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Chapter: 12th Nursing : Chapter 7 : Midwifery Nursing

Maternal Physiological Changes During Pregnancy

Physiological changes during pregnancy.

Maternal Physiological Changes During Pregnancy

Physiological changes during pregnancy.

Genital Organs

Vulva- Vulva becomes oedematous. Labia minoria are pigmented and enlarged.

Vagina- Vaginal walls becomes oedematous, Because of more blood supply, the vaginal walls mucosa looks in bluish colour.

Uterus- The uterus which in non-pregnant state, weighs about 60 gm, during pregnancy uterus increases in size upto 10-12kgs.

Cervix- Softening of the cervix is evident at 6 weeks. It occurs due to fluid accumulation inside the fibros tissue of the cervix and increased vascularity.

Other Organs

Fallopian tube- The total length is increased. The tube becomes congested.

Ovary- Both the ovarian and uterine cycles of the normal menstruation remain suspended.

Changes In Breast

In early pregnancy the women feel fullness of breast or tingle and increase in size as pregnancy progresses. The areola of the nipples darkens and the diameter increases. The Montgomery’s glands (the sebaceous glands of the areola) enlarge and tend to protrude. The surface vessels of the breast may become visible due to increased circulation. By the 16th week (2nd trimester) the breasts begins to produce colostrum. It is a thin, watery, yellowish secretion which thickens as pregnancy progresses. Colostrum may leak from breasts.

Changes In Skin

Skin changes occurs due to increased secretion of Melanocyte Stimulating Hormone (MSH) from pituitary.

Face- There is an extreme form of pigmentation present around the cheeck, forehead and around the eyes. It is called as chloasma gravidarum or pregnancy mask.

Abdomen- A brownish black pigmented line appears on the abdomen stretching from the Xiphisternum to the symphysis pubis. It will disappear after delivery (Linea Nigra).

Striae gravidarum-It is a specific form of scarring of the abdominal skin area due to rapid expansion of the uterus. It looks pinkish in first pregnancy, in subsequent pregnancy both pinkish and white striae are visible (Striae albican).

Maternal Weight Gain

The total weight gain during the course of a singleton pregnancy for a healthy woman averages 11kg. 1kg in first trimester (1-3 months). 5 kg each in second (4-6 months) and third trimester (7-9 months).

Ideally the weight gain depends on pre-pregnancy body mass index (BMI) level. Weight gain for a woman with normal BMI (20-26) is 11 to 16kg. An obese woman (BMI>29) should not gain more than 7 kg. Where as an underweight woman (BMI<19) may be allowed to gain upto 18kg.

Maternal weight gain 6 kg

·  Increase blood volume 1.3 kg

·  Increase in extracellular fluid 1.2 kg

·  Accumulation of fat and protein 3.5 kg

Reproductive weight gain 6 kg

·  Fetus 3.3 kg

·  Placenta – 0.6 kg

·  Liquor (amniotic fluid)-0.8 kg

·  Uterus-0.9 kg

·  Breast – 0.4 kg

Systemic Changes

Respiratory System:

Because of enlargement of the uterus, there is an elevation of the diaphragm and breathing becomes diaphragmatic. Upper respiratory tract mucosa becomes congested. The respiratory rate rises to from 18 to 20 breathes per minute to meet demand of fetus. Decreased functional residual capacity 1.7 to 1.35 litres due to the compression of the diaphragm by the uterus.

Cardiovascular Changes:

The heart enlarges by 70 to 80ml due to small increase in wall thickness and venous filling. Cardiac output increases from 4.5 - 6.0 litre/min. Heart rate increases from 70bpm in non-pregnant state to 78bpm at 20 weeks gestation and a peak around 85 bpm in late pregnancy.

Haematological Changes

Blood volume increases by 40-50% at 30-32 weeks of pregnancy. It causes Haemodilution. Haematocrit decreases. The number of white blood cells (which fight against infection) increases slightly during pregnancy. Blood plasma volume increases to the extent of 1.25 litres (Non pregnant plasma volume is 2500 ml, increase about 3750ml during pregnancy.

Urinary System

·  Glomerular filtration rate (GFR) is increased by 50% all throughout pregnancy. Frequency of micturation is a common symptom of early pregnancy. This is due to changes in pelvic anatomy. A degree of hydronephrosis and hydroureter exist. These result from the loss of smooth muscle tone due to the progesterone, aggravated by mechanical pressure from the ureters at the pelvic brim.

·  Vesicoureteric reflux is also increased. These changes predispose to urinary tract infection.

·  Glycosuria of mild degree in 35% to 50% of all pregnant woman. Increased glomerular filtration leads to more sugar reaching the tubules that can be reabsorbed.

Gastrointestinal System

·  The gums become congested and spongy and may bleed to touch.

·  Relaxation of lower oesophageal sphincter produces regurgitation and heart burn.

·  Slight reduction in gastric secretion and diminished gastric motility result in slow emptying and more effective pulping of food and causes nausea.

·  Reduced motility of large intestine increased time for water reabsorption which leads to induce constipation.

Nervous System

·  There may be generalised neuritis probably due to Vitamin B1 (Thiamine) deficiency.

·  Compression of the median nerve underneath the carpal ligament over the wrist joint, leading to pain in the hands and arm called CARPAL TUNNEL SYNDROME may appear in late pregnancy.

Nausea, vomiting, mental irritability and sleeplessness due to some psychological background.

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12th Nursing : Chapter 7 : Midwifery Nursing : Maternal Physiological Changes During Pregnancy |

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