Integrated Clinical Physiology: Pregnancy - Essay Example

?Integrated Clinical Physiology Table of Contents Introduction 3 Physiology of Normal Pregnancy 4 3-Stages of Prenatal Development 4 Placental Development and Function 5 Uterine Changes 5 Structural and Functional Changes to Maternal Systems 5 Musculoskeletal System 5 Gastrointestinal System 6 Maternal Physiological Adaptations of the Cardiovascular System 7 Haemodynamic Changes 7 Physical Changes 7 Changes to Maternal Coagulation and Haemostasis 9 Maternal Physiological Adaptations of the Respiratory System 9 Changes in Respiratory Function 9 Lung Volume/Function Related Changes 10 Acid/Base Changes 10 Maternal Physiological Adaptations of the Renal System 11 Structural Changes 11 Changes in Renal Haemodynamics 11 Fluid and Electrolyte Homeostasis 11 Summary 12 References 13 Bibliography 15 Introduction Scientifically, the evolution of single cell to multiple cells in the human body, throughout the reproduction process coordinates several organic functions of the body. These functions fundamentally include the reproduction cycle of the human beings, like the endocrine glands, which consists of parathyroid, pineal, pituitary and gonads affected by the reproduction cycle throughout. During the process of reproduction, some of the cells and glandular tissues grow ability to produce, change and absorb the substances of hormone. Undoubtedly, hormones play a vital role in the reproduction process wherein the endocrinal glands ensure that the hormones have reached its targeted tissue in the body. During the correlation of the hormones and the molecules, several other signaling modes arise in the reproducing body such as intracrine, cryptocrine, paracrine, autocrine and neurocrine. All these modes have their significant role in the reproduction process and form the biological basis for reproduction (Chedrese, 2009). Elaborating on the above mentioned changes occurring in human body during reproduction, this paper intends to provide a detailed study on the various changes occurring in the body during pregnancy. The discussion also reflects upon the changes observed in the fetus due to the physiological change in the maternal body. Physiology of Normal Pregnancy 3-Stages of Prenatal Development The prenatal development is generally classified into three stages as described below: The Germinal Stage: This stage refers to the initial period of 15 days after the conception. At this stage, the egg splits into cells and move towards the uterus for implantation in the female body. If the eggs are successful in implantation, the pregnancy is considered to be positive (Martini & et. al., 2011). The Embryonic Stage: This stage starts after the conception and remains till eight weeks of pregnancy. An unborn baby, scientifically termed as ‘embryo’ is developed in the womb. It is during this phase that the various internal organs along with systems of the body develop in the embryo. It is a critical stage for the development of brain of the fetus and thus holds considerable significance to reproduce a healthy baby. Hence, the conceived mother should remain alert regarding her health and must avoid hazards strictly at this stage (Richardson & et. al., 1997). The Fetal Stage: After the embryonic stage, the fetal stage remains till the birth of the baby. It is the longest stage of the pregnancy. The baby gains weight and starts developing at a faster rate at this stage. It is in this stage that all the five senses of the baby begin functioning. At this stage, the baby also continues to grow its immune to the food taken by the mother (Bickley, & Szilagyi, 2012). Placental Development and Function The placental development is a stage quite similar to the embryonic stage in pregnancy. The placenta plays a significant role in the process. It is a particular organ, which is responsible for the mother and the fetus exchanges. It is the first organ developed in the fetus and carries on the process of the exchange of food and nutrients consumed by the mother to the fetus. It carries several functions in the pregnancy process as exchange of food and the endocrine operations. Its major function however is to implant the embryo into the uterus apart from producing hormones that encourage Maternal Recognition of Pregnancy (MRP) (Cross, 2006). Uterine Changes During the pregnancy period in a female body, many physical changes take place. The uterine changes are a phenomenal change. In this process, the uterus increases five times till the term of pregnancy. The uterus expands to such an extent that it can accommodate the fetus and placenta, the fetal membranes and the umbilical cord conveniently. As the head of the fetus gets into the pelvis, the uterus moves slightly in the pre-delivery stage. This dropping process is termed as ‘lightening’ (Medical Education Division, 2007). Structural and Functional Changes to Maternal Systems Musculoskeletal System The placenta creates a hormone in the body to provide relaxation to the ligaments during pregnancy. It increases the mobility of the pubis and joints to allow the fetus to pass through the birth canal from the mother’s womb. Due to the increase in the uterus size, the lumbar lordosis also increases, which causes a pain in the mother’s back at the later period of pregnancy. Musculoskeletal changes also results to weight gain and hormonal changes within the mother. During pregnancy, the retention of certain hormonal fluids further causes vulnerability in the neural structures