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Maternal adaptation in pregnancy

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Maternal adaptation in pregnancy

  1. 1. SEMINAR ON MATERNAL ADAPTATION KHUSHBOO M.Sc Nursing 1st year Dept of OBG, MSKCON,Balongi
  2. 2. MATERNAL ADAPTATION TO PREGNANCY
  3. 3. INTRODUCTION: The period from conception to birth. After the egg is fertilized by a sperm and then implanted in the lining of the uterus, it develops into the placenta and embryo, and later into a fetus. Pregnancy usually lasts 40 weeks, beginning from the first day of the woman's last menstrual period, and is divided into three trimesters, each lasting three months.
  4. 4. PHYSIOLOGICAL CHANGES DURING PREGNANCY
  5. 5. 1.REPRODUCTIVE SYSTEM: Changes in the uterus: • By 12th week, uterus rises out of pelvic cavity and becomes upright. • By 16th week it is midway between umbilicus and symphysis pubis.  By 20th week it is just below the umbilicus.  By 24th week at the umbilicus.  By 30th week midway between umbilicus and xiphisternum  After 38 weeks lightening occurs and fetus sinks down and fundus can be palpated below the level of xiphisternum.
  6. 6. Changes in decidua: • Decidua is the name given to the endometrium during pregnancy. • Estrogen and progesterone produced by corpus luteum, causes the decidua to  Become thicker  More vascular at the fundus and in the upper body of the uterus.
  7. 7. Changes in myometrium: It is made up of smooth muscle fibres.The muscle fibers grow up to 15-20 times their non-pregnant length. Hypertrophy and hyperplasia of muscles occurs due to estrogen and progesterone weighs 750-1000gm & capacity of uterus increases from 50ml -5 liters.
  8. 8. Changes in fallopian tubes: The fallopian tubes on either side are more stretched out in pregnancy and is much more vascular.
  9. 9. Changes in the cervix: The cervix remains tightly closed during the pregnancy. The mucous secreted by endo cervical cells become thicker and more viscous during pregnancy.
  10. 10. Cervix become more vascular and bluish discoloration known as Chadwick sign.
  11. 11. Softening of the cervix known as Goodell sign.
  12. 12. Presence of pulsation at fornices of vagina known as Osiander sign.
  13. 13. Changes in the vagina: Estrogen causes changes in muscle layer and epithelial layer of vagina. The muscle layer hypertrophies and capacity of vagina increases
  14. 14. Changes in the ovaries: Due to increased estrogen and progesterone there is decrease in level of FSH and LH resulting in inhibition of maturation and release of graffian follicles resulting in amenorrhea.
  15. 15. CARDIOVASCULAR SYSTEM:
  16. 16. The heart muscle particularly the left ventricle, hypertrophies leading to enlargement of heart. The growing uterus pushing the heart upwards and to the left.
  17. 17. HEMODYNAMIC CHANGES:  The stroke volume increases from 65ml/beat-75ml/beat.  Pulse rate increases from 75beats/min-85beats/min.  Cardiac output increases from 5litre/min-7litre/min.  Venous pressure increases from 8-10cmH2O-20cmH2O  Blood viscosity decreases from 4.7-3.8 .  Blood volume increases from 4000ml-5500ml.  Plasma volume increases from 2500ml-3750ml.
  18. 18.  Red cell volume increases from 1400ml-1650ml.  Hematocrit value decreases from 38% to 32%.  Clotting factor level increases in 7th, 8th, 9th, 10th factor.  WBC increases changes to 15000cells/mm3 in 2nd and 3rd trimester.  30-50% blood flow increase in kidneys.
  19. 19. RESPIRATORY SYSTEM:
  20. 20. RESPIRATORY SYSTEM: The anterior and posterior diameter of chest increases to 2cm. Displacement of diaphragm by 4cm. The respiratory rate rises to 18-20 . Inspiratory capacity increases.
