lb.(60-70g-

1100-1200g)• VOLUME: 1-2ml to 5000ml(10ml-

5000ml)

Uterine Growth

CERVIX• INCREASE VASCULARITY AND

HYPERTROPHY DUE TO ESTROGEN AND PROGESTERONE

• CHADWICK’S SIGN• GOODELL’S SIGN• MUCORRHEA DEVELOPS- MUCOUS

PLUG FORMS

Bimanual Examination

Hegar's sign

Ladin’s Sign

B Sign

Pisacek’s Sign

VAGINA• INCREASE VASCULARIZATION DUE

TO ESTROGEN AND SOFTEN ING DUE TO PROGESTERONE

• CHADWICK’S SIGN• VAGINAL DISCHARGE TENDS TO BE

THICK AND WHITE=LEUKORRHEA• PH-4-6.5.(NONPREGNANT WOMAN

3.5-4.5)

BREASTS• BREAST CHANGES ARE DUE TO

ESTROGEN AND PROGESTERONE• INCREASE

VASCULARITY,NODULARITY,AND HYPERTROPHY

• PIGMENTATION OF NIPPLES DARKEN• MONTGOMERY’S GLANDS BECOME

PROMINENT

BREASTS• CONT• COLOSTRUM IS PRODUCED AND

MAYBE SECRETED AS EARLY AS 16 WEEKS

• BREAST FEEL FULL,INCREASE SENSITIVITY,TINGLELY,AND HEAVY.

BREAST CHANGES

HEMOLOGICAL CHANGES IN PREGNANCY• BLOOD VOLUME-40-50 %

INCREASE(1500 ML)• PLASMA VOLUME-50%

INCREASE(1200-1300ML) BY 30-34 WEEKS

• RBC’S-17-20% INCREASE(5-6.25MIL/MM

• PLT-150,000-400,000

HEMOLOGICAL CHANGES• CONT• WBC’S-INCRESE IN 2ND -3TH

TRIMESTER(5,000-15,000MM-)• FIBRINOGEN-INCRESAES 50-80%• FACTORS VII,VIII,IX,X- INCREASE• FACTORS XI,XII-DECREASE• SED RATE- INCREASES

CARDIOVASCULAR SYSTEM• HEART RATE- INCREASES 10-15

BEATS PER MIN.• B/P- 1ST TRIMESTER-REMAIN THE

SAME-2ND TRIMESTER DECREASES- AND 3RD TRIMESTER RETURNS TO NORMAL

• CARDIAC OUTPUT-INCREASES 30-50%

CARDIOVASCULAR SYSTEM• CONT• MYOCARDIAL HYPERTOPHY-

INCREASES 12%• THE HEART IS SHIFTED UPWARD,

ANTERIORLY AND LATERALLY TO LEFT

• HEART SOUNDS-S1,S2,S3 AFTER 20WKS.-MURMURS ARE COMMON

Supine Hypotension from pressure on the vena cava

RESPIRATORY SYSTEM• INCREASED CHEST EXPANSION• DIAPHRAGM DISPLACED AS MUCH AS

4CM.• INCREASED VASCULARITY AND

SECRETION OF MUCOUS MEMBRANES

• RESPIRATORY RATE INCREASES 2 BPM

RESPIRATORY SYSTEM • CONT• TIDAL VOLUME INCREASES 30-40%• VITAL CAPACITY UNCHANGED• INSPIRATORY CAPACITY INCREASES• EXPIRATORY VOLUME DECREASES• TOTAL LUNG CAPACITY

UNCHANGED OR SL.DECREASE.

RESPIRATORY SYSTEM• CONT• O2 CONSUMPTION INCREASES 15-

20%• PO2-INCREASES(104-108mmHG)• PCO2-DECREASES(27-32mmHG0• HCO3-DECREASES(18-31mEq/L)• PH-INCREASES(7.4-7.45)

RENAL SYSTEM• RENAL PELVIS AND URETERS DILATE-

RIGHT MORE THAN LEFT• BLADDER CAPACITY-INCREASES TO

1500ML.• GLOMERULAR FILTRATION RATE-

INCREASES 30-50%• RENAL PLASMA FLOW-INCREASES

30%

RENAL SYSTEM • CONT• LABS- GLUCOSE IN URINE UP TO 1+ • PROTEIN-N URINE TRACE TO 1+• BUN-DECREASED 8-20mg/dl• CREATININE-DECREASED (0.6-1.2mg/dl)• URIC ACID -DECREASED 1ST-2ND

