Physiological changes during pregnancy can be extensive. The uterus grows dramatically in size and the cervix softens. The breasts enlarge and darken. Throughout pregnancy, the body retains more fluid and blood volume increases. Respiration increases to support higher oxygen needs. The heart works harder pumping more blood. The kidneys and liver increase in size. Many hormonal changes prepare the body for childbirth and nurturing a baby.
Series of events that takes place in the genital organ in an effort to expel the viable products of conception out of the womb through the vagina into the outer world is called labour.
there are four stages of labour.
Series of events that takes place in the genital organ in an effort to expel the viable products of conception out of the womb through the vagina into the outer world is called labour.
there are four stages of labour.
physiology of labor includes the contraction and retraction of the muscles of uterus. I hope this presentation will help the persons of concerned subject.
When fetal head is delivered, but shoulders are stuck and cannot be delivered it is known as shoulder dystocia.
The anterior shoulder becomes trapped behind on the symphysis pubis, whilst the posterior shoulder may be in the hollow of the sacrum or high above the sacral promontory.
This topic contains detailed description about labour, its definition, date of onset of labour, calculations of date of delivery, causes of onset of labour, physiology of normal labour, and events, clinical course and management of each stages of labour.
Stages of normal labor- easy explanation for Nursing Students(B.Sc & GNM)...
Introduction, definition of normal labor, definition of normal labor by WHO, Mechanism of labor, stages of labor, Intrapartum management of Labor, pain control.
physiology of labor includes the contraction and retraction of the muscles of uterus. I hope this presentation will help the persons of concerned subject.
When fetal head is delivered, but shoulders are stuck and cannot be delivered it is known as shoulder dystocia.
The anterior shoulder becomes trapped behind on the symphysis pubis, whilst the posterior shoulder may be in the hollow of the sacrum or high above the sacral promontory.
This topic contains detailed description about labour, its definition, date of onset of labour, calculations of date of delivery, causes of onset of labour, physiology of normal labour, and events, clinical course and management of each stages of labour.
Stages of normal labor- easy explanation for Nursing Students(B.Sc & GNM)...
Introduction, definition of normal labor, definition of normal labor by WHO, Mechanism of labor, stages of labor, Intrapartum management of Labor, pain control.
Detailed account of the various changes that occur in maternal anatomy, physiology, and metabolism of pregnant women. These physiological changes are often very precise, and deviations of physiological responses can be a prelude to possible disease/infectious states. In this second part of Labor, we will examine the various systems of the human body,its altered states during pregnancy, and how those changes affect the woman preparing for delivery. Special care is imperative in properly determining the needs of an expecting mother, so developing an intimate, trusting relationship between the mother and fully understanding her physiological output will lead to the best chances of a successful delivery.
Pregnancy Week by Week guides women through each of the 40 weeks of pregnancy, giving details on developmental milestones in both Mom and Baby, practical advice and words of encouragement.
obstetric and gyneacology; Changes in pregnancy, cardiovascular changes, respiratory changes, endocrine changes, gastrointestinal changes, related organ changes in pregnancy. hormonal changes during pregnancy.
Maternal Physiology & Related Conditions refers to the physiological changes that occur in a woman's body during pregnancy, childbirth, and the postpartum period. These changes include hormonal fluctuations, cardiovascular and metabolic changes, and structural changes in the reproductive system. Maternal physiology also encompasses the study of any potential complications that may arise during this time, such as gestational diabetes or preeclampsia.
Maternal physiological changes in pregnancy are the adaptations during pregnancy that a woman's body undergoes to accommodate the growing embryo or fetus. ... The pregnant woman and the placenta also produce many other hormones that have a broad range of effects during the pregnancy.
physiological changes during pregnancy
effect of pregnancy on physiological functions during pregnancy
cardiovascular, respiratory and hormonal changes
Shifa Riaz
gynecology
obstetrics
females
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Mastering Wealth: A Path to Financial FreedomFatimaMary4
### Understanding Wealth: A Comprehensive Guide
Wealth is a multifaceted concept that extends beyond mere financial assets. It encompasses a range of elements including money, investments, property, and other valuable resources. However, true wealth also includes non-material aspects such as health, relationships, and personal fulfillment. This guide delves into the various dimensions of wealth, exploring how it can be created, sustained, and enjoyed.
