Introduction

1. Introduction • http://www.youtube.com/watch?v=fpUP6DeOH9U

2. PHYSIOLOGIC ADAPTATIONS TO PREGNANCY Developed by D. Ann Currie, R.N., M.S.N. 2012

4. UTERUS CERVIX VAGINA BREASTS REPRODUCTIVE SYSTEM

5. REPRODUCTIVE SYSTEM • UTERUS-ENLAREMENT DUE TO INCREASE ESTROGEN AND PROGESTERONE • INCREASE VASCULARITY • HYPERPLASIA • HYPERTROPHY

6. Nonpregnant Uterus

7. UTERINE GROWTH • LENGTH:2 1/2 in. to 12 1/2 in(6.5cm-32cm) • WIDTH:1 1/2in to 9 1/2 in(4cm-24cm) • DEPTH:1in to 8 1/2 in(2.5cm-22cm) • WEIGHT;2 1/2oz. to 2 1/2 lb.(60-70g-1100-1200g) • VOLUME: 1-2ml to 5000ml(10ml-5000ml)

8. Uterine Growth

9. CERVIX • INCREASE VASCULARITY AND HYPERTROPHY DUE TO ESTROGEN AND PROGESTERONE • CHADWICK’S SIGN • GOODELL’S SIGN • MUCORRHEA DEVELOPS- MUCOUS PLUG FORMS

10. Bimanual Examination

11. Hegar's sign

12. Ladin’s Sign

13. B Sign

14. Pisacek’s Sign

15. VAGINA • INCREASE VASCULARIZATION DUE TO ESTROGEN AND SOFTEN ING DUE TO PROGESTERONE • CHADWICK’S SIGN • VAGINAL DISCHARGE TENDS TO BE THICK AND WHITE=LEUKORRHEA • PH-4-6.5.(NONPREGNANT WOMAN 3.5-4.5)

16. BREASTS • BREAST CHANGES ARE DUE TO ESTROGEN AND PROGESTERONE • INCREASE VASCULARITY,NODULARITY,AND HYPERTROPHY • PIGMENTATION OF NIPPLES DARKEN • MONTGOMERY’S GLANDS BECOME PROMINENT

17. BREASTS • CONT • COLOSTRUM IS PRODUCED AND MAYBE SECRETED AS EARLY AS 16 WEEKS • BREAST FEEL FULL,INCREASE SENSITIVITY,TINGLELY,AND HEAVY.

18. BREAST CHANGES

19. HEMOLOGICAL CHANGES IN PREGNANCY • BLOOD VOLUME-40-50 % INCREASE(1500 ML) • PLASMA VOLUME-50% INCREASE(1200-1300ML) BY 30-34 WEEKS • RBC’S-17-20% INCREASE(5-6.25MIL/MM • PLT-150,000-400,000

20. HEMOLOGICAL CHANGES • CONT • WBC’S-INCRESE IN 2ND -3TH TRIMESTER(5,000-15,000MM-) • FIBRINOGEN-INCRESAES 50-80% • FACTORS VII,VIII,IX,X- INCREASE • FACTORS XI,XII-DECREASE • SED RATE- INCREASES

21. CARDIOVASCULAR SYSTEM • HEART RATE- INCREASES 10-15 BEATS PER MIN. • B/P- 1ST TRIMESTER-REMAIN THE SAME-2ND TRIMESTER DECREASES- AND 3RD TRIMESTER RETURNS TO NORMAL • CARDIAC OUTPUT-INCREASES 30-50%

22. CARDIOVASCULAR SYSTEM • CONT • MYOCARDIAL HYPERTOPHY-INCREASES 12% • THE HEART IS SHIFTED UPWARD, ANTERIORLY AND LATERALLY TO LEFT • HEART SOUNDS-S1,S2,S3 AFTER 20WKS.-MURMURS ARE COMMON

24. Supine Hypotension from pressure on the vena cava

25. RESPIRATORY SYSTEM • INCREASED CHEST EXPANSION • DIAPHRAGM DISPLACED AS MUCH AS 4CM. • INCREASED VASCULARITY AND SECRETION OF MUCOUS MEMBRANES • RESPIRATORY RATE INCREASES 2 BPM

26. RESPIRATORY SYSTEM • CONT • TIDAL VOLUME INCREASES 30-40% • VITAL CAPACITY UNCHANGED • INSPIRATORY CAPACITY INCREASES • EXPIRATORY VOLUME DECREASES • TOTAL LUNG CAPACITY UNCHANGED OR SL.DECREASE.

