Physiological and psychological changes during pregnancyhanges [Recovered].pptx

Physiological changes during pregnancy

1. Physiological and Psychological changes during pregnancy

2. Introduction During pregnancy there is progressive anatomical, physiological and biochemical changes not only confined to the genital organs but also to all system of the body. The physiological, biochemical & anatomical changes occur during pregnancy are extensive and may be systemic healthy environment for the fetus without compromising the mother’s health. Although sometimes determine small discomfort to the mother.

3. Changes in body during pregnancy Changes in reproductive system Changes in external reproductive system Vulva Vagina Vaginal ph value Vaginal discharge perineum

4. B) Changes in internal reproductive system UTERUS Size of the uterus By the time of pregnancy has reached term , the uterus will have increased five times its normal size- In length from 6.5 to 32cm In depth from 2.5 to 22cm In width from 4to 24 cm In weight from 50 to 1000 grams In thickness of the wall from 0.5 to 1 cm

5. Capacity The capacity of the uterus must expand to normally accommodated a seven pound fetus and the placenta , the umbilical cord, 500mi -1000ml of amniotic fluid and the fetal membranes.

6. Muscle fibers Mechanism of uterine enlargement is due to stretching & hypertrophy of the muscles fiber increase in elastic tissue accumulation of fibrous in external muscle fibers. During pre-pregnant state it is solid & in term muscles are soft due to distention of growing fetus. Arrangement of muscle fiber

7. position As the uterus enlarges to occupy the abdominal cavity it usually rotates on its long axis to the right (dextro-rotation) due to the presence of the rectosegmoid colon on the left side. Contraction of uterus Uterine contraction in pregnancy has been named “Braxton Hick “ who 1 st described its extity during pregnancy. The contraction are irregular, infrequent, spasmodic and painless with out any affect on direction of the cervix. intrauterine pressure remains below 8mmhg.

8. Endomertrium Endomertrium during pregnancy is known as decidua. Increase structural and secretary activity of the Endomertrium that is brought about in response to progesterone following implantation is known as residual reaction . Consistency ,becomes progressively softer due to Increased vascularity, increased of amniotic fluid . Well formed decidual differentiate 3 layers Superficial compact layer Intermediate spongy layer The basal layer

9. Perimertium Thin layer of Perimertium protects the uterus ,in elastic base does not cover the uterus bladder part as uterovesical pouch & rectum part as pouch of Douglas. Utero -placental blood flow – uterine & ovarian vassals increase in diameter. The uterine blood flow increase progressively and reaches about 500 ml/min at term. Isthmus during 1 st trimester isthmus hypertrophic & enlongates to about 3 times its original length. It become shorten. Cervix There is hypertrophy & hyperplasia of the elastic & connective tissue . Vascularity increase specially in beneath the squamaus epithelium of the portion vegina, is responsible for its bluish coloration . These lead to marked softening of the cervix. which is called..

10. Secretion- The copious & tenacious physiological secretion called leuckorrhea of pregnancy .this due to effect of progesterone . The mucus not only fill up the gland but also forms a thick plug effectively sealing the cervical canal . Anatomical The length of the cervix is directed posterior but after the engagement of the head directed in line of vagina. Fallopian tube – The total length is some increased. The tube become congested . Muscles undergo hypertrophy. Epithelium becomes flattened & patches of decidual reaction are observed . Ovary The growth and function of the corpus luteum reaches maximum at 8 th week when it measures about 2.5 cm & b4comes cystic. It looks bright orange , later on become yellow and finally pale.

11. Estrogen & progesterone recreated by the corpus luteum maintain the environment for the groving ovum before the action is taken over by the placenta. The both ovarian & uterine cycle of the normal menstruation remain sustain .

12. Formation of lower uterine segment After 12 week the isthmus (0.5) starts ton expand gradually to form the LUS . Which measures 10cm in length at term. With increasing gestation there is increase stretching of the uterine muscle fibers. This result in the formation of the lower segment in 3 rd trimester (28-40 weeks). By the end of pregnancy the body of the uterus (LS) is prepared for distention and dilatation& its thinner.

13. Changes in skin during pregnancy

14. Hematological changes Blood volume Blood volume start to increase from about 6 th week , expands rapidly there after maximum 40-50% above the nonpregnant state. Plasma volume The maximum is reached to the extent of 50% Total plasma volume increase to the extent of 1.25 liters. The increases greater in multigravida , in multiple pregnancy & with large baby. RBC & hemoglobin The RBC is increase to the extent of 20-30% . The total increase in volume about 350ml. Leukocytes & immune system The increase may be due to rise in the level of estrogen & cortisol. Total protein Total plasma protein increase from the normal 180g (non pregnancy ) to 230 g at term.

15. Blood coagulation factors Pregnancy is a hyper coagulation state . Fibrinogen level is raised by 50% . 200-400mg/dl in nonpregnant state to 300-600mg/dl in pregnancy . As a result of rise in fibrinogen & globulin level and diminished blood viscosity. Erythrocyte sedimentation rate give a much higher value (four fold increase) during pregnancy . There is increase in activities of clotting factors like X,IX,VII,& I. The level of II,V& XII are unchanged or mildly increased. The level of XI and XIII are slightly decreased . The clotting time does not show any significant changes.

