Physiological Changes

Physiological changes during pregnancy and post partum

First Pregnancy: Physiological Changes



During pregnancy, the body undergoes significant physiological changes to support the developing fetus and prepare for delivery.



Cardiovascular and Circulatory Changes

  • Cardiac Enlargement: The heart increases in size by approximately 12% to meet increased demands, with cardiac output rising by 30-50% (8).
  • Blood Volume: Blood volume may increase by up to 50% above pre-pregnancy levels to supply the uterus, counter reduced venous return, and prepare for potential blood loss during childbirth (5).
  • Increased Coagulation: Pregnancy is a hypercoagulable state, with a 50% increase in fibrinogen production and decreased levels of inhibiting factors (e.g., protein C and protein S), heightening the risk of stroke, pulmonary embolism, and deep vein thrombosis (5).


Digestive and Gastrointestinal Changes

  • Progesterone Effects: Elevated progesterone levels relax smooth muscles, reducing esophageal tone (causing reflux), slowing peristalsis (causing constipation), and lowering gallbladder contractility (increasing gallstone risk).
  • Hemorrhoids: The combination of relaxed smooth muscle, constipation, and increased pelvic blood flow raises the likelihood of developing hemorrhoids.


Nutritional and Metabolic Adjustments

  • Calorie Requirements: Calorie needs rise by 180 calories/day during the second trimester and 400-450 calories/day during the third trimester (5, 8).
  • Weight Gain: A typical weight gain of 12-16 kg is considered normal, though standards may vary by region (6).


Respiratory and Musculoskeletal Changes

  • Lung Capacity: The diaphragm elevates by approximately 4 cm, reducing lung capacity by 5% (5, 8).
  • Uterine Growth: By the end of pregnancy, the uterus expands from 6-8 cm to about 30 cm in length, and its weight increases from 40-60 g to approximately 1,000 g (5).


Urinary System Adaptations

  • Kidney Size: The kidneys enlarge by about 1%, and the bladder's capacity diminishes due to uterine compression. Residual urine volume may increase, contributing to higher risks of infections such as bacteriuria and pyelonephritis (5).


Dermatological and Hormonal Changes

  • Skin Pigmentation: Elevated melanocyte-stimulating hormones, estrogen, and progesterone may lead to darkened skin, linea nigra, and pigmentation changes on the face and neck (5).
  • Sweating and Sebum: Increased sweating and acne are common due to higher sebum production.






Postpartum Recovery



The postpartum period, defined as the time required for the body to return to its pre-pregnancy state, involves numerous physiological adjustments:


Cardiovascular and Circulatory Recovery

  • Cardiac Function: Heart rate normalizes within the first few days, and blood volume returns to normal by the end of the first postpartum week.


Uterine and Reproductive Changes

  • Uterine Involution: The uterus begins shrinking immediately after birth, returning to its normal size within six weeks. Contractions, sometimes painful, facilitate this process and are often intensified by breastfeeding due to oxytocin release (5, 6).
  • Cervical and Vaginal Recovery: The cervix requires 15-30 days to return to its pre-pregnancy state, while the vagina typically normalizes within 10 days, though lubrication may remain reduced during lactation (5).


Hormonal Adjustments

  • Hormone Levels: Estrogen, progesterone, and gonadotropin levels normalize postpartum, while prolactin remains elevated if breastfeeding is maintained.


Weight and Fluid Loss

  • Weight Reduction: Women typically lose 5 kg in the first week (baby, placenta, fluids) and an additional 2 kg in the second week (interstitial fluid).


Urinary System Recovery


  • Bladder Function: The bladder regains normal tone and function within two months, though initial difficulties in emptying may occur. Stress incontinence affects approximately 7% of women but often resolves by three months postpartum (5, 6).


Other Changes

  • Immunity: Immune function is temporarily altered, increasing infection risks.
  • Lochia: Postpartum bleeding, initially similar to menstruation, gradually becomes lighter and ceases faster in breastfeeding women due to uterine contractions stimulated by lactation (5, 6).






Conclusion


This summary highlights key physiological changes during pregnancy and the postpartum period. It excludes complex medical details and information lacking sufficient references for broader accessibility.






References


1.https://www.uclh.nhs.uk/OURSERVICES/SERVICEA-Z/WH/MAT2/POSTNATALCARE/Pages/Postnatalphysiotherapy.aspx


2.https://www.webmd.com/parenting/baby/6-exercises-for-new-moms#1


3.https://www.webmd.com/baby/guide/abdominal-separation-diastasis-recti#1


4.http://www.cyh.com/HealthTopics/HealthTopicDetails.aspx?p=438&np=464&id=2825


5. Vine GS. Physiology of Pregnancy in: Obstetrics and Gynecology. Kaufman MS, Holmes JS, Schachel PP, Stead LG. Third edition 2011. McGraw-Hill Medical


6. Postpartum Care in: Obstetrics and Gynecology. Beckmann CRB, Ling FW, Herbert WNP, Laube DW, Smith RP, Casanova R, Chuang A, Goepfert AR, Hueppchen NA, Weiss PM. 7th edition 2014. Lippincott Williams & Wilkins


7.https://www.pregnancybirthbaby.org.au/physiotherapy-advice-after-pregnancy


8. R. Elaine Turner. Nutrition in pregnancy in: Modern Nutrition in Health and Disease. Ross AC, Caballero B, Cousins RJ, Tucker KL, Ziegler TR. 11th Edition 2014. Lippincott Williams & Wilkins

Disclaimer


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The exercises and information presented here are not original creations but have been compiled from credible sources, including scientific literature, medical publications, public health resources, and reputable sites addressing postpartum health and recovery. References to all sources are provided for your convenience.


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