1. Pregnancy and Maternal Physiologic Adaptations
Prepared by :
Ayda khader
Feb.2017

2. Confirmation of pregnancy: Presumptive Indications of Pregnancy
1. Amenorrhea (cessation of menses)
Pregnancy is suspected if more than 10 days elapsed since the time of the expected onset.
2. Breast and Skin Changes
Breast is enlarged and become tender
Nipple become larger and more pigmented
Secrete of colostrum in the 2nd half of pregnancy
Darkening of areola

3. 5. Abdominal Striae (striae gravidarum )
3. Nausea and Vomiting (morning sickness)
Occur mainly in the morning
Usually disappear near the end of the first trimester
4. Vaginal and Cervical Color Changes
Chadwick’s signs = a bluish discoloration and congestion of vaginal wall
5. Abdominal Striae (striae gravidarum )
Appears in abdomen and sometimes in breast, and thigh because of the stretch.
6. Fetal Movement (Quickening Sign)
occurs between 16th and 20th week after the onset of last menses

4. 7. Frequency of Urination
Caused by pressure is exerted on the bladder by expanding uterus
Decrease when the uterus expands into the abdomen away from the pelvis
Reappear when the fetal head engages in the pelvis at the end of pregnancy.
8. Fatigue
Characteristic of early pregnancy that the direct cause unknown but may be related to hormones changes

5. Probable Indications of Pregnancy
1. Abdominal Enlargement
Slow gradual increase of the abdomen size
2. Braxton Hicks Contraction
Irregular painless contractions of the uterus occurring throughout pregnancy.
3. Ballottement
Refers to sinking and rebounding of the fetus in its surrounding amniotic fluid when taping the uterus suddenly (occur at mid-pregnancy/ weeks).
It’s a strong indication of pregnancy

6. 4. Change in the shape, size and consistency of the uterus
Uterus enlarges, elongates and decrease in thickness as pregnancy progress
Hegar’s sign: softening of the lower uterine segment at 6-8 weeks.
5. Changes in the cervix
Goodell’s sign: softening of the cervix at 6-8 weeks
The cervix remains firm during pregnancy in case of cervical inflammation and carcinoma.
6. Pregnancy tests
Human Chorionic Gonadotrophin (HCG) hormone appears in the maternal serum and urine

7. . Positive Indications of Pregnancy
1. Auscultation of fetal heart sounds
Fetal heart sounds can be heard with a fetoscope by 20to 24 weeks of gestation
Electronic Doppler can detect heart motion at 10 weeks of gestation.
2. Felt of fetal movement by the examiner
Should be careful to be not deceived by similar peristaltic movement of large intestine.
3. Visualization of the fetus
The fetus can be detected by transvaginal ultrasonography as early as 4 weeks after the last menstrual period and by transabdominal ultrasonography at 6 weeks.

8. . Maternal physiologic changes during pregnancy
The changes that occur in the body system of the pregnant women caused by several factors:
Hormonal influences
Fetus growth inside the uterus
Maternal adaptation to physiological changes of pregnancy

9. 1. Reproductive System
Uterus
The uterus develops to provide a nutritive and protective environment in which the fetus will develop and grow.
Progesterone and estrogen produced by the corpus lutium cause the decidua.
Become thicker, more vascular at the fundus.
The decidua provides a glycogen until to form placenta

10. Increase in uterus weight and size.
The uterus can be palpated supra publically by the end of 3ed month that by 22 and 36 weeks of gestation the fundus has reached the umbilicus and xiphoid respectively.
The uterus descends slightly into the pelvis during the last 3 weeks
Painless irregular contraction (Braxton Hick’s Contraction) at the first two trimesters. During the last trimester become more frequent and cause some discomfort.

11. B. Cervix
The cervical glands proliferate with increase mucus production. The mucus form plug in the cervical canal and block ascending of bacteria from the vagina into the uterus.
The obvious cervical changes occur in color and consistency that the cervix becomes congested with blood (Chadwick’s sign) due to estrogen stimulation and soft (Goodell’s sign).

