The changes that occur in the pregnant patient's body are caused by several factors. Many of these changes are the result of hormonal influence, some are caused by the growth of the fetus inside the uterus, and some are the result of the patient's physical adaptation to the changes that are occurring. This lesson is closely related to anatomy and physiology.

Changes in the body during pregnancy are most obvious in the organs of the reproductive system.

a. Uterus.

(1) Changes in the uterus are phenomenal. By the time the pregnancy has reached term, the uterus will have increased five times its normal size:

(a) In length from 6.5 to 32 cm.

(b) In depth from 2.5 to 22 cm.

(c) In width from 4 to 24 cm.

(d) In weight from 50 to 1000 grams.

(e) In thickness of the walls from 1 to 0.5 cm.

(2) The capacity of the uterus must expand to normally accommodate a seven-pound fetus and the placenta, the umbilical cord, 500 ml to 1000 ml of amniotic fluid, and the fetal membranes.

(3) The abdominal contents are displaced to the sides as the uterus grows in size, which allows for ample space for the uterus within the abdominal cavity.

(a) Growth of the uterus occurs at a steady, predictable pace.

(b) Measurement of the fundal height during pregnancy is an important factor that is noted and recorded (see figure 5-1).

(c) Growth that occurs too fast or too slow could be an indication of problems.

(d) The size of the uterus usually reaches its peak at 38 weeks gestation. The uterus may drop slightly as the fetal head settles into the pelvis, preparing for delivery. This dropping is referred to as "lightening." This is more noticeable in a primigravida than a multigravida.

NOTE: Remember a primigravida is a woman pregnant for the first time. A multigravida is a woman who has been pregnant more than once.

b. Cervix.

c. Vagina. Increased circulation to the vagina early in pregnancy changes the color from normal light pink to a purple hue which is known as the "Chadwick's sign."

d. Ovaries.