#### Defining Wealth
Traditionally, wealth is defined as the abundance of valuable resources or material possessions. It includes financial assets like cash, savings, stocks, bonds, and real estate. However, a broader understanding of wealth considers factors such as personal well-being, emotional health, social connections, and intellectual growth. This holistic view recognizes that true wealth is not solely about accumulating money but also about enhancing one's quality of life.
#### The Importance of Financial Wealth
Financial wealth remains a critical component of overall wealth. It provides security, freedom, and the ability to pursue opportunities. Key elements of financial wealth include:
1. **Savings**: Money set aside for future use. It is crucial for emergencies, large purchases, and financial goals.
2. **Investments**: Assets purchased with the expectation that they will generate income or appreciate over time. Common investments include stocks, bonds, mutual funds, real estate, and businesses.
3. **Income**: Regular earnings from work, investments, or other sources. Consistent income is essential for maintaining and growing wealth.
4. **Debt Management**: Effectively managing debt ensures that it does not erode financial wealth. This includes paying off high-interest debt and using credit wisely.
#### Creating Wealth
Creating wealth involves generating and accumulating financial and non-financial resources. The process can be broken down into several key strategies:
1. Education and Skill Development: Investing in education and skills enhances earning potential. Higher education, professional certifications, and continuous learning can lead to better job opportunities and higher salaries.
2. Entrepreneurship: Starting and running a successful business can be a significant source of wealth. Entrepreneurship requires innovation, risk-taking, and effective management.
3. Investing: Making smart investments is essential for wealth creation. This involves understanding different types of investments, assessing risks, and making informed decisions. Diversifying investments can reduce risk and increase potential returns.
4. Saving and Budgeting: Effective saving and budgeting help accumulate wealth over time. Setting financial goals, creating a budget, and sticking to it are foundational steps in wealth creation.
5. Real Estate: Investing in property can provide rental income and capital appreciation. Real estate is a tangible asset that can hedge against inflation
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
2. Genital changes
• The body of the uterus
- Height and weight (hyperplasia)
the height increases from 7.5 cm to 35cm
the weight increases from 50g to 1000g at term
- Uterine ligaments
show hypertrophy
- Dextro-rotation
the uterus is tilted and twisted to the right in 80% of cases
- Lower uterine segment (LUS)
the LUS is formed from the isthmus
formed from the 4th month to reach 10 cm at full term
3. Genital changes
• The cervix
- edema and congestion, and becomes soft
- mucus plug (operculum): cervical mucus closing the cervical
canal
- increased secretion from its glands
• The vulva
shows increased vascularity and varicosities
4. Genital changes
• The vagina
- shows increased vascularity soft, moist and bluish
- distention of vagina at birth
• The ovary
shows increased vascularity and size
one ovary contains the corpus luteum
• Pelvic ligaments
- relaxation of the ligaments
- relaxation of the pelvic joints
- the pelvis become more mobile and increases in capacity
5. Breast changes
• Increased size and vascularity
warm, tense and tender
• Increased pigmentation of the nipple and areola
• Secondary areola appear
(light pigmentation around the 1ry areola)
• Montgomery tubercules appear on the areola
(dilated sebaceous glands)
• Colostrum like fluid is expressed at the end of the 3rd month
6. Skin changes
• Pigmentation
due to increased melanocyte stimulating hormone:
- linea nigra: pigmentation of the linea alba, more marked below
the umbilicus
- chloasma gravidarum: Butterfly pigmentation of the face (mask
of pregnancy)
• Striae gravidarum
- stretch of the abdominal wall
rupture of the subcutaneous elastic fibers
pink lines in flanks
- become white after labor
7. Weight increase
• There is an increase weight of approximately 12.5 Kg at term
• The main increase occurs in the 2nd half of the pregnancy, 0.5
Kg/week
• Causes:
growth of the conceptus
enlargement of the maternal organs
maternal storage of fat
increase in maternal blood and interstitial fluid
8. Skeletal changes
• Increased lumbar lordosis
• Relaxation of pelvic joints and ligaments
due to progesterone and relaxin
