Physical and Physiologic Changes
of Pregnancy, Signs and
Symptopms of Pregnancy,
Discomforts of Pregnancy with Its
Management, and Couvade
Syndrome
Cabilin, Allyana Monique
Cortes, Carlyle E.
Estrologo, Lea B.
Anatomical and
Physiological Changes
of Pregnancy
Uterus
The transformations in the uterus during
pregnancy are remarkable. Initially small and solid,
the pear-shaped organ expands significantly by the
end of pregnancy. Its dimensions increase from
7.5 x 5 x 2.5 cm to approximately 28 x 24 x 21 cm,
with a weight gain from 60 g to about 1100 g. The
capacity also grows from 10 to 5000 ml or more
(Cunningham et al., 2010).
Uterus
Structural Changes:
The uterus enlarges primarily due to the increase in size
(hypertrophy) of existing myometrial cells, with only a
limited increase in cell number (hyperplasia). The addition
of fibrous tissue between muscle bands enhances the
strength and elasticity of the uterine wall. The walls
become thicker during the first few months of pregnancy,
driven by elevated estrogen and progesterone levels,
rather than mechanical distention by the fetus, placenta,
and amniotic fluid. The enlargement is more pronounced
around the placental insertion site and in the upper
portion, known as the fundus.
Uterus
Temporal Changes:
Around the third month, intrauterine pressure begins as
uterine contents exert influence. Myometrial
hypertrophy continues in the early months, followed by
musculature distension, resulting in a thinning of the
muscle wall to about 1.5 cm or less at term (38 through
41 weeks of gestation). This thinning allows for easier
palpation of the fetus through the abdominal wall.
Uterus
Vascular Adaptations:
As the uterus enlarges and the fetus and placenta
develop, circulatory requirements increase. The size
and number of blood and lymphatic vessels within the
uterine layers greatly expand. By the end of pregnancy,
approximately one-sixth of the total maternal blood
volume resides within the uterus's vascular system.
Braxton Hicks Contractions
Braxton Hicks contractions are irregular uterine
contractions during pregnancy.
They start occurring periodically throughout pregnancy.
These contractions can be felt manually around the
fourth month of pregnancy.
They contribute to promoting blood flow through the
placenta's intervillous spaces.
In later stages of pregnancy, these contractions may
become more frequent.
Increased frequency may lead to discomfort.
There is a possibility of mistaking them for actual labor
contractions.
Cervix
The cervical tissue, predominantly composed of
connective tissue, undergoes significant
rearrangement during pregnancy. This restructuring
is crucial for facilitating changes in the cervix during
labor, with its strength at term being 1/12 of its
prepregnant strength (Cunningham et al., 2010).
Cervix
Estrogen Influence:
Estrogen plays a key role in stimulating the glandular
tissue of the cervix, leading to an increase in cell
number and heightened activity. At term, the
endocervical glands occupy about half of the cervix's
mass, a notable increase from the nonpregnant state.
These glands produce a thick, tenacious mucus that
forms the mucous plug, sealing the endocervical canal
and preventing the entry of bacteria or other
substances into the uterus. The expulsion of this plug
coincides with the onset of cervical dilatation.
Cervix
Physiological Changes:
The hyperactive glandular tissue also results in an
increase in normal physiological mucorrhea,
occasionally causing a profuse discharge. Increased
vascularization, stemming from the hypertrophy and
engorgement of vessels beneath the growing uterus,
softens the cervix (Goodell’s sign) and imparts a bluepurple discoloration (Chadwick’s sign) to the cervix.
Ovaries
Ovary activity shifts during pregnancy as ovum
production halts. While many follicles temporarily
develop, they don't mature fully. The cells lining
these follicles, known as thecal cells, become
active in hormone production and are referred to
as the interstitial glands of pregnancy.
Ovaries
Hormone Maintenance:
In early pregnancy, human chorionic gonadotropin
(hCG) sustains the corpus luteum, a structure that
produces hormones until approximately weeks 6 to
8 of pregnancy. At its peak, the corpus luteum
engulfs about a third of the ovary. By midpregnancy, it regresses significantly. The corpus
luteum secretes progesterone to support the
endometrium until the placenta takes over
progesterone production. At that point, the corpus
luteum gradually disintegrates.
