Neuromuscular Changes

During pregnancy, the enlarged uterus results in Psychological Changes

elongation of the abdominal muscles and separa-
tion of the linea alba. Passive joint instability (as
seen in pregnancy) alters afferent input from Psychological and Psychological changes during

Physiologic
joint mechanoreceptors and probably affects pregnancy: Pregnancy is always
motor neuron recruitment. A decrease in muscle
associated with changes in
Changes that Occur
stiffness and thus active stability of joints may
result from alteration of muscle spindle regula- psychological functioning of
tion and this is applicable particularly to muscles
around the pelvic girdle. These changes may lead
to poor recruitment of the muscles responsible
in Pregnancy pregnant women. It is usually
associated with ambivalence,
for pelvic girdle stability (particularly gluteus
medius and maximus) and result in decreased frequent mood changes, varying
tension of these muscles during walking, perhaps from anxiety, fatigue, exhaustion,
resulting in pelvic girdle pain (PGP). [2]
sleepiness, depressive reactions to
Cardiovascular changes excitement. During pregnancy,
changes include body appearance,
The heart adapts to the increased cardiac de-
affectivity and sexuality, whereas
mand that occurs during pregnancy in many
ways. Cardiac output increases throughout early the position and role of women
pregnancy, and peaks in the third trimester, usu- attains a new quality. Even
ally to 30-50% above baseline. Estrogen mediates
this rise in cardiac output by increasing the pre-
thoughts of pregnancy can bring
load and stroke volume, mainly via a higher over- about numerous worries about its
all blood volume (which increases by 40– course and outcome, and especially
50%). The heart rate increases, but generally not
above 100 beats/ minute. Total systematic vascu- of the delivery itself, which may be
lar resistance decreases by 20% secondary to the so intense that they acquire a
vasodilatory effect of progesterone. Overall, the
features of phobia (which may be
systolic and diastolic blood pressure drops 10–
15 mm Hg in the first trimester and then returns the reason for avoiding pregnancy).
to the baseline in the second half of pregnan-
cy. All of these cardiovascular adaptations can
lead to common complaints, such as palpitations,
decreased exercise tolerance, and dizziness.

Diadem M. Saligumba BSN2-C

E-mail: [email protected] Diadem M. Saligumba BSN2-C
Physiological Changes
Endocrine System Changes
Articular Changes The resulting increase in intragastric pressure combined with
Pregnancy is a normal physiological process and is lower LES tone leads to the gastroesophageal reflux commonly
Altered levels of relaxin, oestrogen, and experienced during pregnancy. Nausea and vomiting of preg-
associated with changes in hormone levels, one of
progesterone during pregnancy result in an nancy, commonly known as “morning sickness”, is one of the
these hormones called steroid hormones including most common GI symptoms of pregnancy. It begins between
alteration to collagen metabolism, this laxity is
progesterone and estrogen they are important due to the break down of collagen in the the 4 and 8 weeks of pregnancy and usually subsides by 14 to
during pregnancy to save fetus delivery and targeted tissue and replaces it by a modified 16 weeks. The exact cause of nausea is not fully understood
maintenance of pregnancy stable. Its levels increase form that contains higher water content. That but it correlates with the rise in the levels of human chorionic
increases connective tissue pliability and gonadotropin, progesterone, and the resulting relaxation of
gradually with pregnancy progression, unlike relaxin
extensibility. Therefore, ligamentous tissues smooth muscle of the stomach also, constipation and hemor-
reaches the highest level at first trimester then rhoids can occur during pregnancy.
are predisposed to laxity with resultant
decrease at the end of pregnancy. All steroids/ sex reduced passive joint stability, ligament laxity
hormones produced from the placenta during reaches its maximum at the second trimester Renal changes
[9]
pregnancy but the progesterone is the chief one. . The symphysis pubis and sacroiliac
joints are particularly affected to allow for the
Reproductive System Changes A pregnant woman may experience an increase in the size of
birth of the baby. Ligamentous laxity may
the kidneys and ureter due to the increased blood volume and
continue for six months postpartum.
During pregnancy, the internal genital tract/ vasculature. Later in pregnancy, the woman might develop
Biomechanical changes of the spinal and pelvic
reproductive systems undergone anatomical and physiological hydronephrosis and hydroureteronephrosis,
joints may involve an increase in sacral
which are normal. There is an increase in glomerular filtration
physiological changes to accommodate the promontory, an increase in lumbosacral angle,
rate associated with an increase in creatinine clearance, pro-
changes and development of the fetus. a forward rotatory movement of the
tein, albumin excretion, and urinary glucose excretion. There is
innominate bones, and downward and forward
also an increase in sodium retention from the renal tube so
Postural Changes rotation of the symphysis pubis. The normal
edema and water retention is a common sign in pregnant wom-
pubic symphyseal gap of 4–5 mm shows an
The overall equilibrium of the spine and pelvis en
average increase of 3 mm during pregnancy
alters as the pregnancy progresses [7] but there is
still confusion as to the exact nature of any .In the third trimester when the fetus starts to engage in the
Respiratory Changes
associated postural adaptation. With weight pelvis, there is an increased frequency of urina-
gain, increased blood volume, and ventral tion, incontinence.
growth of the fetus, the center of gravity no Respiratory changes during pregnancy are
longer falls over the feet, increase in important to accommodate and meet the
Nutrition
anteroposterior and medial-lateral sway [8], and demands of mother and fetus, there are
women may need to lean backward to gain changes in all lung volumes, changes in the
equilibrium resulting in disorganisation of spinal upper airway respiratory tract, and breathing During pregnancy, both protein metabolism and carbohydrate
curves. Reported postures include a reduction in pattern. metabolism are affected. One kilogram of extra protein is de-
lumbar lordosis an increase in posited, with half going to the fetus and placenta, and another
both lumbar lordosis and thoracic kyphosis or a half going to uterine contractile proteins, breast glandu-
flattening of the thoracolumbar spinal Gastrointestinal changes lar tissue, plasma protein, and hemoglobin. An increased re-
curve. There will be compensatory changes to
quirement for nutrients is given by fetal growth and fat deposi-
posture in the thoracic and cervical spines, and
tion. Changes are caused by steroid hormones, lactogen, and
this combined with the extra weight of the Progesterone causes smooth muscle relaxation
breasts may result in posterior displacement of which slows down GI motility and cortisol. Pregnant women require a caloric increase. Also
the shoulders and thoracic spine, increase decreases lower esophageal sphincter (LES) there's a weight gain of 20 to 30 lb (9.1 to 13.6 kg)
anterior pelvic tilting, and increase of the tone.
cervical lordosis. [2]These changes may be still
similar for 8 weeks after delivery. Caption describing picture or graphic