MATERNAL ADAPTATIONS TO

PREGNANCY
 THE REPRODUCTIVE ORGANS
UTERUS
Changes in Uterine Measurement:
Pregnancy Term
Pregnancy
Weight 50 gm 1100 gm
Thickness 2 cm 0.5 cm
Length 6.5 cm 32 cm
Depth 2.5 cm 20 cm
Width 4 cm 24 cm
Capacity 10 ml 5000 ml
 Blood Flow: Uterine blood flow increases
from 20 ml before pregnancy to 700 to
900 ml at the end of pregnancy. Three
fourths of blood supply to the goes to the
placenta.
 Shape: From pear shape before
pregnancy to spherical and later on to
avoid shape in the last months of
pregnancy.
 Position: After 12 weeks gestation, the
uterus loses its anteflexed position.
 Dextrorotation of the uterus: as the
uterus rises out of the pelvic cavity after
12 weeks gestation, it rotates to the right
because of the presence of rectosigmoid
on the left side of the pelvis. As it grows
larger and occupy much of t he space in
the abdominal cavity, the uterus displaces
the intestines to the sides of the
abdomen.
 Location of the fundus:
 12 weeks – at the level of symphisis pubis
 16 weeks – halfway between symphisis pubis
and umbilicus
 20 weeks – at the level of umbilicus
 24 weeks – two fingers above umbilicus
 30 weeks – midway between umbilicus and
xiphoid process
 36 weeks – at the level of xiphoid process
 40 weeks – two fingers below umbilicus,
drops at 34 weeks level because
 of lightening
 Contractility: Being muscular, the uterus
is a highly contractile organ. Beginning on
the first trimester, the uterus undergoes
irregular contractions. Late in pregnancy,
these contractions, known as
Braxton_Hicks, become more intense and
frequent causing some discomfort on the
pregnant woman. It is the cause fo false
labor.
 CERVIX
 Color: Color of cervix change from pinkish to
purplish due to increased blood supply.
 Leukorrhea: Estrogen stimulation results in
increase mucus production. Formation of
operculum, the mucus plug of cervix that
protects against bacteria and infection.
Discharge of operculum at term, called show, is
in an important sign of labor.
 Consistency: Softening of the cervix, known as
Goodel’s sign is observable by 6 to 8 weeks
gestation.
ISTHMUS
 During pregnancy, the isthmus softens and elongates
up to 25 mm. it will later from the lower uterine
segment together with the cervix.
 Hegar’s sign – softening of the lower uterine segment
begins as early as 5 weeks gestation.
VAGINA
 Increase blood supply results in:
 Chadwick sign – vaginal mucosa change in color from
pinkish to purplish or dark-bluish
 Increased sentivity and heightened sexual
responsiveness.
 Vaginal ph: 3.5 to 6, Acidic
 The vaginal tissues become soft to allow for easier
distension during labor.
OVARIES
 No graafian follicies develop and no ovulation occurs
during pregnancy.
 Corpus luteum pf pregnancy – the corpus luteum is
the chief source of luteum also procedures relaxin,
inhibin and sometimes oxytocin.
BREAST
 Increased breast size due to alveolar tissue growth,
fat deposition and increased vascularity.
 Breast changes associated with pregnancy include
feeling of fallness and tingling sensation, darkening of
the skin around the areola, Montgornery glands
enlarge and become prominent, nipples stand out. A
clear fluid, called colustrum, can be expressed from it
as early as the fourt month.
 CARDIOVASCULAR SYSTEM
BLOOD VOLUME
 Total blood volume increase by 45 to 50 % for
which 75% is plasma and 25%. Is RBC Unequal
proportion in the increase of blood constituents
results in hemodilution and physiologic anemia
and lowered hematocrit.
 Increase blood volume results in increase
cardiac output by 25 to 50%.
 The increase in blood volume reaches its peak
at about 24 weeks, cardiac workload also
reaches its peak during the second trimester.
 BLOOD CONTITUENTS
 There is increased production of RBC by the bone
marrow. RBC increase as much as 33% and
haemoglobin levels by 15% to compensate for the
increase in plasma volume.
 Hemodilution occurs (increase in plasma portion of the
blood) causing pseudoanemia. The rise of the plasma
protein levels. Reduction in protein level lowers down
osmotic pressure within intravascular spaces which
causes fluid shift from intravascular to interstitial
spaces. This contributes to the normal ankle and foot
edema of pregnancy.
 Blood lipids and cholesterols levels increase to provide
for an available supply of energy for the fetus.
 Increased level of clotting factors.
 HEART
 The heart is displaced to the left and toward as
the diaphragm becomes progressively elevated.
 Slight cardiac enlargement by a little more than
10%. Increased blood volume means an
increased in cardiac workload, because of this
slight hypertrophy of the heart occurs.
 Pregnant women usually experience
palpitations during pregnancy.
 Cardiac output is increased appreciably when
the woman is in left lateral position.
The following are normal during
pregnancy