Vagina
The vaginal epithelium undergoes various changes
during pregnancy, including hypertrophy, increased
blood flow, and hyperplasia. Similar to cervical
changes, these alterations are induced by estrogen
and lead to mucosal thickening, loosening of
connective tissue, and an increase in vaginal
secretions.
Vagina
Vaginal Secretions:
The secretions during pregnancy are thick, white, and
acidic (pH 3.5 to 6), playing a crucial role in preventing
infections. However, the acidic pH can also promote
the growth of yeast organisms, leading to moniliasis, a
common vaginal infection during pregnancy.
Vagina
Muscle Changes:
Smooth muscle cells in the vagina hypertrophy,
accompanied by loosening of supportive connective
tissue. By the end of pregnancy, the vaginal wall and
perineal body relax sufficiently, allowing for tissue
distention and the passage of the infant during
childbirth.
Vagina
Blood Flow:
Increased blood flow to the vagina may result in a bluepurple color (Chadwick’s sign), similar to what is
observed in the cervix.
Breast
Shortly after a woman misses her menstrual
period, hormonal changes induced by estrogen and
progesterone impact the mammary glands. These
changes include an increase in breast size and
nodularity, resulting from glandular hyperplasia
and hypertrophy in preparation for lactation.
Notable transformations, such as prominent
superficial veins, more erectile nipples, and
obvious pigmentation of the areola, occur by the
end of the second month. Women with darker
complexions may experience more pronounced
pigmentation.
Breast
Specific Changes:
Hypertrophy of Montgomery’s follicles within the
primary areola is observed, and as the pregnancy
progresses, striae (purplish stretch marks) may
develop, gradually turning silver after childbirth.
These breast changes are typically most noticeable
in first-time pregnant women.
Breast
Colostrum Production:
Colostrum, a yellow secretion rich in antibodies,
may be manually expressed by the 12th week and
may leak from the breasts in the last trimester of
pregnancy. After childbirth, colostrum gradually
transforms into mature milk during the initial days
post-delivery.
Respiratory System
Pregnancy brings modifications to pulmonary function,
inducing a mild form of hyperventilation. Tidal
volume, or the air breathed with ordinary respiration,
steadily increases, resulting in a 30% to 40% rise in the
volume of air breathed per minute compared to
nonpregnant values. Between weeks 16 and 40,
oxygen consumption increases by approximately 15%
to 20%, meeting the heightened needs of both the
mother and the fetus-placenta duo.
Respiratory System
Specific Changes:
Vital capacity, the maximum air moved in and out of
the lungs with forced respiration, slightly increases.
Lung compliance (elasticity) and pulmonary diffusion
remain constant. Airway resistance decreases
significantly due to elevated progesterone levels. The
enlarging uterus elevates the diaphragm, causing the
rib cage to flare and altering chest dimensions.
Respiratory System
Breathing Dynamics:
Breathing shifts from abdominal to thoracic as
pregnancy progresses. While pulmonary function
remains unimpaired overall, many women experience
an increased awareness of the need to breathe, often
perceived as dyspnea, attributed to increased tidal
volume.
Respiratory System
Potential Complications:
Pregnancy-related nasal stuffiness (rhinitis) and
congestion, along with nosebleeds (epistaxis), are not
uncommon. These symptoms result from estrogeninduced edema and vascular congestion in the nasal
mucosa.
Cardiovascular System
The growing uterus impacts cardiovascular
function during pregnancy. The heart is pushed
upward and to the left, resulting in an appearance
of slight enlargement on x-ray. Various changes
occur, including increased blood volume,
alterations in blood pressure, and adjustments in
blood flow to different organ systems.
Cardiovascular System
Cardiovascular Changes:
Blood volume progressively increases throughout
pregnancy, reaching 40-50% above nonpregnant
levels by birth.
Systemic and pulmonary vascular resistance
decreases to adapt to higher blood volume without
elevated vessel pressures.
Cardiac output increases early in pregnancy,
peaking at 25 to 30 weeks, remaining elevated in
the third trimester.
