Maternal Physiology and Healthy Pregnancy Outcome - Essay Example

The Major Changes in Maternal Physiology to a Healthy Pregnancy Outcome and How Placenta may Adversely Affect Pregnancy Outcome Introduction: The human body develops, evolves and transforms according to various stages in life as well as due to certain physical conditions or any changes that occur at a specific point of time, to facilitate adaptation to that particular situation. In the same manner, a woman’s body undergoes several physiological and anatomical changes during pregnancy and delivery. The term pregnancy can be defined as “a sequence of events, that normally includes fertilization, implantation, embryonic growth, and foetal growth that terminates in birth” (Tortora & Anagnostakos 1984, p.735). The changes, mostly those relating to early stages of pregnancy, are partially attributable to “the metabolic demands brought on by the foetus, placenta and the uterus” (Ciliberto & Marx 1998, para. 1). Besides, the increase in the levels of hormones during pregnancy, especially those related to progesterone and oestrogen are also responsible for inducing the changes. However, most of the changes that occur in the later stages of the pregnancy pertain to the woman’s anatomy, as a result of “mechanical pressure from the expanding uterus” (Ciliberto & Marx 1998, para. 1). The physiological changes that occur in a woman during pregnancy are intended to “facilitate the adaptation of the cardio-vascular system to the increased metabolic needs of the mother, thus enabling adequate delivery of oxygenated blood to peripheral tissues and the foetus” (Silversides & Colman n.d., p. 1). The physiological and anatomical changes that a woman undergoes during pregnancy have high significance on pregnancy outcomes and appropriate physiological transformation is a crucial element in achieving healthy pregnancy outcomes. Major Changes in Maternal Physiology during Pregnancy: There are several changes that occur in pregnant woman during the gestation period, which can be anatomical or physiological, such as: gestational weight gain, cardio-vascular changes, hormonal changes, changes in respiratory system, changes in the immunity system etc. This study will contain an analysis of three of the major changes in maternal physiology, such as Gestational Weight Gain, Hormonal Changes and Changes in the Cardio-Vascular System, as endorsed below: - Cardio Vascular Changes: This is one of the major changes that occur in a pregnant female during gestation period. One significant development during pregnancy is that a woman’s uterus undergoes enlargement and, as a consequence, abdominal viscera gets displaced. This, in turn, causes elevation of the diaphragm as a result of which the heart is moved “upwards to the left and assumes a more horizontal position as its apex is moved laterally” (Beckmann et al. 2010, p.43). These developments also entail increase of ventricular muscle mass resulting in an enhancement in the size of both the left ventricle and atrium, to correspond to the “increase in circulating blood volume” (Beckmann et al. 2010, p.43). This causes further functional changes in cardiac system, in terms of an increase of 30 – 50% output due to increased heart rate. Evidence suggests that such increase in heart rate occurs as a “reflex response to a lowered systematic vascular resistance (SVR) caused by circulating oestrogen and progesterone” (Hool 2010, p. 2). In the case of a pregnant woman, the expansion of plasma volume and an enhancement in red blood cell mass begins from the early stages of gestation, like fourth of fifth week of conception. It reaches its highest between 28 and 34 weeks of pregnancy. During this time, a slight increase may occur in red cell volume also. The maternal blood volume during the final stage of pregnancy will be “about 100 ml/kg” (Foley 2012). When a pregnant woman remains in supine position, the inferior vena cava can get compressed by the loaded uterus and, consequently, return of blood to the heart will reduce. This, in turn, entails decrease in cardiac output and may expose the subject to blood pressure or placental perfusion. The study by Heidemann further finds that “the descending aorta can also be compressed by the uterus causing a reduction in uterine blood flow” (Heidemann n.d., p. 1). Such compressions can induce hypotension also in pregnant women, generally from the 21st week of gestation. Studies have further revealed that “pregnant patients compensate for hypertension by an increase in sympathetic tone causing vasoconstriction and tachycardia” (Hool 2010, p. 2). Moreover, this study also suggests that patients can be relieved of such aortocaval compressions by a lateral tilt to the left by 