LESSON PLAN

ON
PHYSIOLOGICAL CHANGESDURING
PREGNANCY
PREPARED BY
Ms. RUCHI M.Sc.

NURSING I YR

VCON
General objectives: The student will acquire adequate knowledge about physiological changes during pregnancy.

Specific objective: The student will be able to,

 Define pregnancy
 Enlist the changes in reproductive organs
 Explain the systemic changes in pregnancy
 Brief about metabolic changes
 Enumerate the nurses role in pregnancy
S.NO TEACHER’S &
TIME SPECIFIC COTENT LEARNER”S AV EVALUATION
OBJECTIVE ACTIVITY AIDS

5min Define PHYSIOLOGICAL CHANGES IN Explaining and Roller What is

1
pregnancy listening board definition of
PREGNANCY
pregnancy?
DEFINITION:
Pregnancy
Carrying fetus or embryo I the womb of he
mother. It begins at fertilization and ends at the
delivery of fetus. Pregnancy lasts for 40weeks.

2 CHANGES IN REPRODUCTIVE
15min Enlist the Explaining and Bulletin What
changes in ORGANS
taking notes. board reproductive
reproductive  Vulva and organs get
organs
 Vagina P changes?
 Uterus P

 Isthmus T

 Cervix
 Fallopian Tube
 Ovary
VULVA:
 Oedematous
 More Vascular
 Superficial varicosities may appear
specially in multiparae.
 Labia minora are pigmented and
hypertrophy.
 perineum-enlarged increased
vasculature, hypertrophy of perineal
body and deposition of it.
VAGINA:
 Vaginal walls become hypertrophied,
oedematous and more vascular.
 Increased blood supply of the venous
plexus
surrounding the walls
 The length of the anterior vaginal wall is
increased. Normal length is 3-4 inches.
 Secretion becomes copious, thin and
curdy white
 pH becomes acidic (3.5-6)
Chadwick sign is a bluish discoloration of the
cervix, vagina, and labia resulting from
increased blood flow. It can be observed as
early as 6 to 8 weeks after conception, and its
presence is an early sign of pregnancy.
UTERUS:
 Uterus increases five times from its
normal size.
 In length from 6.5 to 32cm
 In depth from 2.5 to22cm
 In width from 4 to 24cm
 In weight from 50 to 1000gm
 In thickness of the walls from 1 to 0.5cm
 The capacity of the uterus
accommodates a seven-pound or 500 to
1000ml of amniotic fluid and the fetal
members.
 Changes occur in all the parts of uterus
body, isthmus and cervix.
 Oestrogen and progesteron hormone is
essential for increased vascularity and
dilatation of blood vessels, hyperplasia
 and hypertrophy of muscle fibres,
development of decidua.
CHANGES IN MUSCLE IN ABDOMEN:
Mechanism of uterine enlargement is due to
stretching and hypertrophy of the muscle
fibers, increase in elastic tissues, and
accumulation of fibrous tissues in external
muscle fibers.
During pre pregnancy state it is solid and in
term muscles are soft due to distension of
growing fetus.
ARRANGEMENT OF THE MUSCLE
FIBRES
1)Outer longitudinal – arranged over the
fundus
(2) Inner circular – It is scanty and have
sphincter like
(3) Intermediate – It is the thickest and
strongest layer arranged in criss-cross fashion
through which the blood vessels run.
VASCULAR SYSTEM:
 Uterine artery diameter becomes double
from 3mm to 7mm in term.
 Blood flow increases by eight fold at 20
weeks of pregnancy.
 Vasodilatation is mainly due to estradiol
and progesterone.
 Veins become dilated and are valveless.
 Numerous lymphatic channels open up.
 Vascular changes are most pronounced
at the placental site.
GROWTH OF UTERUS:
SHAPE
 Non pregnant pyriform shape is
maintained in early months.
 Becomes globular at 12 weeks.
 As the uterus enlarge, the shape once
more