16. Weight gain during pregnancy Reproductive weight gain in kg Net maternal weight gain in kg Fetus-3.3kg , placenta -0.6kg & liquor 0.8kg Increase in blood volume 1.9kg Uterus -0.9kg & breasts 0.4 kg Increase in extracellular 1.2 kg fluid Accumulation of fat and protein – 3.5kg The total weight gain during the course of a singleton pregnancy for a healthy women average 11kg . This has been distributed to 1kg in 1 st trimester and 5kg each in second & third trimester.

17. important of weight checking Rapid gain in weight of more than 0.5 kg a week or more than 2kg a month in later months of pregnancy may be the early manifestation of preeclampsia & need for care full supervision Stationary or falling weight Obese women Ideally weight gain should depend on pre-pregnancy body mass index (BMI) level weight gain for a woman with normal BMI (20-26) is 11-16 kg. An obese women (BMI>30) should not more than 7kg , whereas an under weight women (BMI<19) may be allowed to gain up to 18 kg .

18. Changes in cardiovascular system Load Heart changes Heart rate rise 10-15 b/min Stroke volume increases Cardiac out put rise in 35-40% in 1 st pregnancy & 30-50% in later pregnancy . Blood pressure- The slight drop in the 2 nd trimester. Supine hypotension syndrome is 8% of the women 2 nd half of the pregnancy . Venous return The expending uterus & restricting physical movement interfering the return of blood flow. This result in swelling of the feet & legs.

19. Changes in body temperature A slight increase in body temperature in early pregnancy is noted .The temperature returns to normal at about that 16 week of gestation. The mother may feel warmer or experience “Hot Flashes” caused by increased hormonal level & basal metabolic rate.

20. Changes in urinary system Each kidney enlarge 1cm increase in length and weight . The renal pelvis & ureter dilate & lengthen, thus there is an increase urinary stasis increase risk of infection and stone formation. Lower urinary tract Bladder more irritated as growing uterus pushes on it. Urethra Longer, widen, lower tone because of progesterone effects. Stasis in ureter & pelvic of kidney may lead to infection. Renal system Increase in glomerular filtration rate by 50% reached maximum at the end of 1 st trimester & is maintained at this 36 th week of gestation.

21. Changes respiratory system during pregnancy Anatomic & physiologic changes In early pregnancy capillary dilations occurs through out the respiratory tract leading engorgement of the nasopharinx , larynx , trachea & bronchi. This causes the voice to change & makes breathing through the nose difficulty. The uterus enlarges the diaphragm is elevated as much as 4cm & the ribe cage is displaced upward & widens, increasing circumference by to 6cm. Lung volume capacity reduce (4-5%) due to elevation . Inspiration capacity increase 5-10%.

22. Changes in gastro-intestinal system during pregnancy Oral cavity Feel salivation Gum hypertrophic & hyperemic easily bleed Stomach production of gastrin increase gastric volume & decrease ph, mucous production increased . Gastrointestinal mobility may be reduced due to increased progesterone. Gastric emptying is slow. Heart burn Gal bladder Progesterone decrease mortality , empting time of bile ->stasis ->stone formation & infection .

23. Changes in masculo-skeletal system during pregnancy Estrogen - it is responsible for the poliablity of the connective tissue causing the joint capsule to be reduce, makes the pelvic joint mobile. Progesterone- It causes relaxasation & weakening of the pelvic ligaments. Relaxin - It regulate collagen & softens pelvic joints & ligaments as preparation for the delivery so that it allows some expansion of the pelvic cavity during the descent of the fetal head in labor. Postural changes Lordosis – which shifted the women center of gravity back over her leg. The muscles of the abdominal wall may stretch & lose the tone further aggravating back pain.

24. Metabolism during pregnancy Protein – The fetus need little protein in early pregnancy During pregnancy get a minimum of 60g of protein a day, which will account for approximately 20-25 % of calories intake. Approximately 12g of nitrogen a day are needed for the developing maternal uterus, fetus,& storage occurs for lactation. Water metabolism The water content of the fetus, placenta, and amniotic fluid is about 3.5 liters. Pregnancy is a state of hypervolemia. Carbohydrate the recommendation daily allowance for carbohydrate is 175g/day . Fat the fetus accumulation fat late from 2% of the body weight at 32weeks to 12% at term. Calcium the daily requirement of calcium during pregnancy 1200mg /day. Iron daily intake require 27 mg. it is stored in the liver. The mother may have poor iron store because of- To little in diet, there fore give supplements. Too poor absorption.

25. Thyroid gland This gland increase in size due to increase in iodine metabolism return to normal by post delivery period. parathyroid gland This gland increase in size slightly . It meet the increase requirement for calcium needed for fetal growth. Posterior pituitary N ear the end of term, the posterior pituitary will begin to secrete oxytocin that was produced in the hypothalamus & stored there . It will serve to initiate labor . Anterior pituitary At birth the anterior pituitary will begin to secrete prolactine of breast milk. Adrenal gland adrenal cortex thicken due to the secretion of ACTH as result of progesterone. Placenta It produce large amount of estrogen and progesterone by the 10-12 weeks of pregnancy . Changes in endocrine system during pregnancy

26. Psychological changes during pregnancy Emotional reaction experienced by newly pregnant mother Ambivalence Fear& anxiety Uncertainty Factors that may influence the extent of this reaction It is planned or a wanted pregnancy ? It is the first pregnancy ? What experiences and memories does the patient have about previous pregnancies? Firs trimester Second trimester- accept her pregnancy Third trimester Altered self image Fear Aggravation Fatigue Obession wondering