15 degrees. Thus, aiming at a healthy pregnancy outcome, this measure is advisable for women under gestation, especially those who are under regional anaesthesia. The Cardio Vascular method endures numerous variations and even profound variations during pregnancy. “Cardiovascular anatomy, blood volume, cardiac output, and vascular resistance are altered to accommodate the additional maternal and fetal circulatory requirements” (Simpson & Creehan 2008, p. 61). Increased ventricular wall muscle mass, cardiac murmurs, an increased heart rate, and dependent peripheral edema form the data of these functional and anatomic changes. This system “provides a means of aiding the diffusion process, allowing the development of large organisms” (Sunthareswara 2002, p. 3). Physical symptoms may happen throughout pregnancy in response to “normal cardiovascular changes” (Rowell 1993, p. 391). Women with common cardiovascular problem are normally able to accommodate the theatrical cardiovascular modifications connected with pregnancy. “In pregnancy the cardiac output in females is approximately 40 % to 6 liters per minute” (Heazell et al. 2010, p. 4). This change happens early in pregnancy with one half of “this increase occurring prior to 8 weeks gestation” (Beckmann et al. 2010, p. 43). The increase in cardiac output ranges about 20 to 30 weeks gestation. Heart rate enhances through pregnancy from “80 to 90 beats per minute”, (Reece & Hobbins 2007, p. 148) contributing more to the necessary increase in cardiac output. Additionally there is a decrease in the arteriovenous oxygen gradient and an increase in the preload due to the avoidance of systemic vascular opposition. The increased cardiac output is dispersed throughout the body with the uterus getting about “400mL/min extra” and the kidneys getting approximately 300mL/minextra. (Pitkin et al. 2003, p. 2). The significant belongings of pregnancy on the cardiovascular methods are blood volume, blood components, heart changes, cardiac output, and blood pressure. The quantity of rise in blood volume depends on the size, quantity of deliveries and pregnancies and the quantity of fetuses are carrying. “Blood volume increases by approximately 1,500 Ml, or 50% above nonpregnant levels” (Ricci & Kyle 2009, p. 294). The real composition of the blood will also modify during pregnancy. It brings an increase of “about 40 to 50 percent” of in blood plasma. (Oertel & Krittian n.d., p. 20). Additionally, the red blood cell attention will increase by about “20 to 30 percent” (Rogers 2011, p. 193). Due to the reason that the plasma improves more than the red blood cells, it is essential to supplement it with folic and iron acid in order to maintain the ideal stages of hemoglobin. Cardiac output may be traced by the increase in heart rate between pregnant women and the child, in addition to the increase in heart size. Hormonal Changes: During pregnancy, women’s physiology will be affected by many changes. These changes are mostly due to hormonal imbalances. The hormonal changes may lead to change in their moods, high need for food, extra sleep, etc. All these changes in the hormone are essential, as it improves the progress of the child, and keeps the child healthy all throughout the nine months it spends in the mother’s womb. The level of hormones change frequently during the pregnancy period. The hormonal changes happen in the complicated relationship between the ovarian hormones and those produced by “the pituitary gland” (Taylor 1970, p. 1). The following are the types of pregnancy hormones in the women’s body. Estrogen Hormone: The estrogen hormone in the body leads to many problems such as “mood swings and irritability to heavy periods, tender breasts and weight gain” (Facts: On Hormone Balance Issues n.d.). During pregnancy, estrogen will be concealed by the placenta. Estrogen is an “entire class of hormones” (Gittleman 2005). Estrogen is also reliable for the creation of lung, liver, kidneys and glands, as it enables their maturity. This change in women’s body leads to healthy pregnancy and estrogen helps the “progression of lactation”, (Lauwers & Swisher 2011, p. 564) as it is concerned with changing the bone density of the baby, and as it helps the easily flow of blood from the mother to the baby. It also keeps female babies away from the masculinising result of the androgen hormone The release of hormones during breast feeding, and prolactin, relieves the mother from the problems relating to post pregnancy. Progesterone Hormone: Progesterone is another pregnancy hormone that it is created in low amount in the primary stage of the “menstrual cycle” Ten days after the ovulation, the release of progesterone discontinues leading to the beginning of the