NORMAL PREGNANCY

C
GAMETOGENESIS

• Gametogenesis is the process whereby

a haploid cell (n) is formed from a
diploid cell (2n) through meiosis and cell
differentiation. Gametogenesis in the
male is known as spermatogenesis and
produces spermatozoa.
• Gametogenesis in the female is known
as oogenesis and result in the formation
of ova. In this article we shall look at
both spermatogenesis and oogenesis.
• Before Pregnancy

1. The development of ova in females and spermatozoa in males requires a special reduction
division called meiosis, in which the diploid number of chromosomes (mitosis (46) becomes
halves the number of its number (haploid number) (23)
2. Only one of each paired chromosomes (composed of strands of deoxyribonucleic acid DNA]
and protein) is directed to the gamete, 22 autosome (auto, self) and (1) sex chromosome.
These DNAs are composed of genes which are minute particles located in a linear order on
the DNA of cell nuclei.
3. The maturation process of female ovum is called oogenesis and male spermatozoon is called
spermatogenesis, such is termed as gametogenesis.
Oogenesis
• in the human female reproductive system, growth process in
which the primary egg cell (or ovum) becomes a mature ovum.
1. Oogenesis is the process by which female gametes (ova) are
produced which begins in prenatal life.
2. During early fetal life or before birth, the oogenia enlarges to form
primary oocyte (still with 46 chromosomes layered with follicular
tissue called primary follicles).
3. During fetal life, the first meiotic division has begun by the primary
oocyte but remain dormant (inactive) throughout childhood. Indeed,
female fetus has millions of immature eggs in her ovaries but many
of these ova regress during childhood until fewer than 300,000
remain at puberty, and do complete the first meiotic division during
this pubertal period.
SPERMATOGENESIS
1. Spermatogenesis is the formation of male gametes (sperm) in the testes, which begins in
puberty.
2. Primitive sperm cells (speratogenia) which develop during fetal life, begin multiplying during
puberty, and matured into sperm throughout his lifetime. But male in their 50’s, 60’s and
beyond, can still be father though their fertility gradually declines with age.
3. As the spermatogenium (primary sperm cell contains 46 chromosomes [mitosis] by
replication) enters the first meiotic division, it enlarges to become a primary spermatocyte
(still with 46 chromosomes).
1. The first meiotic division forms 2 secondary spermatocytes which
reduces the number to 23 unpaired chromosomes (22 autosomes &
1 sex chromosomes, X or 7)
2. In the second meiotic division, each secondary spermatocyte
divides again to form 2 spermatids.
3. Half of the four (4) spermatids from 2 meiotic divisions carry an X
chromosome and half carry a Y, which these spermatids gradually
mature into sperm.
CONCEPTION
• is the time when sperm travels up through
the vagina, into the uterus, and fertilizes an
egg found in the fallopian tube

How does conception happen?

