Maternal Adaptation During Pregnancy

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Maternal Adaptation During Pregnancy
2010-04-21 22:09:47
system changes

Maternal - Newborn Concepts
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  1. Uterus changes
    • -increase size to 20x that of nonpregnant size
    • -weight increases from 2 oz. to about 2 lbs. at term
    • -walls thin to 1.5 cm or less from a solid globe to a hollow vessel
    • -volume capacity increases from 2 tsp to 1 gallon
    • -1/6 total maternal blood volume is contained within the vasculat system of the uterus by term
  2. Ovarian Changes
    • -cease ovum production
    • -corpus luteum persists til 12 weeks to secrete progesterone until the placenta takes over
  3. Vaginal Changes
    • -increased vascularity & hyperplasia (increase in the number of normal cells in a tissue or organ)
    • -increased vaginal secretions & decreased pH to prevent infections
  4. Cervical Changes
    • -increased mucous froms plug to seal off the cervix
    • -softens b/c of progesterone
  5. Breast Changes
    • -increase in size & nodularity to prepare for lactation (~1-1.5 lbs each)
    • -Nipples increase in size, become more erect & more pigmented
    • -Colostrum is produced - antibody-rich yellow fluid that can be expressed after the 12th week
  6. Cardiovascular Changes
    • -Blood Volume increses rapidly in 2nd trimester (25-30 weeks)
    • -continues into 3rd trimester, reaching 40-45% above nonpregnant levels
    • -plasma volume increases 50%
    • -erythrocytes increase 30%
    • -physiologic anemia of pregnancy (pseudoanemia) b/c plasma increases more that RBCs
    • -Clotting factor changes: fibrin and fibrinogen increase
    • -BP decreases during 2nd trimester - gradually increases to prepregnant level by end of 3rd trimester
    • -Increased supine hypotensive syndrom - when you lie on your back the baby obstructs the great vessels - left lateral position (LLP) is best for perfusion to the baby
  7. Respiratory Changes
    • -Increased O2 needs
    • -Increased air volume exchange
    • -Growing uterus elevates diaphragm - SOB esp when sitting (26-27 weeks)
    • -Rate increases as pregnancy progresses
  8. GI Tract Changes
    • -Reflux of gastric contents common due to relaxation of smooth muscles by progesterone
    • -Ptyalism (excessive salivation) is a common condition of pregnant women
    • -Decrease in intestinal motility causes constipation
    • -N&V (morning sickness) is due to high hCG levels from 6-12 weeks
    • -Appearance/aggrevation of hemorrhoids
    • -Metalic taste in the mouth
  9. Renal Changes
    • -Urinary frequency
    • -Glomerular Filtration Rate (GFR) - increases by 50% by 2nd trimester and remains elevated until delivery
    • -Renal tubular reabsorption - increases during 2nd and 3rd trimester
    • -Glucosuria: if present may indicate development of gestational diabetes - should not eliminate glucose, protein or ketones
  10. Skin & Hair Changes
    • -Darkening of already dark areas: nipples, areola, vulva, perineal area
    • -Linea Nigra: pigmented line along middle of abdomen from umbilicus to above pubic area
    • -Chloasma: darkened spots on face = mask of pregnancy
    • -Striae
    • -Vascular Spider veins
    • -Hyperactive sebaceous glands
  11. Endocrine Changes
    Thyroid gland enlargement, pancreas, anterior pituitary
  12. Metabolism Changes
    • -CHO metabolism altered
    • -BMR increases
  13. Musculoskeletal Changes
    • -Pelvic joints relax = waddling gait
    • -Lumbodorsal spinal curve
    • -due to increased size of uterus, may result in backache
    • -Diastasis Recti: separation of abdominal muscles from pressure of enlarging uterus on abdominal muscles
  14. Mobility Changes
    • -gait changes
    • -center of gravity shift esp in late 2nd and 3rd trimester
  15. Psychological Response to Pregnancy
    • -Ambivalence
    • -Introversion
    • -Acceptance
    • -Mood Swings