menstruation. Estrogen increases and controls the making of progesterone during the nine months of pregnancy. The role of progesterone, is “reducing the risk of preterm delivery” (Keith Edmonds 2011, pg 236), to keep away the womb and fetus from any harmful cells, to stop rapid progress of and lessening of the uterus, to help the increased growth of breast. During delivery, progesterone discontinues. Various symptoms such as headaches, constipation, heart burns, and blurred vision occur, and this is due to the increase of progesterone levels. Testing the level of the progesterone is a complicated activity, as it is hard to measure whether a low progesterone level leads to bad pregnancy. Most of the doctors suspect that abnormal pregnancy causes low level of progesterone. Many researchers are of the opinion that “low progesterone levels may be the root cause of miscarriage for some women. (Krissi Danielsson, William H Kutteh 2008, pg 88) The low level of progesterone is mainly due to stress and other tension related problems in women. Relaxin Hormone: This type of hormone occurs in the primary stage of pregnancy, and it is “responsible for helping limit the activity of the womb and soften the cervix in preparation for delivery” (Narendran 2006, p. 21). Oxytocin Hormone: The level of oxytocin hormone in pregnant women strengthens the relationship between the mother and the child. The researchers find that oxytocin is associated with mental, as well as the behavioral, aspect of “social bonding” (Clarke et al. 2010, p. 104). Endorphin Hormone: The level of endorphin hormone rises during pregnancy delivery of the child. This hormone is created by sports and exercises. “Exercise stimulates the release of endorphins within approximately 30 minutes from the start of activity” (McGovern n.d.). Low level of endorphin causes to extremely painful labor and difficult to in tolerate. Hormonal imbalances can be controlled by eating little and “regulating blood glucose levels” (Pairman et al. 2010, p. 423) and doing the regular exercise will help the pregnant women to reduce stress and anxiety. Relationship between Changes in Maternal Physiology and Pregnancy Outcome: During normal pregnancy, women’s body undergoes certain physiological changes that influence every function of the body. These changes are essential for the development and support of the fetus, and to prepare the women for delivery. The following points indicate the relationship between changes in maternal physiology and pregnancy. The women’s “higher rate of mood disturbance” would lead to either good or bad pregnancy outcome. Higher levels of estrogens, “vasodilatory peptides” (Gosney et al. 1995) and “calcitonin generelated peptide” result to bad pregnancy outcome. There will be increase of cardiac output “by 30-50% with 10-20% increase in heart rate” (Goral n.d.) results in early pregnancy. “Obesity is associated with significant changes in body composition and function” (Leykin 2004) may lead to difficulty during delivery. “Women with pre-existing diabetes” is found to have miscarriage and this result in bad pregnancy outcome. (Teratogenicity Associated With Pre-Existing and Gestational Diabetes 2007). The “relationship between maternal nutrition and birth outcome may be nonlinear” (Handler 2010, p. 331). Various problems such as smoking, malaria, and hyper tension adversely leads to bad results. For “the successful pregnancy outcome, the mother’s immune system must be tolerant of semiallogenic fetus” (Daftary & Desai 2006, p. 10). Desired Changes in Maternal Physiology to a Healthy Pregnancy Outcome: Pregnancy consists of a chain of small, continuous physiologic changes that influence the metabolism of every nutrient. The changes are not in a uniform level, but they vary from woman, to woman depending on her prepregnancy nutrition, maternal lifestyle behaviour, and genetic determinants of fetal size. “Changes in the maternal environment have been shown to have an impact on specific steps of placental transport of the major energy substrates” (Composition and Components of Gestational Weight Gain: Physiology and Metabolism 2009). For instance, maternal diabetes results in increased accessibility of glucose, which is transported directly across the placenta for fetal use. Numerous gastrointestinal changes happen throughout pregnancy, containing decreased motility and tone of the stomach, delayed gastric emptying, decreased gastric acid secretion and increased gastric mucous emission as a function of improved progesterone. “Motility” (Harris 1999) of the lesser intestine is also decreased through gestation; though, nutrient absorption is unaffected, excluding enhanced iron combination. These psychological transformations can influence