5

4
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 by:
Roselle B. Baniel,R.N.
 THE PHYSIOLOGY OF
PREGNANCY

I am alive.  I know this because I have vital signs that even a med school
dropout could recognize. 
My body is generating heat, producing a positive, normal and measurable body
temperature. 
I have a pulse, which means that I have a heart that is indeed pumping blood to
the rest of my body.
This also means that I have a measurable blood pressure, and that's important
because it tells
me and Mr. Med School Dropout that my blood is making its merry little way
throughout
my circulatory system.  Last, but certainly not least, is my respiration.  I am a
 General Over View

• 1. The ultimate goal of human reproduction is

the propagation and survival of the human
species.
• 2. Human reproduction involves specialized sex
cells called gametes:
• a. a female gamete is called an ovum (pl. ova)
• b. a male gamete is called a sperm
• 3. Each gamete has one-half of the parent cell’s
chromosomes (i.e. one of each chromosome pair
or 23 of the 46 chromosomes).
The human SEXUALITY
ERECTION
The first effect of male sexual
stimulation, and is brought
about by parasympathetic
impulses which causing
dilation of penile arteries,
which results in compression
of the exiting veins. Increased
blood supply that is under high
pressure and inability to leave
the area results in filling of the
venous spaces and erection of
the organ.
 Coitus
• A conception can occur
only inside a woman's
body. Here then is the
place where sperm and
egg have to meet. Their
meeting is usually
brought about as a
result of coitus. This
Latin term (literally,
going together) refers to
the kind of sexual
intercourse in which the
penis is inserted into
the vagina. Other words
for coitus are copulation
or vaginal intercourse.
EJACULATION
Is the discharge of semen to the exterior; initiated by the
peristaltic waves moving along the tubes leading from
testes and by rhythmical contractions of the smooth muscle
layers of the testes, epididymis, seminal vesicles, and
prostate gland. Increased pressure in all these structures
causes expulsion of the semen.

SEMEN
Is the fluid that is ejaculated during the male sexual act.
It is a grayish-white viscid liquid that contains 200million
to 500million spermatozoa per ml. At each ejaculation,
2-5 ml of semen are usually expressed through the
urethra.
MALE FERTILITY
Approximately 200-500
million of spermatozoa are
contained in each ml of
ejaculated semen. These
are highly uniform in shape
& size, w/ occasional
sperm having 2 heads or
tails. When the percentage
of the abnormal
spermatozoa is greater
than 25%, or the sperm
count is less than 20
million, fertility is greatly
decreased.
FEMALE FERTILITY
The ovum is capable of being fertilized for only a
short period, about 24 hours. Sperm can remain
viable within 72 hours, therefore, the period of
possible conception is only for a few days, if the
time of ovulation is known. Ovulation is thought
to occur 14 days prior to menstruation.
SEXUAL RESPONSE CYCLE
     4 Phases :
1. Excitement
2. Plateau
3. Orgasm
4. Resolution

Vasocongestion and myotonia are the

primary physiologic processes that
contribute to sexual response in both
the male and female.
 SEXUAL RESPONSE CYCLE
1. Excitement phase
• the arousal phase
• the body begins to prepare for coitus
• ♀♂ tachycardia, ↑RR & BP; erection of nipples,
vasocongestion of skin (sex flush), ↑ muscle tone,
external anal sphincter may contract randomly upon
contract
• ♂ penis: partially erect (may be partially lost &
regained repeatedly during extended excitement
phase
• both testicles drawn upward toward perineum;
scrotum can tense & thicken during erection process
• venous patterns across the breasts become more
visible; breasts ↑ in size;
• labia majora: nullipara – flatter & thinner, rise
upwards & outwards; parous - ↑ 2-3 fold in size
• labia minora: ↑ in size & may protrude above labia
majora
• clitoris becomes tumescent; vaginal lubrication is
produced by vasocongestion of the vaginal walls,
darken in color & become smoother than normal;
uterus elevates; inner 2/3 of the vagina stretch (7-
10cm)
2. Plateau Phase
• period of sexual excitement prior to orgasm
• ♀♂further ↑in circ & HR; sexual pleasure inc w/ ↑
stimulation; muscle tension inc further
• begin to vocalize involuntarily
• ♂urinary bladder closes, muscles @ the base of the penis
begin a steady rhythmic contraction; may start to secrete
seminal fluid; testicles rise closer to the body
• ♀areola & labia further inc in size, clitoris withdraws
slightly, Bartholin glands produce further lubrication
• tissues of the outer 1/3 of the vagina swell considerably;
pubococcygeal muscle tightens, reducing the diameter of
the vagina
3. Orgasmic phase

