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PHYSIOLOGY OF

PREGNANCY
BY
TIYAS K

DEPARTMENT OF CHILD & MATERNITY NURSING,


AIRLANGGA UNIVERSITY, 2013

Definition of pregnancy
The

period from conception to birth (

wordnet.princeton.edu/perl/webwn )

Pregnancy

is a state in which a woman


carries a fertilized egg inside her body
(medical-dictionary.thefreedictionary.com/pregnancy)

Conception
Fertilization

of an ovum by a spermatozoon

Cell division

Chromosome
exchange

Normal Pregnancy
Spans

40 weeks
without any complication in either mother
& fetus
Trimesters:
First: weeks 1 through 13
Second: weeks 14 through 26
Third: weeks 27 through 40

Fetal Growth

Signs and symptoms


Presumptive indicators
Missed menstrual period
Home pregnancy test positive
Amenorrhea, nausea, vomiting, breast
tenderness, urinary frequency, fatigue
(morning sickness)
Quickening (perception of fetal
movement)

Probable indicators
Uterine enlargement
Braxton Hicks contractions
Uterine souffle
Ballotement
Positive pregnancy test

Positive indicators
Presence of fetal heartbeat distinct from
mothers
Fetal movement felt by someone other than
mother
Visualization (e.g., ultrasound examination)

Diagnosis of Pregnancy
USG
Doppler Examination
Estimated date of birth (EDB)
Ngeles rule
Determine first day of LMP(Last
Menstrual Period), subtract 3 months,
add 7 days plus 1 year
Alternatively, add 7 days to LMP and
count forward
9 months

Adaptation of Pregnancy

Psychosocial adaptation:
Maternal adaptation
Accepting pregnancy
Identifying with mother role
Reordering personal relationships
Establishing relationship with fetus
Emotional attachment
Preparing for childbirth

Adaptation of Pregnancy

Psychosocial adaptation:
Paternal adaptation
Accepting pregnancy
Identifying with father role
Reordering personal relationships
Establishing relationship with fetus
Emotional attachment
Preparing for childbirth
Sibling adaptation
Grandparent adaptation

Physical Changes
Hormones
Endocrine

system
Reproduction system
Hematology system
Respiratory system
Urinary system
Gastrointestinal system
Bone and integument system

Pregnancy Hormones

a.
b.
c.

d.
e.

Human Chorionic Gonadotropin(hCG)


glicoprotein lutein hormone like structure
Produce by trophoblast. Rising level to 9th
WOP.
To maintain corpus luteum wich produce
oestrogen & proqesteron before placenta is
available
Change in smell & taste nausea
Decreasing immunosupresan reduce mother
rejection to placenta

Pregnancy Hormones

a.
b.
c.

d.

Human Placental Lactogen(hPL)


Polipeptide produce by syntiotrophoblast
Produce time 510days after implantation
Reduce mother responds to insulin sugar
intake on mother <<
amino acid transferred to fetus

Pregnancy Hormones

a.
b.
c.

Oestrogen
3 kinds of estrogen: Oestriol , Beta-Oestradiol,
Oestrone
Stimulate tissue growth, uterus enlarging,
produce milk duct in mother breast
Tissue softens, >> extra cell matrix water
water retention edema

Pregnancy Hormones

a.
b.
c.
d.
e.

Progesterone
Produce by syntiotrophoblast
Lowering excitability of white muscle
(myometrium, ureter, usus)
Increasing sensitivity of chemoreceptor on CO2
Increasing temperature 0,51,0C
induce varicose & hemorrhoids cause by
dilatation of vein on lower extremity & rectal

Hormone level during pregnancy

Endocrine system
>>

sekresi ACTH
>> Beta endorfin on 3rd trimester >> oxytocin
sekretion
<< FSH & LH
>> corticosteroid @cortisol higher level in
morning , induce striae
>> T3 & T4 intestine calcium absorbtion
>>, excretion by the renal <<

Reproduction system

a.
b.

UTERUS
increasing size & uterus volume from 10mL
preconception to 5L on 3rd trimester
>> contraction frequency (5% per week) especially
nocturnal

. CERVIX
a.
b.

Cervix thickness & soften start at 2nd trimester


cervix Mucus sticky to avoid infection

. VAGINA
a.
b.