• Conception occurs when a sperm cell
from a fertile man swims up through the
vagina and into the uterus of a woman and
joins with the woman's egg cell as it travels
down one of the fallopian tubes from the
ovary to the uterus.
1. Before ovulation, numbers of oocytes begin to mature under the influence of
follicle stimulating hormone (FSH) and luteinizing hormone (LH) from the
woman’s anterior pituitary gland.
2. The maturing oocytes are surrounded by a sac called graafian follicle, which
collapsed and becomes corpus luteum producing estrogen and progesterone to
prepare the endometrium for pregnancy.
3. At ovulation, such mature ovum with the timing of a motile, healthy sperm
after entering the vagina, can be fertilized only within 24 hours (1 day),
though sperm may survive at 1 – 2 days and few may remain fertile in a
woman’s reproductive tract for 5 days.
FERTILIZATION
• Fertilization is the process by which
male and female gametes are fused
together, initiating the development of
a new organism.
• The male gamete or ’sperm’, and the
female gamete, ’egg’ or ’ovum’ are
specialized sex cells, which fuse
together to begin the formation of
a zygote during a process called sexual
reproduction.
PRE – EMBRYONIC STAGE
A. General Information
➢ The pre-embryonic stage period is the first 2 weeks – 3
weeks after conception, from fertilization through
implantation.
➢ The zygote divides into 2 cells, then 4, and 8 while in the
fallopian tube for 3 days up to 16 cell stages. The cells
become smaller with each division, so they occupy about the
same amount of space as original ovum; and eventually form
a solid ball called (morula). After 3 days, the morula while
dividing is delivered into the uterus and spends about 4 days
in the uterine cavity developing further into a blastocyst.
➢ Blastocyst is the outer cells of the
morula that secretes fluid, creating a sac
of cells that has an inner cell mass
placed off the center within the sac.
➢ The blastocyst develops into the embryo
and into a double layer called
embryonic disc from the embryo which
develop with the other embryonic
membrane called amnion.
• The trophoblast attaches itself
to the surface of the
endometrium for further
nourishment. Between 7 and 0
days after fertilization, the zona
pellucida disappears, and the
blastocyst implants itself by
burrowing into the uterine lining
and penetrating down toward the
maternal capillaries until it is
completely covered.
IMPLANTATION (NIDATION)
• is the stage of pregnancy at which the
embryo adheres to the wall of
the uterus. At this stage of prenatal
development, the conceptus is called
a blastocyst. It is by this adhesion that
the embryo receives oxygen and
nutrients from the mother to be able to
grow.
A. General Information
1. Burrowing of developing zygote into endometrial lining of uterus may take 7
– 10 days after fertilization at the upper two third (2/3) of the uterus, while
zygote develops to trophoblastic stage.
2. Chorionic villi appear on surface of trophoblast and secrete human chorionic
gonadotropin (HCG), which inhibits ovulation during pregnancy by
stimulating continuous production of estrogen and progesterone. This
secretion of HCG forms the basis of various tests for pregnancy.
3. Fertilized ovum from conception through first week of pregnancy, nidation
complete by the end of this period.
GERM LAYERS: Embryonic stage: 3rd to 8th week
I. Embryo Organ systems
A. Develop from 3 primary germ layers:
1. Ectoderm – outer layer produces skin, nails, nervous system and tooth enamel.
2. Mesoderm – middle layer, produces connective tissue, muscles, blood and circulatory system.
3. Entoderm – inner layer produces linings of gastrointestinal and respiratory tracts, endocrine
glands, and auditory canal.
A. Critical time in development: Embryo most vulnerable to teratogens (harmful substances or
conditions), which can result in congenital anomalies.
I. Placenta
a. Developed by the first month of pregnancy
b. Provides fetal oxygenation, nutrition and elimination.
c. Produces progesterone; estrogen; HCG; and human placental lactogen (hPL)/
Human maternal insulin production; prepares breasts for lactation.
d. Mother also transmits immunoglobulin G (IgG) to fetus through placenta,
providing limited passive immunity.
I. Umbilical Cord
a. Develops at same time as placenta
b. Connects fetal circulation to placenta
c. Consists of 2 arteries and 1 vein supported by mucoid material (Wharton’s
Jelly) to prevent kinking and knotting
d. Attaches at center of placenta in normal development
e. Is about 55cm long and 2cm in diameter.
I. Amniotic sac
a. Surrounds the fetus and fetal side of placenta.
b. Is made up 2 membranes, chorion and amnion.
c. Also called bag of water (BOW)
d. Contains amniotic fluid between 500 & 100ml by end of pregnancy. Functions are:
1. Protects the embryo against injury; allows fetal movement; provides a constant temperature
2. Is swallowed by fetus; promotes normal prenatal development.
3. Primarily water but contains small amount of protein, glucose, fetal hair, fetal urine and
vernix caseosa.
1. Oligohydramnios (less than 400 ml of amniotic fluid is associated with poor
fetal lung development and malformations that result from compression of
fetal parts. This may occur because the kidneys fail to develop, urine
excretion is blocked, or placental blood flow is inadequate.
2. Polyhydramnios or hydramnios (more than 2000 ml or amniotic fluid index
greater than 97.5 percentile for the corresponding gestational age): may occur
when the fetus has severe malformation of the CNS or gastrointestinal tract
that prevents normal ingestion of amniotic fluid (e.g. esophageal atresia, a