 pyriform or ovoid by 28 weeks.
 Changes to spherical beyond 36th week.
POSITION
 Normal anteverted positions exaggerated
 up to 8 weeks
 The enlarged uterus may lie on the
bladder
afterwards, it becomes erect, the long axis of
the uterus conforms more is a tendency of
anteversion
 Primigravidae with good tone of the
abdominal muscles, it is held firmly
against the maternal spine.
Braxton Hicks contractions are
sporadic contractions and relaxation of the
uterine muscle. Sometimes, they are referred to
as prodromal or ‘false labor’ pains. It is
believed they start around 6 weeks gestation
but usually are not felt until the second or third
trimester of the pregnancy.
ENDOMETRIUM:
Endometrium during pregnancy is known as
decidua. The increased structural and
secreatory activity of the endometrium that is
brought in response to progesterone, following
the implantation is known as decidual reaction.
3 layers of decidua
1. Superficial compact layer- compact
mass of decidual cells, glands ducts and
dilated capillaries.
2. Intermediate spongy layer- it is
dialated uterine glands, decidual cells
and blood vessels.
3. Thin basal layer- basal portion of the
glands and is opposed to uterine muscle.
ISTHMUS:
 During the first trimester isthmus
hypertrophies and elongates to about 3
times its original length.
 Becomes softer.
 Normal length of isthmus is 2cm
CERVIX:
 Hypertrophy and hyperplasia of the
elastic and
 connective tissues
 Vascularity is increased
 Softening of the cervix (Goodell’s sign)
 A mucus plug, which is known as
 operculum is formed in the cervical
canal. This mucus plug is expelled at the
end of the pregnancy. On the onset of
labor, the mucus is blood tinged, it is
referred to as a ‘bloody show’.
FALLOPIANTUBE
 Total length is increased. Normal length
is 10cm.
 Tube becomes congested, at term it
attachment is lower end of the upper1/3rd
of the uterus.
 Muscles undergo hypertrophy.
OVARIES:
 Growth and function of the corpus
luteum reaches its maximum at 8th week
by FSH, which prevents ovulation and
mensuration.
 Hormones-oestrogen and progesterone
secreted by the corpus luteum maintain
the environment for the growing ovum
until 10to12 weeks of pregnancy.
 Afterwards placenta, is capable of
 producing adequate amounts of
progesterone and oestrogen.
 Inhibit ripening of the follicles
BREAST CHANGES
In early pregnancy- The breast may feel full
or tingle, increase in size as pregnancy
progresses. The Montgomery tubercules (the
sebaceous glands of the areola). The vessels on
the surface of the breast may become visible
due to increased circulation.
By second trimester- the breast begin to
produce colostrum. This is precusor of breast
milk. It is thin, watery, yellowish secretion that
thickens as pregnancy progress.
Linea nigra- a dark line runs between
umbilicus to the symphysis pubis and may
extend as high as the sternum.
Mask of pregnancy (chloasma)-hyper
pigmentation in face and forehead.
It gradually begins from 16th week of
pregnancy.
Striaegravidarum– this is due to action of
 adrenocorticosteriods. This occurs in
maximum stretching area like abdomen, thighs
and breasts.
Sweat glands- activity of the sweat glands
during pregnancy is increased due to increased
vascularity, tends to sweat profusely.
Palmar erythema- pinkish red, diffuse
mollting blotches in the Palmar surface of the
hand is about 60 percentages in white women.
Hirsutism-fine hair growth over the face
disappears after the delivery.

