maternal adaptation power point

8/9/2019 Maternal Adaptation Power Point

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MATERNAL ADAPTATIONS TOMATERNAL ADAPTATIONS TOPREGNANCYPREGNANCY


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THE REPRODUCTIVE ORGANSTHE REPRODUCTIVE ORGANS

UTERUSUTERUSChanges in Uterine Measurement:Changes in Uterine Measurement:

PregnancyPregnancy TermTermPregnancyPregnancyWeight Weight 50 gm50 gm 1100 gm1100 gmThicknessThickness 2 cm2 cm 0.5 cm0.5 cmLengthLength 6.5 cm6.5 cm 32 cm32 cmDepthDepth 2.5 cm2.5 cm 20 cm20 cmWidthWidth 4 cm4 cm 24 cm24 cmCapacityCapacity 10 ml10 ml 5000 ml5000 ml


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Dex trorot a tion of t he u t e ru s :Dex trorot a tion of t he u t e ru s : as theas the

uterus rises out of the pelvic cavity afteruterus rises out of the pelvic cavity after12 weeks gestation, it rotates to the right 12 weeks gestation, it rotates to the right because of the presence of rectosigmoidbecause of the presence of rectosigmoidon the left side of the pelvis. As it growson the left side of the pelvis. As it growslarger and occupy much of t he space inlarger and occupy much of t he space inthe abdominal cavity, the uterus displacesthe abdominal cavity, the uterus displacesthe intestines to the sides of thethe intestines to the sides of the

abdomen.abdomen.


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Loc a tion of t he fu nd u s :Loc a tion of t he fu nd u s :

12 weeks12 weeks at the level of symphisis pubisat the level of symphisis pubis16 weeks16 weeks halfway between symphisis pubishalfway between symphisis pubis

and umbilicusand umbilicus20 weeks20 weeks at the level of umbilicusat the level of umbilicus24 weeks24 weeks two fingers above umbilicustwo fingers above umbilicus30 weeks30 weeks midway between umbilicus andmidway between umbilicus and

xiphoid processxiphoid process

36 weeks36 weeks at the level of xiphoid processat the level of xiphoid process40 weeks40 weeks two fingers below umbilicus,two fingers below umbilicus,

drops at 34 weeks level becausedrops at 34 weeks level because

of lighteningof lightening


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Contr a ctility :Contr a ctility : Being muscular, the uterusBeing muscular, the uterus

is a highly contractile organ. Beginning onis a highly contractile organ. Beginning onthe first trimester, the uterus undergoesthe first trimester, the uterus undergoesirregular contractions. Late in pregnancy,irregular contractions. Late in pregnancy,these contractions, known asthese contractions, known asBraxton_Hicks, become more intense andBraxton_Hicks, become more intense andfrequent causing some discomfort on thefrequent causing some discomfort on thepregnant woman. It is the cause fo falsepregnant woman. It is the cause fo false

labor.labor.


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CERVIXCERVIX

Color :Color : Color of cervix change from pinkish toColor of cervix change from pinkish topurplish due to increased blood supply.purplish due to increased blood supply.Leuk orr hea:Leuk orr hea: Estrogen stimulation results inEstrogen stimulation results inincrease mucus production. Formation of increase mucus production. Formation of operculum, the mucus plug of cervix that operculum, the mucus plug of cervix that protects against bacteria and infection.protects against bacteria and infection.Discharge of operculum at term, called show, isDischarge of operculum at term, called show, isin an important sign of labor.in an important sign of labor.Consist e ncy :Consist e ncy : Softening of the cervix, known asSoftening of the cervix, known asGoodel s sign is observable by 6 to 8 weeksGoodel s sign is observable by 6 to 8 weeksgestation.gestation.


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ISTHMUSISTHMUSDuring pregnancy, the isthmus softens and elongatesDuring pregnancy, the isthmus softens and elongates

up to 25 mm. it will later from the lower uterineup to 25 mm. it will later from the lower uterinesegment together with the cervix.segment together with the cervix.Hegar s signHegar s sign softening of the lower uterine segment softening of the lower uterine segment begins as early as 5 weeks gestation.begins as early as 5 weeks gestation.