Cardiovascular System
Blood Flow Distribution:
Organs experience additional blood flow based on
their increased workload.
Blood flow increases to the uterus, placenta, and
breasts, while hepatic and cerebral flow remains
unchanged.
Cardiovascular System
Blood Pressure and Pulse:
Pulse rate often increases during pregnancy, and
blood pressure decreases slightly, reaching its
lowest point in the second trimester.
Blood pressure gradually rises in the third
trimester and approaches prepregnant levels at
term.
Cardiovascular System
Venous Changes:
Increased femoral venous pressure leads to a rise
in the tendency for blood stagnation, causing
dependent edema and varicose veins.
Enlarging uterus pressure on the vena cava may
result in supine hypotensive syndrome, corrected
by lying on the left side.
Cardiovascular System
Blood Composition Changes:
Total erythrocyte volume increases, especially with iron
supplementation, to meet the additional oxygen
demands.
Plasma volume increases more than erythrocyte volume,
causing a slight decrease in hematocrit, termed
physiologic anemia of pregnancy.
Leukocyte production increases, and during labor, levels
may rise dramatically.
Platelet count remains relatively stable, but plasma
fibrinogen increases, contributing to a hypercoagulable
state, increasing the risk of venous thrombosis.
Gastrointestinal System
Many discomforts in pregnancy stem from changes in the
gastrointestinal system. Nausea and vomiting in the first
trimester may be linked to the hCG hormone and shifts
in carbohydrate metabolism. Taste and smell changes
are common, intensifying gastrointestinal issues. Gum
tissue may become sensitive, bleed easily, and excessive
saliva secretion (ptyalism) may occur.
Gastrointestinal System
Second-Half Gastrointestinal Changes:
Growing uterus and progesterone cause gastrointestinal
symptoms in the second half of pregnancy.
Intestines are displaced, leading to heartburn from stomach
acid reflux.
Delayed gastric emptying and intestinal motility result in
bloating and constipation.
Smooth muscle relaxation and increased water reabsorption
in the large intestine worsen constipation.
Hemorrhoids may develop due to constipation or pressure
on vessels below the uterus.
Gastrointestinal System
Liver and Gallbladder Changes:
Minor liver changes occur in pregnancy.
Plasma albumin and cholinesterase levels decrease.
Gallbladder emptying time prolongs, potentially leading to
hypercholesterolemia and gallstone formation.
Retained bile salts may cause itching (pruritus).
Urinary System
In the first trimester, the growing uterus causes
urinary frequency by pressing on the bladder. As
the uterus transitions into an abdominal organ in
the second trimester, the pressure decreases.
However, near term, when the baby's head
engages in the pelvis, bladder pressure reoccurs,
making it more susceptible to infection and
trauma. The bladder's shape changes, becoming
concave and reducing its capacity.
Urinary System
Glomerular Filtration Rate (GFR) and
Renal Plasma Flow (RPF):
GFR and RPF increase early in pregnancy, with
GFR rising up to 50% by the second trimester,
remaining elevated until birth.
A compensatory increase in renal tubular
reabsorption occurs, leading to the excretion of
more amino acids and water-soluble vitamins.
Glycosuria, the presence of glucose in the urine, is
common during pregnancy but may not be
pathogenic, reflecting the kidneys' inability to
reabsorb all filtered glucose.
Urinary System
Renal Function and Clearance:
Increased renal function during pregnancy results
in elevated urea and creatinine clearance.
Blood urea and nonprotein nitrogen values
decrease.
Creatinine clearance measurement accurately
assesses renal functioning during pregnancy.
Skin and Hair
Skin pigmentation changes are common in
pregnancy, stimulated by increased estrogen,
progesterone, and α-melanocyte-stimulating
hormone levels.
Skin and Hair
Pigmentation Changes:
Skin darkening occurs in areas already
hyperpigmented, including the areolae, nipples,
vulva, perianal area, and linea alba.
The linea alba may darken during pregnancy,
becoming the linea nigra.
Facial chloasma, known as the "mask of
pregnancy," presents irregular pigmentation on the
cheeks, forehead, and nose, accentuated by sun
exposure.
Facial melasma is more prominent in dark-haired
women but often fades after birth.
