SYSTEMIC CHANGES DURING PREGNANCY

CHANGES OF THE SKIN DURING PREGNANCY

a. Linea Nigra. This is a dark line that runs from the umbilicus to the symphysis pubis and may
extend as high as the sternum.
b. Mask of Pregnancy (Chloasma). This is the brownish hyper pigmentation of the skin over the
face and forehead.
c. Striae Gravidarum (Stretch Marks). It reflects a separation within underlying connective tissue
of the skin. This occurs over areas of maximal stretch--the abdomen, thighs, and breasts.
d. Sweat Glands. Activity of the sweat glands throughout the body usually increases which
causes the woman to perspire more profusely during pregnancy.
e. Vascular nevi- small, fiery-red branching spots are sometimes seen in the neck, chest, face,
arms and legs. This is due to increased estrogen levels.

CHANGES OF THE CIRCULATORY SYSTEM DURING PREGNANCY

a. Blood Volume
Blood volume increases gradually by 30 to 50 percent (1500 ml to 3 units). This is to
compensate for the blood loss at birth.
Physiologic anemia occurs as the plasma increase exceeds the increase in red blood cell
production.
b. Cardiac Output
Cardiac output increases about 25 to 50 percent during the first and second trimester to
accommodate for hypervolemia. (This is not a problem for patients with a normal heart. A
patient with a diseased heart is especially at risk for cardiac decompensation 28 to 35 weeks
of pregnancy when the blood volume and cardiac load are at their peak; also, during labor and
immediately after delivery when rapid hemodynamic changes occur.)
Change in output is reflected in the heart rate. It usually increases by 10 beats per minute.
Heart size increases and is elevated upward and to the left side because of the
displacement of the diaphragm as the uterus enlarges.
c. Blood Pressure
Normally, the patient's blood pressure will not rise. It will decrease on the second trimester
due to the expansion of the placenta but it will rise again on the third trimester to first trimester
level.
d. Venous Return.
The lower extremities are often hampered in the last months of pregnancy due to the
expanding uterus restricting physical movement and interfering with the return of blood flow.
This results in swelling of the feet and legs. This can also lead to varicosities of the vulva,
rectum and legs.

CHANGES OF THE RESPIRATORY SYSTEM DURING PREGNANCY

The respiratory rate rises to 18 to 20 to compensate for increased maternal oxygen
consumption, which is needed for demands of the uterus, the placenta, and the fetus.
Approximately 60% to 70% of pregnant women experience shortness of breath; this is
because the diaphragm may be displaced by as much as 4cm as the uterus enlarges.
Nasal stuffiness and epistaxis (nosebleeds) are also common during pregnancy,
secondary to vascular congestion caused from the increased estrogen levels.

CHANGES OF BODY TEMPERATURE DURING PREGNANCY

A slight increase in body temperature in early pregnancy is noted because of the secretion
of progesterone from the corpus luteum. The temperature returns to normal at about the 16th
week of gestation as the placenta takes over the function of the corpus luteum.
CHANGES OF THE URINARY SYSTEM DURING PREGNANCY
The kidneys must work extra hard excreting the mother's own waste products plus those
of the fetus. There is an increase in urinary output and a decrease in the specific gravity. To
provide sufficient fluid volume for effective placental exchange, the total body water increases
to 7.5L.
The patient may develop urine stasis and pyelonephritis in the right kidney. This is due to
pressure on the right ureter resulting from displacement of the uterus slightly to the right by
the sigmoid colon.
Frequent urination is a complaint during the first through third trimester.

CHANGES OF THE SKELETAL SYSTEM DURING PREGNANCY

There is a realignment of the spinal curvatures during pregnancy to maintain balance. It is
due to the increase in size of the uterus and pressure on the abdominal wall. The patient
walks with head and shoulders thrust backward and chest protruding outward to compensate
(lordosis). This gives the patient a "waddling" gait.
There is a slight relaxation and increased mobility of the pelvic joints, which allows
stretching at the time of delivery of the infant, this is due to the production of relaxin hormones
by the placenta.

CHANGES OF THE GASTROINTESTINAL SYSTEM DURING PREGNANCY

Nausea and vomiting may occur as a result of the secretion of Hcg
As the uterus enlarges. It rises up and out of the pelvic cavity. This action displaces the
stomach, intestines, and other adjacent organs.
Peristalsis is slowed because of the production of the hormone progesterone, which
decreases tone and mobility of smooth muscles. This slowing enhances the absorption of
nutrients and slows the rate of secretion of hydrochloric acid and pepsin. Slow emptying may
increase nausea and heartburn (pyrosis). Relaxation of the cardiac sphincter may increase
regurgitation and chance for heartburn. Movement through the large intestines is also slowed
due to an increase in water consumption from this area. This increases the chance for
constipation.
Hemorrhoids may occur as a result of increased venous pressure.

CHANGES OF SELECTED GLANDS OF THE ENDOCRINE SYSTEM DURING PREGNANCY

Parathyroid Gland. This gland increases in size slightly. It meets the increased
requirements for calcium needed for fetal growth.
Pituitary Gland. Near the end of term, the posterior pituitary will begin to secrete oxytocin
that was produced in the hypothalamus and stored there. It will serve to initiate labor. Prolactin
is also produced for lactation. There is also an increase in production of growth hormone and
melanocyte-stimulating hormone
Placenta. Produces estrogen, progesterone, hCG, human placental lactogen, relaxin and
prostaglandins. Estrogen causes breast and uterine enlargement and palmar erythema.
Progesterone inhibits uterine contractility, relaxin, softens the cervix and the collagen in joints.
hCG stimulates progesterone and estrogen synthesis in early pregnancy. hPL serves as an
antagonist to insulin.

CHANGES OF THE IMMUNE SYSTEM DURING PREGNANCY

Immunologic compentency decreases to prevent the womans body from rejecting the
fetus. Immunologic G (IgG) is also decreased, which can make a woman more prone to
infection during the pregnancy