Chapter 13

Anatomy and Physiology of

Pregnancy

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 Key Points
 The biochemical, physiologic, and anatomic
adaptations that occur during pregnancy are
profound and revert to the nonpregnant state after
birth and lactation.
 Maternal adaptations are attributed to the hormones
of pregnancy and to mechanical pressures arising
from the enlarging uterus and other tissues.
 Adaptations to pregnancy protect the woman’s
normal physiologic functioning, meet the metabolic
demands that pregnancy imposes, and provide for
fetal developmental and growth needs.

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 Key Points (Cont.)
 Accuracy of results of home pregnancy tests
depends on following instructions correctly.
 Presumptive, probable, and positive signs of
pregnancy aid in the diagnosis of pregnancy;
only positive signs (identification of a fetal
heart tone, verification of fetal movements,
and visualization of the fetus) can establish
the diagnosis of pregnancy.
 Physiologic anemia of pregnancy results from
increase in plasma volume greater than the
increase in red blood cells.

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 Key Points (Cont.)
 During pregnancy maternal blood pressure
remains the same or decreases slightly.
 Heart rate increases 10 to 15 beats/minute by
32 weeks of gestation and persists until term.
 Respiratory rate is unchanged during
pregnancy, although tidal volume and minute
ventilation increase by 30% to 50%.
 Pregnancy is a hypercoagulable state with
increased risk for thrombotic disease.

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 Key Points (Cont.)
 Dilation of renal pelves and ureters during
pregnancy increases the risk of urinary tract
infection.
 Balance and coordination are affected by
changes in joints and in the woman’s center
of gravity as pregnancy progresses.
 Decreased muscle tone during pregnancy
contributes to heartburn, reflux, and
constipation.
 Endocrine changes are essential to
maintaining pregnancy and promoting fetal
growth.
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 Important Terms: Parity
 Parity: number of pregnancies in which fetus or
fetuses have reached viability, not the number of live
fetuses born, 20-22 wks
 Nullipara: woman who has not completed pregnancy
with a fetus or fetuses who have reached the stage of
fetal viability
 Primipara: A woman who has completed one
pregnancy with a fetus or fetuses who have reached
20 weeks of gestation
 Multipara: A woman who has completed two or more
pregnancies to 20 weeks of gestation or more
 Gravida: How many times been pregnant, regardless
of length

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 Important Terms:
Gestational Age of Pregnancy
 Preterm: a pregnancy that has reached 20 weeks of
gestation but ends before completion of 37 weeks of
gestation
 Late preterm: a pregnancy that has reached between
34 weeks 0 days and 36 weeks 6 days of gestation
 Early term: a pregnancy that has reached between
37 weeks 0 days and 38 weeks 6 days of gestation
 Full term: a pregnancy that has reached between 39
weeks 0 days and 40 weeks 6 days of gestation
 Late term: a pregnancy that has reached between 41
weeks 0 days and 41 weeks 6 days of gestation
 Post term: a pregnancy that has reached between 42
weeks 0 days and beyond of gestation

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 Gs & Ps

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 Pregnancy Tests
 Human chorionic
gonadotropin (HcG) is
earliest biochemical
marker for pregnancy
 Production begins as
early as day of
implantation
 Can be detected in
maternal serum or urine
as soon as 7 to 8 days
before the expected
menses
 Peaks at 60-70 days,
then declines
 High serum levels
associated with abn
gestation (Down’s,
multiples or GTD)
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 Signs of Pregnancy
 Presumptive: those changes felt by the
woman (e.g., amenorrhea, fatigue, breast
changes)
 Probable: those changes observed by an
Why do
examiner (e.g., Hegar sign, ballottement, you think
pregnancy tests) this is?
 Positive: those signs attributed only to the
presence of the fetus (e.g., hearing fetal heart
tones, visualizing the fetus, palpating fetal
movements)

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Signs of Pregnancy (Hegar’s)

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 Adaptations to Pregnancy

 Reproductive
system and breasts
 Uterus
• Changes in size,
shape, and position
• Changes in
contractility
 Braxton Hicks
• Uteroplacental blood
flow
• Cervical changes
Ballottement • Pregnancy may
“show” after the 14th
week
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 Adaptations to Pregnancy (Cont.)
 Reproductive  Vagina and vulva
• Leukorrhea
system and breasts • Chadwick sign (color)
 Uterus • Operculum
• Changes related to  Cervical changes
presence of fetus • Goodell sign (color)
 Quickening (flutter)
 Ballottement
• Friability- more apt to
 Lightening: weeks bleed
38 to 40
 Hegar sign
 Braxton Hicks
contractions

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 Adaptations to Pregnancy (Cont.)

 Reproductive
system and breasts
 Uterine growth by
gestational weeks
 Breasts
• Montgomery
tubercles (protective)
• Colostrum

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 Adaptations to Pregnancy (Cont.)
 General body systems
 Cardiovascular system
• Slight hypertrophy
• Blood pressure
 Begins to drop at 16 weeks (decreased vascular
resistance) returns to BL @ term
• Blood volume and composition: increases significantly
during pregnancy by approximately 30% to 45%
 Hgb and hct slightly lower than normal
• Cardiac output
• Circulation and coagulation times
 Pregnancy is considered a hypercoagulable state

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 Adaptations to Pregnancy (Cont.)
Nice to know
General body systems
 Respiratory system
• Pulmonary function
• Basal metabolism
rate
• Acid-base balance:
Pregnancy is a state
of respiratory
alkalosis (facilitates
oxygen transfer to
fetus
 Renal system
• Anatomic changes
• Functional changes
• Fluid and electrolyte 16
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balance
 Adaptations to Pregnancy (Cont.)

 General body systems (Cont.)

 Integumentary system
• Melasma (chloasma or mask of
pregnancy) darkened skin
• Linea nigra-dark line on stomach
• Striae gravidarum- stretch marks
• Palmar erythema- increase of
bloodflo/estrogen
• Pruritus: PUPPP, welts around abd
 Musculoskeletal system- Relaxin,
helps to open up pelvis and allow birth
canal to open
 Neurologic system
• Carpal tunnel

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 http://www.mypregnancybaby.com/puppp-pregnancy-rash/

http://www.thehealthsuccesssite.com/stretch-marks.html

http://www.thehealthsuccesssite.com/stretch-marks.html

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 Adaptations to Pregnancy (Cont.)
 General body systems (Cont.)
 Gastrointestinal system
• Appetite
• Mouth (dental care important)
• Esophagus, stomach, and intestines
• Gallbladder and liver
• Abdominal discomfort
 Pyrosis (heartburn)
 Ptyalism (excessive salivation)
• Appendicitis can be difficult to diagnose in pregnancy
because the appendix is displaced upward and laterally

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 Appendicitis

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Adaptations to Pregnancy (Cont.)

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 Adaptations to Pregnancy (Cont.)
 General body systems (Cont.)
 Endocrine system
• Pituitary and placental hormones
 HcG, HcS
 Progesterone
 Estrogen
 oxytocin
• Thyroid gland
• Parathyroid gland
• Pancreas
 insulin
• Adrenal glands

Have a look @ Table 13-6.

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 Question
1. A number of changes in the integumentary
system occur during pregnancy. What
change persists after birth?
a. Epulis (gum nodule)
b. Chloasma
c. Telangiectasia
d. Striae gravidarum

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