the model of gestational weight gains in premature gestation. “Changes in protein and nitrogen metabolism occur in early pregnancy, presumably in response to pregnancy-related hormones” (Rasmussen & Yaktine 2009). The focus of binding proteins on sex steroids, corticosteroids, vitamin D, and thyroid hormones also increase. “Changes in carbohydrate” (Kuchel & Ho 2004, p. 53) and lipid metabolism occur throughout pregnancy, to ensure a constant supply of nutrients to the rising fetus. In premature pregnancy, glucose tolerance is common or better slightly, and tangential sensitivity to insulin and hepatic basal glucose manufacture are common or raise by as much as 15%. “As pregnancy advances” (Morgan & Dickerso 2003) nutrient-stimulated insulin responses increase despite the minor worsening in glucose tolerance, as it is reliable with progressive insulin resistance. Changes in “maternal physiology during pregnancy” are arbitrated by placenta issued, as proved by the important increase in the creation of motherly insulin, which happens within days after delivery of the placenta and fetus. (Raff 2003, p. 265). The metabolic alterations in insulin sensitivity that happen throughout pregnancy are customized by “inflammatory factors” (Buonocore et al. 2012). In women with common glucose tolerance throughout pregnancy experience loss of postpartum weight and subsequently returns to normal metabolic purpose. On the other hand, in women with “GDM”, (Poretsky 2010, p. 112) there is no loss of post-partum weight or adiposity, there remains an important provocative setting of those outcomes in chronic insulin resistance, at the risk of “diabetes and the metabolic syndrome” (Codario 2011). Depending on the pregravid insulin compassion position of the woman, insulin sensitivity can decrease or increase throughout early pregnancy. In the extremely insulin-sensitive female, insulin compassion most frequently decreases, and is accompanied by an increase in adipose basal and tissue metabolic rate. Effects of Placenta on Pregnancy Outcome: The “Placenta” (Baun n.d.) is the organ formed in the womb in times of pregnancy, and it brings nutrition and oxygen from the mother to the unborn baby (fetus). The placenta helps to get rid of waste products from the unborn baby (fetus). It is a complicated organ, or a complex organ with numerous significant functions and role throughout gestation, and that which serves the purpose of offering nutrition for the developing fetus. There are three kinds of “placenta previa” (Placenta Previa n.d.) that are partial, marginal and complete. A marginal previa is close to the edge of the cervix, but doesnt really block it. A partial previa partly covers the cervix. A complete previa wholly blocks the cervix, creating vaginal delivery unfeasible. To enable the healthy and fit growth fetus, it is highly necessary that the placenta grows extremely healthy in the uterus of the mother. The functions of the placenta as a fetomaternal organ is carried out by two constituents: the fetal placenta, or (Chorion frondosum), which builds up from the same egg cells and sperm that form the unborn baby; and the “maternal placenta”, (Mechanisms Underlying Mammalian Developmental Defects 2002) or (Decidua Basalis), which builds up from the tissue of maternal uterine.. Advantages of Placenta on Pregnancy are the following: A. “Embryos” (Definition of Embryo 1996) are sheltered for a longer period. B. More infants can be had at one time. C. Embryos obtain nourishment, food etc, and eject waste products. D. They dont require nourishment from milk. E. They can assimilate cellulose. F. The baby is sheltered in a pouch. The placenta is a key player in the creation of new lives. Everyone as a human being is as sole the baby itself. All babies require a healthy, strong placenta with the intention of acquiring the most excellent possibility of surviving the pregnancy stage and the birth of the child. “During pregnancy, the placenta takes over making CRH, a corticotrophin-releasing hormone, normally secreted by the hypothalamus, and well-known to be a stress reducer” (Benefits of Placenta Medicine 2012). Placentas are one of the amazing organs during pregnancy. They look after life in the womb from the moment they are created, but their influence and function does not stop at birth. Instead, they are perfectly formed to feed the mother and assist her recover more rapidly from birth and pregnancy itself. By permitting her system to slowly balance itself, capsules of placenta ease the transition to motherhood for numerous women. “If a woman is at her optimum in health and well-being, then she is unquestionably able to mother her baby and nurture her family at a higher level. No mother can perform at her