THE NORMAL
ANTEPARTAL Asst. Prof. RONARICA B. DIONES
PERIOD
ANTEPARTAL PERIOD
The period of pregnancy or the period of
before labor is the ante-partal period, also
called the prenatal period. The woman int this
period is called the gravida
LENGTH OF PREGNANCY
Days – 267 to 280
Calendar Months – 9
Weeks – 40
Trimesters – 3
Lunar Months – 10
It is best to express gestational age or length of pregnancy in
weeks. At expected date of confinement (EDC)
TRIMESTER OF PREGNANCY
A. First Trimester – a period of rapid organogenesis,
teratogens like alcohol, drugs, viruses, and radiation are
highly damaging.
B. Second Trimester – most comfortable for the mother, with
continued growth of the fetus.
C. Third Trimester – with rapid deposition of fats, iron, and
calcium; the period of most rapid fetal growth.
PHYSIOLOGIC
CHANGES OF
PREGNANCY
These changes, which are
Maternal physiology undergoes largely secondary to the effects
many changes during of progesterone and estrogen,
pregnancy. begin as early as 4 weeks
gestation and are progressive.
In the first 12 weeks of
pregnancy progesterone and
estrogen are produced
predominately by the ovary
and thereafter by the placenta.
These changes both enable the
fetus and placenta to grow and
prepare the mother and baby
for childbirth.
HEMATOLOGICAL
Red cell mass, white cell count and platelet
production are all increased during pregnancy.
The rising white cell count during pregnancy, which
peaks after delivery, can make diagnosis of
infection difficult.
Maternal hemoglobin concentrations falls from
150g/L pre-pregnancy to 120g/L during the 3rd
trimester. This is termed physiological anemia of
pregnancy.
CARDIOVASCULAR
Cardiovascular adaptation affects all organ systems.
Cardiovascular anatomy and physiology changes to
accommodate increasing maternal and fetal
circulatory needs.
CARDIOVASCULAR
Heart is enlarged, displaced upward and rotates to the
left. PMI (point of maximal impulse) shifts to 4th intercostal
space and closer to the midclavicular line.
Audible splitting of S1 and S2; S 3 becomes
audible.Benign systolic murmurs are common.Heart rate
increases 15-20 beats as pregnancy progresses.
CARDIOVASCULAR
Estrogen and progesterone mediated relaxation of
vascular smooth muscle in pregnancy cause
vasodilatation reducing the peripheral vascular
resistance by 20%.
Consequently systolic and diastolic blood pressures fall.
A reflex increase in heart rate by 25% together with a
25% increase in stroke volume, results in a 50% increase
in cardiac output. During labour cardiac output may
increase further by up to 45%.
CARDIOVASCULAR
In the supine position the gravid uterus can compress the
inferior vena cava. This will reduce venous return to the
heart resulting in a decrease of cardiac output,
maternal blood pressure and placental perfusion.
The descending aorta can also be compressed by the
uterus causing a reduction in uterine blood flow.
Aortocaval compression must be considered as a cause
of maternal hypotension from the end of the 1st
trimester onwards, though it typically occurs after 20
weeks gestation.
RESPIRATORY
The gravid uterus progressively displaces the
diaphragm cranially reducing diaphragmatic
movement in late pregnancy, particularly in the
supine position causes engorgement of entire tract
from nares to bronchi, voice changes
Bronchial and tracheal smooth muscle relaxation
are a result of increased progesterone
concentrations. This often causes the symptoms of
asthma to lessen in pregnancy.
RENAL
As a result of the changes in the cardiovascular system,
renal plasma flow and glomerular filtration rate increase
in pregnancy.
This results in an increase in urea, creatinine and urate
clearance and excretion of bicarbonate causing plasma
concentrations to be less than in the non-pregnant
population.
Urinary tract infections are more common in pregnant
patients due to urinary stasis from progesterone
mediated ureteric smooth muscle relaxation.
GENITOURINARY
Ureters – dilate and elongate, becoming
compressed by uterus.
Bladder – tone decreases due to progesterone,
becomes displaces as uterus grows.
Uterus – rises out of pelvis during 1st trimester.
Weight increases from 70 gms to 1100 gms.
Volume at term averages 5 L but may be as much
as 20 L. Individual cells increase 100 fold in length
by term, allowing for contractions and involution.
GASTROINTESTINAL
Mouth – changes in tastes, increase in saliva
production, gums swell and bleed easier.
Esophagus – decreased tone leads to reflux.
Stomach – decreased tone and motility.