– Splitting third sound is due to lowered blood

viscosity
– Systolic murmurs in about 90% of pregnant
women
– Diastolic murmur in 20%
– Benign pericardial effusion on x-ray
Pulse rate increases about 10 to
15 bears per minute.

– Left ventricular wall mass

– End diastolic dimensions
– Stroke volume
– Cardiac output
 BLOOD PRESSURE
– Blood pressure remains the same as pregnancy level. It may
drop slightly on the second trimester but returns to normal
levels on the third trimester.
– Arterial blood pressure is highest in sitting position,
intermediate in supine and lowest in left lateral position.
– Supine Hypotensive Syndrome – when the women lies on
her back, the gravid uterus lies on the inferior vena cava
and interferes with blood flow from the lower extremities,
resulting in blood returning to the heart to be greatly
reduced. The extremities, resulting in blood returning to the
heart to be greatly reduced. The decreased amount going
back to the heart result in decreased cardiac output that
leads to:
 Decreased blood pressure
 Decreased blood supply to the brain causing dizziness,
faintness, and lightheadedness
 RESPIRATORY SYSTEM
Changes in respiratory system during pregnancy
are chiefly caused by:
 Increased oxygen requirement as the mother
must supply not only for herself but for the
baby, too.
 Effect of progesterone and estrogen
 Mechanical effect of the enlarging uterus.
 Hyperventilation:
 The mother experience hyperventilation in
an effort to blow off the extra carbon
dioxide from the fetus. Increased
ventilation prevents respiratory acidosis,
(accumulation of carbon dioxide in the
body) which is compensated by increase
renal excretion of bicarbonate.
 Displacement of the diaphragm by the
enlarged uterus up to 4 cm produce the
following effects:

 Chest crowding – the women compensates by

expanding her lungs horizontally
 Decreased residual volume – less air is left in
the lungs after expiration.
 Shortness of breath
 Tidal volume (amount of air inspired)
Increased by as much as 40% to meet
increased oxygen requirements:

 Total body consumption of oxygen increase by

15-20%.
 Nasal congestion occurs due to estrogen
stimulation. Advice women that this is normal
during pregnancy and the there is no need to
take medications.
 URINARY SYSTEM

 Urinary frequency during pregnancy is due to:

