Anatomical and physiological changes in pregnancy

hormones within pregnancy
-- oestrogen - this plays an important role in the development of the fetus by promoting the maternal blood flow to the uterus and the placenta
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hormones within pregnancy
- increases rapidly following on from the 10th week of pregnancy
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Relaxin hormone - when is it produced at its highest level?
what is it responsible for?
what does it effect?
- produced at is highest level in the first trimester
- responsible for softening the ligaments - particularly the pelvic
- has effects on preventing uterine activity in early pregnancy
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what are the signs and symptoms of the effects of the relaxin hormone ?
- what can this then possibly result in?

how can midwives support women with this?
- pelvic girdle pain and lower back pain
- can result in symphysis pubis dysfunction
- midwives can refer to a physiotherapist
- symphysis pubis dysfunction - may result in women needing aids within labour such as a support belt to lift the uterus and
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changes within the reproductive system in pregnancy - blood flow
how does it change to support the fetal growth and development?
- uterine blood flow increases from approx 50ml at 10 weeks to 450ml - 700ml at term - to ensure the support of fetal development
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how does the uterus change to accommodate the growing fetus
- increases in size
- can grow up to 5 times its pre pregnancy state
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how does the shape of the uterus effect the fetus?
and why
- the ovoid shape encourages the fetus to favour a head down cephalic position at term
- this is due to the bulky part of the fetus having more room in the fundal area (at the top of the uterus)
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what are braxton hicks?
what do they do?
- contractions prior to labour
- the body's way of practicing for labour
- they do not dilate the cervix even though they can be palpated abdominally
- they increase the blood circulation to the uterus and placenta
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the cervix during pregnancy
- what does it support with?
- how does it change throuhout the pregnancy ?
- during pregnancy the cervix remains closed this provides a seal against external contamination
- helps with holding in the contents of the uterus
- becomes softer and swollen under the influence of hormones
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what do the endocervical muscles produce?
what does this then create?
- corpus amounts of tenacious mucas
- this then creates an antibacteral plug in the cervix
- this can then show that there has been alterations to the cervix and therefore the mucasw plug has become dislodged and come away
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changes that occur in the vagina during pregnancy
- higher levels of oestrogen
- increased volume of vaginal secretions
-candida ablicans (thrush)
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higher levels of oestrogen in pregnancy
what can these help prevent?
what does it result in?
- these can help in altering the PH levels in the vagina due to the increase in lactic acid
- this can help prevent against genital tract infections
- results in a thick white discharge known as leucorrhoea
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candida abicans
- will require treatment as it can be irritable for women however it is not a risk to the fetus
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how is the cardiac output affected in pregancy?
what position can this be impacted in?
- when the woman is in a supine (flat) position the weight of the growing uterus can compress on the abdominal aorta and inferior vena cava this compression leads to decreased flow back to the heart
- as a consequence this results in reduced cardiac out
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why does the cardiac output increase
what 2 changes occur to make this happen?
- increase in resting heart rate by approx 15pm
- increase in stroke volume (the volume of blood pumped in a single heart beat ) approx 7ml more per heartbeat than non pregnant women
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what other changes occur in the cardiovascular system?
- blood pressure is affected - low in the first trimester
- the growing uterus elevates the diaphram, the heart is then displaced upwards and to the left
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consider TILT - what can midwives advise women not to do pregnancy to support the cardiac output?
- advise women not to lie on back too often eg when sleeping and in labour as it can impact the cardiac output
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blood and volume in pregnancy
how does it change and by what amount?
- which hormone can affect the blood and how ?
- blood flow increases in early pregnancy - to help supply the extra metabolic needs of the fetus
- increases by 30% and up to 50% in the third trimester
- oestrogen is responsible for increasing the formation of new blood vessels and increasing the blo
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how can progesterone affect the blood
- it relaxes the smooth muscle and causes vasodilation - the widening of the arteries
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what is haemodilution?
what is it ?
why does it occur?
what does it then result in?
- the decrease in the amount of haemoglobin present in pregnancy
- this is due to the increase of fluid and plasma volume within the red blood cells
- this is why it is common for women to have low haemoglobin levels (iron) in pregnancy
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what are they?
how many women expereince these?
where does it occur?
- abnormally diluted veins
- up to 40% of women experience these in pregnancy