disorder of esophagus which carries food from the mouth to the stomach).
FETAL DEVELOPMENT MILESTONE
A. By 4 weeks
1. Embryo length about 0.4 cm; weight about
0.4gms; and appears in C shape.
2. All systems in rudimentary form; heart chambers
formed and heart is beating.
3. Head becomes prominent, accounting for about
one third of the entire embryo.
4. Eyes, ears, and nose appear in a rudimentary
form. Nervous system begins form.
A. By 8 weeks
1. Length about 2.5 cm, weight 2gms.
2. Some distinct features in face; head large in proportion to rest of
body; some movement
3. Organ formation is complete. The developing cells are called a
“fetus”
4. Head accounts for about one half of the total body mass
5. Heart is beating and has septum and valves
6. Arms and legs are developed
7. Abdomen is large with evidence of fetal intestine
8. Facial features readily visible; eye folds are developed
9. Gestational sac visible on ultrasound; external genetalia begin to
differentiate
A. By 12 weeks
1. Length 6-8cm; weight 19-45 gms., moves body parts
and swallows
2. Sex distinguishable; ossification in most bones; kidneys
secrete urine
3. Eyes, ears, mouth, nose, heart and circulatory system,
limbs, tail, spinal cord, bones and nails are present.
4. Bile secreted into stomach
5. Refinement and completion of all system occurs.
6. Heartbeat can be heard using Doppler ultrasound
stethoscope
A. By 16 weeks
1. Length 11.5 cm – 17 cm, weights 100 –
200gms.
2. More human appearance; earliest movement
likely to be felt by mother;
3. Meconium in bowel
4. Fetal urine present in amniotic fluid; swallows
amniotic fluid
5. Fetal heart sounds are audible with fetoscope
6. Lanugo present and well formed; scalp hair
develops
7. Skeleton begins ossification
8. Intestines assume normal position in the
abdomen
A. By 20 weeks
1. Length 18 – 25cm; weight about 223- 450 gms.
2. Fetal hair grows, skeleton hardens, sex visible, and fetal
heart audible thru fetoscope
3. Fetus able to suck and swallow
4. Mother is able to feel spontaneous movements by fetus
5. Fetus demonstrates definite sleep and awake patterns
6. Sebum is produced by sebaceous gland
7. Meconium is evident in the upper portion of the
intestines
8. Lower extremities are fully formed
9. Vernix caseosa covers the skin
10. Passive antibody transfer from the mother begins as
early as 20 weeks
A. By 24 weeks
1. Length 28cm – 36 cm; weight 550 – 820
gms.
2. Body well proportioned; skin red and
wrinkled
3. Eyelids are open and pupils can react to light;
well-defined eyelashes and eyebrows are
visible
4. Hearing is developing with the fetus being
able to respond to a sudden sound
5. Lungs are producing surfactant
A. By 28 weeks
1. Length 35 cm – 38 cm; Weight about 1100
gms – 1250 gms
2. Infant viable but immature if born at this
time.
3. Eyelids open; skin red and less wrinkled;
with vernix caseosa
4. Surfactant production begins
5. Some nervous system regulation begins
6. Testes descend into scrotum
A. By 32 weeks
1. Length 38 cm – 43cm; weight 1600 – 2100 gms.
2. More subcutaneous fat beginning to deposit
3. L/S ratio in lungs now 1.2:1
4. Skin smooth and pink.
5. Fetus may assume vertex or breech position in preparation for
birth
6. Iron stores are beginning to develop
7. Growth is most rapid at this period
8. Fingernails increase in length, reaching the tpis of the fingers
9. Vernix caseosa becomes thick
A. By 36 weeks
1. Length 42cm – 48 cm; weight 2200 – 2900 gms.
2. Increased fat deposits, nervous and breathing systems,
and blood developed enough to support extrauterine life
3. Lanugo decreases with vernix caseosa.
4. Soles of the feet have one or two creases
5. The fetus is storing additional glycogen, iron,
carbohydrate, and calcium
6. Skin of the face and body begins to smooth
7. L/S ratio usually 2:1; definitely sleep/wake cycle
A. By 40 weeks
1. Length 48 cm – 52cm; weight 3000 – 3200gms.
2. Full term pregnancy. Baby is active, with good
muscle tone; strong suck reflex; if male, testes
in scrotum; little lanugo
3. Begins to kick actively and forcefully, causing
maternal discomfort
4. Vernix caseosa fully formed
5. Conversion of fetal hemoglobin to adult
hemoglobal
FETAL CIRCULATION
A. GENERAL INFORMATION (starts from the 3rd week)
a. Placenta supplies oxygen and nutrients and removes waste; responsible for:
1. Metabolism, fetal digestive tract
2. Oxygenation and waste removal, fetal lungs and kidney
3. Endocrine secretions, major endocrine glands
a. Umbilical cord contains two (2) arteries and one (1) vein
1. Vein brings oxygen to fetus
2. Arteries remove wastes from fetus
a. Major bypasses in fetal circulation
1. Forament Ovale, opening between right and left atrium of heart, bypassing
lungs. Closes functionally at birth because of increased pressure in left
atrium; anatomic closure may take several weeks to several months.
2. Ductus arteriosus, connects pulmonary artery to aorta, bypassing the lungs;
closes after delivery.
3. Ductus venossu, connecting umbilical vein and ascending vena cava,
bypassing liver or portal circulation. Closes after birth.
A. PHYSIOLOGY
a. The Course of Fetal Circulation
➢ The course of fetal blood circulation is from the fetal heart, to he placenta for exchange of oxygen and
waste products, and back to the fetus for delivery to fetal tissues.
➢ The umbilical cord has two arteries that is high in carbon dioxide and carries other waste products away
from the fetus to the placenta, where these substances are transferred to the mother’s circulation for
elimination.
➢ The umbilical vein carries freshly oxygenated & nutrient rich blood from the placenta back to the fetus.

