Animated explanation of how pregnancy and conception happen!

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CHANGES OF THE REPRODUCTIVE SYSTEM DURING PREGNANCY

Changes in the body during pregnancy are most obvious in the organs of the reproductive system.

a. Uterus.

(1) Changes in the uterus are phenomenal. By the time the pregnancy has reached term, the uterus will have increased five times its normal size:

(a) In length from 6.5 to 32 cm.

(b) In depth from 2.5 to 22 cm.

(c) In width from 4 to 24 cm.

(d) In weight from 50 to 1000 grams.

(e) In thickness of the walls from 1 to 0.5 cm.

(2) The capacity of the uterus must expand to normally accommodate a seven-pound fetus and the placenta, the umbilical cord, 500 ml to 1000 ml of amniotic fluid, and the fetal membranes.

(3) The abdominal contents are displaced to the sides as the uterus grows in size, which allows for ample space for the uterus within the abdominal cavity.

(a) Growth of the uterus occurs at a steady, predictable pace.

(b) Measurement of the fundal height during pregnancy is an important factor that is noted and recorded.

(c) Growth that occurs too fast or too slow could be an indication of problems.

(d) The size of the uterus usually reaches its peak at 38 weeks gestation. The uterus may drop slightly as the fetal head settles into the pelvis, preparing for delivery. This dropping is referred to as “lightening.” This is more noticeable in a primigravida than a multigravida.

Appproximate height of the fundus at various weeks of pregnancy

NOTE: Remember a primigravida is a woman pregnant for the first time. A multigravida is a woman who has been pregnant more than once.

b. Cervix.

(1) The cervix undergoes a marked softening which is referred to as the Goodell’s sign.”

(2) A mucus plug, which is known as “operculum” is formed in the cervical canal. This is the result of enlarged and active mucus glands of the cervix. It serves to seal the uterus and to protect the fetus and fetal membranes from infection. The mucus plug is expelled at the end of the pregnancy. This may occur at the onset of labor or precede labor by a few days. When the mucus is blood-tinged, it is referred to as a “bloody show.”

(3) Additional changes and softening of the cervix occur prior to the beginning of labor.

c. Vagina. Increased circulation to the vagina early in pregnancy changes the color from normal light pink to a purple hue which is known as the “Chadwick’s sign.”

d. Ovaries.

(1) The follicle-stimulating hormone (FSH) ceases its activity due to the increased levels of estrogen and progesterone secreted by the ovaries and corpus luteum. The FSH prevents ovulation and menstruation.

(2) The corpus luteum enlarges during early pregnancy and may even form a cyst on the ovary. The corpus luteum produces progesterone to help maintain the lining of the endometrium in early pregnancy. It functions until about the 10th to 12th week of pregnancy when the placenta is capable of producing adequate amounts of progesterone and estrogen. It slowly decreases in size and function after the 10th to 12th week.

CHANGES OF THE SKIN DURING PREGNANCY

Alterations in hormonal balance and mechanical stretching are responsible for several changes in the integumentary system. The following changes occur during pregnancy:

a. Linea Nigra. This is a dark line that runs from the umbilicus to the symphysis pubis and may extend as high as the sternum. It is a hormone- induced pigmentation. After delivery, the line begins to fade, though it may not ever completely disappear.

b. Mask of Pregnancy (Chloasma). This is the brownish hyper pigmentation of the skin over the face and forehead. It gives a bronze look, especially in dark-complexioned women. It begins about the 16th week of pregnancy and gradually increases, then it usually fades after delivery.

c. Striae Gravidarum (Stretch Marks). This may be due to the action of the adrenocorticosteroids. It reflects a separation within underlying connective tissue of the skin. This occurs over areas of maximal stretch–the abdomen, thighs, and breasts. It will usually fade after delivery although they never completely disappear.

d. Sweat Glands. Activity of the sweat glands throughout the body usually increases which causes the woman to perspire more profusely during pregnancy.

CHANGES OF THE BREASTS

a. In early pregnancy, the breast may feel full or tingle, and increase in size as pregnancy progresses. The areola of the nipples darken and the diameter increases. The Montgomery’s glands (the sebaceous glands of the areola) enlarge and tend to protrude. The surface vessels of the breast may become visible due to increased circulation and turns to a bluish tint to the breasts.

b. By the 16th week (2nd trimester) the breasts begin to produce colostrum. This is the precursor of breast milk. It is a thin, watery, yellowish secretion that thickens as pregnancy progresses. It is extremely high in protein.

c. Nursing implication: Inform the pregnant patient to wear a good, supporting bra.

CHANGES OF THE CIRCULATORY SYSTEM DURING PREGNANCY

a. Blood Volume.

(1) Blood volume increases gradually by 30 to 50 percent (1500 ml to 3 units). This results in decrease concentration of red blood cells and hemoglobin. This explains why the need for iron is so important during pregnancy.

(2) By the time pregnancy reaches term, the body has usually compensated for the decrease resulting in an essentially normal blood count.