- usually found in the legs but can also appear in the ***** or in the anus as haemorrhoids
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how can varicosities be prevented ?
what can midwives recommend?
what are they caused by?
- high fibre diet to ensure they are not constipated
- caused by the effects of progesterone and relaxin on the smooth muscles of the vein walls and increased weight of the growing uterus can contribute to the risk of swelling and oedema
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how to reduce the risk of varicosities ?
- raising and keeping the legs elevated
- wearing supportive stockings to help with circulation
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why is it important that midwives keep an eye on varicosities ?
what could they result in?
what are the symptoms of this ?
- important as they dont want them to result in deep vein thrombosis
- symptoms can include swelling on back of calves
- family history can increase the risk of women developing this condition
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changes within the respiratory system in pregnancy
why do these changes occur?
- occur as a result in the oxygen requirements and physical impact of the growing uterus on the body
- from early pregnancy the shape of the chest alters resulting in an expansion of the chest
- respiratory rate increases to 18-20 breaths per min by third
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more changes within the respiratory system in pregnancy
- progesterone initates hyperventilation (increased breathing) by increasing sensetivity to carbon dioxide
- lung capacity decreases by 5%
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why is it important that midwives investigate if a woman is complaining about shortness of breath especially when stationary?
- important to rule out anaemia or any form of blood clot
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changes that occur in the renal system during pregnancy
- kidneys enlarge due to increased blood flow
- renal blood flow increases as total blood flow has increased
- bladder tone is altered to hold 1l of urine
- later in pregnancy the weight of the uterus pressing on the bladder and fetal movements can als
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what is it essential that the midwife does at every antenatal appointment regarding the renal system?
- takes a urine sample to rule out any urine infections
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gastrointestinal system changes in pregnancy
- up to 50% of women experience an increase in appetite
- 20% of women experience nausea and vomiting
- constipation is common - important to discuss ways of preventing this eg high fibre diet, increased water intake to prevent haemorrhoids
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other changes to the gastrointestinal system in pregnancy - gums
- oral gums can become oedematous soft and spongy and can often bleed
- common in pregnancy - women can be advised to see a dentist - free during pregnancy
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changes to gastrointestinal system - heartburn
- women can have increase of heartburn and reflux this is caused by the pressure of the uterus on the stomach
- to prevent - little and often with food, milk or medication such as Gaviscon to help
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breast changes in pregnancy
- early pregnancy what changes occur?
-lactogenesis what is this?
what does it cause
- in early pregnancy breasts may feel full or tingle
- lactogenesis - the first stage of breast development and colostrum production which commences at weeks 16-40 this causes the breasts to increase in size
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other breast changes throughout pregnancy
- *******
- Montgomery's glands
- darker pigmentation of ******* due to oestrogen and progesterone
- Montgomery's glands (bumps in the areola ) enlarge and stick out more
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skin changes in pregnancy
why do these happen
skin darkening
- skin darkening - due to the oestrogen and progesterone
-this leads to the development of the linea nigra - line down the middle of the stomach
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skin changes in pregnancy
facial chlosma
- what is this
- what causes it
- when does it go
- how can it be minimised
- "mask of pregnancy " can appear as a butterfly mask around the eyes
- caused by the melanin deposition
- usually goes in the postpartum period
- for some women it can persist to up to 10 years
- can be minimised with avoiding sun exposure
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lowered immunity in pregnancy
what causes this?
what are women recommended to get because of this
- human chronic gonadotrophin (HCG) hormone and prolactin are known the supress the immune response of pregnant women
- lymphocyte function is depressed
- decreased resistance to certain viral infections - women are advised to get the flu jab
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sleep disturbances in pregnancy
- why does this occur
- what can help with this ?
- can be impacted by hormonal changes, fetal movements, nocturia - needing to get up to pass urine, body aches and cramps, anxiety
- interventions to help - relaxation methods eg warm baths, staying hydrated
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Other cards in this set

Card 2


hormones within pregnancy


- increases rapidly following on from the 10th week of pregnancy

Card 3


Relaxin hormone - when is it produced at its highest level?
what is it responsible for?
what does it effect?


Preview of the front of card 3

Card 4


what are the signs and symptoms of the effects of the relaxin hormone ?
- what can this then possibly result in?

how can midwives support women with this?


Preview of the front of card 4

Card 5


changes within the reproductive system in pregnancy - blood flow
how does it change to support the fetal growth and development?


Preview of the front of card 5
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