  21. 21. Expiratory volume decreases to 7-11litres in later weeks. Tidal volume is increased to 40%. Residual volume is decreased. Co2 tension is 27-32mmHg. O2 consumption increases from 15-20%. Co2 production is increased.
  22. 22. GASTROINTESTINAL SYSTEM:
  23. 23.  Gums become edematous, soft and spongy and can bleed with a toothbrush.  There is increase in salivation known as ptylism.  At 4-8 weeks women complains of nausea and vomiting, known as morning sickness.  Hyperemesis gravidarum.
  24. 24.  Decreased peristaltic movements resulting in constipation.  Pica  Gall bladder increases in size and empties more slowly during pregnancy • Heartburn.
  25. 25. INTEGUMENTARY SYSTEM:
  26. 26. INTEGUMENTARY SYSTEM:  Pigmentation in pregnant women from the end of 2nd month till term.  Melasma, cholasma or the mask of pregnancy.
  27. 27.  Linea nigra  Linea Alba  Straie gravidarum  Vascular spider nevi: also known as Angioma.This is spider like small bright red elevation of skin from centre to periphery.
  28. 28.  Palmer erythema: This is pinkish red blanches over palmer surface.  Hirsuitism, oily skin and acne vulgaris occur in pregnancy.
  29. 29. SKELETAL SYSTEM:
  30. 30. SKELETAL SYSTEM:  Hormone relaxin increases pelvic capacity that helps in labor process.  Diastasis of rectus abdominus muscle allow gravid uterus to engage in pelvic cavity.
  31. 31.  Symphysis pubis widens by 4mm by 32 weeks and sacrococcxygeal joint loosens allowing coccyx to displace backwards.  Lordosis
  32. 32. URINARY SYSTEM
  33. 33. URINARY SYSTEM:  The bladder capacity is more  Relaxation of soft tissue.  Frequency of urination is more in 1st and 3rd trimester.  Renal blood flow increases by 70-80% by 2nd trimester.  Plasma levels of urea, uric acid and creatinine fall  Glucose excretion increases
  34. 34. MATERNAL WEIGHT GAIN
  35. 35. MATERNAL WEIGHT GAIN:  Total weight gain during pregnancy is 12-14 kg.  4.0 kg in first 20 weeks.  8.5 kg in 2nd 20 weeks(0.4 kg/week)  In breast 0.5kg weight gain.  Fat = 3.5kg  Placenta = 0.6kg  Fetus =3.4kg  Amniotic fluid = 0.6kg  Uterus = 0.9kg  Blood volume =1.5kg  Extracellular fluid = 1kg
  36. 36. ENDOCRINE SYSTEM:
  37. 37. Human chorionic somatomamotrophin hormone increases – it has an anti-insulin effect. HCG hormone level also increases. Beta in blood give confirmatory diagnosis of pregnancy.
  38. 38. MAMMARY GLAND:  AT 3-4 weeks Prickling/tingling sensation of mammary gland.  At 6 weeks Enlargement of breasts Mastodynia-pain in the breast.  At 8 weeks Bluish veins visible over the mammary gland. Stretch marks.  At 8-12 weeks Montgomery tubercle; 15-20 over each mammary gland. Primary areola.  At 16 weeks Secondary areola Expression of colostrum
  39. 39. 1.What are the changes occurring in cardiovascular system? 2.Explain the maternal weight gain during pregnancy. 3.What is osiander sign? 4.Enumerate goodell’s sign.
  40. 40. REFERENCES  Jacob Annamma;A Comprehensive Textbook Of Midwifery And Gynecological Nursing;jaypee publishers;page no.- 230,600-602,568  C.S Dawn;Textbook of obstetrics and neonatology;aarthi dawn publishers;page no.321  Myles;a textbook for Midwives;Elsevier publishers;page no:-653  https://www.google.co.in/search?q=maternal+adaptation&ie=utf-8&oe=utf-8&rls=org.mozilla:en-US:official&client=firefox- a&channel=fflb&gws_rd=cr&ei=pjGPUqY3hY2tB9TIgfgI  http://www.expertconsultbook.com/expertconsult/ob/book.do?method=display&type=bookPage&decorator=none&eid=4-u1.0- B978-1-4377-0324-5..00021-3--s0015&isbn=978-1-4377-0324-5

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