TRIMESTER(4.5-5.8mg/dl)-3rd back to normal

INTEGUMENTARY SYSTEM

• HYPERPIGMENTATION OF NIPPLES,AREOLAE, AXILLAE, AND VULVA

• CHLOASMA• LINEA NIGRA• STRIAE GRAVIDARUM• ANGIOMAS

Linea Nigra

STRIAE GRAVIDARUM

INTEGUMENTARY SYSTEM• CONT.PALMAR ERYTHEMA• HYPERACTIVE SWEAT AND

SEBACEOUS GLANDS• SKIN DISORDERS MAY INCREASE-

INCLUDING PRURITUS AND ACNE• HAIR GROWTH INCREASES

GASTROINTESTINAL SYSTEM• GUMS-INCREASE

VASCULARITY,HYPEREMIC, SPONGY AND SWOLLEN

• EPULIS• PTYALISM• N/V-”MORNING SICKNESS”• HIATAL HERNIA MAY OCCUR IN 15-

20%PREGNANT CLIENTS

GASTROINTESTINAL SYSTEM• HEARTBURN-PYROSIS• DECREASE TONE AND MOLITY OF

GI TRACT• CONSTIPATION• GB EMPTYING TIME IS SLOWED-GB

STONE MAY FORM• STOMACH IS DISPLACED UPWARD

GASTROINTESTINAL SYSTEM• COLON IS COMPRESSED AND

DISPLACED.• APPETITE CHANGES

MUSCULOSKELETAL SYSTEM• LORDOSIS OCCURS• CENTER OF GRAVITY CHANGES• GAIT CHANGES-”WADDLING”• SL. RELAXATION OF PELVIC JOINTS• MUSCLE TONE OF ABDOMINAL

MUSCLESDECREASES• DIASTASIS RECTI ABDOMINIS MAY

OCCUR

POSTURAL CHANGES IN PREGNANCY

Diastasis Recti Abdominis

NEUROLOGIC SYSTEM• COMPRESSION OF PELVIC NERVES• EDEMA INVOLVING PERPHERAL

NERVES MAY RESULT IN CARPAL TUNNEL SYNDROME.

• ACROESTHESIA• TENSION H/A• HYPOCALCEMIA-MUSCLE CRAMPS

AND TETANY

ENDROCINE SYSTEM• PITUITARY GLAND-SUPPRESSION OF

FSH AND LH FROM ANT PITUITARY• INCREASES IN SIZE• MSH.,PROLACTIN,TSH,AND

ADRENOCORTICOTROPIC HORMONE ARE INCREASED

• OYTOCIN INCREASES AS FETUS MATURES AND LABOR IS NEAR

ENDOCRINE SYSTEM• THYROID GLAND-INCREASES IN SIZE

SLIGHTLY• BMR INCREASES 25%(15-20%)• T4 INCREASES AND THAN RETURNS

TO NORMAL• PARATHYROID GLAND-PARATHYROID

HORMONE INCREASES-PEAK AT 15-35 WKS

ENDOCRINE SYSTEM• CONT• PANCREAS-INSULIN PRODUCTION

INCREASES-HOWEVER THERE IS PERIPHERAL RESISTANCE TO INSULIN

• BLOOD SUGARS-DECREASE IN 1ST TRIMESTER 2ND-3RD BLOOD SUGAR RISE TO NORMAL OR INCREASED

ENDOCRINE SYSTEM• ADRENAL GLANDS-INCREASED

ALDOSTERONE LEVELS,INCREASED CORTISOL LEVELS

ENDROCRINE SYSTEM• PLACENTA-PRODUCES ESTROGEN

AND PROGESTERONE• RELAXIN• HUMAN PLACENTAL LACTOGEN• INSULINASE

IMMUNOLOGICAL SYSTEM• HELPER T CELLS DECREASE• SUPPRESSOR T CELLSS INCREASE• B CELL FUNCTION IS SUPPRESSED• IgG DECREASES• RISK FOR INFECTION INCREASES• WBC’S -INCREASE(5000-15000)• POLYMORPHONUCLEAR NEUTROPHILS

INCREASE

DANGER SIGNS DURING PREGNANCY• SEVERE VOMITING• FREQUENT AND

SEVERE H/A• EPIGASTRIC PAIN• FLUID DISCHARGE

FROM VAGINA• VISUAL

DISTURBANCES

• ABDOMINAL-UNUSUAL OR SEVERE PAIN

• FM CHANGES OR ABSENCE

• SWELLING OF HANDS AND FACE

• VAGINAL BLEEDING