WARD TEACHING

ON
PHYSIOLOGICAL CHANGES
DURING PREGNANCY

SUBMITTED TO, SUBMITTED BY

Miss Evangeline Mrs. Ankita Manna
Associate Professor EBMCON
EBMCON M.Sc Nursing 1st year
S. Objectives Time Content Learnin Teaching A.V. Evaluat
No g Activity Aids ion
. Activity
1. To introduce the 2 min INTRODUCTION L L D Introduc
topic. Physiological changes during pregnancy: during the course of I ed
pregnancy many physiological and anatomical alteration occurs S physiolo
in many organ system. C gical
I U changes
These physiologic changes are entirely normal, and
S during
include behavioral (brain), cardiovascular (heart and blood E S pregnanc
vessel), hematologic (blood), metabolic, renal (kidney), posture, I y.
and respiratory (breathing) changes. Increases in blood sugar, S O
breathing, and cardiac output are all expected changes that allow N
a pregnant woman's body to facilitate the proper growth and
development of the embryo or fetus during the pregnancy. The
pregnant woman and the placenta also produce many other A T
hormones that have a broad range of effects during the
pregnancy. O Defined
2. To define the topic. 3 min DEFINITION H physiolo
E P gical
Maternal physiological changes in pregnancy are the adoptions
R changes
during pregnancy that a woman’s body undergoes to during
accommodate the growing embryo or fetus. The pregnant pregnanc
woman and placenta also produce many other hormones that N y.
have a broad range of effects during pregnancy.
N Discusse
3. To discuss the 8 min REPRODUCTIVE SYSTEM P d about
physiological a) Vulva: becomes vascular and hypertrophied, pigmented and I P changes
changes in varicose veins appear in some. T in
reproductive  b) Vagina: becomes vascular and hypertrophied, looks bluish, reproduc
system. felt soft. Vaginal secretion, increases in amount and is acidic due I tive
N system.
to the production of lactic acid.
1. The pH becomes more acidic (3.5-6) due to more
conversion of glycogen into lactic acid by the N
 lactobacillus acidophilus consequent on high oestrogen G
level. This acidic pH prevents multiplication of
pathogenic organisms.
2. (JACQUEMIER’S SIGN): Increased blood supply of the
G L
venous plexus surrounding the walls gives a bluish
colouration of the mucosa of Vagina. Oestrogen increases
cervical vascularity and if viewed through a speculum the
cervix looks purple) L I
C ) Cervix: remains 2.5 cm long throughout pregnancy, but the P
hygroscopic properties of oestrogen cause it to increase in width.
 A mucus plug called “operculum” is formed between the
maternal and external os .Cervical mucosa undergo E S
hypertrophy and hyperplasia and occupies inner half of cervix. P