➢ The umbilical arteries and vein are coiled within the cord to allow them to stretch and prevent
obstruction of blood flow through them.
➢ The entire cord is cushioned by a soft substance called Wharton’s jelly to prevent obstruction caused by
pressure.
a. Fetal Circulatory Circuit
➢ Because the fetus does not breathe air or metabolize substances in the liver,
several alterations of the post birth circulatory route are needed.
➢ Three shunts – the ductus venosus, the foramen ovale, and the ductus
arteriosus divert most circulating blood away from the lungs and liver.
➢ Oxygenated blood from the placenta enters the fetal body through the
umbilical vein.
a. Changes in Blood Circulation After Birth
➢ Fetal circulatory shunts are not needed after because the infant oxygenates bblood in the lunges,
metabolizes substances in the liver ,and stops circulating blood to the placenta.
➢ As the infant breathes, blood flow to the lungs increases, pressure in the right hear falls, and foramen
ovale closes.

➢ Pressure in the aorta rises as pressure in the pulmonbary artery falls ,causing the direction of blood flow
through the ductus arteriosus to reverse, from the aorta into the pulmonary artery. The ductus
aoarteriosus constricts as the arterial oxygen level rises.
➢ The ductus venosus constricts when the blood flow from the umbilical cord stops
➢ The foramen ovale and ductus venosus permanently close as tissue proliferates in these structures.
➢ The ductus venosus and ductus arteriosus become ligaments, as do the umbilical vein and arteries.
PSYCHOSOCIAL CHANGES/ADAPTATIONS IN PREGNANCY

