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LOCAL CHANGES
A. REPRODUCTIVE SYSTEM CHANGES a. Uterine Changes Length: 6.5 32 cm Depth : 2.5 22 cm Width: 4 24 cm Weight: 50 1000g
Braxton-Hicks contraction
Volume: 2ml more than 1000ml /4000g at term End of twelfth week palpated at the symphysis pubis
d. Vaginal changes
with glycogen because of increased estrogen light pink to a deep violet : increased vascularity
LIGHTENING womans breathing becomes easier, lightening the load. *In multipara, it occurs at labor
From pH >7 to pH 4 or 5
Uterine blood flow: before 1520 ml/min, by the end of pregnancy 500-750 ml/min *75% goes to placenta
vaginal secretions because of Lactobacillus acidophilus (grows freely in increased glycogen envt) Candida albicans, itching and burning sensation with creamcheese-like discharge
Candidiasis caused by
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Leukorrhea excessive
discharge e. Ovarian changes
or reddish streaks on sides of abdomen and on thighs caused by rupture and atrophy of connective layer of skin *weeks after birth becomes striae albicantes or atrophicae (silvery-white)
Diastasis separation of
Melasma/chloasma
mask of pregnancy, dark pigmentations on cheeks and nose due to MSH spiders/Telangiectases small, fiery-red, branching spot on thighs due to increasing estrogen
Vascular
Increased in size hyperplasia of mammary alveoli and fat deposits Areola darkens and increases in diameter Increased vascularity and prominent blue veins
Palmar erythema
redness and itching on hands due to estrogen Scalp hair growth increases
Montgomerys tubercles
sebaceous glands enlarge and become protuberant - Keeps nipples supple, preventing drying and cracking during lactation
C. RESPIRATORY SYSTEM
high-protein fluid that is precursor of breast milk, can be expelled at 16th week
SYSTEMIC CHANGES
32mmHg due to increased progesterone level easier fetal CO2 transfer to maternal bloodstream
B. INTEGUMENTARY SYSTEM
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Mild Hyperventilation to
prevent maternal blood pH from becoming acidic bec of CO2 to help, addl H2O and Na is lost
Decreased iron absorption due to decreased gastric acidity Excessive Fe: stomach irritation
Polyuria kidney excretes HCO3 Vital capacity: no change Tidal volume: increased 30-40%
RR: increased 1-2bpm Residual volume: decreased by 20%
More transverse
positioning due to diaphragm displacement pregnancy is due to SNS stimulation ; in later months due to increase thoracic pressure
Palpitations: early in
D. TEMPERATURE
d. Blood pressure
E. CARDIOVASCULAR SYSTEM
Pseudoanemia - conc. of
hemoglobin and RBC decline in first trimester due to faster plasma volume increase than RBC prodn b. Iron, Folic Acid & Vitamin Needs
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Heartburn reflux of
stomach contents into esophagus because of: upward displacement of the stomach relaxed cardioesophageal sphincter (due to relaxin, enzyme produced by ovaries)
Corrected through turning the woman to her left side g. Blood Constitution Fibrinogen: increases by 50% due to increased estrogen level
Slow intestinal
peristalsis and the emptying time of stomach due to pressure caused by uterus displacing abdominal organs: leads to heartburn, constipation and flatulence
Progesterone: makes GI
tract less active
Subclinical Jaundice
(generalize itching) Decreased emptying of bile from the gallbladder: reabsorption of bilirubin in maternal bloodstream
common due to lower total protein load and hypovolemia: equal osmotic and hydrostatic pressure 1/3*
Hypertrohy of gumlines
& bleeding of gingival tissue saliva prodn due to increased estrogen lvls
Hyperptyalism increased
F. GASTROINTESTINAL SYSTEM
G. URINARY SYSTEM Changes results from: o o Effects of high E & P levels Compression of bladder and ureters
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o o
a. Fluid retention
Increased Aldosterone
b. Renal Function Kidneys increased in size Urine output increases 6080% Sp. Gr. Decreases GFR and renal plasma flow increases early in pregnancy At 2nd trimester, they increased by 30-50% Lower BUN and creatinine lvls o 15mg/100ml or higher BUN is abnormal, as well as, Greater than 1mg/100ml creatinine
Gradual softening of pelvic ligaments and joints (relaxin and progesterone) Excessive mobility of joints causes discomfort 3mm-4mm separation of symphysis pubis at 32 weeks o Difficulty walking
Lordosis/ Pride of
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I.
ENDOCRINE SYSTEM a. Placenta Produces large amts of E, P, HCG, HPL, relaxin & prostaglandins
ESTROGEN causes: breast and uterine enlargement, & palmar erythema PROGESTERONE is involved in: maintenance of endometrium, inhibition of uterine contractility, & development of breasts for lactation RELAXIN (corpus luteum): helps in inhibiting uterine activity, softening of the cervix (dilatation at birth) and collagen in joints (laxness in the lower spine & enlargement of birth canal) HCG (trophoblast): stimulates E and P synthesis HPL: insulin antagonist; more glucose for fetus PROSTAGLANDIN: affect smooth muscle contractility, initiates labor
e. Pancreas Increased insulin prodn due to increased glucocorticoid lvls Maternal blood glucose level > fetal glucose level o To prevent hypoglycemia: Increase MBGL than normal Low FBS of mother during first trimester Less effective insulin due to insulin-antagonists (E, P & HPL)
b. Pituitary Gland (-) prodn of FSH and LH due to increased P and E Increased prodn of GH and MSH Later: prodn of oxytocin and prolactin J. IMMUNE SYSTEM
Immunocompetency decreases
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LOVE is a strong word to say it too early, Yet, it is too wonderful to say it too late...
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