2023

Pregnancy Physiology Changes and Adaptations

BD2310 - Pengantar Asuhan Kebidanan

Wiwiek Elsada Nainggolan S.Tr.Keb., M.Tr.Keb

Dilma’aarij Riski Agustia, S.Tr.Keb., M.K.M

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Overview
Changes and adaptations in pregnancy physiology discuss changes in the physiology of
pregnant women regarding external reproductive organs, internal reproductive organs,
breasts, endocrine system, immune system, digestive system, urinary system,
cardiovascular system, integument system, respiratory system, musculoskeletal system
and body mechanics and basic physiological needs of pregnant women.
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Objectives
• After this discussion, students are expected to be able to:
• changes in physiology of pregnant women regarding external and internal reproductive
organs
• changes in the physiology of pregnant women regarding the breast
• changes in the physiology of pregnant women regarding the endocrine system
• changes in the physiology of pregnant women regarding the immune system
• changes in the physiology of pregnant women regarding the digestive system
• changes in the physiology of pregnant women regarding the urinary system
• changes in the physiology of pregnant women regarding the cardiovascular system
• changes in the physiology of pregnant women regarding the integumentary system
• changes in the physiology of pregnant women regarding the respiratory system
• changes in the physiology of pregnant women regarding the musculoskeletal system
and body mechanics
• basic physiological needs of pregnant women
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•
Content
physiological changes in pregnant women regarding external and internal reproductive organs
• changes in physiology of pregnant women regarding breasts
• changes in the physiology of pregnant women regarding the endocrine system
• changes in the physiology of pregnant women regarding the immune system
• changes in the physiology of pregnant women regarding the digestive system
• changes in the physiology of pregnant women regarding the urinary system
• changes in the physiology of pregnant women regarding the cardiovascular system
• changes in the physiology of pregnant women regarding the integumentary system
• changes in the physiology of pregnant women regarding the respiratory system
• changes in the physiology of pregnant women regarding the musculoskeletal system and body
mechanics
• basic physiological needs of pregnant women
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INTRODUCTION TO PREGNANCY PHYSIOLOGY

CHANGES AND ADAPTATIONS
During pregnancy, a woman's body will slowly undergo
physical changes and will adapt to these changes.
Pregnant women need to understand and know about
the physical changes that occur to them and it is the
midwife's job to educate and convey it to pregnant
women.
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External and Internal Reproductive Organs

• There is Chadwick's sign: pigmentation of the vagina, vulva and
labia into a bluish/purple color. This is due to increased hormones
and increased vaginal blood flow.
• Increased hormones during pregnancy can also cause flour
albus (vaginal discharge) and this is normal.
• Internal reproductive organs i.e. changes in the cervix, uterus and
ovaries
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External and Internal Reproductive Organs

• Cervical section
• There is Chadwick's sign and Goodell's sign (Cervix
becomes soft) due to increased estrogen hormones
and increased vascularization and edema of the
cervical glands.
• Uterus Section
• There is a sign of hegar (isthmus changes to become
soft resulting in uterine anteflexion in the first 3
months of pregnancy. And the presence of uterine
enlargement that can be measured by Leopold
palpation.
• Ovary section: during pregnancy ovulation stops.
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Breast
• There are changes in PD from the first trimester to
the third trimester
• There is hyperpigmentation of the areola
mammae resulting in darker and larger areolas.
Montgomery's glands are present.
• In the third trimester, the PD gets bigger and the
prolactin hormone increases. There is milk
production in preparation for breastfeeding.
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The Endocrine System

• During pregnancy the endocrine glands are influenced by the anterior and posterior
hypophysies

Anterior Hypophysies Posterior Hypophysies

Thyroid gland Antideretic hormone
increases and plays a role in fetal growth, especially Will be secreted more so that there is increased
in the nervous system. circulation to the kidneys.
Paratyroid gland Oxytocin hormone
Decreased in TM I and increased in TM II-III, its Increased because it stimulates the smooth muscle
function is to supply calcium to the fetus in the uterus so that there are uterine contractions
during labor
Pancreatic Gland
Regulates the hormone insulin, glucose levels are
reduced sufficiently to maintain fetal glucose needs
Pancreatic Gland
Regulates the hormone insulin, glucose levels are
reduced sufficiently to maintain fetal glucose
needs,
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Immune System Digestive System

• IgG, IgA and IgM levels decrease starting • The presence of nausea and vomiting
from week 10 of pregnancy and reach (morning sickness) due to increased
their lowest levels at week 30 (third estrogen and HCG hormones
trimester). • Pregnant women often experience
• Fetal immunology is acquired from the constipation due to muscle relaxation in
mother around 16 weeks of gestation the intestines
and continues to increase as the • Haemorrhoids occur due to
pregnancy ages. hypervascularization of the blood vessels
in the rectum.
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Urinary System Cardiovascular System

• Polyuria occurs because the bladder is • During pregnancy, the mother's blood
pressured by the enlarged uterus circulation will be affected by circulation to
• Third trimester, pregnant women will the placenta and uterus which is getting

often urinate because the fetal head bigger as well, making the blood vessels

begins to descend to the upper door of expand and widen physiologically.

