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Physiological changes in pregnancy (BODY MASS (BLOOD MORPHOLOGY (Increase…
Physiological changes in pregnancy
Pregnancy dating
Till delivery:
From the first day of last menstrual bleeding – 280 days (40 weeks)
From conception – 266 days (38 weeks)
Gestational weeks – from the first day of last menstruation
Weeks of fetal life – from conception
Physiological delivery, term delivery:
from completed 37 weeks till completed 42 weeks
ESTMATION OF DUE DATE
Last menstrual period – the first day!
Naegele rule: LMP + 1 year – 3 months + 7 days
+/- difference between the patient’s cycle length and 28 days
CHANGES
physiological and don’t require treatment
caused mainly by hormones produced by feto-placental unit
often suggest borderline sufficiency or even disease of organs or systems
Pregnancy-related hormones
hCG
becomes detectable in serum and urine at 7-10 days after conception
rapid increase till 9 weeks, decrease till 15 weeks
does not increase insulin resistance
Abnormal levels of hCG
Increased:
multiple pregnancy, molar pregnancy, Down syndrome
Decreased:
ectopic pregnancy, risk of miscarriage, fetal demise
hPL (human placental lactogen)
gradual increase till 37 weeks, then slow decrease
increases insulin resistance
preparation of mammary glands for lactation.
Progesteron
slow increase during all pregnancy time;
decrease of smooth muscles tension – stops uterine contractions;
increase of immunotolerance;
increase of insulin resistance.
GENITAL ORGANS
Ovaries
increased volume
presence of corpus luteum till 5-9 weeks (cyst up to 5 cm)
after 16 weeks increased ovary without cysts
Uterus
growth and distension, from 60 to 1000 g;
in the first half of pregnancy active growth with hypertrophy and hyperplasia of muscle cells and growth of connective tissue;
in the second half of pregnancy passive enlargement caused by fetal growth.
Vagina and vulva
vagina is expansible and enlarged
grayish mucosa (increased vascularization)
change of vaginal pH (app. 4)
immunoglobulins IgG, IgA i IgM
BREAST
Mammary glands:
glands hyperplasia – result of estrogens exposition
ductal hyperplasia – result of progesteron exposition
visible vascular net
increased pigmentation of the nipples
yellow discharge (colostrum) from the 20th week
BODY MASS
Increase uterus (muscle + content), tissue hydration, blood volume
Physiological body mass increase to 12 kg.
Till 20 weeks from 0 to 5 kg.
Increase of caloric demand – 300 kcal/day
Body mass increase inversely proportional to BMI:
BMI < 18,5 kg/m² - 15,3 kg
BMI 18,5-24,9 kg/m² - 12,0 kg
BMI > 25 kg/m² - 8,9 kg
TISSUE HYDRATION
Increases during all the pregnancy
Physiological edema
BLOOD VOLUME
Increases till 32 weeks by app. 25% (1 liter)
Effect on:
blood count, blood pressure, heart performance
BLOOD MORPHOLOGY
Increase of erythorcyte volume is lower than serum volume – relative anemia
Decrease of Hb
I trimester 11g%, II trimester 10,5-11g%, III trimester 10,5-11g%
Decrease of serum proteins by 1g, serum albumins
Increase of leukocytes from the beginning of the 2nd trimester up to 14000, mainly granulocytes
Decrease of platelet count closer to the end of pregnancy
Increase of cholesterol level
Increase of coagulation factors except factors XI i XIII; decrease of fibrinolytic activity (activity of prosteins C and S) – hypercoagulability.
CIRCULATORY SYSTEM
Increased blood volume:
increased minute heart output (max. in 32nd weeks)
increased heart rate by 20 beats/min/1 fetus
decreased peripheral resistance (systolic pressure) by 10 mm Hg – the lowest at 32 weeks
decreased diastolic pressure in the 2nd trimester
Inferior Vena Cava syndrome – compression of inferior vena cava by enlarged uterus (sleeping on the left side?)
BODY TEMPERATURE
Increased by 0.5 Celsius degree!
RESPIRATORY SYSTEM
Change of breathing mode from costal to diaphragmatic
Distension of trachea and bronchi
Increase of: breathing, inhaling and minute capacity
Decrease of: life and total capacity, inhaling and exhaling margin
Hyperventillation – decrease of arterial pCO2, respiratory alkalosis
Resting dyspnea - 20 % of pregnant women
Exertion dyspnea - 50 % of pregnant
URINARY TRACT CHANGES
Increase in renal pelvis and calicules and ureters
Increased urinary bladder volume, even to 1000 ml
Increased renal blood flow
Increased glomelural filtration (by 50%)
maximal intensity of changes is observed at 32 weeks, then they are heading towards pre-pregnancy values
Decreased renal threshold for glucose (glucozuria), water-soluble vitamins, aminoproteins
Increased resorption of sodium and potassium
Increased pH
DIGESTIVE TRACT
slower bowel perystalsis, due to progesterone
decreased pepsin and stomach acids secretion
increased water absorption in large intestine – constipation, hyperplasia of intestin mucosa
compression by enlarged uterus – nausea, vomiting, heartburn
salivation, decreased saliva pH
stagnation and thickening of bile – tendency to cholelithiasis
MUCOSA
Tendency to hyperplasia:
nose, sinus, throat, mouth (gums)
MUSCULO-SKELETAL SYSTEM
Change of posture and the way of moving.
1.increased lumbar lordosis
2.flexion of cervival vertebral column
3.joint distention – higher mobility of pelvic bones
SKIN AND HEAR
Increased pigmentation – vulva, nipples, linea alba.
Chloasma in the second half of pregnancy on the face.
(pigmentation changes under eyes and on bridge of nose)
Swollen legs, hands, face.
Redness of the hands.
Angiomas of the face, neck and thorax.
Varicoses
Chcanges of connective tissue and colagen (stria, soft fibroids)
increase in swet and sebum production.
Excessive hair growth around umbilicus and nipples
Trimesters
T1 (first trimester): 0-14 wk
T2 (second trimester): 14-28 wk
T3 (third trimester): 28-42 wk
Normal pregnancy term: 37-42 wk