• conclusion of the plateau in a release of sexual tension

• ♀♂ experience quick cycles of muscle contraction of
the anus & lower pelvic muscles w/ women also
experiencing uterine & vaginal contractions
• often associated w/ other involuntary axns, including
vocalizations & muscular spasms in other areas of the
body
• generally, euphoric sensation is associated; causes
perceived tiredness due release of endorphins causing
relaxation & drowsiness or due to body’s need for
rest brought about by vigorous sexual activity
• ♂ ejaculate approximately 2-5 ml of semen (vol
varying considerable depending on the
period of abstinence & degree of sustained
arousal prior to ejaculation
• 4. Resolution phase
• orgasm & allows muscles to relax; ↓ BP
• ♂experience refractory period (orgasm cannot
be achieved again until time has passed
• penis return to a flaccid state
• ♀may not experience refractory period (this
allows for multiple orgasms)
• opening of the cervix, ↓ bld flow to genitals &
nipples
• Each human life
begins as a single
cell called a
fertilized ovum or
zygote
• Reproduces itself in
a continuing process
• Either by process of
meiosis or mitosis
 Comparison of Meiosis and Mitosis
MEIOSIS MITOSIS
• Produce reproductive cells • Purpose - produce cells for
(gametes) growth and tissue repair. Cell
• Reduction of chromosome division characteristic of all
number by half from diploid somatic cells
(46) to haploid (23) so that CELL DIVISION
when fertilization occurs, the • One stage cell division
normal diploid number is NUMBER OF DAUGHTER CELLS
restored; introduces genetic
variability • 2 daughter cells identical to the
CELL DIVISION mother cell, each with the diploid
number (46chromosomes)
• Two stage-reduction
NUMBER OF DAUGHTER
CELLS
• 4 daughter cells, each
containing ½ the number of
chromosomes as the mother
cell, or 23 chromosomes, non
identical to original cell
• The chromosomal material of the ovum and
spermatozoon fuse.(23 chromosomes each)
• 22 autosomes and 1 sex chromosomes.
• XX-XY
 CONCEPTION, THE
BEGINNING OF HUMAN LIFE
• FERTILIZATION
-marks the onset of
pregnancy
-the union of the
ovum and the
spermatozoa
-occurs in the outer
third of the
fallopian tube,
ampular portion
• Ovum – surrounded by 2
layers of tissue
– 1. Zona pellucida – clear,
noncellular whose thickness
influences the fertilization
rate
– layer closest to the cell
membrane
- 2. Corona Radiata – a ring
of elongated cells
surrounding the zona
pellucida
- radiate from the ovum like a
gaseous corona around the
sun
• Increased estrogen during
ovulation facilitates
fertilization by increasing
peristalsis within the fallopian
tubes
• High estrogen causes also
thinning of cervical mucus,
easing passage of sperm
through the cervix, into the
uterus and into the fallopian
tube
At the peak of fertility, the
mucus has a distensible,
stretchable quality called
SPINNBARKHEIT.
• In a single ejaculation,
male deposits approx.
200-500million
spermatozoa, hundreds
only reach the ampulla
(Sadler, 2004)
• Spermatozoa propel themselves
up the female tract by flagellar
movement of their tails
• Transit time from the cervix to
the fallopian tube is about 5
minutes; takes after 2-7 hours
after ejaculation
• Prostaglandins in the semen
increase smooth muscle
contraction to help transport the
sperm
• Fallopian tubes have a dual
ciliary action that facilitates
movement of the ovum toward
the uterus and movement of the
sperm from the uterus toward
the ovary
 2 processes
• 1.CAPACITATION – removal of the plasma
membrane overlying the spermatozoa’s
acrosomal area and the loss of the seminal
plasma lipids, proteins (glycoprotein coat)
• Occurs in the female reproductive tract (aided
by uterine enzymes); thought to take about 7
hours
• 2. ACROSOMAL REACTION – follows
capacitation
• Release of enzymes ( hyaluronidase, a
protease called acrosin, and trypsin-like
substances)
• breaks down the hyaluronic acid that holds the
elongated cells of the corona radiata together
• Hundreds of acrosomes must rupture to clear
enough hyaluronic acid to allow a single
sperm to penetrate the ovum successfully
 Factors affecting fertilization
• Maturation of both sperm and ovum
• Ability of the sperm to reach the ovum
• Ability of the sperm to penetrate the zona
pellucida and cell membrane and achieve
fertilization
• Block to polyspermy – a reaction of the
ovum to prevent additional sperm from
entering
• Cortical reaction – release of materials from
cortical granules just below the ovum’s
surface
 Terms used to denote Fetal Growth
Name Time Period