peak, when her system is depleted and she is exhausted” (Selander 2006). The placenta, grown-up in her womb and symbiotically incorporated into her system, can refill and refresh her, providing her the resources and energy that she needs for the most significant challenge of survival lifetime which is in simpler terms known as motherhood. “Placental grade which refers to the age of the placenta can be determined by the number of white spots found on the surface of the organ” (Placenta Problems in Pregnancy 2001). Adverse Effects of Placenta and Why They Occur: Placental mammals scheme of reproduction is very worse for the lady, while it is healthier and better for the baby. Damage to the placenta can lead to various adverse pregnancy results consisting of preeclampsia, premature birth, or even pregnancy loss. The placenta is devoted to the endurance of the fetus even when the mother is exposed to a deprived maternal atmosphere, “for example when the mother is malnourished, diseased, smokes or takes cocaine, the placenta can often compensate by becoming more efficient. Unfortunately, there are limits to the placentas ability to cope with external stresses. Eventually, if multiple or severe enough, these stresses can lead to placental damage, fetal damage and even intrauterine demise and pregnancy loss” (Kliman 1997). The main pathological procedures visible in the placenta can adversely and negatively affect the outcome of pregnancy, which consist of intrauterine bacterial diseases, reduced flow of blood to the placenta from the infant’s mother and attack on the immune system of the placenta, by the immune system of the mother. Intrauterine diseases, most generally the outcome of migration of vaginal bacteria into the uterine cavity, can lead to stern fetal hypoxia. This is the effect of the villous edema .Both acute and chronic decrease in the flow of blood to the placenta can cause rigorous fetal damage and even death. In addition to supplying the fetus by way of nourishment, the placenta is also a fence between the mother and fetus, defending the fetus from immune refusal by the mother, a pathological procedure that can lead to intrauterine expansion, retardation, or even death. Additionally to these chief pathologic categories, numerous other insults, for example cord accidents, placental separation, viral attack trauma, and parasitic diseases, can negatively affect the outcome of pregnancy. This proves the positive dynamic role of the placenta. Normally placenta cultivates in the upper area of uterus. But at the same time it cultivates near cervix area, and it may lead to block the opening to vagina. During pregnancy the risk in health of the pregnant lady depends on how low the placenta lies in the uterus. Doctors (gynaecologist) advise pregnant women not to disregard any symptoms and signs during pregnancy: as that could denote, the particular lady is in danger. Having placenta previa may enlarge danger for blood clotting. Placenta previa can cause a very grave situation and the pregnant women even may die. Having placenta previa may make the pregnant lady feel scared and worried. In such cases, the pregnant women should consult the family, caregiver, and friends and convey their feelings. Ask the caregiver whether the person has any idea regarding the circumstance, its treatment, or care. “The maternity care providers should closely manage and monitor progress of women who have hypertension during pregnancy, or those whose placenta is posterior, and those effective management strategies need to be developed to care for these women” (Warland 2007, p. 6). A qualified placental pathologist can study the placenta and help in the elucidation for the reasons of poor pregnancy outcome. A through placental check-up is helpful immediately after the delivery so that the affected family can necessity understand what has happened to their infant. Conclusion: A woman’s body undergoes several physiological changes during pregnancy and delivery. The main changes are the cardio vascular changes and the hormonal changed that occur frequently and this lead to either good or bad pregnancy. Various researches and evidences suggest that hormonal changes in pregnant women occur due to the difference in their mood and subsequently it may lead to depression even after the delivery. The placenta starts caring the life in the womb from the moment it is created, though its influence and function does not stop at birth. Despite the advantages provided by placenta, it can adversely affect the fetus, resulting in preeclampsia, premature birth, or even pregnancy loss. The maternal physiology changes result in pregnancy outcome either positively or negatively. 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