REPRODUCTIVE HEALTH NURSING ( Physiological changes during pregnancy).pptx

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1. REPRODUCTIVE HEALTH NURSING PHYSIOLOGICAL CHANGES DURING PREGNANCY

2. PHYSIOLOGICAL CHANGES DURING PREGNANCY There are profound physiological changes in all the system of a pregnant woman. Changes in Body weight : An average weight gain during pregnancy is 11-12kg. A slight gain during the 1 st trimester A rapid increase during the second trimester A slightly lower increase during the 3 rd trimester . Changes in Reproductive system The Uterus The uterus enlarges, gives nourishment and protection to the growing foetus . The blood supply increases from 20-40times. The arteries, veins and lymphatics that supply the uterus are greatly engorged There is increased in size, shape, position and weight. Size : At the end of full term gestation, the uterus is 30-35cm long, 20-25cm wide and 22cm deep.

3. Changes in Reproductive in U terus cont. Weight : From about 60gm to 900-1000gm Shape: As the uterus fills up with the growing foetus , it changes from ovoid in the pelvic cavity to globula as it passes into the abdomen Position of the uterus: The normal ante version and ante flexion position disappears after the 12 th week of pregnancy but becomes more erect as the pregnancy progresses . II. Changes in the Cervix The cervix remain closed during pregnancy The cervix become softer and bluish due to increased vascularity , oedema , hyperplasia and hypertrophy of the cervical glands . The cervical glands secrete more mucus, produces the tenacious mucus called OPERCULUM that minimize the risk of ascending infection to the uterus.

4. Changes in Reproductive system cont. iii. The fallopian tubes and Ovaries They become vertical in position as the growing uterus fills the abdomen. The corpus luteum enlarges, produces more oestrogen and progesterone in the 1 st 10-12 weeks The corpus luteum degenerates after the 12 th week of pregnancy and its endocrine function taken over by the placenta The ovaries become dormant and produces no ova(ovulation ). IV. The Vagina There is increase in thickness and hypertrophy of the muscle layer in preparation for distension needed in labour There is bluish discoloration and increase pulsation of the fornices due to increased blood supply There is increase in vaginal secretion with increase in vaginal PH from 3.5-6

5. v ) The Vulva There is increased in vascularity and oedema ; woman is more predisposed to vulva varicosity. Perineum also shows similar changes to that of the vagina Changes in the Breast There is marked changes in breast because its growth continues throughout pregnancy Enlargement, firm feeling and tenderness from the 6 th week of pregnancy Tingling sensation due to the effect of hormones Oestrogen stimulates the growth of the glandular tissue and the duct while progesterone activates the secretory function of the breast The nipple and the surrounding area become large, more pigmented, darker and more erectile The primary areolar become darkened and oedematous with increase diameter Montgomery gland enlarges Secondary areolar (dark spot on the skin) appears at 16 th week and covering almost half of the breast Dilated veins can be visualized as a result of increased vascularity

6. CHANGES IN INTEGUMENTARY SYSTEM Striae gravidarum (tiny scars): stretch marks that are red/purple on the abdomen, thighs and breast develops and may be due to effect of pregnancy hormones(16 th week .) Linea nigra : Pigmentation of linea alba(a dack line between the umbilicus and rectus muscles . Nipple and areolar areas of the breast become dark brown or black Chloasma or mask of pregnancy: Pigmentation around the eyes, nose and cheek bones CHANGES IN GASTRO INTESTINAL TRACT 50% of pregnant women experience nausea and vomiting in early pregnancy Heartburn is common due to frquent regurgitation of gastric content into the oesophagus Constipation often occurs as a result of bowel relaxation

7. CHANGES IN CARDIOVASCULAR SYSTEM There is 30-40% increase in blood volume from 8 th week Increase in plasma, erythrocyte and leukocyte count 20-25% increase in cardiac output above non-pregnant state in the 1st trimester and therefore continues to rise slowly to approximately 30 %. Increase in pulse and heart rate at15 % There is reduction in vascular resistance, which brings about reduction in diastolic Blood Pressure Increase in blood supply to the uterus, skin, kidneys, breast and alimentary canal Increase in venous pressure in the leg leading to stagnation of blood which accounts for oedema of feet with increase incidence of varicosities

8. CHANGES IN URINARY SYSTEM There is increase in kidney size, thus lead to great alteration in renal function Increase in renal flow and glomerular filteration rate Glycosuria may occur due to poor renal threshold Proteinuria may occur in pre- eclampsia Frequency of micturition is common from 6 th -12 th week due to pressure of the uterus, It reoccur in the later stage of pregnancy due relaxation of the pelvic floor CHANGES IN MUSCULOSKELETAL SYSTEM There is change in gait of pregnant woman during the second trimester when the centre of gravity(balance) of the body is altered by the weight of gravid and enlarged uterus The shoulder are thrown backward and the lumbar curve is increased to almost lordosis Relaxation of pelvic joints and ligaments during the last week of pregnancy may give rise to discomfort and backache

9. CHANGES IN NERVOUS SYSTEM Emotional instability is common in pregnancy and the woman cries easily There is increase tendency to anxiety, fear and even depression CHANGES IN THE ENDOCRINE SYSTEM There is increase in hormonal production throughout the period of pregnancy Placenta act as an endocrine and the hormones produce are: i ) Human Chorionic Gonadotrophin (HCG ) It is the basis of immunological pregnancy test It is secreted throughout pregnancy by syncytiotrophoblast of the placenta It appears in maternal blood from the 8 th day of fertilization and reaches peak at 60-70days Declines after 20 th week till term HCG disappears in blood and urine 7-10days after delivery

10. CHANGES IN THE ENDOCRINE SYSTEM cont. ii ) Human Placenta Lactogen (HPL ) It stimulate the growth of the breast and has lactogenic effect on the breast iii) Human Chorionic Thyrotrophin (HCT ) IV) Progesterone: Maintains pregnancy by its relaxing effect on the uterus and causes mammary growth v) Estrogens: Causes uterine growth and increases vascularity