Skin and Hair
Stretch Marks and Vascular Spider Nevi:
Stretch marks (striae) are reddish streaks over the
abdomen, breasts, and thighs due to reduced
connective tissue strength from elevated adrenal
steroid levels.
Vascular spider nevi, small red elevations on the
skin, may appear on the chest, neck, face, arms,
and legs, linked to increased subcutaneous blood
flow from elevated estrogen levels.
Skin and Hair
Hair Changes:
Hair growth rate may decrease during pregnancy,
with fewer hair follicles in the resting phase.
After birth, the number of resting hair follicles
sharply increases, leading to increased hair
shedding for 1 to 4 months.
Nearly all hair is replaced within 6 to 12 months.
Musculoskeletal System
Teeth:
No demonstrable changes or demineralization occur in a
pregnant woman's teeth.
Dental caries during pregnancy is often due to inadequate
oral hygiene and dental care, not intrinsic changes.
Musculoskeletal System
Pelvic Joints:
The sacroiliac, sacrococcygeal, and pubic joints in the pelvis
relax later in pregnancy due to hormonal changes.
This may cause a waddling gait, and a slight separation of the
symphysis pubis can be seen on X-rays.
Musculoskeletal System
Posture Changes and Aches:
The sacroiliac, sacrococcygeal, and pubic joints in the pelvis
relax later in pregnancy due to hormonal changes.
This may cause a waddling gait, and a slight separation of the
symphysis pubis can be seen on X-rays.
Musculoskeletal System
Rectus Abdominis Muscle:
Pressure from the enlarging uterus may cause the rectus
abdominis muscle to separate, known as diastasis recti.
Severe separation without postpartum muscle tone recovery
may lead to inadequate support in subsequent pregnancies,
causing a pendulous abdomen.
EYES
Two subtle changes occur in the eyes during
pregnancy:
Intraocular pressure decreases, likely due to
increased vitreous outflow.
The cornea undergoes a slight thickening,
attributed to fluid retention.
EYES
Some pregnant women may find it challenging to
wear previously comfortable contact lenses.
The corneal change typically resolves by 6 weeks
postpartum.
Psychological Response
of the Expectant
Family to Pregnancy
Pregnancy
Developmental Challenge/Stage
Transition Period
Change in Finances
Can be a Developmental Crisis
A. Mother
Pregnancy alters body image and relationships.
Pregnancy stress responses is influences by her
emotions, sociology, cultural background, and the
acceptance/rejetion of the pregnancy.
Many pregnant women manifest similar
psychologic and emotional responses.
A.1. Intendedness
Refers to a woman who wants/does not want to
become pregnant before the time of conception.
Many pregnancies are unintended, but not all
unintended pregnancies are unwanted.
Unintended pregnancy can be a risk factor for
depression.
A.2. Ambivalence
Refers to mixed or contradictory feelings.
Timing could be wrong.
Having to change existing career plans.
Fear of being a ‘bad’ mother.
Unresolved issues with own mother.
Fear of pregnancy, labor, and birth.
Indirect evidence includes depression, physical
discomfort, body image issues, mood swings, and
difficulty accepting the changes in pregnancy.
A.2. Ambivalence
Unwanted pregnancies result in more pronounced signs
of ambivalence.
Delays prenatal care resulting in problems.
Partner’s reaction affects the want of pregnancy.
Financial and emotional support are important.
May consider abortion.
Thoughts of abortion or miscarriage may distress the
woman and add guilt.
A.3. Acceptance
Lower acceptance with unplanned pregnancies.
She may feel physical discomfort and depression.
Accepted pregnancies make a woman happy, lessens
discomfort, and tolerates the pain especially during the
third trimester.
Older women accept pregnancy faster but may have
lesser pregnant peers.
During first trimester, the woman would not feel the
gravity of pregnancy yet.
A.3. Acceptance
During 2nd trimester, the woman begins to accept he
reality of her pregnancy.
Quickening makes her percieve baby is real.
Would exhibit the pregnancy ‘glow’ when happy.
Third trimester makes her proud and anxious, people
view her as ‘helpless’ thus giving help, whe could accept
or reject this help.