Ovum From ovulation to fertilization

Zygote From fertilization to implantation

Embryo From implantation to 5-8 weeks

Fetus From 5-8 weeks until term

Conceptus Developing embryo or fetus and placental

structure throughout pregnancy
 SEGMENTATION OR CELL
MULTIPLICATION
• First, it divides into two cells,
then four, eight, sixteen, and
so on, doubling the number
with each new division.
• The zygote, by cell
division,grows into a morula,
and then into a blastocyst.
• The zygote undergoes cellular
divisions referred to as
CLEAVAGE divisions. These
divisions increase the number
of cells but, does not
significantly increase the cell
volume.

Zygote- early cleavage- blastomere -morula- blastocyst-

trophoblast- chorion and embryonic disc ( embryo and amnion)
 Implantation

• The blastocyst implants

itself in the uterine
lining.
• The zygote migrates
toward the body of the
uterus, aided by the
contractions of the
fallopian tubes.
• Takes 3-4 days for the
zygote to reach the
uterus.
Decidua- the endometrium that thickens
and increase in vascularity
• Decidua basalis – portion of the uterus
directly under the implanted blastocyst
• Decidua capsularis – portion of the decidua
that covers the blastocyst
• Decidua Vera ( Parietalis) – portion that
lines the rest of the uterine cavity
Physical Changes in Pregnancy
 Signs of Pregnancy
Presumptive Signs Probable Signs Positive Signs
•Amenorrhea Enlargement of Fetal heartbeat: as
•Nausea /vomiting abdomen early as eighth week
•Urinary frequency Goodell’s sign w/ electronic device;
Hegar’s sign after 16th week w/
•Fatigue
fetoscope
•Breast changes Braxton Hick’s
Fetal movements
•Weight change contractions
felt by examiner
•Skin changes Ballottement
(after 20 weeks)
•Vaginal changes Quickening X-ray visualization
(Chadwick’s Sign) Leukorrhea of the fetus(after 16
Outlining of fetal weeks)
parts upon Leopolds USD evidence
Maneuver (after 8 weeks
(+) HCG gestation).
 Reproductive System
 Ovaries – no ovulation; corpus luteum persists in early
pregnancy until development of placenta (10-12 wks.)
 Vagina – Chadwick’s sign (blue reddish vagina)
 Cervix – Goodell’s sign (softens and loosens); operculum
 Uterus – hypertrophy and hyperplasia of muscle cells;
shape changed fro pearlike to ovoid;
- Hegar’s sign( increased vascularity and
softening of isthmus)
- Braxton Hick’s sign (mild contractions
beginning 4th month through end of pregnancy)
 Breasts – tenderness and tingling; increase in size; nipple
and areola become larger and pigmented; glands of
Montgomery elevates.
 Cardiovascular system
 Blood volume expands as much as 50%.
 Progesterone relaxes smooth muscle, resulting in
vasodilation and accomodation of increased
volume.
 Slight decline in hematocrit (leads to anemia).
 Stroke volume and cardiac output increase.
 WBCs increase.
 Greater tendency for coagulation.
 Heart rate increases, palpitations possible
 Blood flow to uterus and placenta is maximized by
left side-lying position.
 Varicosities may occur in vulva, rectum and lower
extremities.
Respiratory system
 Shape of thorax shortens and widens to
accommodate the growing fetus.
 Slight increase in respiratory rate.
 Dyspnea may occur at end of third trimester
before engagement or “lightening.”
 Renal System
 Kidney filtration rate increases by 50%.
 Glucose threshold drops; sodium threshold rises.
 Water retention increases as pregnancy progresses.
 Enlarging uterus cuases pressure on bladder
resulting in frequency of urination, especially
during first trimester; later in pregnancy relaxed
ureters are displaced laterally, increasing
possibility of stasis and infection.
 Presence of protein (not an expected component of
maternal urine) indicates possible renal disease or
PIH.
Integumentary System
 Increased pigmentation of nipples and
areolas.
 Appearance of chloasma ( mask of
pregnancy)
 Appearance of linea nigra (darkened line
from symphysis pubis to umbilicus)
 Striae gravidarum (stretch marks)
 Greater sweat and sebaceous gland activity.
 Musculoskeletal System
 Alterations in posture and walking gait caused by
change in center of gravity as pregnancy
progresses.
 Possible backache.
 Occasional cramps in calf may occur with
hypocalcemia.
 Lordotic posture- the pride of pregnancy.
 Neurologic system
 Few change s in typical pregnancy.
 Pressure on sciatic nerve (sciatica) may occur later
in pregnancy due to fetal position.
 Gastointestinal system
 Nausea and vomiting in 1st trimester due to rising
levels of HCG.
 Cravings and pica
 Tooth loss due to demineralization should not occur.
 Bleeding gums and hypersalivation may occur.
 Appetite usually improves.
 Heartburn. Progestine-induced relaxation of muscle
tone leads to slow movement of food through GI tract.
 Constipation may occur as water is reabsorbed in large
intestine.
 Emptying time for gallbladder may be prolonged;
increased incidence of galllbladder stones.
 Endocrine System
 Pituitary: FSH and LH greatly decreased; oxytocin
secreted during labor and after delivery; prolactin
responsible for initiation and continuation of lactation.
 Progesterone secreted by corpus luteum until placental
formation.
 Principal source of estrogen is placenta.
 HPL produced by placenta; it prepares breasts for
lactation.
 Ovaries secrete relaxin during pregnancy.
 Slight increase in throid activity and BMR.
 Pancreas may be stressed due to complex interaction of
glucose metabolism, HPL and cortisol, resulting in
diminished effectiveness of insulin, and demand for
increased production.
 Prenatal Visits
• First 7 lunar months – every month
• 8th and 9th lunar months – every other week
or twice a month
• 10th lunar month – every week until labor
pains sets in