12. C. Vagina and Vulva
Increase vascularity of the vagina cause vaginal wall to appear bluish (Chadwick’s sign).
Softening of vaginal tissue and loosens of connective tissue cause distend of vaginal wall to prepare for childbirth.
The subsequent breakdown of glycogen into lactic acid assists in producing a low vaginal pH which prevents infection

13. D. Ovaries
Ovulation ceases during pregnancy because circulating estrogen and progesterone are high that inhibiting release of LH and FSH (these hormones are necessary for ovulation).
Progesterone produced in early pregnancy by special glandular structure of the ovaries called corpus luteum. Later the placenta produces it in increasing quantities

14. 2. Integumentary System
Pigmentation changes occur ( increase of melanin).
Chloasma: patchy coloring on the face.
Linea nigra: pigmented line running from the pubis to the umbilicus.
Striae gravidarum: thin and stretch marks appear as red strips, its appers in the skin of the abdomen, breast and thighs.
Oily skin and acne may occur in pregnancy

15. 3. Breast Changes
Some women may experience tender and tingle in the early weeks of pregnancy.
The breast size increased by 2ed month
Nipple becomes large, more deeply pigmented and more erectile, Areola becomes broader and more deeply pigmented.
Colostrum may be experienced in some women by 2ed trimester. It has protein and mineral but less sugar and fat compared to mature milk.

16. A. Weight Gain 4. Metabolic System
Women are encouraged to gain an adequate amount of weight during pregnancy.
Expected increase: total weight gains are 7-18 kg for normal maternal pre-pregnancy weight, kg for underweight women, kg for overweight and at least 6-8 kg for obese women. Average weight gain for twines pregnancies is kg.

17. B. Water Metabolism
Average women retains 6.5 liter of extra water during pregnancy.
Many pregnant women experience edema in the legs and ankles.
Carpal tunnel syndrome (pain, burning and numbness of the hand and wrist) may be occurred in some women results from compress of edema in the median nerve.

18. C. Carbohydrate Metabolism
Pregnancy is potentially diabetogenic.
D. Iron Metabolism
Iron requirements increase that the needs for iron are often exceed the available amounts.
Supplementation of iron are necessary for several weeks after pregnancy.

19. 5. Cardiovascular System
A. Heart
Diaphragm is progressively elevated during pregnancy and displaced to the left and upward with moving the apex laterally.
Heart murmur is common and usually disappears after delivery.
B. Circulation
Heart beat usually increases from beat/minute during pregnancy.
Cardiac volume increase by 10% and increase cardiac output (reversed after childbirth).

20. C. Blood pressure
Blood pressure decreased slightly during first and second trimester and by the end of third trimester blood pressure return to pre-pregnancy state.
D. Hematologic
hemoglobin concentration at term averages 11g/dl.
Leukocytes count is increased to during labour with unknown causes.

21. 6. Respiratory System
Maternal oxygen requirement increase by 15-20% during pregnancy to meet fetal needs for oxygen
Increase respiratory rate and reduce Pco2
Diaphragm is elevated in the late of pregnancy due to enlarged uterus.
7. Urinary System
Glomerular filtration increases due to elevated level of human placental lactogen (HPL) hormone during pregnancy
Glycosuria and mild proteinuria may be evident during pregnancy.
Frequency of urination.

22. 8. Gastrointestinal System
Stomach and intestine are displaced upward and laterally by enlarged uterus.
Heart burn is common
Hemorrhoid is common due to constipation resulted from decreases of intestinal motility.

23. 9. Musculoskeletal System
Alteration in posture and walking due to increase in the maternal weight which result in back pain.
Increasing the mobility of pelvic joints and ligaments in the second trimester resulting from increases the relaxin and progesterone productions by the placenta.
Calcium absorption and storage is increased starting from the first trimester to meet fetal demands in the late of pregnancy,