of the maternal body (Calzolari & Dalgleish, n.d). Gastrointestinal System Concerning the gastrointestinal system changes occurring in the mother during pregnancy, it can be observed that the uterus enlarges with the progress of the pregnancy period. It results to a rise in the pelvic cavity. These actions further create disorders in the stomach and the intestines of the mother. The production of the hormones also reduces the peristalsis rate. This reduction encourages the absorption process and decreases the hydrochloric acid in the reproducing body. Thus, it then hampers the stomach and the intestines resulting to the problems of constipation and other digestive issues. The cardiac relaxation may also increase the chances of heartburn while the movement through the large intestines gets slower, which results to constipation (Medical Education Division, 2007). Thus, the pregnant women must be careful regarding her balanced diet and prevent rising problem of constipation, vomiting or heartburn due to gastrointestinal system changes. Maternal Physiological Adaptations of the Cardiovascular System Haemodynamic Changes During pregnancy, normal physiological changes happen at a substantially greater rate. A healthy pregnant woman can increase her plasma volume up to 50% during her gestation period. The excess rise in the plasma volume can increase the chances of being anemic. The erythropoietin also increases the total red cell mass, but hemoglobin concentration never hampers the post pregnancy levels to a considerable extent. In effect of the haemodynamic changes, the cardiac output increases by 30-50% along with 15% rise in the heart rate and 25-30% in the stroke volume. These changes usually take place within the 12 weeks of pregnancy when the cardiac function may be problematic during the initial stages (Arulkumaran & et. al., 2011). The blood pressure further keeps on changing throughout the pregnancy period. During the first 18 to 20 weeks of pregnancy, the blood pressure remains the lowest and continues at a lower rate until 36 weeks. The regular checking of the blood pressure keeps the information about the smooth functioning of placenta (Bickley & Szilagyi, 2012). Physical Changes The major physical changes occurring during the pregnancy are the changes in the cardiac output. It is the most important physical change in the pregnancy process. During the process, the plasma volume increases by 40 to 50% and the red blood cells goes only by 15 to 20% within the mother. The cardiac output also increases by 30 to 40% wherein the maximum can take place till 24 weeks of gestation. It results to an increase in the heart beat and ultimately rises up to 10 to 15 beats during 28 to 32 weeks of pregnancy. Cardiac output varies according to the size of the uterus and the maternal conditions. Principally, the cardiac output increases during the labor period and shows maximum changes in the postpartum period. This increase can be harmful in the pregnant women causing various forms of heart diseases including ‘Coronary Arterial Disease’ as well (Datta & et. al., 2006). Changes to Maternal Coagulation and Haemostasis The procoagulant activity in the maternal blood increases in a normal pregnancy. There also occurs a decline in the anticoagulant activity due to the reduction of certain proteins in the body. All these happen due to presence of adequate placenta in the maternal body. Conceptually, the changes in the haemostasis, in the process, lead to a healthy pregnancy. This change is a secondary phenomenon containing placentae and amniotic fluid embolism. Hence, it is suggestible that a pregnant women must deal with the haemostasis changes effectively rather than affecting the coagulation activities within the body (Letsky, 2001). Maternal Physiological Adaptations of the Respiratory System Changes in Respiratory Function Mechanical Factors: Pregnancy is a state resulting to mechanical and hormonal changes in the maternal body. The increase in the size of the uterus leads to a change in the shape and size of the abdomen. Subsequently, the position of the fetus moves upward to 4 cm from its original place of rest within the maternal body. The thoracic circumference also increases by 5 to 7 cm and the diameter of the chest by 2 cm according to the increase in the size of the abdomen (Blackburn, 2012). Hormonal Factors: The hormonal changes are important in relation to the change in the respiratory system observed in the maternal body. The major change observed is the interaction of estradiol and prostaglandins within the body at this stage. As a result, the serum level increases during the entire pregnancy period. It also acts as a major change in the respiratory system and raises the responses to hypercapnica (Blackburn, 2012). Foetal Demands: The fetus develops with the time period of the pregnancy. As it grows, it starts responding to its maternal body. It is when the respiratory organs also start operating within the fetus. It is worth mentioning in this context that with its growth, the fetus needs air to breathe in, which is provided through the breathing organs of the mother. Thus, the changes in the respiratory system of the pregnant women occur for the ease of the fetus developing in the womb during pregnancy (Blackburn, 2012). Lung Volume/Function Related Changes The changes in the lung volume start in the middle of the second week and increases later with the gradual development of the fetus. In general, the maternal body experiences an increase