•Weight gain of 1 lb/week during the second trimester is

expected. Sudden weight gain may indicate fluid retention.
 Determination of Estimated date of
birth using the Naegel’s rule
• Uses 280 days as the mean length of
pregnancy
• Note 1st day of LMP, count back 3
months and add 7 days.
• Example:
Oct. 10,2005 (-3 months) (+7days)
Jan. 30, 2004
July 17, 2005
 GTPAL system
• G =GRAVIDA-any pregnancy, regardless of duration including
present pregnancy
– Nulligravida – a woman who has never been pregnant
– Primigravida – a woman who is pregnant for the first time
– Multigravida – a woman who is in her second or any subsequent
pregnancy
• T =TERM - the number of term infants born
• P = PARA – birth after 20 weeks of gestation regardless whether the
infant is born alive or dead
• A =ABORTION, birth that occurs before the end of 20 weeks of
gestation
• L = LIVING-the number of living children
• PRETERM – birth that occurs after 20 weeks but before completion
of 37 weeks’ gestation
• POSTERM – birth that occurs after 42 weeks’ gestation
• STILLBIRTH – an infant born dead after 20 weeks’ gestation
• Multiple gestation does not change G (gravida) and P (para).
 Exercise
• Jean Sanchez has 1 child born at 38 weeks’
gestation and is pregnant for the second
time. At her initial prenatal visit, the nurse
indicates her obstetric history as ______.
• Jean Sanchez’s present pregnancy
terminates at 16 weeks’ gestation. Her
obstetrical score now is________.
 Another one……..
• 2. Tracy Legaspi is pregnant for the 4th time
. At home she has a child who was born at
term . Her second pregnancy ended at 10
weeks’ gestation . She then gave birth to
twins at 35 weeks. One twin died soon after
birth. At her antepartal assessment, the
nurse records her obstetric history as_____.
Nutrition during Pregnancy
Weight gain: both weight
gain and pre-pregnancy
weight are directly related
to infant birthweight
Average weight gain:
• a. Normal weight for
height: about 20 lbs
• b. Underweight women:
about 30 lbs
• c. Overweight women:
about 16 lbs
Nutrients: Non Pregnant Pregnant
Calories (kcal) 2000 +300-400
Protein(gm) 46 + 10-20 gm
Carbohydrate 55% to 60%
of the diet
Fats Not exceed
305 calories
Iron(mg) 18 +18 (30-
60mg supp)
Calcium(mg) 800 +400

