CHAPTER V.
CHANGES IN THE MATERNAL ORGANISM CAUSED BY PREGNANCY.
The general changes of pregnancy depends upon the changes in the blood and nervous system.
The Blood.
The blood changes in composition and increases in quantity. The watery element, white corpuscles and fibrim increases, its albumen and red corpuscles de- creases. Its clotting power is augmented.
The Heart.
The heart, having more work to do, increases one- fifth in weight. There is often palpitation, caused in the earh' stages from a sympathetic condition, in the later stage by the enlarged uterus.
The Breast.
During pregnancy the breasts undergo a change in preparation for their functual activity. They increase in size and present characteristic changes in structure. They begin to enlarge as early as the second month and after the third month they contain a thin fluid known as colostrum. The superficial veins enlarge and form a blue tracery beneath the skin. The nip- ples become elongated and prominent and increases
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in size and are sensitive and have a soft feel. The areola becomes darker, and the papilla around the
Fig. 11 — Breast in pregnancy.
nipple becomes prominent, and the development of
iular tissue At times they are very pain-
the follicles and grandular tissue which gives the
breast a knotty feel
fill.
The Abdomen. — The abdomen increases in size to accommodate the enlarged uterus, but this is not noticed until about the fifth or sixth month. In the sixth month the uterus reaches the umbilicus or navel, and in the eighth month it reaches the end of the sternum or breast bone. During the last two weeks of pregnancy the uterus sinks somewhat into the pelvic cavity. About the fifth month the navel begins to diminish in depth and about the seventh month becomes level with the skin. During the last two months the navel is often protuberant, caused by pressure of the uterus which forms a rounded elevation. Another condition of the abdomen is the stretching of the abdominal walls which result in the later months of pregnancy- in the formation of reddish, bluish and white sflisteninsr streaks (strias)
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in the skin covering the sides of the abdomen, thighs, and breast, which do not disappear after delivery
Fig*. 12 — Striae gravidarum.
but lose their coloring leaving white scars on the skin This condition is found in over ninety percent of preg- nant women. They are due to an atrophic condi- tion of all the skin layers, and obliteration of the lymph spaces. There is a displacement and partial rupture of the connective tissue of the deeper layers of the skin. The great stress and stretching of the abdominal wall causes the different layers of the skin to waste or die. as it were, for want of nutrition. This is true, not only in pregnancy, but in any disease which causes the same condition, as Tumor or dropsy. Where ever pigment is found normally it is increased. Thus there is often a deep brown line running from the umbilicus to the pubes.
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The Uterus. — The uterus changes in size and shape to accommodate the growing fetus, and about the fourth month contractions are felt. The neck is soft to the touch, and the vulva assumes a purplish blue color, owing to the dilatation of the veins, The ex- ternal generatives organs are, also, much more de- veloped and prominent.
The Bladder. — The bladder is diminished in size caused by the increased size of the uterus, and as a consequence there is an increased frequency of urination. Albumen in the urine is not an infrequent occurence, due probably in mild cases to a transitory catarrh of the bladder, more common in the latter than in the beginning of pregnancy. Glucose ( sugar) is, also found. The urine increases in quantity and is of a low apecific gravity.
The Bowels. — The bowels are usually constipated caused by the enlarged uterus pushing them to each side in such a manner as to compress them.
The Veins. — Edema of the legs and feet, and en- largements of the veins of the legs, rectum and vulva are very common during the latter months of preg- nancy ; due to pressure and increased vascular full- ness of the pelvic vessels induced by pregnancy. If accompanied by a scanty secretion of urine, severe headaches and great disturbance of mind, it is a ser- ious symptom, and should be reported to the phy- sician in charge of the case at once. But if there is no suppression of urine, no mental disturbance or depression, and so long as the veins themselves are not involved they are of little importance. Thev are often, however, the seat of much suffering. Under
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these conditions the patient should be massaged sev- eral times a week by a competent Masseuer, and this
Fig-. 13 — Varicose veins of the lower extremity in a pregnant woman at term. (Hirst.)
painful and uncomfortable condition can be entirely overcome.