of 500 to 700ml in the vitamins, decrease of 15 to 20% in the expiratory reserve volume and also decline of 20 to 30% in the residual volume and FRC as per the need of the fetus. The basic changes in the lung occur due to the change in the diaphagrm and chest of the mother (Blackburn, 2012). Acid/Base Changes The increased metabolic demands in the maternal placenta lead to an increase of carbondioxide production, oxygen consumption and basal metabolic rate. The decline in the blood buffer decreases the mother’s ability to interact for a metabolic acidosis during the labor period. It is a primary change occurring in the pregnancy process’ final stage (Blackburn, 2012). Maternal Physiological Adaptations of the Renal System Structural Changes The urinary system and the reproductive system are related with each other. Correspondingly, when the size of the kidneys increases upto 2cms in length, the glomerular size, vascular volume and the interstitial apce also increases in the mother. The renales and the uterus get enlarged during the pregnancy period. These changes occur from the third week of the gestation period and remains till the 12th week before the delivery. The increase in the oestrogen and progesterone also causes structural change in the urinary tract of the mother (Renal Society of Australasia, 2007). Changes in Renal Haemodynamics At this stage, the renal plasma and glomerular filtration increases up to 50% to 80% in the human body. This increment occurs after the conception, remains throughout the pregnancy and then decreases in the later period. The excess filtration does not affect the maternal body during the pregnancy period. The changes also causes the maternal body to absorb the nutrients, proteins and the uric acid to be provided to the embryo developing in the womb (Renal Society of Australasia, 2007). Fluid and Electrolyte Homeostasis The body fluid in the pregnancy period gets affected due to the changes in the renal system of the body. The loss of the fluid is caused from the physiological imbalances during this period. The mother is thus advised to take a lot of water in this period so that the baby and the mother both can avail the fluid adequately. The kidneys also act as a vital part of the renal system which gets enlarged due to the increase in the size of the uterus within the maternal body. If the women do not take sufficient fluid at this stage, the health of the mother and the baby can both be affected (Saade & et. al., 2010). Summary The study in the assignment above is prepared to review the various changes occurring during the pregnancy period. During the three stages of prenatal development, the fetus undergoes many changes in the maternal body. Along with these changes, the organs of the fetus also develop in the womb. These changes take place systematically along with the due course of the pregnancy stage. For instance, during the prenatal development, the size of the womb gets bigger in order to accommodate the growing fetus. Subsequently, it is after the gestation period the changes in the cardiovascular and respiratory organs take place. Hence, at this moment the major emphasis of the experts not only lies on the healthy development of the maternal body but also on the expected growth of the fetus. References Arulkumaran, S., & et. al., 2011. Oxford Desk Reference: Obstetrics and Gynecology. Oxford University Press. Bickley, L., & Szilagyi, P. G., 2012. Bates' Guide to Physical Examination and History-Taking. Lippincott Williams & Wilkins. Blackburn, S. T., 2012. Maternal, Fetal, and Neonatal Physiology. Elsevier Health Sciences. Calzolari, A. & Dalgleish, D. J., N.d. Anatomical and Physiological Changes in Pregnancy Relevant to Anaesthesia. Endocrine Function. [Online] Available at: http://totw.anaesthesiologists.org/wp-content/uploads/2010/11/25-Anatomical-and-physiological-changes-in-pregnancy-relevant-to-anaesthesia.pdf [Accessed October 2, 2013] Chedrese, P. J., 2009. Reproductive Endocrinology: A Molecular Approach. Springer. Cross, J. C., 2006. Placental Development and Function. Reproduction, Fertility and Development, 18, pp. 71-76. Datta, S., & et. al., 2006. Maternal Physiological Changes during Pregnancy, Labor, and the Postpartum Period. Changes in the Cardiovascular System, pp. 1-13. Letsky, E. A., 2001. Best Practice & Research Clinical Obstetrics & Gynaecology. Disseminated Intravascular Coagulation, Vol. 15, No. 4, pp. 623-644. Martini, F. H., & et. al., 2011. Fundamentals of Anatomy and Physiology. Benjamin-Cummings Publishing Company. Medical Education Division, 2007. Obstetric and Newborn Care – I. Physiologic Changes During Pregnancy. [Online] Available at: http://www.brooksidepress.org/Products/Obstetric_and_Newborn_Care_1/lesson_5_Section_1.htm [Accessed October 2, 2013]. Renal Society of Australasia, 2007. Pregnancy and Renal Function. Renal Society of Australasia Journal, Vol 3. No. 2, pp. 47-49. Richardson, M. K., & et. al., 1997. There Is No Highly Conserved Embryonic Stage In The Vertebrates: Implications For Current Theories Of Evolution And Development. Anat Embryol, pp. 91-106. Saade, G. R., & et. al., 2010. Critical Care Obstetrics. John Wiley & Sons. Bibliography Bullock, S., & Hales, M., 2012. Principles of Pathophysiology. Pearson Education Australia. Bloch, S., & Singh, B., 2007. Foundations Of Clinical Psychiatry, Revised 3rd Eds. Melbourne University Press. Bryant, B., & Knights, K., 2011. Pharmacology for Health Professionals, 3rd eds. Mocby Elseiver. Read More