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(4cm24cm)
• DEPTH:1in to 8 1/2 in(2.5cm22cm)
• WEIGHT;2 1/2oz. to 2 1/2 lb.(6070g-1100-1200g)
• VOLUME: 1-2ml to 5000ml(10ml5000ml)
Uterine Growth
CERVIX
• INCREASE VASCULARITY AND
HYPERTROPHY DUE TO
ESTROGEN AND
PROGESTERONE
• CHADWICK’S SIGN
• GOODELL’S SIGN
• MUCORRHEA DEVELOPSMUCOUS 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,AN
D 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 3034 WEEKS
• RBC’S-17-20% INCREASE(56.25MIL/MM
• PLT-150,000-400,000
HEMOLOGICAL
CHANGES
• CONT
• WBC’S-INCRESE IN 2ND -3TH
TRIMESTER(5,000-15,000MM-)
• FIBRINOGEN-INCRESAES 5080%
• FACTORS VII,VIII,IX,XINCREASE
• 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 HYPERTOPHYINCREASES 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 3040%
• 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 CAPACITYINCREASES TO 1500ML.
• GLOMERULAR FILTRATION
RATE- INCREASES 30-50%
• RENAL PLASMA FLOWINCREASES 30%
RENAL SYSTEM
• CONT
• LABS- GLUCOSE IN URINE UP
TO 1+
• PROTEIN-N URINE TRACE TO 1+
• BUN-DECREASED 8-20mg/dl
• CREATININE-DECREASED (0.61.2mg/dl)
• URIC ACID -DECREASED 1ST2ND 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 GLANDSUPPRESSION 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 GLANDPARATHYROID HORMONE
INCREASES-PEAK AT 15-35
WKS
ENDOCRINE SYSTEM
• CONT
• PANCREAS-INSULIN
PRODUCTION INCREASESHOWEVER 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
DANGER SIGNS DURING
PREGNANCY
• SEVERE
VOMITING
• FREQUENT AND
SEVERE H/A
• EPIGASTRIC
PAIN
• FLUID
DISCHARGE
FROM VAGINA
• VISUAL
DISTURBANCES
• ABDOMINALUNUSUAL OR
SEVERE PAIN
• FM CHANGES
OR ABSENCE
• SWELLING OF
HANDS AND
FACE
• VAGINAL
BLEEDING