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Adaptation of the body

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Adaptation of the body

  1. 1. Adaptation of the body during pregnancy By Dr. Ahmed
  2. 2. Adaptations to pregnancy These adaptations are attributed to; The hormones of pregnancy Mechanical pressures arising from the enlarging uterus Other issues. These adaptations; Protect the woman`s normal physiologic functioning Meet the metabolic demands pregnancy imposes on her body Provide a nurturing environment for fetal development and growth.
  3. 3.  The pregnant woman, her partner and family must all adjust to the reality of pregnancy and anticipated new roles as mother, father, grandparent or sibling.
  4. 4. Body systems affected by pregnancy Other body systemsReproductive system oCardiovascular oRespiratory oUrinary oGastrointestinal oMusculoskeletal oIntegumentary oMetabolic changes oEndocrine oImmunological oUterus oCervix oOvaries and fallopian Tubes ovagina oVulva oBreast
  5. 5. Uterus:  The phenomenal uterine growth in the first trimester is simulated by high levels of estrogen and progesterone. Size: increase to 20 times of its non-pregnant size due to increased vasculariy, hyperplasia and hypertrophy. Weight: increase from 50 grams – 1000 grams. Volume: increases from less than 10 ml to 5000 ml. Contraction: Braxton Hicks sign ( irregular, painless intermittent uterine contraction). Shape: changes from that of an inverted pear to that of soft globular or spherical. Later it become ovoid and rises out of the pelvis into the abdominal cavity.
  6. 6. Uterus: continue-  Endometrium : consists of 3 layers: 1. Decidua basalis 2. Decidua capsularis 3. Decidua vera  Cervix: 1. Goodell’s sign; softening of cervix 2. Operculum ( mucus plug)  Ovaries and fallopian tubes: Involution due to suppression of FSH
  7. 7. Vagina:  Chadwick’s sign; bluish color, cervix, vagina  Hypertrophy and hyperplasia  Leukorrhea , acid pH 3.5 to 6 (a whitish or yellowish discharge of mucus from the vagina). 
  8. 8. Vulva: Increased vascularity Fat deposition causes labia majora to close and partially cover introitus.
  9. 9. Breasts: 3-4 weeks: prickling, tingling sensation 6 weeks: developing ducts and glands 8 weeks: bluish surface veins are visible 8-12 weeks: Montgomery’s glands become more prominent, primary areola become darker. 16-18 weeks: colostrum expresses. Secondary areola appears.
  10. 10. Adaptation of other body systems
  11. 11. Cardiovascular system: Slight enlargement of myocardium Shift in chest contents: - Heart is displaced upwards and to the left Heart rate increases by 10 to 15 b/m Blood volume increases 40-50% physiological anemia Hemoglobin and hematocrit decrease in relation to increased plasma volume Cardiac output increases by 30% during the 1st and 2nd trimesters.
  12. 12. Respiratory system:  The upper respiratory tract becomes more vascular in response to estrogen that can result in nasal stuffiness, epistaxis, voice changes, impaired hearing and a sensation of fullness in the ears..  Enlarged uterus prevent the lungs from expanding shortness of breath.  Basal metabolic rate increases and oxygen requirement increases by 30 to 40 mlmin.
  13. 13. Urinary system: Frequency of micturition due to pressure of the growing uterus. Decreased bladder capacity and bladder tone. Renal functions changes:  Changes occur to accommodate an increased workload while maintaining stable electrolyte balance.  Increased glomerular filtration rate.  Glucosuria may occur.
  14. 14. Gastrointestinal system: Gums become hyperemic and have a tendency to bleed. Ptyalism is seen in some women. Smooth muscle relaxation occurs related to increased progesterone production; this can cause:  Decreased peristalsis and constipation.  Heartburn, slowed gastric emptying and esophageal regurgitation.  Hemorrhoid from the pressure of the gravid uterus. Appetite usually increases, after a temporary decrease due to nausea and vomiting.
  15. 15. Musculoskeletal system:  Alteration in posture can result in lordosis ( waddling gait due to increased level of progesterone and relaxing hormone).  Diastasis recti is associated with enlarged uterus in some women.  Relaxation and increased mobility of joints occur because of the relaxing hormone.
  16. 16. A, Normal position in no pregnant woman. B, Diastasis recti abdominis in pregnant woman.
  17. 17. Integumentary system (cutaneous changes)  Chloasma is the brownish “ mask of pregnancy”.  Nipples, areolae, axilae, vulva and perineum all darken.  Striae graviderium ( stretch marks) appear on the breasts and abdomen.
  18. 18. Striae gravidarum,
  19. 19. Metabolic changes: Increase metabolic rate. Increase the demands for carbohydrate, protein and minerals. Weight gain of 9-11 kg. Water requirement is increased to supply fetus, placenta and amniotic fluid.
  20. 20. Endocrine system:  FSH and LH production is suppressed.  Thyroid gland enlarges, resulting in increased iodine metabolism.  Pancreas: Insulin production is increased throughout pregnancy to compensate for placental hormone insulin antagonism.  Ovaries produce:  Estrogen  Progesterone  Relaxing hormone. - Relaxing can regulate the mother’s cardiovascular and renal systems to help them adapt to the increase in demand for oxygen and nutrients for the foetus.
  21. 21. Immunological system: Resistance to infection is decreased. Maternal IgG levels are decreased. Maternal IgM levels remain unchanged.
  22. 22. Pregnancy signs and symptoms
  23. 23. Presumptive evidence: woman reports Signs: Amenorrhea. Breast changes. Chloasma and lina nigra. Chadwick’s sign; bluish color of the cervix during pregnancy. Abdominal enlargement and striae.
  24. 24. 1.Presumptive evidence: continued- Symptoms: Nausea and vomiting Urinary frequency Weight gain Constipation Fatigue Quickening Breast tenderness, tingling, and heaviness.
  25. 25. 2.Probable evidence : Noted by examiner  Goodell’s sign - softening of cervix  Chadwick’s sign - bluish color, cervix, vagina  Hegar’s sign - softening of lower uterine segment ◦ Enlarged abdomen ◦ Pigmentation changes ◦ Stretch marks  Ballottement- A method of diagnosing pregnancy, in which the uterus is pushed with a finger to feel whether a fetus moves away and returns again.  Positive pregnancy test  Palpation of fetal outline
  26. 26. Figure 7–4 Hegar’s sign, a softening of the isthmus of the uterus, can be determined by the examiner during a vaginal examination.
  27. 27. 3. Positive ; Noted by examiner - only caused by pregnancy; Hearing of fetal heart rate. Fetal movement palpable by the examiner Fetal parts felt by examiners. Visualization of the fetus by ultrasound.
  28. 28. Positive evidence:  .