3 20min Explain the SYSTEMIC CHANGES P

systemic Explaining P What are the
CIRCULATORY SYSTEM
changes in
Listening and T systemic
pregnancy A.) Blood volume
asking doubts changes in
 blood volume increases gradually by 30
pregnancy?
to 50 percent (1500 ml to 3 units) this
results in decrease in hemoglobin.
 Blood count is interpreted as in anemia
because hemoglobin falls 10.5 gm per
100ml.
 Increased blood volume compensates for
 hypertropied vascular system of
enlarged uterus. It improves placental
performance.
B.) cardiac output
⚫ Cardiac output incrreases about 30
percent during the 1st and 2nd trimester to
accommodate the hypervolemia.
⚫ Changes in output results in changes in
heart rate. It usually increases by 10
beats per min.
C.) blood pressure
 Normally, patient BP does not changes.
 duringmid trimester, BP can change and
cause fainting.
 In late pregnancy, hypotension may
occur in 10% of women in unsupported
supine position. This is termed as supine
hypotension syndrome.
 The pressure of the gravid uterus
compresses the vena cava, reducing the
venous return.
 Cardiac output is reduced by 25-30
 percent and the blood pressure may fall
10-15%.
 BP increases only by life style
modification in today’s life.
 Advised to do breathing exercise
regularly.
D.) WBC
WBC count increases during pregnancy upto
5000-12000/ml in last trimester.
Counts as high as 25000-30000/ml indicates
abnormality in pregnancy for both mother and
fetus.
E.) Clotting factor
There are marked increase in fibrinogen and
factors. Factors VII, IX, X and XII increases
but for a lesser amount.
Regional distribution of the blood flow
Uterine blood flow is increased by50ml in non-
pregnancy stage to 750ml in term.
Pulmonary blood flow is increased by
2500ml/min. Normal is 6000ml/min.
Renal blood flow is increased by 400ml/min at
16th week and remains same till term. Normal
is 800ml/min.
RESPIRATORY SYSTEM:
 Shape of the chest and circumference
increases in pregnancy by 6cm.
 Progressive increase in oxygen
consumption, which is caused by the
increased metabolic needs of the mother
and fetus.
 Total lung capacity is reduced 4-5% by
the elevation of the diaphram.
 A state of hyperventilation occurs
during pregnancy leading to increase
tidal volume 35-50%
CHANGES IN BODY TEMPERATURE
A slight increase in body temperature
in early pregnancy.
The temperature returns to normal at
16th week of gestation.
The mother may feel warmer or
experience ‘hot flashes’ caused by
increased hormonal level and basal
 metabolic rate.
URINARY SYSTEM
KIDNEY
 Dilatation of the ureter, renal pelvis and
calyces occurs. The kidneys enlarge in
length by 1 cm.
 Renal plasma flow is increased by 50-
75%, maximum by the 16 weeks and is
maintained until 34 weeks. Thereafter it
falls by 25%.
 Glomerular filtration rate (GFR) is
increased by 50% all throughout the
pregnancy.
 Bladder is displaced and moved upward
and fllatened in the anterior posterior
diameter.
 During pregnancy protein level more
than 500mg/h is lost, hypertension is
suspected.
GI SYSTEM
a. Oral cavity:
Salivation increases due to difficulty n
swallowing, if ph is decreased then it prone to
tooth decay.
b. GI motility:
GI motility is decreased in pregnancy due to
progesterone. Transmit time of food may be
slower so, water absorption decreased leading
to constipation.
c. Gallbladder:
Gallbladder function is also altered during
pregnancy. Bile becomes thick and stasis leads
to gallstone.
d. Liver
No apparent changes in liver. Some of
enzymes decrease like albumin/globulin ratio
normally in pregnancy.
ENDOCRINE SYSTEM:
Thyroid glandincrease in size due to iodine
metabolism return to normal in postnatal
period.
Para thyroidincrease in size slightly to meet
the calcium need of the fetus.
Posterior pituitary glandnear to end of term,
secrets oxytocin which severe to initiate labor.
Anterior pituitary glandwill begin to secrete
prolactin, which stimulates production of
breast milk.
Adrenal cortexthickens due to the secretion of
ACTH as result of progestrone.
Placentaproduces large amount of estrogen
and progesterone by 10 to 12th weeks of
pregnancy. It maintains the uterine activity
and maternal changes in the body.
Changes in body weight during pregnancy
Reproductive weight gain: 6 kg
Fetus – 3.3 kg, placenta –0.6 kg and
liquor – 0.8 kg
uterus – 0.9 kg and
breast -0.4 kg,
accumulation of the fat and protein 3.5kg
Net maternal weight gain: 6 kg
Increases in bloodvolume – 1.3 kg
 Increases in extracellularfluid – 1.2 kg
 There is a weight los in early pregnancy
due to nausea and vomiting.
 Gains 2-4kg in first trimester
 Gains upto 5kg or more in 2ndans 3rd
trimester.
 Upto totally 11kg weight gain is
composed (breast, blood, uterine tissue)

7min Brief about

4 METABOLIC CHANGES IN
metabolic Explaining P What are
changes PREGNANCY Taking notes P metabolic
Water metabolism: there is a tendency to T changes?
water retention secondary to sodium retention.
Protein metabolism: there is a tendency to
nitrogen retention for fetal and maternal tissues
formation.
Carbohydrate metabolism:
 Pregnancy is potentially diabetogenic.
 Alimentary glucosuria occurs in early
pregnancy.
 Renal glucosuria occurs in middle of
pregnancy.
 Fat metabolism: There is increase in plasma
lipids with tendency to acidosis.
Mineral metabolism: There is increase in
demand for iron, calcium, phosphate and
magnesium.

5 5min Enumerate the ROLE OF NURSE IN PREGNANCY Explaining and P What are the
nurses role in  Monitor the woman’s vital signs, level listening P nursing care?
pregnancy
of mobility, level of consciousness, and T

perception of pain and level of pain

relief.
 Monitor fetal status. Pause the infusion
to replace empty infusion syringes or
infusion bags with new, pre-prepared
solutions containing the same
medication and concentration, according
to orders provided by the anesthesia care
provider and re-start the infusion.
 Stop the continuous infusion if there is a
safety concern or the woman has given
birth.
 Remove the catheter, if the RN has had
 appropriate educational training, criteria
have been met, and institutional policy
and law allow.
 Removal of the catheter by an RN is
contingent upon receipt of a specific
order from a qualified anesthesia or
physician provider.
 Initiate emergency therapeutic measures
if complications arise according to
institutional policy, protocol, and RN
scope of practice.
 Communicate clinical assessments and
changes in patient status to the obstetric
and anesthesia care providers as
indicated by institutional policy.
SUMMARY: In this class we learned about definition of pregnancy, reproductive organ changes, systemic changes, metabolic
changes and role of nurse.

CONCLUSION: at last, the students are able to learn physiological changes in pregnancy and role of nurse in detail and they
will implement in their practical activities in clinical posting.

BIBLIOGRAPHY:
 DC Dutta’s textbook of obstetrics including perinatology and contraception, Eighth edition, Jaypeebrothers medical
publishers, 2015.Pg .no:52 to 64.