VAGINA VAGINAIncrease blood supply results in:Increase blood supply results in:Chadwick signChadwick sign vaginal mucosa change in color fromvaginal mucosa change in color frompinkish to purplish or darkpinkish to purplish or dark- -bluishbluishIncreased sentivity and heightened sexualIncreased sentivity and heightened sexualresponsiveness.responsiveness.

Vaginal ph: 3.5 to 6, Acidic Vaginal ph: 3.5 to 6, AcidicThe vaginal tissues become soft to allow for easierThe vaginal tissues become soft to allow for easierdistension during labor.distension during labor.


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OVARIESOVARIESNo graafian follicies develop and no ovulation occursNo graafian follicies develop and no ovulation occurs

during pregnancy.during pregnancy.Corpus luteum pf pregnancyCorpus luteum pf pregnancy the corpus luteum isthe corpus luteum isthe chief source of luteum also procedures relaxin,the chief source of luteum also procedures relaxin,inhibin and sometimes oxytocin.inhibin and sometimes oxytocin.

BREASTBREASTIncreased breast size due to alveolar tissue growth,Increased breast size due to alveolar tissue growth,fat deposition and increased vascularity.fat deposition and increased vascularity.Breast changes associated with pregnancy includeBreast changes associated with pregnancy include

feeling of fallness and tingling sensation, darkening of feeling of fallness and tingling sensation, darkening of the skin around the areola, Montgornery glandsthe skin around the areola, Montgornery glandsenlarge and become prominent, nipples stand out. A enlarge and become prominent, nipples stand out. A clear fluid, called colustrum, can be expressed from it clear fluid, called colustrum, can be expressed from it

as early as the fourt month.as early as the fourt month.


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CARDIOVASCULAR SYSTEMCARDIOVASCULAR SYSTEM

BLOOD VOLUME BLOOD VOLUME Total blood volume increase by 45 to 50 % forTotal blood volume increase by 45 to 50 % forwhich 75% is plasma and 25%. Is R BC Unequalwhich 75% is plasma and 25%. Is R BC Unequalproportion in the increase of blood constituentsproportion in the increase of blood constituentsresults in hemodilution and physiologic anemiaresults in hemodilution and physiologic anemiaand lowered hematocrit.and lowered hematocrit.Increase blood volume results in increaseIncrease blood volume results in increase

cardiac output by 25 to 50%.cardiac output by 25 to 50%.The increase in blood volume reaches its peakThe increase in blood volume reaches its peakat about 24 weeks, cardiac workload alsoat about 24 weeks, cardiac workload alsoreaches its peak during the second trimester.reaches its peak during the second trimester.


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BLOOD CONTITUENTSBLOOD CONTITUENTS

There is increased production of R BC by the boneThere is increased production of R BC by the bonemarrow. R BC increase as much as 33% andmarrow. R BC increase as much as 33% andhaemoglobin levels by 15% to compensate for thehaemoglobin levels by 15% to compensate for theincrease in plasma volume.increase in plasma volume.

Hemodilution occurs (increase in plasma portion of theHemodilution occurs (increase in plasma portion of theblood) causing pseudoanemia. The rise of the plasmablood) causing pseudoanemia. The rise of the plasmaprotein levels. Reduction in protein level lowers downprotein levels. Reduction in protein level lowers downosmotic pressure within intravascular spaces whichosmotic pressure within intravascular spaces whichcauses fluid shift from intravascular to interstitialcauses fluid shift from intravascular to interstitialspaces. This contributes to the normal ankle and foot spaces. This contributes to the normal ankle and foot edema of pregnancy.edema of pregnancy.Blood lipids and cholesterols levels increase to provideBlood lipids and cholesterols levels increase to providefor an available supply of energy for the fetus.for an available supply of energy for the fetus.Increased level of clotting factors.Increased level of clotting factors.