9. Urinary changes
• Kidneys
- increase in size
- hydronephrosis
- effective renal plasma flow is increased
• Dilatation of the ureters
- Atony of the ureteric muscles caused by progesterone and relaxin
hydro-ureter
- vesico-ureteric reflux increased - pressure of the uterus on the ureter
affects more the right ureter due to the dextro-rotation of the uterus
Changes in the ureter in pregnancy leads to urinary stasis and pyelitis
10. Urinary changes
• Frequency of micturation
causes: 1st trimester: pressure of the uterus on the bladder
late in pregnancy: engagement of the head
• Urinary output
- diminished on a normal fluid intake
- increase in tubular reabsorption
- 100 extra liters of fluid pass into the renal tubules each day
- extracellular water is increased by 6 to 7 liters during pregnancy
- this is due to increased amounts of
aldosterone progesterone and oestrogen
11. Gastro-intestinal changes
• Increased salivation (ptyalism)
• Taste is often altered very early in pregnancy
• Increase appetite & thirst frequent small snacks
• Heart burn (reflux oesophagitis)
relaxation of the cardiac sphincter due to progesterone and relaxin
• Emesis gravidarum, morning sickness in 50 %
• Decreased gastric acidity, which interfere with iron absorption
• Constipation
reduced gut motility due to progesterone
increased water and salt absorption
12. Gastro-intestinal changes
• Liver
- Hepatic synthesis of albumin, plasma globulin and fibrinogen
increases
- Total hepatic synthesis of globulin increases stimulated by
estrogen
- Hormone-binding globulins rise
- gall bladder increases in size and empties more slowly
- relaxation of gall bladder increases the tendency of stone
formation
- cholestasis is almost physiological
- secretion of bile is unchanged
13. Cardiovascular changes
• Fall in total peripheral resistance by 6 weeks gestation to a nadir ~
40% by mid gestation
• Circulatory underfilling
activation of renin-angiotensin- aldosterone system
necessary expansion of the plasma volume
the bigger the expansion, the bigger the baby birthweight
• Total extracellular volume 16% by term
• Plasma osmolality by 10mOsm/Kg as water is retained
14. Cardiovascular changes
• The heart
- the heart rate rises synchronously by 10-15 b.p.m.
from 70 to 85 b.p.m.
- stroke volume rises
- cardiac output begins to rise by 35-40% in a first pregnancy
and ~ 50% in later pregnancies
15. Cardiovascular changes
• The blood pressure
- Korotkoff 5 used with auscultatory techniques
- slight drop in the 2nd trimester
small fall in systolic, greater fall in diastolic B.P.
opening of arterio-venous shunts at the placenta
increased pulse pressure
- supine hypotension syndrome in 8% of the women
2nd half of the pregnancy:
maternal hypotension occurs in the supine position due to pressure of
the uterus on the inferior vena cava
decreased venous return and cardiac output
16. Cardiovascular changes
• Noradrenaline
- pressor response to angiotensin II reduced in normal
pregnancy, unchanged to noradrenaline
- plasma noradrenaline is not increased in normal pregnancy
• Pulmonary circulation
- able to absorb high rate of flow without an increase in pressure
- pressure in right ventricle, pulmonary arteries and capillaries
does not change
- pulmonary resistance falls in early pregnancy
- progressive venodilatation + rises in venous distensibility +
capacitance throughout a normal pregnancy
17. Respiratory changes
• Tidal volume rises by 30% in early pregnancy
40-50% by term
Driven by
• Fall in expiratory reserve and residual volume progesterone
decrease the threshold
increase the sensitivity of medulla oblongata to CO2
• Respiratory rate does not change
the minute ventilation rises by a similar amount
from 7.25L to 10.5L
• Elevation of the diaphragm in late pregnancy
dyspnea
18. Respiratory changes
• Carbon dioxide production rises sharply during the 3rd trimester
as fetal metabolism increases
• The fall in maternal P CO2
- allows more efficient placental transfer of CO2 from the fetus
- results in a fall in plasma bicarbonate concentration
( from 24-28 mmol/L to 18-22 mmol/L)
fall in plasma osmolality
venous pH rises slightly ( from 7.35 to 7.38)
19. Respiratory changes
• The increased alveolar ventilation small rise in PCO2
(from 96.7 to 101.8 mmHg)
• Rightward shift of the maternal oxyhaemoglobin dissociation curve
( due to an increase in 2,3-DPG in erythrocytes)
oxygen unloading to the fetus which has:
- lower PCO2 (25-30 mmHg, 3.3-4 KPa)
- marked leftward shift of the oxyhaemoglobin dissociation curve,
(due to lower sensitivity of fetal haemoglobin to 2,3-DPG)
20. Respiratory changes
• Increase of 16% in oxygen consumption by term
