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Physiological Adaptations in Pregnancy-Resources Table

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Physiological Adaptations in Pregnancy-Resources Table Responsibility/ Adaptations in Pregnancy Additional Information Hormones ➢ Maintaining homeostasis Perinatal Nursing – 2021 ➢ Regulation of growth Simpson, Creehan, O’Brien-Abel, Roth ➢ Development and Cellular communication & Rohan Chapter three – Physiological Changes of Pregnancy Blackburn, Susan Tucker Page 48 Placenta ➢ Responsible for transfer of nutrients to the fetus ❖ Placental Hormones are critical and waste products away from the fetus for many of the metabolic and ➢ Functions as the fetal lungs, gi, liver, kidney and endocrine changes during endocrine organ pregnancy ➢ Major Hormones ❖ Fetal bone growth and placental ❖ hCG - Human chorionic gonadotropin calcium transport is mediated ❖ hPL – Human Placental Lactogen by Parathyroid hormone related ❖ Estrogen protein or PTHrP ❖ Progesterone ❖ Corticotrophin-releasing ❖ Serves as an endocrine gland hormone or CRH and PGs have a ❖ Major Hormones major role in initiation of ❖ hCG - Human chorionic gonadotropin myometrial contractility and ❖ hPL – Human Placental Lactogen labor onset ❖ Estrogen Page 49 ❖ Progesterone ➢ HCG ➢ Primarily secreted by the placenta Page 49 1 | P a g e ➢ Major function is to maintain progesterone and estrogen production by the corpus luteum until the placental function is adequate (approximately 10 weeks post-conception) ➢ Thought to have a role in fetal testosterone and corticosteroid production and angiogenesis ➢ Found in maternal serum by within 7-8 days after implantation ➢ Positive pregnancy test – 3 weeks after conception and 5 weeks after LMP ➢ Elevated in multiple and molar pregnancies ➢ Lower in ectopic or abnormal placentation ➢ Human Placental ➢ Produced by syncytiotrophoblast tissues of the Page 49 Lactogen (hCS) placenta ➢ Growth parallel to the placental growth and peaks near term ➢ Critical for fetal growth as it alters maternal protein, carbohydrate and fat metabolism and acts as an insulin antagonist ➢ free fatty acid availability for maternal metabolic and maternal glucose uptake and use o Allows glucose to be reserved for fetal use o Mother will be at a higher risk for ketosis with significant in maternal food intake ➢ Estrogens ➢ Steroid hormones secreted by the ovaries in early Page 49 (estrone, pregnancy and by the placenta in late pregnancy 2 | P a g e estradiol & ➢ Prevents further ovarian follicular development estriol) during pregnancy ➢ Prepares the breast for lactation ➢ blood flow to the uterus, growth of the uterine muscle and enhances myometrial activity – involved in the timing and onset of labor ➢ Rapid last 6 weeks in pregnancy o Factor in onset of labor ➢ Progesterone ➢ Initially produced by the corpus luteum & later by Page 49 the placenta ➢ Assists with implantation and myometrial relaxation – smooth muscle relaxer o GI system o Venous wall to accommodate in blood volume ➢ Respiratory center - CO2 sensitivity ➢ Aids in the structural development of the breast to prepare for breastfeeding ➢ Mediates the changes in the immune system o Prevents rejection of the fetus ➢ Relaxin ➢ Secreted by the corpus lutum and later by the Page 49 myometrium and placenta ➢ Inhibits uterine activity during pregnancy ➢ Plays a role in decidual development and implantation 3 | P a g e ➢ Prostaglandins ➢ From the family of eicosanoids which includes PGs, ➢ PGI2s & Thromboxane thought to prostacyclins (PGI2s), thromboxanes and contribute to hypertensive leukotrienes disorders – PCI2 is release is ➢ PGI2 & Thromboxane thought to contribute to mediated by nitric oxide which hypertensive disorders regulates vascular tone and SVR ➢ Effect smooth muscle contractility Page 50 o Mediate the onset of labor, myometrial contractility and cervical ripening ➢ Prolactin ➢ Released from the anterior pituitary gland Page 50 ➢ Increase in and maturation of ducts in the breast to aid in breastfeeding o After removal of placenta, high levels of estrogen disappear, signaling the anterior pituitary gland to produce prolactin o Levels rise rapidly and are elevated by the infants suckling ➢ Cardiovascular ➢ Heart is displaced upward, forward to the left ➢ Perfusion depends on the heart ➢ Heart rate 15-20 beats/minute rate ➢ Exaggerated split of the first sound and audible ➢ Benign systolic murmurs are third ♥ sound common ➢ Stroke volume25-30% ➢ ECG changes: inverted P waves, ➢ Cardiac output 30-50% small Q wave, tachyarrhythmias ➢ Blood volume 40-60% with in Hematocrit ➢ Physiologic anemia o RBC’s 20-30% ➢ risk for clot formation ➢ WBC to 15,000 o Venous thromboembolism ➢ Blood pressure is the second trimester DIC – Disseminated Intravascular Coagulation 4 | P a g e ➢ Widening of pulse pressure ➢ Plasma volume returns to normal ➢ Hypercoaguable: procoagulant activity and after 6 weeks PP fibrinolytic activity ➢ Post-partum – Left atrium appears enlarged due to the ↑in blood volume immediately following removal of placenta Pages 50-52 ➢ Respiratory ➢ Pressure from the uterus shifts the diaphragm ➢ Compensated respiratory alkalosis upward approx. 