Adaptation of the body during pregnancy

By
Dr. Ahmed

Adaptations to pregnancy
These adaptations are attributed to;
The hormones of pregnancy
Mechanical pressures arising from the enlarging
uterus
Other issues.
These adaptations;
Protect the woman`s normal physiologic functioning
Meet the metabolic demands pregnancy imposes on
her body
Provide a nurturing environment for fetal development
and growth.

The

pregnant woman, her partner and

family must all adjust to the reality of
pregnancy and anticipated new roles as
mother, father, grandparent or sibling.

Body systems affected by pregnancy

Other body systems
oCardiovascular
oRespiratory
oUrinary
oGastrointestinal
oMusculoskeletal
oIntegumentary
oMetabolic changes
oEndocrine
oImmunological

Reproductive system
oUterus
oCervix
oOvaries and fallopian
Tubes
ovagina
oVulva
oBreast

Uterus:
The

phenomenal uterine growth in the first trimester is

simulated by high levels of estrogen and progesterone.
Size: increase to 20 times of its non-pregnant size due
to increased vasculariy, hyperplasia and hypertrophy.
Weight: increase from 50 grams 1000 grams.
Volume: increases from less than 10 ml to 5000 ml.
Contraction: Braxton Hicks sign ( irregular, painless
intermittent uterine contraction).
Shape: changes from that of an inverted pear to that
of soft globular or spherical. Later it become ovoid and
rises out of the pelvis into the abdominal cavity.

-Uterus: continue
Cervix:
1. Goodells sign; softening of
cervix
2. Operculum ( mucus plug)

Ovaries

and fallopian tubes:

Involution due to suppression of FSH

:Vagina
Chadwicks sign;

bluish color, cervix,

vagina
Hypertrophy and hyperplasia
Leukorrhea

, acid pH 3.5 to 6 (a
whitish or yellowish discharge of
mucus from the vagina).

Vulva:
Increased

vascularity
Fat deposition causes labia majora to
close and partially cover introitus.

:Breasts
3-4

weeks: prickling, tingling sensation

6 weeks: developing ducts and glands
8 weeks: bluish surface veins are visible
8-12 weeks: Montgomerys glands become
more prominent, primary areola become
darker.
16-18 weeks: colostrum expresses.
Secondary areola appears.

Adaptation of other body

systems

:Cardiovascular system
Slight

enlargement of myocardium
Shift in chest contents:
- Heart is displaced upwards and to the left
Heart rate increases by 10 to 15 b/m
Blood volume increases 40-50%
physiological anemia
Hemoglobin and hematocrit decrease in
relation to increased plasma volume
Cardiac output increases by 30% during the 1 st
and 2nd trimesters.

Respiratory system:
The

upper respiratory tract becomes more

vascular in response to estrogen that can result
in nasal stuffiness, epistaxis, voice changes,
impaired hearing and a sensation of fullness in
the ears..
Enlarged uterus
prevent the lungs
from expanding
shortness of breath.
Basal metabolic rate increases and oxygen
requirement increases by 30 to 40 ml\min.

Urinary system:
Frequency

of micturition due to pressure

of the growing uterus.
Decreased bladder capacity and bladder
tone.
Renal functions changes:
Changes occur to accommodate an increased
workload while maintaining stable electrolyte
balance.
Increased glomerular filtration rate.
Glucosuria may occur.

:Gastrointestinal system
Gums

become hyperemic and have a tendency to

bleed.
Ptyalism is seen in some women.
Smooth

muscle relaxation occurs related to increased

progesterone production; this can cause:
Decreased peristalsis and constipation.
Heartburn, slowed gastric emptying and esophageal regurgitation.
Hemorrhoid from the pressure of the gravid uterus.

Appetite

usually increases, after a temporary

decrease due to nausea and vomiting.(morning
sickness).

Musculoskeletal system:
Alteration in posture can result in
lordosis ( waddling gait due to increased
level of progesterone and relaxing
hormone).
Diastasis recti is associated with enlarged
uterus in some women.
Relaxation and increased mobility of
joints occur because of the relaxing
hormone.

A, Normal position in no pregnant woman. B,

.Diastasis recti abdominis in pregnant woman

Integumentary system
(cutaneous changes)
Chloasma

is the brownish mask of

pregnancy.

Nipples,

areolae, axilae, vulva and

perineum all darken.
Striae graviderium ( stretch marks)
appear on the breasts and abdomen.

Striae gravidarum,

Metabolic changes:
Increase

metabolic rate.
Increase the demands for carbohydrate,
protein and minerals.
Weight gain of 9-11 kg.
Water requirement is increased to supply
fetus, placenta and amniotic fluid.

Endocrine system:
FSH

and LH production is suppressed.

Thyroid gland enlarges, resulting in increased iodine
metabolism.
Pancreas: Insulin production is increased throughout
pregnancy to compensate for placental hormone insulin
antagonism.
Ovaries produce:
Estrogen
Progesterone
Relaxing hormone.
Relaxing can regulate the mothers cardiovascular and renalsystems to help them adapt to the increase in demand for oxygen
.and nutrients for the foetus

Immunological system:
Resistance

to infection is decreased.
Maternal IgG levels are decreased.
Maternal IgM levels remain unchanged.

Pregnancy signs and symptoms

Presumptive evidence: woman reports

Signs:
Amenorrhea.
Breast

changes.
Chloasma and lina nigra.
Chadwicks sign; bluish color of the
cervix during pregnancy.
Abdominal enlargement and striae.

1.Presumptive evidence:
continuedSymptoms:
Nausea

and vomiting
Urinary frequency
Weight gain
Constipation
Fatigue
Quickening
Breast tenderness, tingling, and heaviness.

2.Probable evidence : Noted by examiner

Goodells

sign - softening of cervix

Chadwicks sign - bluish color, cervix, vagina
Hegars sign - softening of lower uterine segment
Enlarged abdomen
Pigmentation changes
Stretch marks
Ballottement- A method of diagnosing pregnancy,
in which the uterus is pushed with a finger to feel
whether a fetus moves away and returns again.
Positive pregnancy test
Palpation of fetal outline

.Figure74Hegarssign,asofteningoftheisthmusoftheuterus,canbedeterminedbytheexaminerduringavaginalexamination

3. Positive ; Noted by examiner - only

caused by pregnancy;
Hearing

of fetal heart rate.

Fetal movement palpable by the
examiner
Fetal parts felt by examiners.
Visualization of the fetus by
ultrasound.