1. Factors influencing a woman’s response to pregnancy (varies with developmental stage)

a. Memories of her own childhood
b. Cultural background
c. Existing support system
d. Socioeconomic conditions
e. Perceptions of maternal role
f. Impact of mass media
g. Coping mechanisms
1. Maternal adaptations to pregnancy
a. 1st trimester: initial ambivalence about pregnancy; pregnant woman places
focus on self e.g. physical changes associated with pregnancy and emotional
reactions pregnancy.
b. 2nd trimester: relatively tranquil period: acceptance of reality of pregnancy;
increased awareness and interest in fetus; introversion and feeling of well-
being.
c. 3rd trimester: anticipation of labor and delivery and assuming mothering
role, viewing infant as reality vs. fantasy; fears and fantasies and dreams
about labor are common; “nesting behaviors” (e.g. preparing layette)
 PSYCHOLOGICAL CHANGES/ADAPTATIONS IN
PREGNANCY

1. Pregnancy validation/Accepting the pregnancy: first trimester

a. Often shock and denial first
b. Introversion begins and lasts 7 – 8 months; encouraged by weight gain and
other outward signs of pregnancy.
c. Ambivalent feeling (2 feelings) either to accept pregnancy or not, but finally,
acceptance came
1. Fetal embodiment/Accepting the baby: second trimester
a. Attempts to incorporate fetus into her body image as integral part of self.
b. Readjusts to life roles
c. Develops feelings of inner strength
d. Appears to be time of maturation.
e. Acceptance of baby.
1. Fetal distinction
a. Encouraged but quickening
b. Fetus becomes distinct and apart from herself. Prepares for physical separation from fetus
c. Daydreams about baby and herself as mother; dreams are often unrealistic
1. Role Transition/Preparing for parenthood: third trimester
a. Separates fetus from herself and makes concrete plans. Attainment of maternal role.
b. Becomes more anxious and wants pregnancy to end.
c. May express fear of unknown.
d. Wish for healthy baby.
 PHYSIOLOGICAL CHANGES/ADAPTATIONS IN
PREGNANCY

• Terminologies of Pregnancy

• Gravida – number of times pregnant, regardless of duration, including the present pregnancy.

A. Nulligravida – a woman who is not now and never has been pregnant.
B. Primigravida – pregnant for the first time
C. Multigravida – pregnant for second or subsequent time.
• Para – number of pregnancies that lasted more than 20 weeks, regardless of
outcome.

A. Nullipara – a woman who has not given birth to a baby beyond 20 weeks
gestation.
B. Primipara – a woman who has given birth to one baby more than 20 weeks
gestation.
C. Multipara – a woman who has had two or more births at more than 20 weeks
gestation; twins or triplets count as 1 para.
 Presumptive Signs of Pregnancy
• more subjective signs, cannot be used to diagnose pregnancy
• Recall FANS BVOUW
1. Fatigue
2. Amenorrhea
3. Nausea and Vomiting
4. Urinary frequency
5. Breast tenderness and changes
6. Excessive fatigue
7. Uterine enlargement
8. Quickening
9. Weight Changes
10. Skin Changes
 Probable Signs of Pregnancy
• objective signs results of vascular congestion in pelvis. Recall PH CAB BUG
P- Positive Pregnancy Test
H- Hegar’s sign –
C- Chadwick’s sign –
A- Abdominal striae
B- Ballotment –
B- Braxton Hicks Contraction
U - Uterine enlargement-
G – Goodell’s sign-
 Positive Signs of Pregnancy
• absolute indicators of pregnancy; recall FFUX
➢ F-etal heart Sounds/ Fetal heartbeat – may be heard at 8th to 12th weeks by Doppler examination;
may be heard through regular fetoscope by 18 to 20 weeks. Normal heart rate – 120 to 60
beats/minute.
➢ F-etal movements – felt by the examiner about 20 weeks gestation (2nd trimester)
➢ U-ltrasound study of fetus – at 6 to 8 weeks, fetal identification positive; earliest positive method of
diagnosing pregnancy.
➢ X-ray – visualization of the fetus (after about 20 weeks gestation).
 CHANGES/EFFECTS OF PREGNANCY ON BODILY
SYSTEM

• The body needs to adapt in the physiologic changes it needs to sustain the requirements in pregnancy.