GASTROINTESTINAL
Intestines – smooth muscle relaxation and decreased
tone and motility - constipation
Increased intra-abdominal pressure by the gravid
uterus, displacement of the gastric axis and
progesterone mediated reduction in lower esophageal
sphincter tone cause gastro-esophageal reflux in as
many as 80% of term parturients.
GASTROINTESTINAL
Esophagus, stomach and intestines move as uterus
grows. Round ligament stretches as uterus expands.
Gallbladder –decrease tone and motility combined
with increased emptying time can cause increased
risk of gallstones.
Hyperemesis – common in first trimester. Strong
sense of smell. Increased saliva production. Can
persist throughout pregnancy.
IMMUNOLOGICAL
Placenta functions to help protect the fetus from
infection with IgG.
Decreased T-cell activity with pregnancy that
increases susceptibility to viral infections.
Immunity is enhanced by sleep/rest and
decreased stress.
MUSCULOSKELETAL
Abdominal muscles relax and pelvis tilts forward. Center
of gravity shifts.
Joints relax – waddling. Muscle aches from increasing
weight of uterus.
Posture change due to lumbo-dorsal curve of spine.
Normal weight gain 25-35lbs.
Slight weight loss in 1st trimester from nausea and
vomiting.
Average 1lb/wk weight gain in 2nd and 3rd trimesters.
ENDOCRINE
Thyroid - function increases to meet metabolic
and growth needs.
Parathyroid - helps regulate calcium,
phosphorus, Vit. D and magnesium
concentration. Increases in pregnancy to help
skeletal growth.
REPRODUCTIVE SYSTEM
Uterine changes
The most obvious alteration in the woman’s body
during pregnancy is the increase in size of the
uterus to accommodate the growing fetus.
UTERINE CHANGES
Length grows from approximately 6.5 to 32 cm.
Depth increases from 2.5 to 22 cm.
Width expands from 4 to 24 cm.
Weight increases from 50 to 1,000 gms.
UTERINE CHANGES
Early in pregnancy, the uterine wall thickens
from about 1 cm to about 2 cm, toward the end
of pregnancy, the wall thins to become supple
and only about 0.5 cm thick
The volume of the uterus increases about 2 ml
to more than 1000 ml of amniotic fluid, a total
of 4000 gms
UTERINE CHANGES
Hegar’s sign – the extreme softening of the lower
uterine segment, a probable sign of pregnancy.
Ballottement – from the French word balloter,
meaning to toss about; on bimanual examination, it
the lower uterine segment is tapped sharply by the
lower hand, the fetus can be felt to bounce or rise in
the amniotic fluid against the top examining hand.
Amenorrhea – absence of menstruation.
FUNDAL HEIGHT
CERVICAL CHANGES
The cervix of the uterus becomes more vascular
and edematous.
Increased fluid between cells causes to soften in
consistency, and increased vascularity causes it
to darken from a pale pink to a violet hue.
CERVICAL CHANGES
Operculum – also known as the
mucous plug, acts to seal
Goodell’s sign – softening of the
cervix
Just before the labor, the cervix
becomes so soft that it takes on
the consistency of butter or is
said to be “ripe” for birth.
VAGINAL CHANGES
Under the influence of estrogen, the vaginal
epithelium and underlying tissue become hypertrophic
and enriched with glycogen; structures loosen from
their connective tissue attachments in preparation for
great distention at birth.
Chadwick’s sign – color of vaginal walls changes from
normal light pink to a deep violet.
VAGINAL CHANGES
Vaginal secretions during pregnancy fall fro a
pH of greater than 7 (an alkaline pH) to 4.5
(an acid pH).
The changing acid content helps to make the
vagina resistant to bacterial invasion for the
length of pregnancy.
EMOTIONAL/PSYCHOSOCIAL ADAPTATIONS IN
PREGNANCY
A. First Trimester
Normal denial to confirmation of pregnancy
Ambivalence about pregnancy, child and
parenting
Mood swings or emotional lability
Focusing on the self
EMOTIONAL/PSYCHOSOCIAL ADAPTATIONS IN
PREGNANCY
B. Second Trimester
Acceptance of the baby as distinct from self;
enhanced by quickening which is “my baby is
alive” to the layman
With fantasy and daydreaming
Introspective; evaluates marriage, career, in-laws
Most comfortable signs
EMOTIONAL/PSYCHOSOCIAL ADAPTATIONS IN
PREGNANCY
C. Third Trimester
Fear/anxiety/ dreams about labor, pain,
mutilation and death
Anxiety related to responsibilities
Preparation for birth: nesting behavior; role
playing