4cm which the length of the ➢ in Oxygen consumption lungs ➢ Shortness of breath is a common o To compensate for this the chest enlarges complaint 2cm ➢ Increased pressure from the uterus widens the substernal angle 50% and causes the ribs to slightly flare out ➢ Circumference of the thoracic cage may by 5-7 cm ➢ Ph 7.40-7.45 ➢ PaCO2 27-32mmHg ➢ HCO3 18-21 mmHg ➢ Tidal volume 30-40% ➢ Expiratory Reserve Vol ▪ 15-20% Page 55 ➢ Renal ➢ Glomerular filtration 40-60% ➢ Proteinuria, Glycosuria and renal ➢ Dilatation of the renal calyces, pelvis and ureters clearance and in serum levels of are due to the effects of progesterone some electrolytes more common 5 | P a g e ➢ Hypertrophy of the kidneys due to in blood o Filtered load of substance volume exceeds the tubular ➢ Dilatation of the ureters on the right side is more reabsorptive capacity pronounced than on the left side ➢ Hydronephrosis and Hydroureter – o Cushioning that occurs due to the may take 3-4 months to resolve displacement of the uterus by the sigmoid post-partum colon. ➢ Increased risk of urinary tract infections o Due to increase in muscular relaxation, increase in urine volume and urinary stasis ➢ Gastrointestinal ➢ Nutritional requirements increase Page 57 ➢ Common discomforts of pregnancy are due to physiological and structural changes ❖ Heartburn, gingivitis, constipation, nausea and vomiting ➢ Mouth ➢ Gingival edema and hyperemia Page 57 ❖ Begins in the 2nd month and peaks in the 3rd trimester ➢ Gingival changes are related to increase in vascularity and blood flow, changes in connective tissue and the release of inflammatory mediators ➢ in plaque and dental calculus ➢ in previous periodontal disease ➢ 3-5% have an epulis (tumor like enlargement (i.e. lump) situated on the gingival or alveolar mucosa.) between their upper, anterior maxillary teeth 6 | P a g e ❖ Regresses during post-partum but may reoccur with subsequent pregnancies ➢ Esophagus ➢ Decrease in lower esophageal sphincter Page 57 (LES)muscle tone and pressure due to effects of progesterone ➢ LES function further altered after the uterus is large enough to change the positioning of the stomach & intestines and move the LES into the thorax ❖ Changes heartburn and reflux ➢ Nausea and ➢ Affects 70-80% of pregnant women Page 57 Vomiting ➢ Exact mechanism unclear ➢ Theories: ❖ Mechanical, endocrinologic, allergic, metabolic, genetic and psychosomatic ➢ Most frequent hormone linked is estrogen- particularly HCg ➢ Usually begins at 4-6 weeks and peaks at 8-12 weeks but may begin sooner and last longer ➢ TX- supportive ❖ Frequent small meals ➢ Hyperemesis Gravidarum –associated with weight loss, electrolyte imbalance, ketosis and dehydration more serious and requires fluid replacement ❖ Stomach ❖ Progesterone 7 | P a g e o Decreases stomach gastric smooth muscle tone and motility ❖ Gravid uterus displaces the stomach ❖ Small and Large ➢ Pushed upwards and laterally ➢ Why a pregnant woman is prone to Intestines ➢ Appendix is displaced superiorly constipation? ❖ Reaches the right costal margin by term ❖ Reduced motility ❖ Milder guarding and rebound tenderness ❖ Mechanical obstruction of due to cushioning by the uterus may delay the uterus diagnosis of appendicitis during pregnancy ❖ Increased water absorption ➢ progesterone levels GI tract tone and from the colon intestinal motility ➢ Hemorrhoids may develop due to ➢ nutrient absorptive capacity due to height of straining and from increased the duodenal villi and activity of brush border pressure exerted on the vessels enzymes below the level of the uterus o Absorption of Calcium, amino acids, iron, Pages 57-58 glucose, sodium, chloride, and water are ↑ ➢ Liver ➢ Size and structure does not change during ➢ Liver changes can alter pregnancy biotransformation of drugs from ➢ Production of many proteins is altered due to the maternal circulation effects of estrogen ➢ Liver changes return to normal by 3 ➢ Hepatic blood flow increases but % of blood weeks post-partum reaching the liver remains unchanged Page 58 ➢ Fibrinogen levels by 50% by the end of 2nd trimester ➢ Serum proteins, enzymes and lipids are altered during pregnancy 8 | P a g e ➢ Serum alkaline phosphatase & serum cholesterol can be doubled and higher in multiple gestation ➢ Aspartate(AST), Serum bilirubin & Alanine aminotransferase (ALT) are normal or slightly lower in pregnancy – making these test good markers for liver disease in pregnancy ➢ Gallbladder ➢ Unlike the liver, size and function are altered ➢ Generally, returns to normal 2 during pregnancy
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