Paper Outline
Introduction
Cardiovascular System
Blood Volume and Pressure
Blood Constituents
Cardiac Output, Size and Position
Aortocaval Compression
Venous Distension
Clinical Implications
Conclusion
CHILDBIRTH: ANATOMICAL AND PHYSIOLOGICAL CHANGES
Introduction
Changes occur in the body tissues around the pelvic and the mammary glands during pregnancy. The pregnancy not only affects the pelvic, but also other organs of the body. These changes are caused by increased metabolic activities required for the growth of the foetus. Once the pregnancy is carried up to midterm, the anatomical nature of the pregnancy causes pressure on the uterus which in turn stretches the skin. These changes are gradual and mostly evident in mid pregnancy. A number of organs are affected by this process. They include the endocrine system, the thyroid gland, the respiratory system, and increased body weight (Tortora & Derrickson, 2009). After birth, the body goes back to its original status through what is referred to as puerperium. This process lasts for an average of six weeks. It is divided into three sections. The first one is the immediate effects which are evident 24 hours. Second is the early stage that occurs seven days after childbirth. The last one is the remote stage, which becomes evident six weeks later. Throughout these changes, alterations are likely to occur in the body (Jacob, 2011). This paper will discuss on the possible abnormalities and the consequences they may have on the rest of the body.
Cardiovascular System
The cardiac output is expected to rise by about 50% influenced by the volume of stroke and the pulse rate. This level is expected to remain uninterrupted until delivery. This may increase slightly during delivery and return to normal two weeks after delivery. Despite the increase in cardiac activity, blood pressure is expected to be normal. This is aided by progesterone which keeps the peripheral resistance down. The cardiovascular disease is known to affect 10 to 15 per cent of all pregnancies (Thompson, 2007). This disease mostly occurs later in life after child birth. Abnormalities likely to be experienced are hypertension in which the cardiac is not able to support the increase work load. If these cardiovascular abnormalities are not checked in good time, the woman may experience stroke, coronary heart disease, or hypertension which may become chronic. Obesity and diabetes are also possible effects of an abnormal cardio vascular system in pregnancy (Heazell, 2010).
Blood Volume and Pressure
During pregnancy, the volume of blood increases to accommodate the demands of the growing foetus. This is common during the first 6 to 8 weeks of pregnancy. For normal and healthy women, this process goes up to thirty four weeks after which very minimal changes in blood volume occur. This automatically leads to swelled pharynx and larynx and the whole respiratory system. It is associated with the increased blood volume which is necessary to serve the bigger capacity of the uterus, the breasts and also the increased body mass (Hermes, et al., 2010). These serve to facilitate exchanges of respiratory gases, food components and metabolism between the mother and the foetus. It also serves as a reserve for the blood lost during birth. The increased blood volume comes with increased respiratory demands which can have negative effects on the mother. Abnormalities likely to be experienced at this stage include varicosities due to the higher pressure of blood coming from the uterine veins. Heart sounds are also likely to be experienced because the pressure in the hearts left atrium is greater than that in the left Ventricle. For a healthy pregnant woman, the body can control this through the hormones produced in the adrenal gland and the placenta (Marieb, 2005).
Increase blood volume means an increase in blood flow in the skin and mucus membranes. This flow is fast, and the pregnant woman is likely to experience discomfort in terms of hot flushes and increased sweating. This is normal, and alarm can only be raised if this condition goes to unbearable levels in which the hot flushes and sweating is a lot and more frequent (Tortora & Derrickson, 2009).
Blood Constituents
Blood volume directly influences the constituents of the blood. The amount of leucocyte is not standard, but keeps changing. However, it remains above the normal count. Plasma increases considerably while the platelets increase slightly. Plasma is crucial in the body of a pregnant woman because it reduces the viscosity of blood. Less viscosity encourages ease in exchange between the foetus and the mother as well as good circulation in the foetus. It also minimises the effect of blood loss in the third stage of child labour. Increased platelets serve to control the bleeding experienced during delivery. A little clotting or bleeding should not lead to panic during pregnancy. Unbalanced count of the blood constituents in the blood may cause a great health risk to the pregnant women. Altered plasma volume results to renal disease and further concentration in plasma urea can be dangerous to the pregnant woman’s health. A lot of bleeding can be experienced during child birth that can be a cause for death. If the red blood cells count is low, glycosuria results due to increased glucose filtration with less absorption. Further effects can be diabetes mellitus. Tolerance should be administered to ensure that glucose excreted through urine is at the minimum to protect this glucose (Heazell, 2010).