• Third trimester, the enlargement of the
the pelvis.
uterus causes aortic pressure so that
uteroplacental blood flow to the kidneys is
reduced. The solution, pregnant women
sleep on their left side, not on their back.
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Integumentary System Respiratory System

• Changes due to hormonal influences and • The mucosa in the respiratory system
skin growth mechanisms
becomes hyperemic (increased), often
• There is hyperpigmentation on the face,
causing shortness of breath in pregnant
abdomen, and areola PD area.
• Skin discoloration (spots) is called cloasma women.

gravidarum.
• Skin pigmentation in the form of a line from
the symphysis to the upper fundus of the
abdomen is called linea nigra.
• Pigmentation of the skin on the abdomen is
called striae gravidarum.
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Musculoskeletal System and Body Mechanics

• In the first trimester, the mother's calcium and phosphorus
needs increase and her intake will be affected as it will affect
the bones and teeth.
• Second and third trimester, posture will change due to weight
gain and uterine enlargement. The body seems to be lordotic
and this will normalize after postpartum.
• The rectus abdominalis muscle separates (diastasis recti),
and rarely returns to its original state except with good
physical exercise.
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Basic Physiological Needs of Pregnant Women

Nutrition
• The fulfillment of maternal nutrition affects fetal nutrition.
The ideal weight gain for pregnant women is 9-13.5 kg. the calculation of
nutritional adequacy in pregnant women is contained in Permenkes RI No. 28 of 2019. Energy needs 2300-2500 kcal per day.

Rest
• Pregnant women are recommended to rest 1 hour during the day, 8 hours at night.

Hygiene
• And it is recommended to get into the habit of washing hands, maintaining oral hygiene, taking care of intimate organs and PD.

Mobilization
• It is recommended for pregnancy exercises especially for mothers with a UK of more than 20 weeks.

Elimination
• Pregnant women need to prevent constipation by drinking plenty of water, fruits and eating fiber foods.

Oxygenation
• Oxygen intake in pregnant women needs to be considered, it is recommended to be able to exercise, especially in the third trimester.
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Unit Summary
• After this discussion, students are expected to be able to:
• changes in physiology of pregnant women regarding external and internal
reproductive organs
• changes in the physiology of pregnant women regarding the breast
• changes in the physiology of pregnant women regarding the endocrine system
• changes in the physiology of pregnant women regarding the immune system
• changes in the physiology of pregnant women regarding the digestive system
• changes in the physiology of pregnant women regarding the urinary system
• changes in the physiology of pregnant women regarding the cardiovascular
system
• changes in the physiology of pregnant women regarding the integumentary
system
• changes in the physiology of pregnant women regarding the respiratory system
• changes in the physiology of pregnant women regarding the musculoskeletal
system and body mechanics
• basic physiological needs of pregnant women
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Session 2: Discussion
• Bentuk menjadi 6 kelompok (kurang lebih 6-7 orang)
• Diskusikan (25 menit) dan cari dari referensi relevan terkait dengan kebutuhan fisiologi
dasar ibu hamil terkait dengan
• Kebutuhan nutrisi : kel 1
• Kebutuhan istirahat : kel 2
• Kebutuhan hygiene : kel 3
• Kebutuhan mobilisasi : kel 4
• Kebutuhan eliminasi : kel 5
• Kebutuhan oksigenasi : kel 6
• Dipresentasikan di zoom dan hasil Diskusi tulsi di LMS forum pertemuan 2 + tulis nama
kelompok.
 Quiz
https://forms.gle/Byg3nRSFS85QenUt6

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 Video
https://youtu.be/oEUZvgXNd4g?si=5d0BZej2zujH1uVI

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 Question & Answer

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 Reference
• Cunningham, F Gary, Obstetri Williams Volume 1 Edisi 23, Jakarta : EGC ,
2012
• Bayu Fijri. 2021. Pengantar Asuhan Kebidanan. Yogyakarta: Bintang
Pustaka Madani
• Varney, H , Buku Ajar Asuhan Kebidanan Edisi 4 Volume 2 , Jakarta : EGC ,
2008

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