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The following are normal duringThe following are normal during

pregnancypregnancy Splitting third sound is due to lowered bloodSplitting third sound is due to lowered blood

viscosityviscosity Systolic murmurs in about 90% of pregnant Systolic murmurs in about 90% of pregnant

womenwomen Diastolic murmur in 20%Diastolic murmur in 20%

Benign pericardial effusion on xBenign pericardial effusion on x- -rayray


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Pulse rate increases about 10 toPulse rate increases about 10 to

15 bears per minute.15 bears per minute. Left ventricular wall massLeft ventricular wall mass End diastolic dimensionsEnd diastolic dimensions Stroke volumeStroke volume Cardiac output Cardiac output


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BLOOD PRESSUREBLOOD PRESSURE Blood pressure remains the same as pregnancy level. It mayBlood pressure remains the same as pregnancy level. It may

drop slightly on the second trimester but returns to normaldrop slightly on the second trimester but returns to normallevels on the third trimester.levels on the third trimester.

Arterial blood pressure is highest in sitting position, Arterial blood pressure is highest in sitting position,intermediate in supine and lowest in left lateral position.intermediate in supine and lowest in left lateral position.

Supine Hypotensive SyndromeSupine Hypotensive Syndrome when the women lies onwhen the women lies onher back, the gravid uterus lies on the inferior vena cavaher back, the gravid uterus lies on the inferior vena cavaand interferes with blood flow from the lower extremities,and interferes with blood flow from the lower extremities,resulting in blood returning to the heart to be greatlyresulting in blood returning to the heart to be greatlyreduced. The extremities, resulting in blood returning to thereduced. The extremities, resulting in blood returning to theheart to be greatly reduced. The decreased amount goingheart to be greatly reduced. The decreased amount goingback to the heart result in decreased cardiac output that back to the heart result in decreased cardiac output that leads to:leads to:

Decreased blood pressureDecreased blood pressureDecreased blood supply to the brain causing dizziness,Decreased blood supply to the brain causing dizziness,faintness, and lightheadednessfaintness, and lightheadedness


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RESPIRATORY SYSTEMRESPIRATORY SYSTEM

Changes in respiratory system during pregnancyChanges in respiratory system during pregnancyare chiefly caused by:are chiefly caused by:

Increased oxygen requirement as the motherIncreased oxygen requirement as the mothermust supply not only for herself but for themust supply not only for herself but for thebaby, too.baby, too.Effect of progesterone and estrogenEffect of progesterone and estrogenMechanical effect of the enlarging uterus.Mechanical effect of the enlarging uterus.


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Hyperventilation:Hyperventilation:

The mother experience hyperventilation inThe mother experience hyperventilation inan effort to blow off the extra carbonan effort to blow off the extra carbondioxide from the fetus. Increaseddioxide from the fetus. Increasedventilation prevents respiratory acidosis,ventilation prevents respiratory acidosis,(accumulation of carbon dioxide in the(accumulation of carbon dioxide in thebody) which is compensated by increasebody) which is compensated by increaserenal excretion of bicarbonate.renal excretion of bicarbonate.


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Displacement of the diaphragm by theDisplacement of the diaphragm by theenlarged uterus up to 4 cm produce theenlarged uterus up to 4 cm produce the

following effectsfollowing effects ::

Chest crowdingChest crowding the women compensates bythe women compensates byexpanding her lungs horizontallyexpanding her lungs horizontallyDecreased residual volumeDecreased residual volume less air is left inless air is left inthe lungs after expiration.the lungs after expiration.

Shortness of breathShortness of breath


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Tidal volume (amount of air inspired)Tidal volume (amount of air inspired)Increased by as much as 40% to meet Increased by as much as 40% to meet

increased oxygen requirements:increased oxygen requirements:

Total body consumption of oxygen increase byTotal body consumption of oxygen increase by

1515--20%.20%.Nasal congestion occurs due to estrogenNasal congestion occurs due to estrogenstimulation. Advice women that this is normalstimulation. Advice women that this is normalduring pregnancy and the there is no need toduring pregnancy and the there is no need totake medications.take medications.


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URINARY SYSTEMURINARY SYSTEM

Urinary frequency during pregnancy is due to:Urinary frequency during pregnancy is due to:First trimesterFirst trimester uterus pressures on the bladderuterus pressures on the bladderas it rises out of the pelvic cavity.as it rises out of the pelvic cavity.Second trimesterSecond trimester pressures on the presentingpressures on the presentingpart on the bladder after lightening.part on the bladder after lightening.

