E Maternal Adaptations To Pregnancy

MATERNAL ADAPTATIONS TO PREGNANCY
 CHANGES IN THE REPRODUCTIVE SYSTEM

UTERUS
pregnancy term pregnancy
Weight 50gm 1100gm
Thickness 2cm 0.5cm
Length 6.5 cm 32 cm
Depth 2.5 cm 20cm
Width 4cm 24 cm
Capacity 10 ml 5000ml
Growth of Fundic height
 12 weeks : at 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
 28-30 weeks: midway between umbilicus and xiphoid
process
 36 weeks : at the level of xiphoid process
 40 weeks: two fingers below xiphoid, drops because of
lightening.
Uterine shape changes
 Theuterus loses its pear shape
during pregnancy. It becomes
spherical around 8 weeks gestation
and becomes ovoid from 16 weeks
until term.
Dextrorotation of the uterus
 Asthe fetus grows larger, occupy much
space in the abdominal cavity, the uterus
displaces the intestines to the sides of the
abdomen, shifts the diaphragm and liver
upward, compresses the stomach and the
bladder.
Uterine consistency:
 Uterusbecomes increasingly softer
because of the growth of deciduas and
presence of amniotic fluid.
Uterine contractility
 Uterusundergoes irregular
contraction starting on the first
trimester. Late pregnancy-Braxton –
hicks or painless uterine contraction
causing minor discomfort during
pregnancy.
Isthmus
 It is the narrow portion of the uterus that joins the
connective tissue of the cervix to the muscle fibers of
the body of the uterus.
 From 0.5 cm at 12 weeks, it expands to 10cm in
length at term to form the lower uterine segment

together with the cervix.
 HEGAR’S SIGN – refers to the softening of the lower
uterine segment that begins as early as 5 weeks

gestation.
Cervix changes during pregnancy
 Color : cervical color changes from pinkish to purplish
due to increased blood supply.
 Leukorrhea: estrogen causes increase cervical mucus
production.operculum- a mucus plug at the cervical

canal forming an effective barrier against ascending
infection .During labor this mucus plug mixes with
the blood ruptured capillaries and is dislodged when
cervix dilates and is called SHOW which is important
sign of labor.
GOODEL’S SIGNS:
 SOFTENING OF THE CERVIX DUE TO INCREASED

VASCULARITY AND EDEMA STARTING 6 TO 8 WEEKS OF
PREGNANCY.
 CERVIX before pregnancy- as soft as NOSE
 during pregnancy –as soft as the EARLOBE
 During labor –as soft as BUTTER
Vagina changes during pregnancy
 Increase blood supply results in:
CHADWICKS SIGN: the purplish discoloration of the
vagina.
 Increased sensitivity and heightened sexual
responsiveness .
 Decreased vaginal pH 3 to 4.more acidic vaginal pH.
 Softening of the vagina under the influence of
estrogen
Breast changes
 Increased breast size is due to alveolar tissue growth,
fat deposition and increased vascularity.
Breast changes associated with pregnancy include:
1. feeling of fullness
2. tingling sensation
3. darkening of the skin around the areola
4. Montgomery glands enlarge and become prominent
Breast changes
5. nipples become more erectile
6. A clear fluid, called colostrum, can be expressed from
it as early as the fourth month.
CARDIOVASCULAR SYSTEM
 HEART
 * increase heart rate
 * benign cardiac enlargement
 * displacement of the heart by the uterus-
enlargement of the uterus pushes the

diaphragm upward, displacing the apex of
the heart.
 * cardiac arrhythmias and palpitation
Blood volume and cardiac output
 * increased blood volume
 * physiologic anemia
 * cardiac output
 * Regional blood flow – increased supply of
blood to areas like skin, uterus,kidney and

decreased blood flow to lower extremities
caused by the pressure of the gravid uterus
causing varicosoties, foot edema common in
late pregnancy.
 *
Blood pressure
 Arterial blood pressure remains the same as pre- pregnancy
level. It may drop slightly on the 2nd trimester due to
peripheral vasodilatation but returns to normal level on the
third trimester.
 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.
Respiratory System
 1 increased oxygen requirements as the mother
must supply not only for herself but for the baby ,
too.
 2. estrogen causes nasal stuffiness that requires no
medication.
 3. displacement of the diaphragm by the enlarging
uterus up to 4 cm and chest crowding produce the

following:
 * dyspnea or shortness of breath that is relieved
after lightening
Urinary system
 Urinary frequency during pregnancy is due to:

 1. First trimester : uterus exerts pressures on the
bladder as it rises out of the pelvic cavity.

 2. Third trimester : pressures of the presenting part on
the bladder after lightening.

 3. throughout pregnancy: increased blood flow to the
kidney increases glomerular filtration rate and urinary

output.
Urinary system changes
* lactosuria: presence of sugar or lactose in the urine is
considered normal.
* Nocturia: during the day , the pregnant woman tends

to accumulate water in the form of dependent edema
this fluid is mobilized and excreted via the kidney
( urine ) during the night.
Effects of progesterone
 1. Increase urine capacity of the bladder for about 1500ml
due to decrease bladder tone .as result
the woman
may not sense it when her bladder is already
distended with urine.
 2. increased aldosterone production resulting
in sodium and water retention which causes

edema.
 3. urinary stasis predisposes the pregnant to
infection.
Gastrointestinal system
 Nausea and vomiting on the first trimester is

attributed to:
1. increased HCG levels
2. increased estrogen levels
3. decreased maternal glucose levels as glucose is being
utilized for fetal brain development

PICA:
craving for non food stuff or
unusual food stuffs is common in
some cultures.
 Reduces sensitivity of the taste buds
during pregnancy creates the desire

for markedly sweet, sour or salty
foods.
Hemorrhoids are common due to:
1. mechanical pressure of the uterus
2. slowed intestinal movement due to
relaxant effect of progesterone
3. constipation
Effects of progesterone :
1. constipation : decreased GIT motility and longer
emptying time which leads to constipation.
2. Pyrosis/ heartburn: relaxation of cardiac sphincter
results in reflux of acidic gastric contents ( due to
hydrochloric acid) into
3. Generalized itching : slower bile movement from gall
bladder result in reabsorption of bilirubin into maternal
blood stream which causes generalized itching.
Effects of estrogen
1. Ptyalism : increased salivation
2. Epulis : hypertrophy or swelling of the gums.

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E Maternal Adaptations To Pregnancy

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MATERNAL ADAPTATIONS TO PREGNANCY

 CHANGES IN THE REPRODUCTIVE SYSTEM

length at term to form the lower uterine segment

uterine segment that begins as early as 5 weeks

production.operculum- a mucus plug at the cervical

 SOFTENING OF THE CERVIX DUE TO INCREASED

enlargement of the uterus pushes the

blood to areas like skin, uterus,kidney and

uterus up to 4 cm and chest crowding produce the

 Urinary frequency during pregnancy is due to:

bladder as it rises out of the pelvic cavity.

the bladder after lightening.

kidney increases glomerular filtration rate and urinary

* Nocturia: during the day , the pregnant woman tends

in sodium and water retention which causes

 Nausea and vomiting on the first trimester is

during pregnancy creates the desire

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