The Liver And The Spleen. — Enlargement of the liver and the spleen are often present during preg- nancy. The latter is caused by its relation to the circulatory system.
Cough. — In the earlier months there is often a sympathetic nervous cough.
Lightening. — About two weeks before delivery the Uterus sinks somewhat downward into the pelvis, while the fundus falls forward. This is termed lightening. When the head of the fetus sinks into the pelvic cavity. This change of position is followed by considerable relief to the respiration, at the same time there is experienced an increased difficulty in
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locomotion, caused by the presenting part descending- low in the pelvic cavity. This pressure, also, on the bladder causes frequent urinations.
Respiration. — During the latter part of pregnancy the respiration is somewhat embarrassed and a state of dyspnea is present, caused by upward pressure on the diaphragm by the enlarged uterus ; and as the mother must supply more blood the lungs are very active eliminating carbon dioxide and absorbing oxygen so there is considerable relief experienced when the pressure is removed by the presenting part sinking low in the pelvic cavity a few weeks before delivery. The pressure upon the Lungs becomes less, so that the difficulty in breathing is removed.
Quickening. — There is another condition which ap- pears about the middle of pregnancy, the eighteenth week, and it is termed "quickening." It is the earliest movement of the fetus preceived by the mother, when she first feels life. The sensation at first is compared to the flutter of a little bird held in the hand, but the movement becomes stronger and increases in intensity as pregnancy advances. In young mothers these movements often cause anxiety, they are painful and annoying. If they continue the physician in charge, of the patient should be consulted.
The Fetal Heart. — We may have all of the above described conditions and still not pregnancy. But the one positive proof we have is the beating of the fetal heart. It is usually heard about the fifth month through the stethoscope. It can be heard later in pregnancy by applying the ear to the mother's ab- domen. This furnishes conclusive evidence of preg- nancy. The position and place we hear the heart beat-
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ing often aids us in determining the position of the child There are some positions, however, in which it is quite or entirely absent, via. when there is a great deal of adipose tissue, the walls of the mother's abdomen are very thick, or where there is a laree amount of amninotic fluid, and in some positions of the fetus. It has been compared to the tic-toe of a watch and ranges from one hundred and twenty to one hundred and fifty beats per minute. It is easy to distinguish from the mother's pulse, and when clear- ly heard is the positive proof of the presence of a liv- ing child.
The Nervous System. — The nervous system under- goes a change. A woman during this period is more subject to nervous influences and should be ke . quiet. The most amiable, loving and sweet tempered women are apt to become cross, fretful unreasonable, irritable and despondent. The spirits are often de- pressed and melancholy in women predisposed to in- sanity may terminate in mania. But for the sake of both her child and herself she must try and overcome this tendency. Despondency is sometimes caused by indigestion or the accumulation of waste products in the blood. This the physician can relieve. On the other hand there are women who are very delicate and frail, nervous and irritable : and very disagreeable under other circumstances that experience a sense of well being, and are very happy and pleasant during the entire period of pregnancy. The salivary secre- tions is increased. Neuralgia affection of the face and teeth are common. Pregnancy tests the integrity of every organ in the body.
Nervous Impressions. — Nervous impressions of the mother rarely make impressions on the child, as the
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fetus is completely funned at the end of eight weeks; but women should be careful during the early months of pregnancy to prevent miscarriges. Deformities in children are generally due to development of embr- yonic layers of tissue.
The Duties Of Her Friends. — Her husband and those who are the immediate friends of the patient should do all they can to make her happy. Keep all that is unpleasant from her. and shield her as far as possible from all disturbing influence. Little enter- tainments that she can indulge in should not be over looked, and pleasant amusement to divert her mind. She should look forward to her delivery with joy and pleasure and not fear or dread. The better a woman's health and strength is during her pregnane}-, the bet- ter will she be able to pass through the ordeals of labor and perform the duties oi motherhood.
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