Folic acid(mcg) 400 +400

The Food Guide Pyramid
Psychosocial Adaptation to
Pregnancy
 1st trimester: Accept the Pregnancy
 Mother is ambivalent, uncertain, introverted
and focused on herself (self-centered)
 2nd trimester: Accept the Baby
 Mother demonstrates growing realization of
baby as separate entity and needing person.
 Extroverted, have the glow of pregnancy,
enjoys extra attention.
 3rd trimester: Prepare for Parenthood
 “Nesting” activity.
 Desire to be finished with pregnancy.
 Health teachings:
1.Activity and exercise: moderation should be encouraged

2. Sexual activity: no problem as long as pregnancy progresses

normally

3. Diet: a general balanced diet is usually all that is required

4. Bathing and swimming: no high speed sports or jet skis

5. Douching: avoided. Gentle cleansing of genitals

6. Dentition: a dental check-up is recommended, any work is

OK
7. Immunizations: should probably avoid live virus
vaccines

8. Travel: no problems, but should have frequent stops to

stretch

9. Employment usually no contraindication as long as

pregnancy is normal

10. Clothing: loose and comfortable.

11. Medications: No medications, including OTC drugs or

herbal remedies without the approval of care provider.
12. Substance Use:
-Caffeine: controversial. Used in moderation.
-Tobacco: contraindicated; risk for SGA, preterm
delivery, still births, SIDS,asthma.
-Alcohol: no safe amount of consumption; may lead to
FAS characterized by microcephaly, facial
deformilities, growth restriction and mental
retardation.
-Marijuana: infants born show evidence of stressed
nervous systems (high-pitched cry, lower IQs, deficits
in language, behavior and visual-perceptual tasks.
-Cocaine: associated with higher rate of spontaneous
abortion, premature labor and abruptio placenta.
 Common Discomforts in Pregnancy
Discomfort Trimester Intervention
Morning 1st Eat dry carbohydrates in a.m.
Sickness before rising in bed. Avoid fried,
® rising levels of odorous, and greasy foods; Small
HCG meals rather than large.
Fatigue 1st Rest frequently, as needed.
Urinary 1st, end of Kegel exercise, perineal pad for
frequency 3rd leakage.
Heartburn 2nd, 3rd Small meals, bland foods, avoid
® intra- smoking, coffee, chocolate, heavy
abdominal spices.
Pressure;acid Avoid lying down after a meal.
reflux
Constipation and 2nd, 3rd Sufficient fluids, eat plenty of
Hemorrhoids fiber;Use stool softener if prescribed.
Regular bowel habits.
®Slow GI & inc.
Blood flow, press. in
pelvic area
Varicosities 3rd Avoid crossing of legs and long
®Inc. pelvic press., Periods of sitting or standing; Rest w/
vasodilation and feet and hips elevated. Wear
pooling of bld. In lower compression stockings.
extremities.
Leg cramps 3rd Avoid plantar flexion. Eat food high in
®Imbalanced Ca: calcium. When cramps occur, extend
Phosphorus ratio; affected leg and dorsiflex the foot.
pressure on nerves
Low back pain 3rd Avoid gaining too much weight. Use
®Change in center of good body mechanics. Low-heeled
gravity shoes.
Insomnia 3rd Conscious relaxation; supportive
®many discomforts pillows as needed. Warm glass of
as well as inc.size of milk and shower before retiring.
uterus
Fainting spells 1st, Change position slowly. Eat small
®postural hypoten- 2nd, frequent high-carbohydrate meals.
sion w/ hemodynamic 3rd
changes
Shortness of breath 3rd Sit up straight to increase diameter of
®uterus pushes the the chest. Prop up with pillows
diaphragm during sleep.

