Maternal adaptation during Pregnancy Chapter 11

Uterus

• Expands more in length than width

• estrogen stimulates uterus to grow

• increases in capacity by 5000 mL

  • amniotic fluid, baby, placenta

• BV elongate and dilate and can make new branches

  • important in preeclampsia

• 80-90% of blood flow goes to placenta

• contractility increases

• By 20wks gestation Fundus of uterus should be at umbilicus and it eaches highest level at Xiphoid process by 36wks

Cervix

• By 6-8wks cervix begins to soften d/t

  vasocongestion and estrogen

• softens over time due to vasocongestion and estrogen

• progesterone helps form mucus plug

• Increased vascularization causes chadwick sign

• about 4 weeks before labor

• Signs to look for: chadwicks and goodell’s

Braxton Hicks

Vagina

• vascularity increases

• mucous in vagina thickens

• connective tissue loosens (to accomodate for baby)

• vaginal wall lengthens

• vaginal secretions become more acidic, thicker, and white (look out for yeast/fungal infection) → for protection

• ALL DUE TO ESTROGEN

Ovaries

• release ovum

• active to support pregnancy until 6-7 week; then inactive

• Increased blood supply causes them to enlarge until about wk 12-14

• Ovulation ceases during pregnancy secondary to increase in estrogen and progesterone

Breasts

• increase in fullness

• more tender and larger

• increase in vascularity

• areola become darker

• produce colostrum (prolactin)

GI system

• main change is mostility

• esophagus shifts and relaxation of sphincter → decreases tone

  • less room; more GERD

• Gums → swollen and friable

  • gingivitis, plaques, debris

• Smooth muscle relaxation; decreased peristalsis secondary to progesterone

• prolonged emptying of gallbladder; gall stones

• N/V most prominent in weeks 6-12

Cardiovascular (IMPORTANT)

• blood volume increases by 1500 mL (1.5 liter) → perfusion to placenta

  • plasma (1000) and RBC(450)

• Cardiac output increases by 30-50%

  • can go into CHF

• BP- DBP creases → bv dilate

• HR increases by 10-15 beats

• Blood components

  • hypercoagulable state (PE, DVT

Respiratory

• change occurs in long volume and ventilation

• chest circumference and diameter increases

• increases in inhaled tidal volume by 30-40%

• O2 consumption increases by 30-40%

• increases congestion secondary to increased vascularity d/t increases estrogen

Renal

• kidneys anatomically get larger

  • adapt to increase blood volume and increase in maternal/fetal waste

• Blood flow to kidneys increase by 50%

• GFR elevated

• dilation of renal pelvis and uterus

• dilation of kidneys and ureters increases urinary stasis → infection

Musculoskeletal

• These changes are progressive

• Secondary to hormonal changes, growing fetus, and weight gain

• Joints widen and loosen, ligaments soften

• progesterone and robaxin

• Increased sway back coupled by joints widening/softening causes low back pain

• Lordosis compensates for swayback in the lumbosacral curve

• Increased risk of falls

• waddling

integumentary

• Changes are d/t increased activity of

  • Adrenal and pituitary glands

  • Increased cortisone levels

  • Accelerated metabolism

  • Increase in estrone and progesterone

• 90% of women will have hyperpigmentation

• Varicosities

• Vascular spiders

• Palmar erythema

• Hair & nails

Endocrine

• thyroid

  • responsible for hormones and fetal brain development

• Pituitary

  • hormonal changes due to placental hormones

  • oxytocin - released by posterior pituitary; trigger uterine contractions for labor and delivery

• Pancreas

  • insulin control - gestational diabetes

• Adrenal

• Prostaglandin

• Placenta

Immune

• Innate and adaptive immunity work cooperatively

• Enhanced Innate- inflammatory response & phagocytosis

• decreases - easily sick

• Suppressed Adaptive- protective response to foreign antigen

• Help prevent mother from rejecting fetus

• Increased risk of developing certain infections

• Influence chronic disorders and autoimmune diseases

Psychosocial Adaptations

• Ambivalence

• Proud and excited and at same time feel fearful and anxious

• mix of emotions

• Introversion

• Preoccupied with herself and baby

• heightened in 1st and 3rd trimester

• Acceptance

• Reality & validity of pregnancy

• 2nd trimester

• Mood swings & body image

• Becoming a mother

• screening for depression, anxiety, stress

• Couvade syndrome in partners

nutritional needs and changes

• Maternal weight and diet quality affect the uterine environment

• Prenatal vitamins

• Iron, folic acid, and calcium

• Recommended calorie increase: 300 during pregnancy; 500 if breastfeeding (should be nutritious)

• Maternal weight gain

• Normal prepregnancy wt- 25-35lbs

• Under wt- 28-40lbs

• Overweight- 15-25lbs

• Obese- 11-20lbs

• Food concerns: sweeteners, Fish, Listeriosis

• Pica- intense craving for eating NONFOOD items for at least a period of time of over 1 month

• Anemia usually precedes this condition

• hemoglobin diluted

Placenta

• considered an organ

• diffusion mechanisms; osmosis situation → no direct exchange of blood between baby and mom

• source of stored energy

• hormone factory: HPL, HCG

• Conditions to worry about: abruptions and previa

amniotic fluid

• oligohydramnios - not enough fluid <500ml

  • can use amnio infusion (usually warm NS)

  • think renal issues with baby

• polyhydramnios - too much; >2000ml

  • think of gestational diabetes

  • risk of preterm labor

  • esophageal atresia in baby