1. PHYSIOLOGIC ADAPTATIONS TO PREGNANCY
Developed by
D. Ann Currie, R.N., M.S.N.

3. REPRODUCTIVE SYSTEM
UTERUS
CERVIX
VAGINA
BREASTS

4. REPRODUCTIVE SYSTEM
UTERUS-ENLAREMENT DUE TO INCREASE ESTROGEN AND PROGESTERONE
INCREASE VASCULARITY
HYPERPLASIA
HYPERTROPHY

5. Nonpregnant Uterus

6. 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 g)
VOLUME: 1-2ml to 5000ml(10ml-5000ml)

7. Uterine Growth

8. CERVIX
INCREASE VASCULARITY AND HYPERTROPHY DUE TO ESTROGEN AND PROGESTERONE
CHADWICK’S SIGN
GOODELL’S SIGN
MUCORRHEA DEVELOPS- MUCOUS PLUG FORMS

9. Bimanual Examination

10. Hegar's sign

11. Ladin’s Sign

12. B Sign

13. Pisacek’s Sign

14. 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 (NONPREGNANT WOMAN )

15. BREASTS BREAST CHANGES ARE DUE TO ESTROGEN AND PROGESTERONE
INCREASE VASCULARITY,NODULARITY,AND HYPERTROPHY
PIGMENTATION OF NIPPLES DARKEN
MONTGOMERY’S GLANDS BECOME PROMINENT

16. BREASTS
CONT
COLOSTRUM IS PRODUCED AND MAYBE SECRETED AS EARLY AS 16 WEEKS
BREAST FEEL FULL,INCREASE SENSITIVITY,TINGLELY,AND HEAVY.

17. BREAST CHANGES

18. HEMOLOGICAL CHANGES IN PREGNANCY
BLOOD VOLUME % INCREASE(1500 ML)
PLASMA VOLUME-50% INCREASE( ML) BY WEEKS
RBC’S-17-20% INCREASE(5-6.25MIL/MM
PLT-150, ,000

19. 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

20. CARDIOVASCULAR SYSTEM
HEART RATE- INCREASES BEATS PER MIN.
B/P- 1ST TRIMESTER-REMAIN THE SAME-2ND TRIMESTER DECREASES- AND 3RD TRIMESTER RETURNS TO NORMAL
CARDIAC OUTPUT-INCREASES 30-50%

21. 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

23. Supine Hypotension from pressure on the vena cava

24. RESPIRATORY SYSTEM INCREASED CHEST EXPANSION
DIAPHRAGM DISPLACED AS MUCH AS 4CM.
INCREASED VASCULARITY AND SECRETION OF MUCOUS MEMBRANES
RESPIRATORY RATE INCREASES 2 BPM

25. RESPIRATORY SYSTEM CONT TIDAL VOLUME INCREASES 30-40%
VITAL CAPACITY UNCHANGED
INSPIRATORY CAPACITY INCREASES
EXPIRATORY VOLUME DECREASES
TOTAL LUNG CAPACITY UNCHANGED OR SL.DECREASE.

26. RESPIRATORY SYSTEM CONT O2 CONSUMPTION INCREASES 15-20%
PO2-INCREASES( mmHG)
PCO2-DECREASES(27-32mmHG0
HCO3-DECREASES(18-31mEq/L)
PH-INCREASES( )

27. 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%

28. RENAL SYSTEM CONT LABS- GLUCOSE IN URINE UP TO 1+
PROTEIN-N URINE TRACE TO 1+
BUN-DECREASED 8-20mg/dl
CREATININE-DECREASED ( mg/dl)
URIC ACID -DECREASED 1ST-2ND TRIMESTER( mg/dl)-3rd back to normal

29. INTEGUMENTARY SYSTEM
HYPERPIGMENTATION OF NIPPLES,AREOLAE, AXILLAE, AND VULVA
CHLOASMA
LINEA NIGRA
STRIAE GRAVIDARUM
ANGIOMAS

30. Linea Nigra

31. STRIAE GRAVIDARUM

32. INTEGUMENTARY SYSTEM CONT.PALMAR ERYTHEMA
HYPERACTIVE SWEAT AND SEBACEOUS GLANDS
SKIN DISORDERS MAY INCREASE-INCLUDING PRURITUS AND ACNE
HAIR GROWTH INCREASES

33. GASTROINTESTINAL SYSTEM
GUMS-INCREASE VASCULARITY,HYPEREMIC, SPONGY AND SWOLLEN
EPULIS
PTYALISM
N/V-”MORNING SICKNESS”
HIATAL HERNIA MAY OCCUR IN 15-20%PREGNANT CLIENTS

34. 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

35. GASTROINTESTINAL SYSTEM
COLON IS COMPRESSED AND DISPLACED.
APPETITE CHANGES

36. 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

37. POSTURAL CHANGES IN PREGNANCY

38. Diastasis Recti Abdominis

39. 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

40. 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

41. 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 WKS

42. 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

43. ENDOCRINE SYSTEM
ADRENAL GLANDS-INCREASED ALDOSTERONE LEVELS,INCREASED CORTISOL LEVELS

44. ENDROCRINE SYSTEM PLACENTA-PRODUCES ESTROGEN AND PROGESTERONE RELAXIN
HUMAN PLACENTAL LACTOGEN
INSULINASE

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

47. 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