Physiological and Psychological Changes of Pregnancy

Fakulti
Kejururawatan
Physiological and Psychological
Changes Of Pregnancy
Puan Nor Marini Bt. Ibrahim

Physiologic Changes In
Pregnancy
Physiologic Changes In
Pregnancy
Objectives:
On completion of this topic, the student
will be able to do the following:
 Describe the physiological changes
during pregnancy
Changes In Reproductive System
Uterus
 Development of new fibro-elastic tissue between
hands of muscles
 Hypertrophy of the myometrial cells which
stimulates by estrogen
 Increased in size – weight increases from 70 gm
to 1100 gm
 By end of pregnancy, 1/6 total maternal blood
volume is circulating through the uterus. Blood
flow at term is 500 – 700 ml/min
 At the end of pregnancy it measures about
28x24x21cm
Cervix
 Becomes more vascular and edematous
– Chadwick’s sign (bluish)

– Goodell’s sign (softening of the cervix)

Changes In Reproductive System –
con’td
Vagina
 Estrogen causes a thickness of the vagina
mucosa, a loosening of the connection tissue and
increase in vagina secretions
 Increased in white vaginal discharge throughout
pregnancy due to estrogen
 Increased acidity (pH 3.5 to 6.5) is due to the
production of lactic acid from glycogen in the
vaginal epithelium by action of Lactobacillus
acidophilus
 The acid pH helps prevent bacteria infection but
Favors growth of moniliasis (yeast infection)
 The vagina may show blue-purple color as the
cervix due to increase
Breast Changes
 During pregnancy, the
breasts increase in size
& sensitivity;
pigmentary changes
(arcola and nipple
darkening) and striae
may be observed.
 The breast enlarge &
become more nodular
as the glands increase
in size
 Preparing for lactation
 Colostrum, an
antibody-rich yellow
secretion, may leak or
be expressed from the
Intergumentary
Changes
Skin Changes
Increase in skin
pigmentation are
thought to be
stimulated by
increased estrogen,
progesterone &
melanocytic-
stimulating hormon
 Chloasma
 Linea Nigra
 Striae Gravidarum
 Increase pigmentation
Gastrointestinal Changes
 Nausea/Vomiting due to hCG
 Gastric tone and motility decrease, slowing

of the gastric”s emptying time and possibly
causing regurgitation with bile reflux
 Relaxation of cardiac sphineter – heartburn

may occur due to reflux of acidic secretions
into the lower esophagus.
 Colon motility decreased and this leads

to greater water absorption, which may
predispose patient to constipation
Respiratory Changes
 Changes occur to meet the increased
oxygen requirements for fetus & all
maternal body system
 The volume of air breathed each minute
increases 30%-40%
 Oxygen consumption increases
 Respiratory rate increases
 No change in vital capacity
 Dyspnea at rest toward end of pregnancy
due to enlargement of the uterus, presses
the diaphragm
 Diaphragm is displaced > SOB
Cardiovascular Changes
 Increased in blood volume 30 – 50%
– occurs gradually and peaks at 28 – 32
weeks
– adequate exchange of nutrients
 Increase in cardiac output 30 – 50% ,

reaching its maximum at 20-24 week’s
gestation and continuing at this level until
term
– pulse rate increases
– BP ; a little changes in systolic, but
diastolic pressure is reduced (5-10 mmHg)
from about 12-26 weeks.
Hematologic Changes
 Plasma volume increases by about 50%
 RBC volume increases by about 30%. The
result is the concentration of Hgb and
erythrocytes may initially decline
 Physiologic anemia caused increase in
plasma volume 50% and lesser increase in
red cell mass
 WBC count increases during pregnancy
 Platelet count decreases, but stays within
normal limits
 Coagulation system : In pregnancy as a
“hypercoagulable state” and serious
thromboembolic disease is more common in
pregnancy
Endocrine Changes
 Placenta produces:  Thyroid:
 estrogen  increased vascularity
 progesterone  hyperplasia
 hCG  increased Basal
 hPL Metabolic Rate (BMR)
 increased O2
 Pituitary: consumption
 decreased FSH and LH
 increased prolactin  Pancreas (early
 secretes Oxytocin pregnancy):
 there is decrease in
 thus results in: insulin production
related to increase fetal
 anovulation demands
 lactation  after 1st trimester,
 increased pigmentation increase in insulin
production related to
insulin antagonist
Urinary Tract Changes
 Bladder capacity decreases due to compression
from gravid uterus and results in urinary
frequency (1st trimester and again in near term).
 Hypertrophy of the bladder walls as pregnancy

progresses, and results in edema of the bladder
tissues and causes it more susceptible to
trauma and infection during labor and birth
 Dilatation of kidneys and ureters may occur due

to the position of uterus during pregnancy as a
result of increased blood volume and
enlargement of their interstitial spaces
 Clinical consequences – statis of urine and

increased susceptibility to urinary tract
infections (UTIs) throughout pregnancy.
Skeletal Changes
 Relaxation and
softening of the pelvic
ligaments and joints
related to hormone
relaxin
Psychological Response To Pregnancy
 Attitude depends on:

 Environment
 Social
 Cultural
 Family
 Individual
 Accept pregnancy
 Accept the baby
 Prepare fot parenthood
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Fakulti

Puan Nor Marini Bt. Ibrahim

– Chadwick’s sign (bluish)

 Gastric tone and motility decrease, slowing

 Relaxation of cardiac sphineter – heartburn

 Colon motility decreased and this leads

 Increase in cardiac output 30 – 50% ,

 Hypertrophy of the bladder walls as pregnancy

 Dilatation of kidneys and ureters may occur due

 Clinical consequences – statis of urine and

 Attitude depends on:

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