 First trimester – uterus pressures on the bladder
as it rises out of the pelvic cavity.
 Second trimester – pressures on the presenting
part on the bladder after lightening.
 Increased blood flow to the kidney which
increases glomerular filtration rate in urinary.
Lactosuria:
 Presence of sugar or lactose in the urine is
considered normal. Lactose is secreted by
the mammary glands but since it is not yet
used during pregnancy. It is normally
spills in the urine.
The following are increased during
pregnancy:
 Increase urinary output as the mother excrete
her metabolic waste products and those of the
fetus, too. With the increase in the volume of
urine, specific gravity decreases.
 Glomerular filtration rate (GFR) and renal plasma
flow by as much as 40%.
 Concentration of rennin, anglotensin I and II.
 The kidney increases slightly in size.
 Greater loss of amino acids and water soluble
vitamins in the urine of pregnant women.
 Effects of progesterone:
 Dilatation of the ureters particularly on the right side.
 Increased urine capacity of t he bladder for about 1,
500 ml. due to decrease bladder tone.
 Increased aidosterone production resulting in sodium
and water retention which causes edema.
 Elongation and distention of the ureter which produce
single or double curves of varying size.
 Diliatation and kinking of the ureteres due to the
relaxavent effect of progesterone and the compression
caused by the enlarged uterus at the level of the
pelvic brim leads to urinary statis. Urinary statis
predisposes the pregnant of infection.
Nocturia:
 During the day, the pregnant woman tend
to accumulate water in the form of
dependent edema. This fluid is mobilized
and excreted via the kidney (urine) during
the night.
 GASTROINTESTINAL SYSTEM
Nausea and vomiting on the first trimester is
attributed to:
 Increased HCG levels
 Increased estrogen levels
 Decreased maternal glucose levels as
glucose levels is being utilized for fetal
brain development.
Effects of progesterone:
 Decreased GIT montility and longer emptying
time which leads to constipation
 Pyrosis/Heartburn – relaxation of cardiac
sphincter results in reflux of acidic gastric
contents (due to hydrochloric acid) into the
lower esophagus which irritants such as coffe,
tea and chocolates.
 Slowed bile movement from gall bladder results
itching and increased predisposition to gallstone
formation.
Effects of Pestrogen
 Ptyalism – increased salivation
 Epulis – hypertrophy or swelling of the
gums, advise to use soft toothbrush to
avoid gum bleeding.
 INTEGUMENTARY SYSTEM
 Increased melanin production:
 During pregnancy, the anterior pituary gland
produces more melanotropin stimulating
hormone which stimulates the melanocytes in
the skin to produce more melanin. This results
in darker skin coloration in certain parts of the
body.
– Melasma – facial discoloration
– Linea negra – dark line from umbilicus to symphisis.
– Darker areola
Estrogen effects:
 Palmar erythema – redness and itching of
the hands
 Vascular Spider Nevi – prominent
capillaries under the skin
 Activation of sweat and sebaceous glands
result in increased perspiration and oily
skin.
Striae gravidarum
 Enlargement of the uterus results in
stretching and tearing of the elastic fivers
of the abdominal skin, thus striaes. Striaes
appear pinckish during pregnancy and
turn silvery white after delivery. Pruritus or
severe itching of the abdominal skin is due
to stretching of the skin. Striaes may also
appear in the thighs and breasts.
 ENDOCRINE SYSTEM
 Thyroid Gland – slight enlargement of thyroid gland due to increased
metabolic rate.
 Pancreas – elevated glococorticoid levels stimulate increase insulin
production.
 Parathyroid Gland – enlargement of parathyroid to meet increased needs for
calcium to be utilized for the development of fetal bones and teeth.
 Adrenal Gland – increased corticosteroid production and aldosterone
production promote sodium reabsorption and water retention.
 Pituitary Gland – the pituitary gland enlarges but this is not essential to
pregnancy.
 High estrogen and progesterone levels inhibit LH and FSH production.
 Increased secretion of growth hormone and melanocyte stimulating
hormone.
 Posterior pituitary gland secrete increasing amounts of oxytocin and
prolactin as pregnancy nears term.
 SKELETAL SYSTEM