1. Endocrine Glands
A. Fatigue result of increased levels, causing sodium and water retention and smooth muscle relaxation
B. Human Chorionic Gonadotropin (HCG) (a hormone created by chorionic villi of the placenta, in the
urine and blood serum of the pregnant woman) produced by 4 th day secreted trophoblastic tissue of
conceptus (takes place 7 – 10 days after fertilization while zygote or fertilized ovum develops),
measured as part of pregnancy test.
C. Melanocyte stimulating hormone (MSH) caused increased pigmentation in localized areas.
D. Estrogen produced by corpus luteum first 5 – 8 weeks, then by placenta, with levels rising throughout
pregnancy. Main functions are:
a. Growth of uterine muscles and ability of uterine muscles to constrict.
b. Aids in development of breast ducts and secretory system to prepare for lactation
E.Progesterone: produced by corpus luteum for first 5 – 8 weeks, then by placenta. Main functions are:
a. Acting as regulatory mechanism to handle increased needs of woman and fetus
b. Causing slight increase in basal metabolic rate (BMR)
c. Causing smooth muscle of uterus to relax
d. Sustaining pregnancy
e. Relaxing uterine muscle
f. Causing endocervical glands to secrete thick mucus, impedes sperm migration
g. Body temperature increases slightly.
F. Angiotensin – renin system in the kidney increases in response, under the influence of
progesterone. This leads to increased aldosterone production leading to increased sodium-water
retention that increases blood volume and serves as a ready nutrient to the fetus.
G. Adrenal gland. Adrenal gland activity increases in pregnancy as increased levels of
corticosteroids and aldosterone are produced to suppress an inflammatory reaction or help to
reduce the possibility of woman’s body rejecting the foreign protein of the fetus, as in the case of
foreign tissue transplant.
• Aldosterone (steroid hormone produced by the adrenal cortex causing sodium reabsorption (+) and
potassium and hydrogen (-) loss) increased to overcome the salt – excreting/wasting effects of
progesterone to maintain the necessary level of sodium in the greatly expanded blood volume to meet
the needs of fetus.

• Insulin increases in response to higher levels of glucocorticoid produced by the adrenal glands. But
insulin is less effective due to some antagonists
A. Prostaglandins and relaxin hormones booth increase in levels

• Prostaglandins are found in the female reproductive tracts, and deciduas

during pregnancy which they affect smooth muscle contractility.
Prostaglandins prostacyclin (a potent vasodilator) also helps maintain
normal blood pressure, but with its declined level comes the elevation of
blood pressure, such in preeclampsia.

• Relaxin, on the other hand, secreted by the corpus luteum, helps prevent
the uterine activity, soften the cervix and the collagen in the joints.
A. Total thyroxine (t4) and thyroxin binding protein increase in the 1st trimester.
• This change causes the basal metabolic rate (BMR) increased during
pregnancy causing greater cardiac output, pulse rate, and heat intolerance.
A. Parathyroid hormone production increases during pregnancy as needed for
calcium. Metabolism, being important for fetal growth, The parathyroid
glands’ hypertrophy is necessary to satisfy the increased requirement in
calcium.
A. Pancreatic changes lead to:
a. During the 1st trimester, the increasing glucose demand by the fetus causes
a fall in maternal blood glucose resulting to martnal hypoglycemia.
b. During the 2nd trimester and throughout pregnancy, though insulin being
produced by the Islets of Langerhans increases, it appears not to be
effective because maternal tissue sensitivity to insulin begins to decline
due to tohe effects of human placenta lactogen (HPL), prolactin,
progesterone, estrogen and cortisol, which this results to hyperglycemia.
A.Pituitary gland changes lead to:
a. Prolactin increases from the anterior pituitary gland to prepare
the breasts to produce milk.
b.The posterior pituitary secretes oxytocin, which stimulates milk
ejection reflex after childbirth. It also stimulates the contraction
of the uterus, but during pregnancy, uterine contraction is
inhibited (prevented) by progesterone which results to the
relaxation of uterine smooth muscle fibers (a normal condition).
1. Reproductive system
a. Amenorrhea occurs; ovulation is prevented by the increased progesterone and estrogen
levels.
b. Softening of the cervix (Goodell’s sign) due to increased blood supply.
c. Softening of lower segment of uterus (Hegar’s sign)
d. Purplish hue to vaginal mucosa (Chadwick’s sign)
e. Secretion of vaginal cells increase; leucorrhea acts as body’s first line of defense against that
rise in pH makes the pregnant more prone to yeast infections.
f. Uterus enlargers.
1. Cardiovascular system.
A.Main functions:
1.Deliver blood to uterine vessels at pressure adequate to
fulfill requirements of placental circulation.
2.Bring about physical, chemical, and cellular changes in
blood to provide adequate oxygen exchange between mother
and fetus.
A. Major changes include:
1. Cardiac enlargement; cardiac output increased by 30% to 50% peaking in the third trimester
2. Increased cardiac rate and stroke volume
3. Increased potential for varicose veins
4. Pseudoanemia (false anemia without the blood sign of anemia) due to increased fluid volume
5. Displacement of the heart upward and to the left from pressure on the diaphragm.
6. Supine hypotension results from obstructed blood flow from the lower extremities due to the weight of
the growing uterus pressing the vena cava against the vertebrae when patient lies in supine position.
Position patient in left sidelying position.
7. Pressure of the enlarged uterus on the pelvic veins and inferior vena cava results to increased femoral
venous pressure.
• 4. Respiratory system

