Physiologic Change in Pregnancy

A.

Cardio System
Heart Rate - increase 10 bpm (80-90)
Elevation Blood/Plasma Volume
- increases 4,000-5,250 mL; 2,600-3,600 mL
- normal blood loss
NSD: 300-400mL
CS: 800-1000mL
Anemia
(pseudo anemia: false anemia)
Hemoglobin: 11.5-14g/dL --- <11.5
Hematocrit: 32-42% --- <30%
RBC/WBC
- RBC: 4.2-4.6 M
- WBC: 20,000 cells (compensatory mechanism)
The Fibrinogen
- constituent of blood necessary for clotting
- 50% increase (300-450mg/dL)
- risk for blood clots
B. Respiratory System
- the RR increases to about 18-20 bpm
- nasal stuffiness (hormonal changes, avoid OTC medications; advice humidifiers)
C. Skeletal System
Leg Cramps
- alteration of calcium and phosphorous
- dorsiflexion
Leg Edema - management: elevation
Lordosis - wear low heeled shoes
D. GUT
Greater Bladder Capacity - 1,500 mL
Urinary Frequency
- first and third trimester
- kegels exercise
Traces of Glucose (urine)
E. GIT
Gets Heart Burn (reflux)

- elevation of head of bed

- small frequent feedings
Inactivity
- constipation: increase oral fluid/increase fiber:0
- decrease emptying of gallbladder: reabsorption of bilirubin -> subclinical jaundice ->
generalized itchiness (regular bathing + lotion)
The Morning Sickness
- nausea and vomiting: 1st trimester (dry crackers)

1.
2.
3.
4.
5.
6.

F. Integumentary System
Striae Gravidarum - stretch marks
Linea Nigra
Palmar Erythema - redness and itchiness of palms
Vascular Spiders - fiery veins or distended veins
Diastasis - bluish groove as muscles of the abdomen are stretched
Melasma - brown pigmentation

G. Reproductive System
7.
Amenorrhea - suppression of your menstruation
8.
Breast Engorgement and Tenderness - breast tissue increases in size as milk is
formed
Signs and Symptoms (must seen on both breasts)
Swelling

Hot Feeling

On Redness
Tenderness

*if seen only on one breast: infection (mastitis)

Management:

Suck More

Apply Warm Packs

Continue Empty Breast

Keep Firm Fitting Bra - 2x larger during pregnancy

3. Cervical Changes
Coating of mucus: operculum (mucus coat)
Color of cervix: pale pink - violet hue
Cervical softening: Goodelle's sign (6th week)
4. Uterus
Uterus is 1-2cm thick (early) --> 0.5cm thin (late)

Tapping of lower uterine segment --> fetus bounces (Ballottement:20th week)

Elevation --> Bartholomew's Rule (12-16-20-36)
Regarding weight: 50g-1,000g
Uterine Contractions
- Braxton Hicks
Felt on the abdomen
A constant intensity
La effacement at dilatation
Stops when sedated/slows down when walking
Erregular painless contraction
Softening of lower uterus: Hegar's sign (6th week)
5. Vagina
Leukorrhea - increase whitish vaginal discharge
Bluish Discoloration
Chadwick's Sign - bluish discoloration (6th week)
H. Endocrine System Changes
1. Hormones
a. Estrogen - hormone of being a woman and female appearance
Nasal stuffiness

Breast enlargement

Uterine Growth

Increase Vaginal Discharge

Vascular spider

Palmar erythema

Increase fibrinogen level

b. Progesterone
Slight increase of body temperature
Smooth muscle relaxation (prevents pre-term labor)
Maintains endometrial layer
c. HCG - glycoprotein hormone produced initially by developing embryo later by
placenta
- role is to maintain corpus luteum of ovaries
d. Prostaglandin
- Initiates labor at TERM
- smooth muscle contraction
e. Human Placental Lactogen
Helps Regulation (glucose, CHON, Fat) levels
Promotes mammary growth
Laban sa insulin "antagonist" (insulin cannot, glucose can pass through placenta)
To make glucose available for fetal development

2. Pituitary Gland
Anterior: prolactive - production of milk
Posterior: oxytocin - uterine contraction and milk/let down reflex
Psychological Changes
First Trimester

Acceptance of Pregnancy: ambivalence (interwoven feelings of wanting and not wanting

the baby)
Second Trimester

Accepting the Baby (over protectiveness)

Third Trimester
Preparing for Baby (nest building activities)
Emotional Responses
9.
Changes in sexual desire
1st TM: decrease sexual desire d/t N&V
2nd TM: increase sexual desire d/t increase of blood to pelvic organs
3rd TM: may be increase or decrease (discomforts/uncomfortable position, myths and
fears)
2. Emotional Lability
Mood changes - extra sensitive d/t hormonal changes
Menstrual Cycle
Hypothalamus