(3) Blood count is interpreted as anemia by the physician if the hemoglobin falls below 10.5 grams per 100 ml and the hematocrit drops below 30 percent.

(4) Increased blood volume compensates for hypertrophied vascular system of enlarged uterus. It improves the placental performance. Blood lost during delivery, less than 500 cc is normal (300 to 400 cc is average).

b. Cardiac Output.

(1) Cardiac output increases about 30 percent during the first and second trimester to accommodate for hypervolemia. This is not a problem for patients with a normal heart. A patient with a diseased heart is especially at risk for cardiac decompensation 28 to 35 weeks of pregnancy when the blood volume and cardiac load are at their peak; also, during labor and immediately after delivery when rapid hemodynamic changes occur.

(2) Change in output is reflected in the heart rate. It usually increases by 10 beats per minute.

(3) Nursing implication. Patients with a diseased heart need to be advised to get plenty of rest and to report any shortness of breath or unusual symptoms to their physician.

c. Blood Pressure.

(1) Normally, the patient’s blood pressure will not rise.

(2) Nursing implications.

(a) The patient’s blood pressure should be checked carefully and often since a significant increase is one of the indicators of toxemia of pregnancy.

(b) When monitoring the blood pressure, be sure it is done under the same circumstances (that is, patient sitting and left arm).

d. Venous Return.

(1) The lower extremities are often hampered in the last months of pregnancy due to the expanding uterus restricting physical movement and interfering with the return of blood flow. This results in swelling of the feet and legs.

(2) Nursing implications.

(a) Advise the patient to rest frequently. This will improve venous return and decrease edema.

(b) Have the patient to elevate her feet and legs while sitting.

(c) Remind the patient not to lie in a supine position since this inhibits return blood flood flow as the heavy uterus presses on the vessels. This leads to the vena cava syndrome or supine hypotension. The patient may complain of feeling dizzy, nauseated, or weak.

Vena cava syndrome

CHANGES OF THE RESPIRATORY SYSTEM DURIN PREGNANCY

a. The respiratory rate rises to 18 to 20 to compensate for increased maternal oxygen consumption, which is needed for demands of the uterus, the placenta, and the fetus.

b. Women may feel out of breath and may need to sit a moment to catch their breath.

CHANGES OF BODY TEMPERATURE DURING PREGNANCY

a. A slight increase in body temperature in early pregnancy is noted. The temperature returns to normal at about the 16th week of gestation.

b. The patient may feel warmer or experience “hot flashes” caused by increased hormonal level and basal metabolic rate.

CHANGES OF THE URINARY SYSTEM DURING PREGNANCY

a. The kidneys must work extra hard excreting the mother’s own waste products plus those of the fetus. There is an increase in urinary output and a decrease in the specific gravity.

b. The patient may develop urine stasis and pyelonephritis in the right kidney. This is due to pressure on the right ureter resulting from displacement of the uterus slightly to the right by the sigmoid colon.

c. Frequent urination is a complaint during the first through third trimester. As the uterus rises out of the pelvic cavity in early pregnancy, pressure on the bladder decreases and frequency diminishes. When lightening occurs during the final weeks of pregnancy, pressure on the bladder returns to cause frequency.

CHANGES OF THE SKELETAL SYSTEM DURING PREGNANCY

a. There is a realignment of the spinal curvatures during pregnancy to maintain balance. It is due to the increase in size of the uterus and pressure on the abdominal wall. The patient walks with head and shoulders thrust backward and chest protruding outward to compensate. This gives the patient a “waddling” gait.

b. There is a slight relaxation and increased mobility of the pelvic joints, which allows stretching at the time of delivery of the infant.

Postural changes during pregnancy

CHANGES OF THE GASTROINTESTINAL SYSTEM DURING PREGNANCY

a. As mentioned, as the pregnancy progresses, the uterus enlarges. It rises up and out of the pelvic cavity. This action displaces the stomach, intestines, and other adjacent organs.

b. Peristalsis is slowed because of the production of the hormone progesterone, which decreases tone and mobility of smooth muscles. This slowing enhances the absorption of nutrients and slows the rate of secretion of hydrochloric acid and pepsin. Flare-up of peptic ulcers is uncommon in pregnancy. Slow emptying may increase nausea and heartburn (pyrosis). Relaxation of the cardiac sphincter may increase regurgitation and chance for heartburn. Movement through the large intestines is also slowed due to an increase in water consumption from this area. This increases the chance for constipation.

c. Nursing implications.

(1) If the mother has difficulty with nausea and/or heartburn, advise her to eat small, frequent meals.

(2) The patient should eat a well- balanced diet high in protein, iron, and calcium for fetal growth; high fiber and fluids to prevent constipation.

(3) The mother should not lie flat for 1 to 2 hours after eating because this may cause heartburn and/or regurgitation.