• a. Increased volume of air per minute

• b. Increased alveolar ventilation

• c. Improved exchange of CO2 and O2 at cellular level

• d. Increased estrogen leads to nasal swelling and stuffiness

• e. Enlarging uterus puts pressure on diaphragm, decreasing respiratory

movement
• 5. Urinary System

• a. Increased renal blood flow.

• b. Increase renal plasma flow.

• c. Increased glomerular filtration rate (GFR) and increasing efficiency of clearance to meet the increased
needs of circulatory system, resulting in polyuria.

• d. Increased susceptibility to infection from dilation of ureters and renal pelvis.

• e. Pressure from the uterus and loss of bladder tone, leading to urinary frequency.
• Gastrointestinal system

a) Increased appetite and thirst

b) Increased food requirements.
c) Decreased gastric acids and pepsin levels
d) Heartburn caused by esophageal reflux
e) Increased time of contents in bowel, leading to increased absorption of water and constipation
f) Delayed gastric emptying time, resulting in better absorption of nutrients, especially glucose and iron
• 7. Musculoskeletal changes

• a. Lordosis is forward curvature of the spin due to the pressure of the gravid uterus.

• b. Calcium and phosphorous needs are increased during pregnancy, because the fetal skeleton must be
built.

• c. Woman’s pelvic ligaments and joints gradually softens under the influence relaxin and progesterone to
facilitate the passage of the fetus.
• 8. Immune System

• a. Immunologic competency is decreased, making fetus become foreign to women’s body as if it were
transported organ.

• b. Immunoglobulin G (IgG) production is decreased resulting to the woman’s prone of infection during
pregnancy.

• c. Increased white blood cells may help to counteract the decrease IgG response.
• 9. Acid – Base balance

• a. By about 10th week of pregnancy, there is decreased of about 5mm Hg in PCO2.

• b. Progesterone maybe responsible for increasing the sensitivity of the respiratory center receptors pH
rises (becomes more basic).

• c. Alterations in acid-base balance indicate that pregnancy is a state of respiratory alkalosis compensated
by mild metabolic acidosis.
A. INTEGUMENTARY SYSTEM CHANGES

B. Pigmentation changes occur in the areola, nipple, abdomen, thighs and vulva.
C. Facial chloasma (mask of pregnancy) and vascular spider nevi may develop.
D. Streae (stretch marks) commonly appear on the abdomen, breasts, and thighs.
E. Activity of sebaceous and sweat glands may increase.
METABOLIC CHANGES

1. Metabolism accelerates 20% during pregnancy

2. Average weight gain during pregnancy is 24 to 30 lbs.
3. Increased water retention is a basic chemical alteration of pregnancy.