Increased blood flow to the kidney whichIncreased blood flow to the kidney whichincreases glomerular filtration rate in urinary.increases glomerular filtration rate in urinary.


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La ctos u ri a:La ctos u ri a:

Presence of sugar or lactose in the urine isPresence of sugar or lactose in the urine isconsidered normal. Lactose is secreted byconsidered normal. Lactose is secreted bythe mammary glands but since it is not yet the mammary glands but since it is not yet used during pregnancy. It is normallyused during pregnancy. It is normallyspills in the urine.spills in the urine.


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The following are increased duringThe following are increased duringpregnancy:pregnancy:

Increase urinary output as the mother excreteIncrease urinary output as the mother excreteher metabolic waste products and those of theher metabolic waste products and those of thefetus, too. With the increase in the volume of fetus, too. With the increase in the volume of urine, specific gravity decreases.urine, specific gravity decreases.Glomerular filtration rate (G FR) and renal plasmaGlomerular filtration rate (G FR) and renal plasmaflow by as much as 40%.flow by as much as 40%.Concentration of rennin, anglotensin I and II.Concentration of rennin, anglotensin I and II.The kidney increases slightly in size.The kidney increases slightly in size.Greater loss of amino acids and water solubleGreater loss of amino acids and water solublevitamins in the urine of pregnant women.vitamins in the urine of pregnant women.


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Effects of progesterone:Effects of progesterone:Dilatation of the ureters particularly on the right side.Dilatation of the ureters particularly on the right side.Increased urine capacity of t he bladder for about 1,Increased urine capacity of t he bladder for about 1,500 ml. due to decrease bladder tone.500 ml. due to decrease bladder tone.

Increased aidosterone production resulting in sodiumIncreased aidosterone production resulting in sodiumand water retention which causes edema.and water retention which causes edema.Elongation and distention of the ureter which produceElongation and distention of the ureter which producesingle or double curves of varying size.single or double curves of varying size.

Diliatation and kinking of the ureteres due to theDiliatation and kinking of the ureteres due to therelaxavent effect of progesterone and the compressionrelaxavent effect of progesterone and the compressioncaused by the enlarged uterus at the level of thecaused by the enlarged uterus at the level of thepelvic brim leads to urinary statis. Urinary statispelvic brim leads to urinary statis. Urinary statispredisposes the pregnant of infection.predisposes the pregnant of infection.


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Nocturia:Nocturia:

During the day, the pregnant woman tendDuring the day, the pregnant woman tendto accumulate water in the form of to accumulate water in the form of dependent edema. This fluid is mobilizeddependent edema. This fluid is mobilizedand excreted via the kidney (urine) duringand excreted via the kidney (urine) duringthe night.the night.


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G ASTROINTESTINAL SYSTEMG ASTROINTESTINAL SYSTEM

Nausea and vomiting on the first trimester isNausea and vomiting on the first trimester isattributed to:attributed to:

Increased HCG levelsIncreased HCG levelsIncreased estrogen levelsIncreased estrogen levelsDecreased maternal glucose levels asDecreased maternal glucose levels as

glucose levels is being utilized for fetalglucose levels is being utilized for fetalbrain development.brain development.


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Effects of PestrogenEffects of Pestrogen

PtyalismPtyalism increased salivationincreased salivationEpulisEpulis hypertrophy or swelling of thehypertrophy or swelling of the

gums, advise to use soft toothbrush togums, advise to use soft toothbrush toavoid gum bleeding.avoid gum bleeding.


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INTE G UMENTARY SYSTEMINTE G UMENTARY SYSTEM

Increased melanin production:Increased melanin production:During pregnancy, the anterior pituary glandDuring pregnancy, the anterior pituary gland

produces more melanotropin stimulatingproduces more melanotropin stimulatinghormone which stimulates the melanocytes inhormone which stimulates the melanocytes inthe skin to produce more melanin. This resultsthe skin to produce more melanin. This resultsin darker skin coloration in certain parts of thein darker skin coloration in certain parts of thebody.body. MelasmaMelasma facial discolorationfacial discoloration Linea negraLinea negra dark line from umbilicus to symphisis.dark line from umbilicus to symphisis.