GnRH - secretion of FSH

LHrH - secretion of LH
Anterior Pituitary Gland
FSH - maturation of ova (15-20 egg cells stimulated b y ovaries)
LH - release of mature ova
Ovaries
Triggers LH - dominant Follicle to release Egg (Ovulation: occurs 14 days before onset of
next cycle)
Uterus
Menstrual Phase
(Day 1-5)
Menstrual Flow: 30 to 80 mL (1/4 cup)
Elevated Prostaglandin - contractility - dysmenorrhea
Normal - 28 days
Start - 8 to 9 years old average 10 years(menarche) 50years(menopause)

Proliferative Phase
(Day 6-14)
FSH - ovary - increase estrogen - FSH decrease - LH - ovulation
Estrogenic Phase
Secretory Phase
(Day 15-21)
LH - corpus luteum - increase progesterone - increases capillaries uterus
Inner lying will be corkscrew and twisted
Ischemic Phase
(22-28)
CL will regress - decrease estrogen and progesterone - rupture capillaries - sloughing off
Dysmenorrhea

Mild exercise
Analgesics (otc)

Iron

Warm compress

The Beginning of Lite:

10.
Fertilization
11.
Zygote - mitotic cell division - morula - blastocyst(structure that attaches to
endometrium) - form finger-like projections - chorionic villi sampling
Risks if Chorionic Villi Sampling
12.
Bleeding
13.
Infection
14.
Leaks of AF
Fetal Growth Development
Week 3: trachea and esophagus - single vessel TEFistula
Week 4: trachea and esophagus begins to separate; spinal chord
Week 8: organogenesis/chromosomal analysis (sex)
Fetal outline: ultrasound
Week 10 - 12: fetal heart sounds - doppler
Week 11: fetus movement - ultrasound
Week 12: urine forms
Week 16: fetal heart sound (stethoscope), lanugo/meconium, amniotic fluid (urine
excreted) 800-1,200mL (<400 oligoH) (>2,000 polyH)
Amniotic fluid - swallowed by fetus - esophagus block: e.atresia,

Sex- ultrasound
Week 20: brown fat/vernix caseosa, quickening
Week 24: surfactant (lungs)
Week 28: alveoli, capillaries
Week 32: subq fat begins to form
Pre-Term

Pre 37 weeks

Premature lungs

Prone to infection
Poor muscle term

Prominent lanugo
Post-Term

Post 42 weeks

Parchment like skin

Produce long fingernails

Prominent scalp hair

Progressive placental insufficiency

Age of Gestation
Nagele's Rule: EDC
- 3 months + 7 days
Ex.
LMP: March 13 - March 18
Dec 20

Obstetric History
Gravida - # of pregnancy
Para - # reached viability (alive or not)
* twins as 1
T - > 37 weeks
P - < 37 weeks
A - miscarriages
L - ive
M - ultiple (twins)

Pre-Natal Visits
Standards
q 4 weeks = 4-28 week gestation
q 2 weeks = 28-36 week
Weekly = 36 to birth
Weight gain
25-35 lbs
1lb/month:1st trimester
1lb/week: 2nd and3rd trimester

Signs and Symptoms

Presumptive

Probable

Positive

- subjective
- amenorrhea
- breast changes
- nausea and vomiting
- quickening

- objective
- (+) by HCG laboratory test
- abdominal changes
- Hegar's sign
- Goodel's
- Ballotement
- chadwick's sign
- braxton hicks contraction

- fetal parts
- ultrasound and xray
- fetal heart rate

Laboratory Studies
Alpha Fetoprotein
- a substance produced by the fetal liver that is present in amniotic fluid and maternal
serum
- done at 15 to 18 week gestation
MSAFP
- elevated: neural tube defects - spina bifida; abdominal wall defects
- decreased: chromosomal defect - down syndrome
Ultrasound

Age of gestation
Biophysical Profile
- Af volume

- fetal movement
- fetal breath
- fetal tone
- fetal reactivity

Complications

Delivery Estimation

Establish position, sex of baby

15.

Abdominal
- full bladder
- supine with pillow under right buttocks
2. Transvaginal
- empty bladder
- dorsal lithotomy
Amniocentesis
- aspiration of amniotic fluid
- empty bladder
- sonogram must be done first (determine location of fetus)
- color of amniotic fluid (green: meconium stain; yellow: increased bilirubin and Rh
incompatibility - RHogam)
- lung maturity: shake test (bubbles will appear - L:S ratio 2:1) done 35 weeks of gestation
- chromosomal analysis: 14-16 weeks
- complications
Amniotic Fluid Embolism - clot - pulmonary artery (DOB); CNS (alteration LOC)
Bladder puncture - hematuria
Check infections
Assessment of Fetal Well Being

Fetal Kicks
Fetal movements
- increase: mother is eating/loud noise/increase activity of mother
- decrease: intake of nicotine/placental insufficiency
Carefully sit/side lying
Kick normally occurs twice every 10 mins. (10-12/hr)

Results:
16.
<10 -repeat
17.
<3 - notify doctor
18.
>12 - fetal distress

Non Stress Test

- fetal heart rate
Increases: fetus moves (acceleration)
Decreases: uterine contractions (deceleration)
Apply Fetal Monitor
By left side lying
Carefully press button (movements)
Reactive: normal result