MATERNAL ADAPTATIONS TO PREGNANCY
Dr. Cayabyab
(revised:other slide from previous lecture
included)
Edited by: Arago, Gamelaah Aika G.,R.N.
Pregnancy –period of adjustment to demands
of the product of conception/.growth, inc
vascularity and increase mobility thus giving
changes to the ff:
- Uterus – hypertrophy (increase in
size)
- non – pregnant uterus – 10 ml
capacity
- pregnant uterus- 5 liters to as much
as 10 liters
- 500 – 1000X its non pregnant
o state
- non pregnant weight – 70 grams
- pregnant weight – 1,100 grams
Uterus
Size – 12 weeks AOG – occupies the
abdominal cavity
-fundus at the level of the symphysis
Shape
pear shape – normal shape
pyriform -- 6 weeks
globular ---- 8 weeks
sperical --- 12 weeks – 20 weeks
ovoid - - till term
Braxton Hick’s contractions – irregular painless
Uterus
-Blood flow – 500ml/min
Cervix- hypertrophy/ hyperplasia/edema
Hegar’s sign – softening of isthmus
Gooddel’s sign – softening of the
cervix
Show – bloody discharge/ sign of labor
Vagina
- Chadwick’s sign – violaceous/bluish
- discoloration of the vagina,due to
increase vascularity
- presence of thick white secretions
- dec ph (3.5-6 due to increasing lactic
acid from glycogen in vaginal epithelium
due to lactic acidosis
Ovaries – function stops
Fallopian Tube/oviducts/salphinx - mucosa
flattens slightly
-may undergo torsion due to increasing size
uterus
Abdominal wall and skin-
striae gravidarum – due to laceration
of deeper skin layers
diastasis recti – separation of recti
muscles at the mid abdomen
Skin
- Linea nigra – brownish black line at the
middle of the abdomen
- Chloasma/ mask of regnacy –
irregular brown patches over the face
and neck
- Or melisma gravidarum/inc. MSH or
by estrogen and progesterone
- Vascular change- angiomas vascular
- Spider face, neck, upper chest and
arms
- Palmar erythema
Breasts – tingling and tenderness
engorgement
-milk secretion
Metabolic changes:
weight gain – 1st trimester – 1 kg
2nd trimester – 5 kg
3rd trimester - - 5 kg
water metabolism - water retention/
dependent edema
protein metabolism – more than 500gm of
protein. ½ of total increase, growth and dev. Of
fetus, placenta, uterus, breast MBV
2nd half of pregnancy needs 1000 gms of
protein(5-6gms/day)
Animal source-meat,milk, cheese, egg,poultry
and fish
Carbohydrate – potentially diabetogenic
Diabetes mellitus dependent
In pregnancy there is:
a.mild fasting hypoglycemia
b.postprandial hyperglycemia
c.hyperimsulinemia
-pregnant wome changes rapidly from a
postprandial hyperglycemia due to increase
glucose to fasting state due to drecrease plasma
glucose
Fat metabolism – increased by 17-60%
 Maternal Hyperlipidemia-Increase
apolipoproteins in plasma during pregnancy
 Leptin increase and peaked at 2nd half of
pregnancy
 Secreted by adipose tissue
 Key role- body fat and energy expenditure
regulation
 Ghrelin-peptide sec. By stomach in
response to hunger
 Role –homeostatis regulation
Electrolyte and Mineral metabolism
 increased iron req. due to dec. iron
1000mg/day
 Iron req. inc. after midpregnancy 6-7
mg/day for normal pregnancy
  w/o iron supplement Hbd and Hct dec
as plasma volume inc.
 1000 meq of Na and 300 meg of K
 Total serum CA- dec.
 Serum Mg- dec.
Total iron content in normal pregnancy
= 1 gm distributed as follows:
300mg – fetus and placenta
200mg lost thru normal routes
500mg latter half in pregnancy
Acid-base equilibrium – respiratory
alkalosis
Hematological changes –
 Blood volume-40-45 % above
nonpregnant volume after 32-34
weeks
Pregnancy induced hypervolemia is vital to:
 1.meet metabolic demands of uterus
 2.provde nutrient for fetal growth
 3. protects mother/fetus against venous
return in supine and erect position
 4.protects mother against bleeding upon
delivery
 hematologic – hypervolemia – 45%
 hemoglobin of less than 11gm/dl –
anemia late in pregnancy
Leucocytes – increased in pregnancy
Blood coagulation factors – all are increased
except XI and XIII
Puerperium ave. maternal blood loss-500-600
ml for a single fetus
Ave. blood loss for CS/twin delivery-1000 ml
Cardiovascular system- change apparent at 8
weeks AOG
Heart – pulse and cardiac rate increased by
10 – 15 beats /min
 cardiac volume increased
 cardiac output increased
Blood flow to skin – increased in cutaneous
areas
Arterial pressure- decreases at 24-26 weeks
and rises thereafter
Respiratory tract
 diaphragm rises by 4 cm
 pulmonary function increased
hyperventilation
 thoracic circumference increases by
6cm
 FRC/RV-dec
 TLC-unchanged
 TV/RMV-inc
Urinary system
 ureteral dilatation due to dextrorotationof
uterus cushioning left ureter by sigmoid
 Renal function - increased
Gastrointestinal tract
 appendix may be pushed up to the flank
 gastric emptying is decreased
 pyrosis or heartburn is common
Liver – decrease plasma albumin
spider nevi and palmar erythema due to
circulating estrogen
Gallbladder- decrease responsiveness to
cholecystokinin thus there is sluggish
sequestration and precipitation of bile
predisposing to cholesterol / calcium
gallstone formation.
Endocrine system
 pituitary gland – increase in size
 ovaries – function totally stops
 thyroid gland – hyperplasia
 increase blood supply and augmented
 function
Endocrine
 placenta – main endocrine gland of
pregnancy
 increase HCG detectable in maternal
 plasma 8-10 days after implantation
 increase maximal level – 10 weeks ges
 nadir /decrease – 20 weeks
Musculoskeletal system
 progressive lordosis due to increase
mobility of sacroiliac, sacrococcygeal,pubic joints.
 Lordosis of pregnancy- pride of pregnancy
Central Nervous System-few and subtle changes
 Memory decline-3rd trim
Eyes-intraocular pressure dec.
-Corneal sensitivity dec. especially on late pregnancy
Sleep difficulty @ 12 weeks AOG and 1st 2 months
post partum
May lead to post partum blues/depression