PHYSIOLOGIC ADAPTATIONS TO PREGNANCY
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Transcript of PHYSIOLOGIC ADAPTATIONS TO PREGNANCY
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PHYSIOLOGIC ADAPTATIONS TO PREGNANCY
Developed by D. Ann Currie, R.N., M.S.N.
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REPRODUCTIVE SYSTEM• UTERUS• CERVIX• VAGINA• BREASTS
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REPRODUCTIVE SYSTEM• UTERUS-ENLAREMENT DUE TO
INCREASE ESTROGEN AND PROGESTERONE
• INCREASE VASCULARITY• HYPERPLASIA• HYPERTROPHY
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Nonpregnant Uterus
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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)
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Uterine Growth
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CERVIX• INCREASE VASCULARITY AND
HYPERTROPHY DUE TO ESTROGEN AND PROGESTERONE
• CHADWICK’S SIGN• GOODELL’S SIGN• MUCORRHEA DEVELOPS- MUCOUS
PLUG FORMS
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Bimanual Examination
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Hegar's sign
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Ladin’s Sign
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B Sign
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Pisacek’s Sign
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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)
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BREASTS• BREAST CHANGES ARE DUE TO
ESTROGEN AND PROGESTERONE• INCREASE
VASCULARITY,NODULARITY,AND HYPERTROPHY
• PIGMENTATION OF NIPPLES DARKEN• MONTGOMERY’S GLANDS BECOME
PROMINENT
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BREASTS• CONT• COLOSTRUM IS PRODUCED AND
MAYBE SECRETED AS EARLY AS 16 WEEKS
• BREAST FEEL FULL,INCREASE SENSITIVITY,TINGLELY,AND HEAVY.
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BREAST CHANGES
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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
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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
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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%
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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
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Supine Hypotension from pressure on the vena cava
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RESPIRATORY SYSTEM• INCREASED CHEST EXPANSION• DIAPHRAGM DISPLACED AS MUCH AS
4CM.• INCREASED VASCULARITY AND
SECRETION OF MUCOUS MEMBRANES
• RESPIRATORY RATE INCREASES 2 BPM
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RESPIRATORY SYSTEM • CONT• TIDAL VOLUME INCREASES 30-40%• VITAL CAPACITY UNCHANGED• INSPIRATORY CAPACITY INCREASES• EXPIRATORY VOLUME DECREASES• TOTAL LUNG CAPACITY
UNCHANGED OR SL.DECREASE.
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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)
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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%
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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
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INTEGUMENTARY SYSTEM
• HYPERPIGMENTATION OF NIPPLES,AREOLAE, AXILLAE, AND VULVA
• CHLOASMA• LINEA NIGRA• STRIAE GRAVIDARUM• ANGIOMAS
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Linea Nigra
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STRIAE GRAVIDARUM
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INTEGUMENTARY SYSTEM• CONT.PALMAR ERYTHEMA• HYPERACTIVE SWEAT AND
SEBACEOUS GLANDS• SKIN DISORDERS MAY INCREASE-
INCLUDING PRURITUS AND ACNE• HAIR GROWTH INCREASES
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GASTROINTESTINAL SYSTEM• GUMS-INCREASE
VASCULARITY,HYPEREMIC, SPONGY AND SWOLLEN
• EPULIS• PTYALISM• N/V-”MORNING SICKNESS”• HIATAL HERNIA MAY OCCUR IN 15-
20%PREGNANT CLIENTS
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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
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GASTROINTESTINAL SYSTEM• COLON IS COMPRESSED AND
DISPLACED.• APPETITE CHANGES
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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
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POSTURAL CHANGES IN PREGNANCY
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Diastasis Recti Abdominis
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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
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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
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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
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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
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ENDOCRINE SYSTEM• ADRENAL GLANDS-INCREASED
ALDOSTERONE LEVELS,INCREASED CORTISOL LEVELS
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ENDROCRINE SYSTEM• PLACENTA-PRODUCES ESTROGEN
AND PROGESTERONE• RELAXIN• HUMAN PLACENTAL LACTOGEN• INSULINASE
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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
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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
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