Darker areolaDarker areola


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Estrogen effects:Estrogen effects:

Palmar erythemaPalmar erythema redness and itching of redness and itching of the handsthe hands

Vascular Spider Nevi Vascular Spider Nevi prominent prominent capillaries under the skincapillaries under the skinActivation of sweat and sebaceous glands Activation of sweat and sebaceous glandsresult in increased perspiration and oilyresult in increased perspiration and oilyskin.skin.


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ENDOCRINE SYSTEMENDOCRINE SYSTEM

Thyroid GlandThyroid Gland slight enlargement of thyroid gland due to increasedslight enlargement of thyroid gland due to increasedmetabolic rate.metabolic rate.PancreasPancreas elevated glococorticoid levels stimulate increase insulinelevated glococorticoid levels stimulate increase insulinproduction.production.Parathyroid GlandParathyroid Gland enlargement of parathyroid to meet increased needs forenlargement of parathyroid to meet increased needs forcalcium to be utilized for the development of fetal bones and teeth.calcium to be utilized for the development of fetal bones and teeth.Adrenal Gland Adrenal Gland increased corticosteroid production and aldosteroneincreased corticosteroid production and aldosteroneproduction promote sodium reabsorption and water retention.production promote sodium reabsorption and water retention.Pituitary GlandPituitary Gland the pituitary gland enlarges but this is not essential tothe pituitary gland enlarges but this is not essential topregnancy.pregnancy.High estrogen and progesterone levels inhibit LH and FSH production.High estrogen and progesterone levels inhibit LH and FSH production.Increased secretion of growth hormone and melanocyte stimulatingIncreased secretion of growth hormone and melanocyte stimulatinghormone.hormone.Posterior pituitary gland secrete increasing amounts of oxytocin andPosterior pituitary gland secrete increasing amounts of oxytocin andprolactin as pregnancy nears term.prolactin as pregnancy nears term.


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SKELETAL SYSTEMSKELETAL SYSTEM

Softening of joints and ligaments,Softening of joints and ligaments,especially of symphisis and sacroiliac jointsespecially of symphisis and sacroiliac jointsis caused by relaxin and estrogen.is caused by relaxin and estrogen.Leg cramps is caused by pressure of Leg cramps is caused by pressure of gravid uterus on nerves and imbalance of gravid uterus on nerves and imbalance of calc ium in the body.calc ium in the body.


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SI G NS AND SYMPTOMS OF SI G NS AND SYMPTOMS OF PRE G NANCY PRE G NANCY

PRES UMPTI VE SI G NS PRES UMPTI VE SI G NS S ym p toms S ym p toms

Amernorrhea

Amernorrhea pregnancy is suspected if more thanpregnancy is suspected if more than10 days have elapsed since the expected menstrual10 days have elapsed since the expected menstrual

period.period.Breast changesBreast changes starting on the fourth week of starting on the fourth week of pregnancy, breast enlarge, feels tender and heavy,pregnancy, breast enlarge, feels tender and heavy,veins become prominent under the skin, areola getsveins become prominent under the skin, areola getsdarker and wider, nipple stand out and Montgomerydarker and wider, nipple stand out and Montgomeryglands become prominent.glands become prominent.


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QuickeningQuickening the first fetal movement felt bythe first fetal movement felt bythe mother, felt by primis at 30 weeks andthe mother, felt by primis at 30 weeks and

multis at 16 weeks.multis at 16 weeks.Easy, fatigability.Easy, fatigability.LeukorrheaLeukorrhea increase vaginal dischargeincrease vaginal dischargecharacterized as white mucoid is due tocharacterized as white mucoid is due to

elevated estrogen levels.elevated estrogen levels.Nausea and vomiting/Morning sicknessNausea and vomiting/Morning sickness commences 6 weeks after the LMP andcommences 6 weeks after the LMP andpersists believed to be caused by elevatedpersists believed to be caused by elevated

HCG levels.HCG levels.Chadwick s signsChadwick s signs Increase blood supplyIncrease blood supplyresults in purplish discoloration of the vaginaresults in purplish discoloration of the vagina


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Skin changes:Skin changes:

