Physiological And Psychological Changes Of Pregnancy

Fakulti Kejururawatan

Physiological and Psychological Changes Of Pregnancy

Puan Nor Marini Bt. Ibrahim

Physiologic Changes In Pregnancy

Physiologic Changes In Pregnancy Objectives: On completion of this topic, the student will be able to do the following:  Describe the physiological changes during pregnancy

Changes In Reproductive System Uterus  Development of new fibro-elastic tissue between hands of muscles  Hypertrophy of the myometrial cells which stimulates by estrogen  Increased in size – weight increases from 70 gm to 1100 gm  By end of pregnancy, 1/6 total maternal blood volume is circulating through the uterus. Blood flow at term is 500 – 700 ml/min  At the end of pregnancy it measures about 28x24x21cm Cervix  Becomes more vascular and edematous – Chadwick’s sign (bluish) – Goodell’s sign (softening of the cervix) 

Changes In Reproductive System – con’td

Vagina  Estrogen causes a thickness of the vagina mucosa, a loosening of the connection tissue and increase in vagina secretions  Increased in white vaginal discharge throughout pregnancy due to estrogen  Increased acidity (pH 3.5 to 6.5) is due to the production of lactic acid from glycogen in the vaginal epithelium by action of Lactobacillus acidophilus  The acid pH helps prevent bacteria infection but Favors growth of moniliasis (yeast infection)  The vagina may show blue-purple color as the cervix due to increase

Breast Changes  During

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pregnancy, the breasts increase in size & sensitivity; pigmentary changes (arcola and nipple darkening) and striae may be observed. The breast enlarge & become more nodular as the glands increase in size Preparing for lactation Colostrum, an antibody-rich yellow secretion, may leak or be expressed from the

Intergumentary Changes Skin Changes Increase in skin pigmentation are thought to be stimulated by increased estrogen, progesterone & melanocyticstimulating hormon  Chloasma  Linea Nigra  Striae Gravidarum  Increase pigmentation

Gastrointestinal Changes 

Nausea/Vomiting due to hCG

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Gastric tone and motility decrease, slowing of the gastric”s emptying time and possibly causing regurgitation with bile reflux

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Relaxation of cardiac sphineter – heartburn may occur due to reflux of acidic secretions into the lower esophagus.

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Colon motility decreased and this leads to greater water absorption, which may predispose patient to constipation

Respiratory Changes 

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Changes occur to meet the increased oxygen requirements for fetus & all maternal body system The volume of air breathed each minute increases 30%-40% Oxygen consumption increases Respiratory rate increases No change in vital capacity Dyspnea at rest toward end of pregnancy due to enlargement of the uterus, presses the diaphragm Diaphragm is displaced > SOB

Cardiovascular Changes 

Increased in blood volume 30 – 50% – occurs gradually and peaks at 28 – 32 weeks – adequate exchange of nutrients

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Increase in cardiac output 30 – 50% , reaching its maximum at 20-24 week’s gestation and continuing at this level until term – pulse rate increases – BP ; a little changes in systolic, but diastolic pressure is reduced (5-10 mmHg) from about 12-26 weeks.

Hematologic Changes  

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Plasma volume increases by about 50% RBC volume increases by about 30%. The result is the concentration of Hgb and erythrocytes may initially decline Physiologic anemia caused increase in plasma volume 50% and lesser increase in red cell mass WBC count increases during pregnancy Platelet count decreases, but stays within normal limits Coagulation system : In pregnancy as a “hypercoagulable state” and serious thromboembolic disease is more common in pregnancy

Endocrine Changes     

Placenta produces: estrogen progesterone hCG hPL

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Pituitary: decreased FSH and LH increased prolactin secretes Oxytocin

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thus results in: anovulation lactation increased pigmentation

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Thyroid: increased vascularity hyperplasia increased Basal Metabolic Rate (BMR) increased O2 consumption Pancreas (early pregnancy): there is decrease in insulin production related to increase fetal demands after 1st trimester, increase in insulin production related to insulin antagonist

Urinary Tract Changes 

Bladder capacity decreases due to compression from gravid uterus and results in urinary frequency (1st trimester and again in near term).

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Hypertrophy of the bladder walls as pregnancy progresses, and results in edema of the bladder tissues and causes it more susceptible to trauma and infection during labor and birth

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Dilatation of kidneys and ureters may occur due to the position of uterus during pregnancy as a result of increased blood volume and enlargement of their interstitial spaces

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Clinical consequences – statis of urine and increased susceptibility to urinary tract infections (UTIs) throughout pregnancy.

Skeletal Changes

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Relaxation and softening of the pelvic ligaments and joints related to hormone relaxin

Psychological Response To Pregnancy         

Attitude depends on: Environment Social Cultural Family Individual Accept pregnancy Accept the baby Prepare fot parenthood

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