Cardiac Output, Size and Position
This increases the blood volume while the stroke level goes up to around 35%. The heart rate becomes increasingly rapid while the vascular resistance maintains a normal blood circulation in the body. This is also influenced by the progesterone levels in the body. Progesterone helps in maintaining a normal blood pressure which keeps the cardiac output at pace with the increased activity. The size and position of the heart changes too. This is attributed to the increased muscular walls required to pump a significant amount of blood. Dilation causes a slight change in the way blood flows and mild systolic murmur are felt. As the uterus grows, it pushes the diaphragm up. In turn, this pushes the heart to the left and front slightly (Heazell, 2010).
Aortocaval Compression
The enlarging uterus also has effects on some of the main blood vessels to the heart. The inferior vena cava is compressed when the pregnant woman lies in a supine position. This also happens to the lower aorta. This compression is risky because the blood flow changes its course and flows back which in turn leads to a reduced cardiac output. This is a risk of a cardiac attack and care should be taken in regards to the lying positions the expectant mothers take while sleeping. The pelvic veins are also affected by the growing uterus. The uterus exerts pressure on the inferior vena cava, and it results to oedema of the feet. In worse situations, the varicose veins located in the feet may be affected. This is a potential health risk (Marieb, 2005).
Venous Distension
The dilation of the capillary ends causes a reduction in blood flow. Consequently, this leads to a delay in the absorption of the substances that go through the subcutaneous layer or even such things as medication injected through the muscles. There tends to be more fluids going outside than inside the endothelium, and this causes fluid retention in the body. It is regarded as normal though if the levels of fluids are more than the body can manage, then the patient may need clinical intervention. The gastrointestinal functions are affected by the increased progesterone levels. It inhibits the peristalsis process causing slow emptying of the stomach and increased acid levels in the stomach. This may affect some women, and they develop Hyperemesis gravid arum that poses a great risk to life (Norris & Siegfried 2011).
Clinical Implications
The body of the pregnant woman is expected to adapt to the changes that come with the pregnancy. This is possible through the increased progesterone levels. In cases where impairments occur, such as in the cardiac activity, analgesia of the spine can be performed during delivery. This helps in the increased workload. Women who are known to experience gestational hypertension may not have abnormal symptoms during child delivery. However, this may slowly progress later in life. It is advisable for them to undergo check ups after delivery to ensure that these symptoms do not advance to unmanageable levels (Hermes, et al, 2010). Fluid retention has been identified as the most crucial maternal change in pregnancy. This is because the most of the fluids are more on the extra cellular tissue than in the intracellular location. The body adopts by altering its functionalities that results to changes in physiological processes experienced by pregnant women. They alternatively affect the body organs and hormones involved. Anatomical and physiological changes experienced are closely linked, and they affect each other (Jacob, 2011). The changes occurring in the bodies of pregnant women are inevitable. Therefore, the clinical concerns directed towards this cause are meant to control them. They cannot be stopped or changed and thus the issue is detecting the abnormal processes from the expected changes.
Conclusion
Pregnancy is a process that involves a lot of anatomical and physiological changes in the body. The anatomical changes involve the uterus growth, changes in the pelvic organs like the cervix and the vaginal cytology. The breasts also experience permanent changes, which affect the glands and tissues around them. The physiological changes are very significant and may put the lives of some expectant women at risk if not checked. These include supine hypotension and the unbalanced rise in blood plasma and erythrocytes, as well as the respiratory functions. The ovary is also significant in supporting the provision of progesterone hormone before the placenta takes over. Progesterone plays a very important role in pregnancy, and any lack of it can result to an abortion. In this case, it should be closely monitored. Child birth directly or indirectly affects all the major organs and processes of the body. There is a big likelihood of abnormalities, and this requires a close monitoring of a pregnancy. Care should be given from the early stage up to child birth and also in post delivery. This will ensure that any danger signs are realized in good time and acted upon before adverse effects can be felt.
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