Striae gravidumStriae gravidum Linea negraLinea negra CholoasmaCholoasma Increased perspirationIncreased perspiration Hair grows more rapidlyHair grows more rapidly


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PRO B ABLE SIGNSPRO B ABLE SIGNSHegar s SignHegar s Sign softening of the lower uterinesoftening of the lower uterinesegment which is felt starting 6 to 8 weeks aftersegment which is felt starting 6 to 8 weeks afterLMP.LMP.Uterine GrowthUterine Growth the uterus doubles in sizes as earlythe uterus doubles in sizes as earlyas 10 weeks and pregnancy becomes obvious by 14as 10 weeks and pregnancy becomes obvious by 14weeks. Uterine growth is determined by measuringweeks. Uterine growth is determined by measuringfundal height.fundal height.Ballotement Ballotement refers to the rebound that occursrefers to the rebound that occurs

when the examiner s fingers tap the floating fetuswhen the examiner s fingers tap the floating fetuswithin the uterus and caused by the fetus floatingwithin the uterus and caused by the fetus floatingaway and returning back to its previous position.away and returning back to its previous position.Ballotement is observable beginning 6 to 8 weeks.Ballotement is observable beginning 6 to 8 weeks.Uterine suffleUterine suffle a muffled swishing sound heard overa muffled swishing sound heard overthe abdomen in union with the mother s heart beat.the abdomen in union with the mother s heart beat.


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Positive pregnancy testsPositive pregnancy tests it is presenceit is presenceof HCG in the woman s blood and urineof HCG in the woman s blood and urinethat gives a positive result to athat gives a positive result to apregnancy test. HCG production most pregnancy test. HCG production most probably begins at the time of probably begins at the time of implantation. Highest level at 100implantation. Highest level at 100- -130130days of pregnancy. HCG is present days of pregnancy. HCG is present beginning 24 to 46 hours afterbeginning 24 to 46 hours afterimplantation. The earliest time that it canimplantation. The earliest time that it canbe detected in maternal serum is:be detected in maternal serum is:

8 days after ovulation8 days after ovulation 23 days after LMP23 days after LMP 5 days before the expected menstrual period5 days before the expected menstrual period


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2. Immunologic Test which are based in2. Immunologic Test which are based in

antigenantigen--antibody reaction in the urine.antibody reaction in the urine.Examples are:Examples are:Rapid slide test Rapid slide test

Tube testingTube testingRadioreceptor assayRadioreceptor assayRadioimmunoasay tests is the earliest Radioimmunoasay tests is the earliest

test to detect the presence of HCGtest to detect the presence of HCG


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ABSOLUTE OR POSITIVE ABSOLUTE OR POSITIVESIGNSSIGNS

1.Fetal Heart Tone which can be detected by1.Fetal Heart Tone which can be detected byDoppler at 12 weeks, by fetoscope at 16Doppler at 12 weeks, by fetoscope at 16weeks and by stethoscope at 20 weeks.weeks and by stethoscope at 20 weeks.

2.Funic Suffle2.Funic Suffle a swishing sound synchronousa swishing sound synchronouswith fetal heart beat caused by blood rushingwith fetal heart beat caused by blood rushingthrough the umbilical arteries.through the umbilical arteries.

3.Fetal movement can be felt by the examiner3.Fetal movement can be felt by the examiner

from 20 weeks onward.from 20 weeks onward.4.X 4.X--ray visualisation of fetal skeleton as early asray visualisation of fetal skeleton as early as14 weeks14 weeks


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5. Ultrasonographic evidence of pregnancy:5. Ultrasonographic evidence of pregnancy: Abdominal pulse echo sonography can Abdominal pulse echo sonography can

detect intrauterine pregnancy at 4 to 5detect intrauterine pregnancy at 4 to 5weeks.weeks.

Small white gestational ring can be detectedSmall white gestational ring can be detectedafter six weeks.after six weeks.

Fetal brain and heart action is demonstratedFetal brain and heart action is demonstratedby eight weeks using Doppler or real timeby eight weeks using Doppler or real timesonography.sonography.

Fetal head and thorax can be identified byFetal head and thorax can be identified by14th week14th week

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