 Softening of joints and ligaments,

especially of symphisis and sacroiliac joints
is caused by relaxin and estrogen.
 Leg cramps is caused by pressure of
gravid uterus on nerves and imbalance of
calc ium in the body.
 SIGNS AND SYMPTOMS OF
PREGNANCY
 PRESUMPTIVE SIGNS
 Symptoms
 Amernorrhea – pregnancy is suspected if more than
10 days have elapsed since the expected menstrual
period.
 Breast changes – starting on the fourth week of
pregnancy, breast enlarge, feels tender and heavy,
veins become prominent under the skin, areola gets
darker and wider, nipple stand out and Montgomery
glands become prominent.
 Quickening – the first fetal movement felt by
the mother, felt by primis at 30 weeks and
multis at 16 weeks.
 Easy, fatigability.
 Leukorrhea – increase vaginal discharge
characterized as white mucoid is due to
elevated estrogen levels.
 Nausea and vomiting/Morning sickness –
commences 6 weeks after the LMP and
persists believed to be caused by elevated HCG
levels.
 Chadwick’s signs – Increase blood supply
results in purplish discoloration of the vagina
Skin changes:
– Striae gravidum
– Linea negra
– Choloasma
– Increased perspiration
– Hair grows more rapidly
 PROBABLE SIGNS
 Hegar’s Sign – softening of the lower uterine
segment which is felt starting 6 to 8 weeks after
LMP.
 Uterine Growth – the uterus doubles in sizes as early
as 10 weeks and pregnancy becomes obvious by 14
weeks. Uterine growth is determined by measuring
fundal height.
 Ballotement – refers to the rebound that occurs
when the examiner’s fingers tap the floating fetus
within the uterus and caused by the fetus floating
away and returning back to its previous position.
Ballotement is observable beginning 6 to 8 weeks.
 Uterine suffle – a muffled swishing sound heard over
the abdomen in union with the mother’s heart beat.
 Goodel’s sign – softening of the cervix
can be observed beginning 6-8 weeks
after LMP. Incarcinoma of the cervix, the
cervix remains firm until the onset of
labor.
 Braxton-Hicks contractions – they are
painless palpable contractions occurring
at irregular interval and felt by the
mother as sensation of tightness over
her abdomen. They begin as early as
eight weeks gestation and tend to
vecome stronger as pregnancy advances.
 Fetal outline – is paipable at 24 weeks.
 Positive pregnancy tests – it is presence
of HCG in the woman’s blood and urine
that gives a positive result to a
pregnancy test. HCG production most
probably begins at the time of
implantation. Highest level at 100-130
days of pregnancy. HCG is present
beginning 24 to 46 hours after
implantation. The earliest time that it can
be detected in maternal serum is:
– 8 days after ovulation
– 23 days after LMP
– 5 days before the expected menstrual period
 Types of Pregnancy Tests
1. Biologic or Bloasay Tests involves the use
of live animals
 Examples are:
 Ascheim Zondek Test
 Friedman Test
 Hogben Test
 American Male Frog Test
2. Immunologic Test which are based in
antigen-antibody reaction in the urine.
 Examples are:
 Rapid slide test
 Tube testing
 Radioreceptor assay
 Radioimmunoasay tests is the earliest
test to detect the presence of HCG
 ABSOLUTE OR POSITIVE
SIGNS
1.Fetal Heart Tone which can be detected by
Doppler at 12 weeks, by fetoscope at 16 weeks
and by stethoscope at 20 weeks.
2.Funic Suffle – a swishing sound synchronous
with fetal heart beat caused by blood rushing
through the umbilical arteries.
3.Fetal movement can be felt by the examiner
from 20 weeks onward.
4.X-ray visualisation of fetal skeleton as early as 14
weeks
5. Ultrasonographic evidence of pregnancy:
– Abdominal pulse echo sonography can
detect intrauterine pregnancy at 4 to 5
weeks.
– Small white gestational ring can be detected
after six weeks.
– Fetal brain and heart action is demonstrated
by eight weeks using Doppler or real time
sonography.
– Fetal head and thorax can be identified by
14th week