• Fall in arterio-venous oxygen difference
• Pregnancy places greater demands on the cardiovascular than the
respiratory system
21. Haematological changes
• Circulating red cell mass increases by 20-30%
( rises more in multiple pregnancies and iron supplement)
• Serum iron concentration falls
absorption from gut and iron-binding capacity rise
• Plasma folate concentration halves by term ( renal clearance)
red cell folate concentration falls less
• Mild maternal anaemia associated with
increased placental/birthweight ratio
decreased birthweight
22. Haematological changes
• Erythropoietin rises especially if iron supplement not taken
• Human placental lactogen may stimulate haematopoiesis
• Fall in packed cell volume from 36% in early pregnancy to 32% in the 3rd
trimester ( normal plasma volume expansion)
• WBC count rises ( increase in polymorphonuclear leucocytes)
• Neutrophil number rises with oestrogen
peak at 33 weeks
stabilizing after that
until labour and the puerperium, when they rise sharply
23. Haematological changes
• T and B lymphocyte counts do not change but their function is
suppressed
( women become more susceptible to viral infections, malaria and
leprosy)
• Platelet count and platelet volume are largely unchanged
24. Haematological changes
• Coagulation
- factors VII, VIII and X rise
- absolute plasma fibrinogen doubles
- antithrombin III falls
- erythrocyte sedimentation rates increase
- Protein C unchanged
- Protein S concentrations, co-factor of protein C, fall in 1st & 2nd
trimesters
- plasma fibrinolytic activity decreases during pregnancy & labour
returns to normal values within an hour of delivery of placenta
25.
26. Endocrinal changes
• Pituitary
- anterior pituitary increases in size and activity
- posterior pituitary releases oxytocin on the onset of labor
• Thyroid
- increases in size and activity: physiological goiter
- most pregnant women are euthyroid
- thyroid binding globulin concentrations double (not other thyroid
binding proteins)
- total T3, T4 are increased (not the free T3 ,T4)
• Parathyroid
increases in size and activity to regulate calcium metabolism
27. Endocrinal changes
• Adrenals
- increases in size and activity
- total cortisol is increased (free cortisol unchanged)
• Placental hormones
Progesterone
- produced by the corpus luteum
- levels rise steadily during pregnancy, output reaches 250mg/day
- actions:
colon activity reduced, nausea, constipation
reduced bladder and ureteric tone
diastolic pressure reduced, venous dilatation
raises temperature
28. Endocrinal changes
• Placental hormones
Oestrogens
- source:
ovary in early pregnancy
later, oestrone and oestradiol produced by the placenta
increased a hundredfold
oestriol produced by the placenta and fetal adrenals
increased thousandfold
- levels: output of oestrogens reaches a maximum of at least 30-40mg/day
oestriol accounts 85%
levels increase up to term
29. Endocrinal changes
• Placental hormones
Oestrogens
- possible actions:
1- induce growth of uterus and control its function
2- responsible for the development of breasts ( with progesterone)
3- alter chemical constitution of connective tissue, become more pliable
4- cause water retention
5- reduce sodium excretion
30.
31. Metabolic changes
• Carbohydrate metabolism
- pregnancy is hyperlipidaemic and glucosuric
- after mid-pregnancy, resistance of insulin develops
- plasma glucose concentrations rise, maintained between 4.5-5.5 mmol/L
- glucose crosses the placenta, the fetus uses glucose as primary energy
substrate, transport occurs by carrier mediated mechanism
- the insulin resistance is endocrine-driven, via increase in cortisol and hPL
- concentrations of glucagons and the catecholamines are unaltered
32. Metabolic changes
• Carbohydrate metabolism
- carbohydrate deposited in the liver as glycogen
- some escapes to general circulation
- portion metabolised by the tissues:
converted to depot fat
stored as muscle glycogen
- first noticeable change occurs in blood sugar
- tested by giving a load of oral glucose (glucose tolerance test)
- the blood sugar, after meal, remains high facilitating placental
transfer
33. Metabolic changes
• Carbohydrate metabolism
- with increased placental production of steroid, less glycogen
deposited in liver and muscles
- the effect of fasting is pronounced in pregnancy
overnight fast of 12hrs
hypoglycaemia, production of ketone bodies
34. Metabolic changes
• Protein metabolism
- positive nitrogen balance
- on average 500 g of protein retained by the end of pregnancy
- blood and urine urea are reduced
• Fat metabolism
- by 30 weeks, 4Kg are stored in form of
depot fat in the abdominal wall, back and thights
modest amount in breasts