Pregnant women care ( normal maternal physiology during pregnancy){G.I.T.}

Physiologic , biochemical , anatomic changes that occur during pregnancy are enormous but return normal after the end of pregnancy.

Adaptation means healthy changes in the mother for her baby without affection to her health.

1-G.I.T.

 

 during pregnancy nutritional requirements are increased ,several maternal adaptations occur to meet this demand :

 # Pregnant women tend to be more at rest conserving their energy to enhance fetal nutrition.

 # Appetite is increased, also food intake is greater.

 # Sometimes there is nausea and vomiting due to increased H.C.G. hormone.

   Management:

Small frequent meals.

Smelly food should be avoided.

Keep water 2 hours after meals. 

(Hyper-emesis will be explained as it concerns only doctors ).

 # Women may crave bizarre substances ( clay - soap - starch ).

    Management:

Correct iron deficiency anemia.

Good & controlled nutrition should be explained to the women.

 # Stomach and intestine are displaced forwards by the enlarged pregnant uterus.

 Oral cavity (mouth):

 # Salivation may increase due to nausea , difficult swallowing difficulty.

 # Gums are hypertrophied hyperemic ,so they are spongy , friable , bleed easily with tooth brush due to  increased estrogen and vitamin C deficiency.

 # Epulis ( focal highly vascular swelling of the gum ).

 # Pregnancy doesn't increase tooth decay.

Stomach motility:

 # Reduces gastrointestinal tract motility during pregnancy is due to increased progesterone hormone.

 # Increased estrogen hormone leads to : Increase release of nitric oxide from nerve endings (nor-adrenergic non - cholinergic ) that modulate motility .
                                                         Decrease motilin hormonal peptide which has smooth muscle stimulation effect.

 # Transit  time or food through gastrointestinal tract is slowed ,so more water is reabsorbed and this lead to constipation.

Stomach & esophagus:

 # Increase gastrin hormone will increase stomach acidity ( decrease PH ).

 # Increase gastric production of mucus.

 # Esophageal peristalsis is decreased with reflux of acidic secretion into lower esophagus , so increased gastric reflux and heartburn.
Management:

Try to elevate the head after eating for enough time at the bed.

Antacids are usually enough.

H2 receptor blockers may be used in resistant cases.

(If persists: peptic ulcer may be expected ,it concerns doctors only).

This is dangerous during anesthesia :

 # Delayed emptying time so food stays longer in the stomach.

 # Relaxation of gastric sphincter.

 #  Elevation of the stomach late in pregnancy so increased gastric pressure more than esophageal pressure.

  # Lying on back.

All will increase aspiration of food particles or gastric acid contents during operations


Small & large bowel and appendix:

By the gravid uterus all intestine are displaced upwards and lateral.

Appendix is displaced supperiorlly in right flank.

motility and tone of intestine are decreased.

so constipation and  piles are common.
Management:
 # Increase fluid intake.
 # Dailly exercise.
 # Mild laxatives or stool softening agents.

Liver:

 # No obvious shape changes but there is functional altration.

 # Alkaline phosphatase enzyme doubles because the placenta secretes similar enzyme.

 # A.L.T.&A.S.T.&G.G.T.&bilirubin are slightly decreased.

 # Decrease plasma albumin (3g/dl)      normal is(4.5g/dl).

 # Slight decrease in plasma globulin.

 Gallbladder:

 #  Its function is altered due to weak smooth muscle tone ,emptying time is slowed so emptying is not complete.

 # Bile become thick and static with increase stone formation.

 # Hormones of pregnancy decrease transport of bile acid in the pile ducts.

 # Intra hepatic retained  bile acids and bile salts which cause skin itching to pregnant women