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H:\Physiological Changes In Pregnancy[2]


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H:\Physiological Changes In Pregnancy[2]

  1. 1. Physiological Changes in Pregnancy<br />Sandy Warner RNC – OB, MSN<br />
  2. 2. Adaptations<br />Nurses must understand the normal anatomical and physiological changes in pregnancy to recognize any deviation from normal.<br />In addition to physical changes, there are also psychological changes that occur with pregnancy.<br />
  3. 3. Body system alterations<br />Cardiovascular <br />Hematological<br />Respiratory<br />Genitourinary<br />Gastrointestinal<br />Immunological<br />Musculoskeletal<br />Endocrine<br />
  4. 4. Cardiovascular <br />Cardiovascular adaptation affects all organ systems.<br />Cardiovascular anatomy and physiology changes to accommodate increasing maternal and fetal circulatory needs.<br />
  5. 5. Heart<br />Anatomic changes:<br />Heart is enlarged, displaced upward and rotates to the left. <br />PMI (point of maximal impulse) shifts to 4th<br /> intercostal space and closer to the midclavicular line.<br />
  6. 6. Heart sounds and rate:<br />Audible splitting of S1 and S2; S 3 becomes audible.<br />Benign systolic murmurs are common.<br />Heart rate increases 15-20 beats as pregnancy progresses.<br />
  7. 7. Cardiac Output<br />Defined as the amount of blood pumped from the left ventricle into the aorta each minute.<br />(heart rate x stroke volume = CO)<br />In pregnancy increased by 40% by 36-38 wks.<br />Influenced by: <br />Blood volume<br />Stroke volume<br />Heart rate<br />
  8. 8.
  9. 9. Blood Pressure<br />Due to decreased systemic vascular resistance, blood pressure is lower at end<br /> of 1st trimester and throughout 2nd, returning to baseline in 3rd trimester.<br />Also affected by renin-angiotensin-aldosterone system from kidneys.<br />
  10. 10. Hematological Changes<br />Increase in WBCs and RBCs.<br />Increase blood volume for uterus, fetus and increased perfusion of other organs, especially kidneys.<br />Increased plasma volume ratio to RBC volume leads to hemodilution.<br />
  11. 11. Hematological changes cont.<br />Hypercoagulation<br />Decreased fibrinolytic activity<br />Platelets remain normal or might decrease slightly<br />Increased need for iron related to RBCs<br />
  12. 12. Respiratory<br />Anatomic changes:<br />Diaphragm elevation<br />Chest expansion<br />Capillary dilation early in pregnancy causes<br />Engorgement of entire tract from nares to bronchi<br />Voice changes<br />
  13. 13. Respiratory<br />Physiological changes:<br />Increased need for oxygen<br />Improved oxygen delivery<br />Hyperventilation<br />Compensatory respiratory alkalosis<br />
  14. 14. Genitourinary<br />Kidneys – increase in size and GFR.<br />Ureters – dilate and elongate, becoming compressed by uterus.<br />Bladder – tone decreases due to progesterone, becomes displaces as uterus grows.<br />
  15. 15. Genitourinary<br />Urine flow accumulates and slows.<br />Increased renal excretion of BUN, creatinine and glucose.<br />Decreased serum BUN, creatinine and glucose.<br />Decreased tubular reabsorption of glucose.<br />Increased tubular reabsoption of sodium.<br />
  16. 16. Genitourinary<br />Uterus – rises out of pelvis during 1st trimester.<br />Weight increases from 70 gms to 1100 gms.<br />Volume at term averages 5 L but may be as<br /> much as 20 L.<br />Individual cells increase 100 fold in length by term,<br /> allowing for contractions and involution.<br />
  17. 17. Genitourinary<br />Cervix:<br />Increases in mass and fluid content.<br />85% connective tissue and 15% smooth muscle.<br />Ripening occurs via softening and effacement with the influence of hormones.<br />
  18. 18. Gastrointestinal<br />Mouth – changes in tastes, increase in saliva production, gums swell and bleed easier.<br />Esophagus – decreased tone leads to reflux.<br />Stomach – decreased tone and motility.<br />Intestines – smooth muscle relaxation and<br />decreased tone and motility - constipation<br />
  19. 19. Gastrointestinal<br />Esophagus, stomach and intestines move as uterus grows.<br />Round ligament stretches as uterus expands.<br />Gallbladder –decrease tone and motility<br /> combined with increased emptying time can<br /> cause increased risk of gallstones.<br />
  20. 20. Gastrointestinal<br />Hyperemesis – common in first trimester.<br />Strong sense of smell.<br />Increased saliva production.<br />Can persist throughout pregnancy.<br />
  21. 21. Immunological<br />Placenta functions to help protect the fetus from infection with IgG.<br />Decreased Tcell activity with pregnancy that increases susceptibility to viral infections.<br />Immunity is enhanced by sleep/rest and decreased stress.<br />
  22. 22. Musculoskeletal<br />Abdominal muscles relax and pelvis tilts forward.<br />Center of gravity shifts.<br />Joints relax – waddling.<br />Muscle aches from increasing weight of uterus.<br />Posture change due to lumbodorsal curve of spine.<br />
  23. 23. Musculoskeletal<br />Normal weight gain 25-35#.<br />Slight weight loss in 1st trimester from<br /> nausea and vomiting.<br />Average 1#/wk weight gain in 2nd and 3rd trimesters.<br />
  24. 24. Endocrine<br />Thyroid:<br />Function increases to meet metabolic and growth needs.<br />Parathyroid:<br />Helps regulate calcium, phosphorus, Vit. D and magnesium concentration.<br />Increases in pregnancy to help skeletal growth.<br />