27. RESPIRATORY SYSTEM • CONT • O2 CONSUMPTION INCREASES 15-20% • PO2-INCREASES(104-108mmHG) • PCO2-DECREASES(27-32mmHG0 • HCO3-DECREASES(18-31mEq/L) • PH-INCREASES(7.4-7.45)

28. RENAL SYSTEM • RENAL PELVIS AND URETERS DILATE-RIGHT MORE THAN LEFT • BLADDER CAPACITY-INCREASES TO 1500ML. • GLOMERULAR FILTRATION RATE- INCREASES 30-50% • RENAL PLASMA FLOW-INCREASES 30%

29. RENAL SYSTEM • CONT • LABS- GLUCOSE IN URINE UP TO 1+ • PROTEIN-N URINE TRACE TO 1+ • BUN-DECREASED 8-20mg/dl • CREATININE-DECREASED (0.6-1.2mg/dl) • URIC ACID -DECREASED 1ST-2ND TRIMESTER(4.5-5.8mg/dl)-3rd back to normal

30. INTEGUMENTARY SYSTEM • HYPERPIGMENTATION OF NIPPLES,AREOLAE, AXILLAE, AND VULVA • CHLOASMA • LINEA NIGRA • STRIAE GRAVIDARUM • ANGIOMAS

31. Linea Nigra

32. STRIAE GRAVIDARUM

33. INTEGUMENTARY SYSTEM • CONT.PALMAR ERYTHEMA • HYPERACTIVE SWEAT AND SEBACEOUS GLANDS • SKIN DISORDERS MAY INCREASE-INCLUDING PRURITUS AND ACNE • HAIR GROWTH INCREASES

34. GASTROINTESTINAL SYSTEM • GUMS-INCREASE VASCULARITY,HYPEREMIC, SPONGY AND SWOLLEN • EPULIS • PTYALISM • N/V-”MORNING SICKNESS” • HIATAL HERNIA MAY OCCUR IN 15-20%PREGNANT CLIENTS

35. GASTROINTESTINAL SYSTEM • HEARTBURN-PYROSIS • DECREASE TONE AND MOLITY OF GI TRACT • CONSTIPATION • GB EMPTYING TIME IS SLOWED-GB STONE MAY FORM • STOMACH IS DISPLACED UPWARD

36. GASTROINTESTINAL SYSTEM • COLON IS COMPRESSED AND DISPLACED. • APPETITE CHANGES

37. MUSCULOSKELETAL SYSTEM • LORDOSIS OCCURS • CENTER OF GRAVITY CHANGES • GAIT CHANGES-”WADDLING” • SL. RELAXATION OF PELVIC JOINTS • MUSCLE TONE OF ABDOMINAL MUSCLESDECREASES • DIASTASIS RECTI ABDOMINIS MAY OCCUR

38. POSTURAL CHANGES IN PREGNANCY

39. Diastasis Recti Abdominis

40. NEUROLOGIC SYSTEM • COMPRESSION OF PELVIC NERVES • EDEMA INVOLVING PERPHERAL NERVES MAY RESULT IN CARPAL TUNNEL SYNDROME. • ACROESTHESIA • TENSION H/A • HYPOCALCEMIA-MUSCLE CRAMPS AND TETANY

41. ENDROCINE SYSTEM • PITUITARY GLAND-SUPPRESSION OF FSH AND LH FROM ANT PITUITARY • INCREASES IN SIZE • MSH.,PROLACTIN,TSH,AND ADRENOCORTICOTROPIC HORMONE ARE INCREASED • OYTOCIN INCREASES AS FETUS MATURES AND LABOR IS NEAR

42. ENDOCRINE SYSTEM • THYROID GLAND-INCREASES IN SIZE SLIGHTLY • BMR INCREASES 25%(15-20%) • T4 INCREASES AND THAN RETURNS TO NORMAL • PARATHYROID GLAND-PARATHYROID HORMONE INCREASES-PEAK AT 15-35 WKS

43. ENDOCRINE SYSTEM • CONT • PANCREAS-INSULIN PRODUCTION INCREASES-HOWEVER THERE IS PERIPHERAL RESISTANCE TO INSULIN • BLOOD SUGARS-DECREASE IN 1ST TRIMESTER 2ND-3RD BLOOD SUGAR RISE TO NORMAL OR INCREASED

44. ENDOCRINE SYSTEM • ADRENAL GLANDS-INCREASED ALDOSTERONE LEVELS,INCREASED CORTISOL LEVELS

45. ENDROCRINE SYSTEM • PLACENTA-PRODUCES ESTROGEN AND PROGESTERONE • RELAXIN • HUMAN PLACENTAL LACTOGEN • INSULINASE

46. IMMUNOLOGICAL SYSTEM • HELPER T CELLS DECREASE • SUPPRESSOR T CELLSS INCREASE • B CELL FUNCTION IS SUPPRESSED • IgG DECREASES • RISK FOR INFECTION INCREASES • WBC’S -INCREASE(5000-15000) • POLYMORPHONUCLEAR NEUTROPHILS INCREASE

48. SEVERE VOMITING FREQUENT AND SEVERE H/A EPIGASTRIC PAIN FLUID DISCHARGE FROM VAGINA VISUAL DISTURBANCES ABDOMINAL-UNUSUAL OR SEVERE PAIN FM CHANGES OR ABSENCE SWELLING OF HANDS AND FACE VAGINAL BLEEDING DANGER SIGNS DURING PREGNANCY

50. QUESTIONS