Final trimester worries more about the health and safety
of her child and herself due to the pain.
A burst of energy (nesting) may happen that makes a
woman clean or organize their home.
A.4. Introversion
Pregnant woman would prefer rest and time alone.
During this time woman’s concentration of attention
permits the woman to plan, adjust, adapt, build, and
draw strength in preparation for her child’s birth.
Woman becomes more sensitive.
Her partner might have problems with the introversion.
Fantasizes about her unborn child.
A.5. Mood Swings
May fluctuate from great joy to deep despair.
Tearful with little apparent cause, when asked she can’t
explain why she feels that way.
Partner may be unsettled causing them to feel confused
and inadequate, may withdraw or ignore the problem.
Woman perceive this reaction as unloving/unsupportive.
Once the couple understands that this behavior is
characteristic of pregnancy, it becomes easier for them
to deal with it more effectively—although it will be a
source of stress to some extent throughout pregnancy.
A.6. Changes in Body
Image
Pregnancy produces marked changes in a woman’s body
within a relatively short time.
Changes in body image are normal but can be very
stressful for the pregnant woman.
Explanation and discussion of the changes may help both
the woman and her partner deal with the stress
associated with this aspect of pregnancy.
A.7. Parental Reactions to Pregnancy
Psychological Tasks of
the Mother
1. Ensuring safe passage through
pregnancy, labor, and birth
Competent maternity care provides control.
Seeks to ensure safe passage by engaging in selfcare activities related to diet, exercise, alcohol
consumption, etc.
In the third trimester, she becomes aware of
external threats in the environment.
Worries if partner is late or if she is home alone.
Sleep is difficult.
2. Seeking of acceptance of this child
by others
Birth of child alters a woman’s support groups.
Woman’s partner is the most important figure.
The partner’s support and acceptance influence
her completion of her maternal tasks and the
formation of her maternal identity.
Achieving social acceptance of the child and of
herself as mother may be more difficult for the
adolescent mother or single woman.
3. Seeking of commitment and
acceptance of self as mother to the
infant (binding-in)
The mother experiences the movement of the
child within her in an intimate, exclusive way, and
out of this experience bonds of love form.
This binding-in process, motivates the pregnant
woman to become competent in her role and
provides satisfaction for her in her role of mother.
This possessive love increases her maternal
commitment to protect her fetus now and her
child after she or he is born.
4. Learning to give of oneself on
behalf of one’s child
Childbirth involves many acts of giving.
Life is given to an infant; a sibling is given to older
children of the family.
The woman begins to develop self-denial and
learns to delay immediate personal gratification to
meet the needs of another.
Baby showers and baby gifts are acts of giving that
help the mother’s self-esteem while also helping
her acknowledge the separateness and needs of
the coming baby.
The Father
Until fairly recently, the expectant father was
often viewed as a “bystander” or observer of his
partner’s pregnancy.
This view has changed, and the father of today
is expected to fulfill the role of nurturing, caring,
involved parent as well as provider.
Many men have actively sought to be more
involved in the experience of childbirth and
parenting.
Expectant fathers experience many of the same
feelings and conflicts experienced by expectant
mothers when the pregnancy has been
confirmed.
The expectant father must establish a
fatherhood role just as the woman develops a
motherhood role.
First Trimester
After the initial excitement an expectant father may begin
to feel left out of the pregnancy.
He is also often confused by his partner’s mood changes
and perhaps bewildered by his responses to her changing
body.
He may resent the attention given to the woman and the
need to change their relationship as she experiences
fatigue and a decreased interest in sex.
Fathers often picture interacting with a child of 5 or 6
rather than a newborn.
Even the pregnancy itself may seem unreal until the
woman shows more physical signs.
Second Trimester
Role in pregnancy is vague, involvement can increase by
his watching and feeling fetal movement and heartbeat.
For many men, seeing the infant on ultrasound is an
important experience in accepting the reality of the
pregnancy.
Expectant fathers need to confront and resolve some of
their own conflicts about the fathering they received.
An open and honest discussion about the expectations
each parent has about their roles will help the father-tobe to determine his transition to fatherhood.
