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Pre-natal concepts


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ANTEPARTAL MATERNAL CHANGES

Physiological Changes Reproductive organs

Uterus increases in weight from 57 grams toabout 907 grams at the end of gestation and insize from five to six times larger.

Changes in tissue. a. Hypertrophy of muscle cells with limited

development of new muscle cells. b. Development of connective and elastic

tissue, which increases contractility .


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Reproductive organs changes

Increase in the size and number of blood vessels.

hypertrophy of the lymphatic system.

growth of the uterus is brought about by theinfluences of estrogen during the early monthsand the pressure of the fetus.


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Other changes of the uterus Contractions occur throughout pregnancy,

starting from very mild to increased strength.

As the uterus grows, it rises out of the pelvisdisplacing intestines and may be palpatedabove the symphysis pubis.


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Ligaments broad ligaments in the pelvisbecome elongated and hypertrophied to helpsupport and stabilized uterus during pregnancy.

Cervix Becomes shorter, more elastic, and larger in

diameter. Marked thickening of mucous lining and

increased blood supply.


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Edema and hyperplasia of the cervical glandsand increased glandular secretions.

4. Mucous plug expelled from cervix as cervixbegins to dilate at onset of labor.

CHADWICKS SIGN - Increased vascularity,deepening of color to dark red or purple cervix


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Vagina Hypertrophy and thickening of muscle. Loosening of connective tissue.

Increased vaginal discharge. High pH secretions.

Perineum.

Increased vascularity. Hypertrophy of muscles. Loosening of connective tissue.


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Ovaries and Tubes Usually one large corpus luteum present in one

ovary. Ovulation does not take place

Breast Changes in tissue

Extensive growth of alveolar tissue, necessary forlactation.

Montgomerys glands enlargement of sebaceousglands of primary areola.


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Other changes. breast increases in size and firmness and becomes

nodular. Nipples become more prominent and areola deepens

in color. Superficial veins grow more prominent.

At the end of the third month, colostrum appears. After delivery, anterior pituitary stimulates

production and secretion of milk.


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Abdomen

Contour changes as the enlarging uterus extendsinto the abdominal cavity.

Striae gravidarum usually appear on theabdomen as pregnancy progress.


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Skin

Pigmentation increase in certain areas of thebody. Breast primary areola deepens in color. Abdomen linea nigra, dark streak down the

midline of abdomen, especially prominent inbrunettes.

Face Chloasma, the mask of pregnancypigmentation distributed over the face. Usuallydisappears after pregnancy.


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Skin changes

Face and Upper Trunk occasionally spidernevi or palmar erythema develops with theincrease in estrogen.

Pigmented areas on abdomen and breast usuallydo not completely disappear after delivery.


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Circulatory System

Considerable increase (up to 50 percent) in volume as a result of: Increased in metabolic demands of new tissue. Expansion of vascular system, especially in the

reproductive organs Retention of sodium and water


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Circulatory System

Increase in plasma volume is greater thanincrease in red blood cells and hemoglobin. Decline in hemoglobin due to hemodilution referred

to as pseudoanemia. Low hemoglobin in pregnancy, below 11.5 percent,

usually caused by iron-deficiency anemia.

Iron requirements are increased to meetdemands of increased blood supply and growingfetus (need cannot be met by diet alone;supplement usually given


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Circulatory System

Heart increases in size. Cardiac output is increased (25to 50 percent).

Blood pressure should not rise during pregnancy. Slight

decline is normal in second trimester Fibrinogen concentration increase to term Palpitations may be experienced during pregnancy due

to sympathetic nervous disturbance and intra-abdominal pressure caused by enlarging uterus.


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Respiratory System

Thoracic cage is pushed upward and diaphragmis elevated as uterus enlarges

Thoracic cage widens to compensate, so vitalcapacity remains the same or is increased

Oxygen consumption is increased 15 percent tosupport fetus and tissue

Shortness of breath may be experienced in latterpart of pregnancy due to pressure upondiaphragm caused by enlarging uterus


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Digestive System

Nausea, vomiting and poor appetite are present in earlypregnancy because of decreased gastric motility andacidity

Flatulence and heartburn maybe present, due todecreased gastric acidity and decreased motility of thegastrointestinal tract

Constipation is due to a decrease in gastrointestinalmotility, reduced peristaltic activity and the pressure ofthe uterus; it may be present in latter half of pregnancy.


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Urinary System

Kidneys Kidney and renal function increase. Renal threshold for sugar is reduced in some

women. Renal blood flow and glomerular filtration increase


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Urinary System Bladder and ureters

Blood supply to the bladder and pelvic organs isincreased

Pressure of the uterus on the bladder causes

frequent urination in early and late pregnancy Atonia of smooth muscles during pregnancy leads to

dilatation of ureters and renal pelvis, and may causeurine stasis

A decrease in bladder tone is caused by hormonalinfluences and a decrease in bladder capacity occursbecause of crowding; may lead to complicationsduring pregnancy and in the postpartum period.


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Joints, Bones, Teeth and Gums

Softening of pelvic cartilages occurs, probably due tothe hormone relaxin.

Posture changes as upper spine is thrown forward to

compensate for increased abdominal size Increased vascularity of gums due to hormonal changes

with tendency to bleed easily

Demineralization of teeth does not occur as a result ofnormal pregnancy but may be related to poor dentalhygiene


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Endocrine System Placenta produces the hormones human chorionic

gonadotropin (HCG) and placental lactogen (HPL). Production of estrogen and progesterone is taken

over from the ovaries by the placenta/feta unit afterthe second month.

Aldosterone levels gradually increase beginningabout the fifteenth week Anterior lobe of pituitary gland enlarges slightly during

pregnancy

Adrenal cortex enlarges slightly Thyroid enlarges slightly and thyroid activity increases Normal cycle of production of estrogen and

progesterone is suspended until after delivery


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Metabolism

Increase in body weight an 11 kg weight gain usuallyrecommended Some of the weight gain is caused by retention

of fluid and by deposits of fatty tissue. Water metabolism

Tendency to retain fluid body tissue especially in thelast trimester.

Reversal of fluid retention usually takes place in theform of diuresis in the first 24 hours postpartum Metabolic rate increases 20 percent


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Psychosocial Changes

Altered Emotional Characteristics Pregnancy maybe viewed as a developmental

process involving endocrine, somatic and psychological changes, as a period of increasedsusceptibility to crises with an altered state ofconsciousness.

Emotional reactions to pregnancy may varyfrom early rejection to elation


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Psychosocial Changes

Altered Emotional Characteristics Mother may be puzzled by changes in her

feelings. Mother may have fears and worries about the

baby and herself. Mother may experience dependency-

independency conflict. Quick mood changes are common; some

emotional instability usually occurs.


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Socialization for Parental Role

Pregnant woman mat fantasize or daydream toexperience the role of mother before the actualbirth.

Takes adaptive behaviors that are best suited toher own personality and situation

Experiences a letting go of her former role(e.g. as a career woman).

May experience ambivalence about letting go of herold role to take on the new one. Desire to have a baby influences adjustment.


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Socialization for Parental Role

Concerns First and second trimester concerns about body

changes, fear of labor and delivery; beginningconceptualization of fetus as separate individual

Third trimester more confident about labor anddelivery, shows readiness to assume care of infant;incorporation of concept of fetus as a separateindividual should be complete.

Father may also experience ambivalence at taking on

new role, assuming increased financial responsibility,and sharing wifes attention with child. Father may experience physiologic changes, such as

weight gain, nausea and vomiting

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