Hello, welcome to a conversation about pregnancy.
Today, we're going to talk about the
physiological changes of pregnancy.
This lays the foundation for everything,
we're going to talk about in this course.
So, spend some time in this lecture
and use it for a reference point,
if you ever feel like you're
struggling with any of the content.
Are you ready? Here we go!
We're going to talk about:
The reproductive system,
we're going to talk about
the cardiovascular system,
the hematologic system,
the endocrine system, the renal system,
the gastrointestinal system,
the musculoskeletal system,
the respiratory system and finally,
the integumentary system.
So, beginning with reproductive system changes,
so, these are the things that go
on in the reproductive system,
that are going to change as a result of pregnancy.
When we think about changes
in the breast, the estrogen,
also causes changes in the milk ducts.
So, let's look at this in detail.
As we have an increase in blood supply,
we're going to have growth and
proliferation of the milk ducts.
This is where the milk is
going to be produced later on,
so, we have to start early.
Progesterone causes, specifically
the development of the mammary lobes,
so, remember estrogen causes growth
and proliferation of the milk ducts
and progesterone causes
development of the mammary lobes.
When we think about the areola,
that's the dark area around the nipple,
this area is going to become enlarged
and the pigment is going to change,
it's going to be much darker than it is normally.
Sometimes, this is a cause
for a concern for clients,
make sure they know that this is expected.
We also may notice something
that looks like little pimples,
around the nipple.
These are called the, “Tubercles of Montgomery.”
The function of these tubercles is to supply,
sort of, a lubrication for the breast.
Remember, the function of the
breast is to feed the new-born,
so, we want to make sure
that area doesn't get dry,
so, the tubercles of Montgomery
will help with that process.
Also, in terms of how the breasts
look, they're going to change,
so, they may look more transparent,
they may have more vessels
that are visible superficially.
Again, these are things we want
to reassure the client about,
let them know, these are normal changes.
There may be stretch marks that
form on the breast as they enlarge
and again, this may not be the most fun,
but it is normal.
This process of milk production
starts during the pregnancy.
So, not just when the baby arrives.
We start the production of
colostrum during Lactogenesis I,
this happens during the pregnancy.
It's important that you know
that the lobes are formed,
that the alveolar cells start to grow and
we also have formation of the milk ducts.
Fatty tissue will also help
to support breast function.
The areola as we mentioned
previously, will become dark,
the nipple will become more
sensitive and often larger as well.
It's important that you remind clients, that,
although colostrum is produced during pregnancy,
it's normal for it to leak out before delivery.
Let them know that, and also let
them know they will not run out.
This is all a part of lactogenesis I.
Lactogenesis II, we'll talk
about in a later lecture,
because that occurs after delivery.
Now, let's talk about the uterus.
Now, the uterus is prime time, when
we talk about reproductive changes.
Under the influence of estrogen, the
cells proliferate and the uterus grows.
Now, because estrogen is present,
whether the pregnancy is in the uterus
or as in the case of an ectopic
outside the uterus, no matter what,
the uterus is going to grow and stretch.
So, understanding that the
uterus grows from the beginning,
all the way until the end of pregnancy
to create a home for the baby.
Let's talk about some other
changes that also happen.
Because of the increase of
blood flow to the uterus,
we have softening of the uterus.
So, specifically when we speak of the isthmus,
which is right above the
cervix, that area becomes soft
and it has a name it's called “Hegar’s sign.”
So, softening of the isthmus is, “Hegar.”
So, “High up on the cervix,” is how I remember.
“Chadwicks,” is also another sign of pregnancy,
but specifically, what's going
on, is all that extra blood flow,
into the cervix, makes it take
on, kind of a bluish color.
So, if you place the speculum into
the vagina and you open up the blades
and you see the cervix, you may notice
that it looks a little cyanotic,
that seems bad, but it's actually good,
it means we have great blood flow, to the cervix,
“C for color C for Chadwicks.”
Softening of the cervix itself
is called, “Goodell’s sign.”
So, I remember it by thinking of
something being good and soft,
you know like a doughnut,
right? Get it? Cervix, doughnut?
Anyway, so a Goodell sign is when we can feel,
how soft the uterus is, under the
influence of all of those hormones,
as it proliferates and blood flow comes in,
it's going to be softer.
Within the cervical canal, we have
the formation of a mucus plug,
also called, “Operculum.”
I actually just love saying that,
operculum operculum, operculum,
it makes me feel really smart.
But what it actually is, is a wad of mucus
and when it comes out later in pregnancy,
it looks like a wad of, well, mucus or
snot, which is not really that nice looking,
but it is important, because
functionally, what it does,
is to protect cletus the fetus as they're inside,
from all the bacteria they may form,
inside the vagina.
That's the operculum or mucus plug.