The woman’s appearance begins to alter at this time too,
and men react differently to the physical change.
Third Trimester
If the couple have communicated their concerns and
feelings to one another and grown in their relationship,
the third trimester is a special and rewarding time.
They may become involved in childbirth education
classes and make concrete preparations for the arrival of
the baby.
The father may also begin to have anxiety and fantasies
about what could happen to his partner and the unborn
baby during labor and birth and feels a great sense of
responsibility.
Discomforts of
Pregnancy with its
Management
Nausea and Vomiting
Eat small, frequent meals.
Avoid greasy, high-fat foods.
Consume dry starch foods, such as crackers,
toast or cereal, in the morning before you get
out of bed.
Limit consumption of coffee.
Constipation
Increase the amount of fiber in the diet, eating
foods high in fiber such as fruits, raw
vegetables, whole grain products, nuts and
dried fruits.
Drink a lot of fluids.
Exercise, even walking, will help relieve
constipation.
Iron supplements can aggravate constipation
— the prescription for iron can be adjusted if it
becomes a problem.
Hemorrhoids
To help avoid hemorrhoids, prevent
constipation by maintaining a diet that is high
in fluids and fiber.
Witch hazel or Tucks pads can be applied to
the hemorrhoid area to relieve symptoms.
Avoid over-the-counter laxatives. If hard
stools are aggravating hemorrhoids, stool
softeners can be used, but first consult
practitioner for specific suggestions.
Fatigue
Get as much sleep or rest — even short
naps will help.
A warm bath, massage or hot drink before
bed often helps to relax and get ready to
sleep.
Breast Tenderness
Wearing a good support bra may help to feel
more comfortable.
Hot or cold compresses .
Frequent Urination
Do not restrict fluid intake in an effort to
decrease the frequency of urination. As long
as there is no burning or pain with urination,
increased frequency is normal and will go
away with time.
Leg Cramps
Do calf stretches before going to bed to
prevent the cramping. But don't point toes
while stretching.
Straighten leg and flex foot . A gentle
massage of the calf may help relax the
muscle.
Make sure to drink lots of liquids during the
day.
If your doctor says it's OK, get regular
exercise, which can help reduce cramps.
Heartburn
Try eating smaller but more frequent meals.
Avoid highly seasoned, rich and fatty foods.
Do not lie down flat after eating.
Milk often can help alleviate heartburn.
Certain antacids are not recommended during
pregnancy. Check with a health care provider
before using over-the-counter antacid
preparations.
Backache
Try not to stand in one position for too long.
An exercise called the pelvic rock will help
alleviate back pain and strengthen the lower
back muscles that experience the most
stress.
Elevating the feet onto a stool while sitting will
help.
Dizziness
Move slowly when getting up from a sitting or
lying position.
Eat well and frequently. Women who are
prone to low blood sugar should carry snacks
at all times. Juices and fruit are particularly
good choices.
Swelling of the Hands and Feet
Adequate fluid intake is always important. Improve the circulation in legs and feet by
elevating them as often as possible.
Lie on a bed or floor and raise legs up on the
wall keeping the knees bent.
Couvade Syndrome
The term couvade traditionally referred to the observance of certain rituals and
taboos by the male to signify the transition to fatherhood. This observance
affirms his psychosocial and biophysical relationship to the woman and child.
These taboos may have taken specific form—for example, the man may have
been forbidden to eat certain foods or carry certain weapons before and
immediately after the birth.
Men who demonstrate couvade syndrome tend to have a higher degree of
paternal role preparation and be involved in more activities related to this
preparation.
Physical signs and symptoms of sympathetic pregnancy
(couvade syndrome in men) can include the following:
Intestinal problems such as abdominal pain,
bloating, diarrhea, constipation
Heartburn
Changes in appetite
Weight gain or loss
Toothaches
Skin problems
Leg cramps
Fainting
Weakness
Urinary or genital irritations
Psychological signs and symptoms of sympathetic
pregnancy (couvade syndrome in men) can include the
following:
Change in sleeping patterns
Anxiety
Depression
Reduced libido
Restlessness.
There is no specific treatment for couvade syndrome, since it is not considered
a disease or recognized as a psychological condition.