D) Uterus: Gravid uterus gradually enlarges from 50 gm muscular
organ to 900 gm at term pregnancy. A T
 The muscle layer is involved in the contraction necessary to T
expel the fetus at the end of the pregnancy
 The myometrium or muscle coat surrounds the lower uterine
segment and cervix during labour. R E
 The perimetrium is the outermost layer of the uterus. It does
not totally cover the uterus.
 The thickened upper segment acts as a piston to force the
foetus into the receptive, passive lower segment. N N
 The outer longitudinal layer of muscle fibres contract and
retract during labour causing upper segment to thicken.
 The endometrium lines the body of the uterus and is rich in
I I
blood supply. It is known as the decidua when the fertilised
ovum gets embedded in it.
E) Ovaries: Ovulation ceases throughout pregnancy. Corpus luteum of
usual menstrual cycle persists and enlarges to 2.5 cm till 8th week due
N N
to the changes in the fertilized ovum (trophoblast) and helps in
P
producing hormones.
P
F) Breasts:
  under the stimulation of estrogen and progesterone the breasts T
increase in size, nodularity and sensitivity throughout G G
pregnancy with increased vascularitis .
 The nipples enlarge, become dark, erect and the gland of
Montogomery enlarges. Total weight becomes 0.4 kg volume.
Enlargement is due to alveolar proliferation and deposition of L L
fat.
 Areola becomes dark pigmented, which is primary areola, and
a second zone of pigmentation appears around the primary
areola in second trimester, which is secondary areola. The E I
breast ductal system has intense growth during the 1st three
months of pregnancy. As pregnancy progresses, the alveolar
cell becomes secretory.
CARDIOVASCULAR SYSTEM: Heart works more during A S
4. To describe 5 min pregnancy. F Describe
cardiovascular  increase in the cardiac volume by 10% L d
changes during  Heart works more during pregnancy. I cardiova
pregnancy.  Cardiac output increases by 15-30% due to increased heart rate R T P scular
and increase stroke volume. C changes
H during
 Pulse rate near term increases by 10 per minute.
A pregnanc
 Platelet count shows slight decrease due to increased
N E R y.
concentration.
T
 Blood Pressure and Blood volume
 Blood pressure remains within normal limits.
 Due to pressure of gravid uterus on pelvic veins Venous I N
pressure– Femoral venous pressure rises from 10 cm water to
30 cm water.
 Blood volume increases from 3rd month and reaches a peak of
25% rise at 32 weeks.
 The red cell volume increases by 200 ml, plasma volume
increases to 1000 ml. I
RESPIRATORY SYSTEM
5. To explained about 3 min  Increased inspiration so the increased oxygen intake results in N C Explaine
respiratory changes improved oxygen supply to the foetus. H d about
 during pregnancy.  Increased expiration, more carbondioxide is expelled, there is N A respirato
low maternal carbondioxide leading to easy transfer of CO2 R ry
from foetus to mother’s blood. G T changes
 Breathing difficulty which is relieved after lightening. during
URINARY SYSTEM G pregnanc
6. To know about the The kidneys also work harder throughout pregnancy: H y.
urinary changes 1 min  The filter increasing volume of blood throughout of pregnancy. L A Know
during pregnancy.  During pregnancy each kidney increases in length by 1-15cm. N about the
 The uterus is dilated about the brim of the bony pelvis. L D urinary
GASTRO-INTESTINAL SYSTEM O changes
7. To list down the • Increased salivation (ptyalism) E U during
gastro intestinal 3 min • Taste is often altered very early in pregnancy T pregnanc
changes during • Increase appetite & thirst frequent small snacks I B y.
pregnancy. • Heart burn (reflux oesophagitis) relaxation of the cardiac sphincter L List
due to progesterone and relaxin A A down the
• Emesis gravidarum, morning sickness in 50 % C gastro
• Decreased gastric acidity, which interfere with iron absorption S K intestinal
• Constipation reduced gut motility due to progesterone increased B changes
water and salt absorption. R O during
Pica-is the persistent eating of substances such as dirt or paint that have no A pregnanc
nutritional value. T R y.
ENDOCRINE SYSTEM D Discusse
8. To discuss the 5 min Placental Hormones N C d about
endocrine system  Placenta produces several hormones H endocrin
changes during E A al
 The high levels of estrogen and progesterone produced by the
pregnancy. R changes
placenta are responsible for breast changes, skin pigmentations
I T during
and uterine enlargement in the first trimester
pregnanc
 Human placental lactogen stimulates the growth of the breasts
y.
 Chorinonic gonadotrophin is the basis for the immunologic
pregnancy tests. N N
Pituitary hormones
 The secretion of prolactin, adrenocorticotrophic hormone,
thyrotrophic hormone and melanocyte-stimulating hormone
increases G I
  Follicle stimulating hormone and luteinzing hormone
secretion is greatly inhibited by placental progesterone and
estrogen.
 The effects of prolactin secretion are suppressed during L N
pregnancy
 Posterior pituitary gland releases oxytocin in low-frequency
pulses throughout pregnancy. At term the frequency of pulses
increases which stimulates uterine contractions. E G
Thyroid Function
 Gland increases in size by about 13 percent due to hyperplasia
of glandular tissue and increased vascularity.
 Increased uptake of iodine during pregnancy. A L
 Pregnancy can give the impression of hyperthyroidism, thyroid
function is basically normal
 The basal metabolic rate is increased mainly because of
R I
increased oxygen consumption by the fetus and the work of the
Explaine
maternal heart and lungs.
d about
INTEGUMENTARY SYSTEM
9. To explain about 2 min F skin
skin changes during  Face (cholasma gravidarum or pregnancy mask) an extreme N S L changes
pregnancy. form of pigmentation around the cheek, forehead and around A during
the eyes S pregnanc
 Breast changes Abdomen H y.
 Linea nigra : a brownish black pigmented area in the midline I T C
stretching from the xiphisternum to the symphysis pubis. A
 Straie graviderum :slightly depressed linear marks with N R To
varying length and breadth found in pregnancy. D discuss
METABOLIC CHANGES E C about
10. To discuss about 5 min General Metabolic Changes H metaboli
metabolic changes  Total metabolism is increased due to the needs of the growing G A c
during pregnancy. fetus and the uterus R changes
 Basal metabolic rate is increased to the extent of 30% higher N during
than that of the average for the non- pregnant women. pregnanc
Protein Metabolism L y.
 Positive nitrogenous balance throughout pregnancy
  At term, the fetus and the placenta contain about 500 gm. of I
protein and the maternal gain is also about 500 gm
Carbohydrate Metabolism E
 Insulin secretion is increased in response to glucose and amino
acids.
 Hyperplasia and hypertrophy of beta cells of pancreas.
 Increased insulin level favours lipogenesis (fat storage).This A N
mechanism ensures continuously supply of glucose to the
fetus.
Fat Metabolism
 An average of 3-4 kg of fat is stored during pregnancy mostly R
in the abdominal wall, breasts, hips and thighs I
Iron Metabolism
 Iron is absorbed in ferrous form from duodenum and jejunum
and is released into the circulation as transferring. N
 10 percent of ingested iron is absorbed
 Total iron requirement during pregnancy is estimated
N
approximately 1000mg
I
 In the absence of iron supplementation, there is drop in
haemoglobin, serum iron and serum ferritinin concentration at
term pregnancy
Weight Gain N
 In early weeks, the patient may lose weight because of nausea G
and vomiting
 During subsequent months, the weight gain is progressive until
the last one or two weeks, when the weight remains static G
 The total weight gain during the pregnancy for a healthy L
woman averages 11 kg
 Distributed to 1 kg in first trimester and 5 kg each in second
and third trimester L Describe
NERVOUS SYSTEM I P d about
11. To describe about 3 min  Temperamental changes are found during pregnancy and in the P nervous
nervous system puerperium T system
during pregnancy.  Nausea, vomiting, mental irritability and sleeplessness are E during
 probably due to some psychological background S pregnanc
 Postpartum blues, depression or psychosis may develop in a y.
susceptible individual.
ROLE OF NURSE IN MANAGEMENT OF PHYSIOLOGICAL A Explain
12. To explain about 3 min CHANGES DURING PREGNANCY: T nurse’s
nurses role in 1. Preconceptional counselling is to be done regarding role
physiological physiological changes during pregnancy and the result of these during
changes during changes by the health care provider. R pregnanc
pregnancy. 2. Psychological support is to be given regarding changes during E y.
pregnancy.
3. Health education should be given regarding diet and antenatal
care. N
4. Health education should be given regarding changes during N
pregnancy like reproductive changes, cardiovascular changes,
respiratory changes etc.
5. Educate them that if any complications occurs except these I
chamges take advice from doctor. I Summari
SUMMARY zed the
13. To summarize the 1 min Today I have discussed about introduction, definition of physiological topic.
topic. changes during labour. And changes in reproductive system, N
cardiovascular system, respiratory system, gastro-intestinal system, N
endocrine system, metabolic changes, nervous system.
CONCLUSION Conclud
The physiological changes that occurs during pregnancy are the result G G ed the
14. To conclude the 1 min of hormonal and metabolic adaptations that are necessary to support topic.
topic. the developing fetus.
BIBLIOGRAPHY
1. C.S.Dawn,Pictorial and practical under graduate and post
graduate text book of obstetrics ,neonatology and
reproductive and child health education.16
ed.Kolkatta,India:2004.p.79-96.
2. Myles ,Diane M.Fraser,Margaret A. Cooper.Myles text
book for midwives.5 ed.China:Elseiver;2009.p.167-182.
3. Sudha salhan ,text book of obstetrics, first ed. New Delhi,
 India: Jaypee publications;2007.p.1.
4. Sabaratnam Arul kumaran, V. Siva nesaratnam,
Alokendu chatterjee, Pratap kumar. Essential of
obstetrics. New Delhi, India: Jaypee publishers,
2004.p.102-107.
5. Samantha M .Pfeifer.National medical sciencesfor
independent study obstetrics and gynaecology .6 ed.New
Delhi, India:Lippincott Williams and Wilkins;2008.p.42-
52.
6. Susan L.Ward,Maternal –child nursing care.India:Jaypee
publications;2010.p.256-286.
7. TK.Indrani ,Text book of Midwifery.New
Delhi,India:Jaypee publishers;2003.p.1.