>> blood flow vena enlargement


>> mucus + normal bacteria vagina >acid

UTERUS

Hematology system
Hemodilution
Increased

blood volume 3050% from week

734
Hemoglobin, immunoglobulin, platelet &
protein <<

Respiratory system
High

metabolismeOxygen consumption
20% increase
Chemoreceptor Sensitivity >>hyperventilation
Snoring especially women with preeclampsia
(Izci etal,2005)

Urinary system
Increased

GFR 4050% on 1st trimester


Activity of Reninangiotensinaldosterone
system increaseelektrolit
Glycosuria
Urinate frequencies >>

Gastrointestinal system
Slow

gastric emptying
Nausea, vomiting
constipation

Mother Weight Distribution


Fetal

weight : 28%
Plasenta : 5,7%
amnion : 4,1%
uterus : 8%
breast : 6,5%
Blood volume : 13,1%
Body fat : 33,6%
(Neil, 1995)

Increase Body Weight


BMI PRENATAL
Underweight (<19.8)

Normal Increase of body


weight (Kg)
12.518

Healthy (19.826)

11.516

Overweight (<26)

7.011.5
AUS National Research Council, 1990

Nutrition of Pregnant women


Makronutrien:
Mikronutrien:

fat, carbohidrat, protein

Fe, Ca, Zn, Iod, folate,


vitamins A, B12, C, D

Bone and integument system


Softer

joint: symphysis pubis, sacroilliac &


sacrococcygeal
Broaden pelvis
>> Melanocyte stimulating hormone hyper
pigmented skin

Striae

Linea nigra

Care Management
Purpose

of prenatal care is to identify


existing risk factors and other deviations
from normal
Emphasis on preventive care and optimal
self-care

Assessment

Initial visit: interview

Reason for seeking care


Current pregnancy
Obstetric and gynecologic history
Medical history
Nutritional history
History of drug use
Family history
Social and experiential history
History of physical abuse
Review of systems
Physical examination
Laboratory tests

Follow-up visits

Interview
Physical examination
Fetal assessment
Fundal height
Gestational age
Health status
Laboratory tests
Multiple-marker or triple-screen blood test
Other blood tests (RPR/VDRL, CBC, anti-Rh)
Other tests

Ultrasonography
Amniocentesis

Obstetric History
Terminology

G (gravida): the current pregnancy


T (term births): the number of pregnancies ending
>37 weeks gestation, at term
P (preterm births): the number of preterm
pregnancies ending >20 weeks or viability but before
completion of 37 weeks
A (abortions): the number of pregnancies ending
before 20 weeks or viability
L (living children): number of children currently living

Physical Examination
Pelvic

examination

Examination of external and internal genitalia


Bimanual examination
Pelvic shape: gynecoid, android, anthropoid,
platypelloid
Pelvic measurements: diagonal conjugate,
true (obstetric) conjugate, and ischial
tuberosity

Abdomen
Leopolds

maneuvers

Fundal height (FH) and age of gestation by


Mc Donalds

Months of gestation = FH ( cm ) X 2/7


weeks of gestation = FH ( cm ) X 8/7

Estimated Fetal Weight (EFW) based on


Johnson Tausack formula

EBW = [FH(cm) N ] X 155

N = 13 if fetal head have not pass the pelvic inlet yet


N = 12 if fetal head is above the spina iskhiadika.
N = 11 if fetal head is below the spina iskhiadika.

Auscultation
Normal

Fetal Heart Beat(FHB) = 120160


times/ min

Follow-up Visits
Visit

schedule:

Every 4 weeks up to 28 weeks


Every 2 weeks from 29 to 36 weeks
Every week from 37 weeks to birth

1st Trimester Discomforts


Urinary

frequency or incontinence (see


Teaching Guidelines 12-1)
Fatigue
Nausea and vomiting
Breast tenderness
Constipation
Nasal stuffiness, bleeding gums, epistaxis
Cravings
Leukorrhea

2nd Trimester Discomforts


Backache
Varicosities

of the vulva and legs


Hemorrhoids
Flatulence with bloating

3rd Trimester Discomforts


Return

of 1st trimester discomforts


Shortness of breath and dyspnea
Heartburn and indigestion
Dependent edema
Braxton Hicks contractions

Intervention
Education on:
Nutrition
Personal hygiene
Prevention of urinary tract infections
Kegel exercises
Preparation for breastfeeding newborn
Dental health
Physical activity
Posture and body mechanics
Rest and relaxation
Employment and travel
Clothing

Medications
Immunizations
Alcohol, cigarettes, and other substances
Normal discomforts
Recognizing potential complications

Printed list of signs and symptoms


Emergency telephone numbers

Recognizing preterm labor

After the 20th week


Before 37th week of pregnancy
Uterine contractions, if untreated, cause cervix to open
earlier, with resulting preterm birth

Sexual

counseling

Permission
Countering misinformation
Suggesting alternative behaviors

Psychosocial

support
Cultural influences

Emotional response
Clothing
Physical activity and rest
Sexual activity
Diet

Childbirth and Perinatal


Education

Birth setting choices

Labor, delivery, recovery, postpartum


(birthing) rooms
Birth centers
Home birth
Factors increasing the safety of birth at home

Pain

management

Key Points

Maternal physical and familial adaptations to


pregnancy generate needs that nurse can anticipate
and meet
Nurse must be alert to hazards such as supine
hypotension, warning signs and symptoms, and
signs of family maladaptation
Each pregnant woman needs to know how to
recognize and report preterm labor
Cultural prescriptions and proscriptions influence
responses to pregnancy and health care
Childbirth education helps parents make transition
from role of expectant parents to role and
responsibilities of parents