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