(B).REFERENCES ON JOURNALS :

1. Asim kwyak , Frank A.Chervenak.Donald school journal

of ultrasound in obstetrics and gynaecology . New
Delhi,India: January-march 2010. 4(1).p.13-16.
2. Lynn L.Simpson.Obstetrics and gynaecology clinics of
North America . London :Elseiver
publishers;March2004.31(1).p.35.
3. Micheal O.Crardner,Manju Monga . Obstetrics and
gynaecology clinics of North America . London :june-
2004.31(2)p.345.
4. Neal M. Lonky .Obstetrics and gynaecology clinics of
North America. London: Dec-2002.29(2).p.613-614.
5. Susan M.Ramin. Obstetrics and gynaecology clinics of
North America. London: Sept-2001.28(3).p.513.
6. Val Vogt ,Thomas D.Elmora,Frank Wiling. Obstetrics and
gynaecology clinics of North America. London: june
2001.28(2).p.189- 202.
(C) WEBSITE REFERENCES:
1. www.jaypeejournals.com
2. www.dsjuog.com
3. www.pubmed.com
4. www.scribd.com
5. www.wkkf.org
6. www.muhsnashik.com
7. wiki. answers.com
8. www.acvademic journals.org/…/5hrestha.p…
9. www.eng.unibo.it/…/dettaglio.htm?..
10.www.cervicalcancervaccination.com…org au.