Breast tenderness 2nd, Well-fitted support bra.

®Progesterone and 3rd
estrogen causes
tingling & heaviness.
Ankle edema 3rd Rest frequently w/ feet elevated.
®Progesterone Soak in a warm pool or bath.
effects, inc. capillary Avoid constrictive garments in
permeability lower extremities.
Vaginal discharge 2nd Correct personal hygiene, refer to
physician. Do not douche.
Stretch marks 2nd, Gradual weight gain. Lotions and
3rd oils as indicated.
Round ligament pain 3rd Avoid sudden changes in position.
®Sharp, severe pain, Lie on the side opposite the pain.
usually on the right Apply heat.
side, stretching of the
round ligament that
support the uterus
Leopold’s Maneuver
• 1st Maneuver= Determine
presentation
Head is more firm,hard and
round that moves
independently of the body.
Breech is less well defined
that moves only in
conjunction with the body.
• 2nd Maneuver= Determine
position
Fetal back is smooth, hard,
resistant surface. Knees and
elbows of fetus feel with a
number of angular nodulation.
 • 3rd Maneuver= Confirm
presentation

“What is in the inlet of the

pelvis?” Grasp the lower
portion of the abdomen,just
above the symphysis pubis.

4th Maneuver = Determine attitude

“What is the fetal attitude (degree of flexion)?”

Fingers on both sides of the uterus (2 inches above inguinal liga-
ments) pressing down and inwards.
 Factors Affecting Labor(5 Ps)
• 1.Passenger = the size, presentation,and position
of the fetus.
• 2. Passageway = shape and measurement of
maternal pelvis.
• 3. Powers = forces of labor, acting in concert, to
expel the fetus and placenta.
• 4. Placenta = position of placenta
• 5. Psychologic Response = A woman who is
relaxed, aware, and participating in the birth
usually has a shorter, less intense labor.
1.) PASSENGER
a. fetal skull
• Attitude: This refers to the posturing of
the joints and relation of fetal parts to one
another. The normal fetal attitude when
labor begins is with all joints in flexion.

• Lie: relationship of fetal spine to maternal

spine (i.e., transverse, oblique, or
longitudinal (parallel).

• Presentation: This describes the part on

the fetus lying over the inlet of the pelvic
or at the cervical os.
 Types of Presentation
1. Cephalic = head. Vertex(occiput) ost favorable
2. Breech (buttocks) or (lower extremities)
a.Frank: thighs flexed, legs extended on
anterior surface, buttocks
presenting
b.Full or complete: thighs and legs flexed,
buttocks and feet
presenting(squatting)
c. Footling: one or both feet are presenting
3. Shoulder (Scapula).CS
Position: relationship of referance point on fetal presenting part
to maternal bony pelvis. Maternal bony pelvis divided into 4
quadrants (R and L anterior, R and L posterior)
 2.) PASSAGEWAY
= shape and measurement of maternal pelvis and
distensibility of birth canal.
False Pelvis
• Shallow upper basin
of the pelvis
• Supports the enlarging
uterus
True Pelvis
• Consists of the pelvic
inlet, pelvic cavity,
and pelvic outlet.
• Influence the conduct
and progress of labor
and delivery
•Engagement: This occurs when the biparietal
diameter is at or below the inlet of the true pelvis.
•Station: This references the presenting part to the
level of the ischial spines measured in + or -
centimeters.
 3.) POWER

• Major forces: Involuntary and voluntary

• Involuntary: includes frequency, regularity,
intensity and duration.
• Voluntary: bearing-down efforts. The
contraction of levator ani muscles.
Uterine contraction
4.) PLACENTA
Placenta Previa
Abruptio Placenta
 5.) PSYCHOLOGICAL RESPONSE
The woman feels confident in her ability to cope and
find ways to work with the contractions, the labor
process is enhanced.

However, if the laboring woman becomes fearful or

has intense pain, she may become tense and fight the
contractions.

 This situation often becomes a cycle of fear, tension,

and pain that interferes with the progress of labor.