CHANGES OF SELECTED GLANDS OF THE ENDOCRINE SYSTEM DURING PREGNANCY

a. Parathyroid Gland. This gland increases in size slightly. It meets the increased requirements for calcium needed for fetal growth.

b. Posterior Pituitary. Near the end of term, the posterior pituitary will begin to secrete oxytocin that was produced in the hypothalamus and stored there. It will serve to initiate labor.

c. Anterior Pituitary. At birth, the anterior pituitary will begin to secrete prolactin. This stimulates the production of breast milk.

d. Placenta. The placenta acts as a temporary endocrine gland during pregnancy. It produces large amounts of estrogen and progesterone by 10 to 12 weeks of pregnancy. It serves to maintain the growth of the uterus, helps to control uterine activity, and is responsible for many of the maternal changes in the body.

CHANGES IN BODY WEIGHT DURING PREGNANCY

a. Normal weight gain is about 24 to 30 pounds during pregnancy.

b. Weight gain in pregnancy.

(1) There is a slight loss of pounds during early pregnancy if the patient experiences much nausea and vomiting.

(2) She then gains 2 to 4 pounds by the end of the first trimester.

(3) A gain of a pound per week is expected during the second and third trimesters.

(4) Monitoring of weight gain should be done in conjunction with close monitoring of blood pressure.

(5) A lack of significant weight gain may be an indication of intrauterine growth retardation (IUGR) of the infant.

(6) Patients with multiple fetuses will require a higher caloric diet and expect a higher weight gain than a patient with only one fetus.

c. Adequate protein intake should be emphasized to the patient for development of the healthy fetus and proper diet reviewed at each prenatal visit.

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Many women feel awkward and even a bit frightened when they see their gynecologist for a routine check up. This level of anxiety can be compounded when there’s a serious medical problem requiring continuing visits. For this reason, women are often selective in who they choose as their gynecologist.

One of the decisions a woman must make in selecting a gynecologist is whether to choose a male or female doctor. When making this decision, it’s important to understand the advantages of choosing a male or female gynecologist. There is no doubt that there are highly competent and caring gynecologists of both sexes, so it will be important to consider the individual and their background over sex. What are the advantages of choosing a female gynecologist over a male gynecologist?

Women doctors tend to spend more time with their patients.

You may have a variety of questions and concerns when you visit your gynecologist. You need a gynecologist who’s willing to take the time to answer your questions. Several studies have shown that, women doctors tend to spend more time with patients when compared to their male counterparts. Again, you’ll want to consider the individual physician since this doesn’t hold true in every case.

Women doctors may have more natural empathy for gynecological problems.

Women physicians have the same reproductive organs that you do and often experience the same problems as their patients. This may give her unique insight and empathy into what you’re experiencing. It can be reassuring to know someone understands what you’re going through.

Women physicians may be gentler with their exam.

Having experienced the cold and often uncomfortable nature of a gynecologic exam, a woman gynecologist may have a gentler touch. She knows what it’s like to lie exposed on a table in a cold room, half naked with fluorescent lights shining down on you.

A gynecologic exam can be less awkward with a female physician.

Some women naturally feel more comfortable not exposing themselves to the opposite sex, even if it is a medical professional.

Certain medical problems may be more easily discussed with a female gynecologist.

If you’re uncomfortable talking about problems of a sexual nature with a male gynecologist, this can be a good reason to select a female gynecologist. Certain topics such as painful intercourse, vaginal discharge, and sexually transmitted diseases may be difficult to discuss with the opposite sex. This should be considered before you choose a gynecologist to provide your care.

It’s reassuring to know that there are gynecologists of both sexes that have your best interests in mind. If the sex of your doctor isn’t an issue, choose a gynecologist based on good credentials and a good bedside manner and you should get excellent medical care.

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Types of Placenta Previa
There are four types of placenta previa:

• Complete previa is where the cervix is completely covered by the placenta.
• Partial previa is where a portion of the cervix is covered by the placenta.
• Marginal previa is where the placenta extends to the edge of the cervix, without covering it.
• Low-lying previa is where the placenta is implanted in the lower uterine area, but not touching the cervixdge of the cervix.

Suspecting Placenta Previa
Placenta previa is usually suspected if there are one or more of the following symptoms:

• Painless bleeding during the end of the second trimester or third trimester.
• Premature contractions.
• Breech or transverse position.
• Larger uterus measurements.

Resolving Placenta Previa
90-95% of placenta previa diagnoses are resolved when the baby reaches full term. The partial previa can self-correct as the uterus enlarges and the placental site moves. You will usually undergo follow-up ultrasounds to determine the placement of the placenta in relationship to your cervix.

Placenta Previa Complications
Complications for the baby include:

• Possible abornmal intrauterine growth.
• Increased occurances of abnormalities.

Complications for the mother include:

• Possible hemorrhaging.
• Cesarean delivery.

Increased risk of placenta accreta.

Who is at Risk for Placenta Previa?

• Women with previous c-sections.
• Women diagnosed with a previous placenta previa.
• Women pregnant with multiple babies.
• Women over the age of 30.

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