Alterações na gravidez
Autor: Segredos | Publicado: 2011-10-26T20:26:00-07:00

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 <![endif]-->  Útero  O útero tem seu volume aumentado em centenas de vezes, sua consistência diminuída e sua massa aumentada de menos de 100g para mais de 1 kg. De piriforme torna-se globoso e, depois da vigésima semana, cilíndrico. Esta última alteração é também chamada de conversão&nbsp; uterina. Seu crescimento na posição inicial de anteversoflexão é acentuado até a décima segunda semana, o que causa compressão da bexiga e, por isso, aumento da frequência urinária. Após esse período, o crescimento torna-se mais longitudinal e a fixação do colo sigmoide no retroperitôneo determina uma dextrorrotação do órgão. A acomodação uterina também envolve a hiperplasia do miométrio, antes da nidação, e, após este fenômeno, sua hipertrofia e seu alongamento, dependente do estiramento das fibras musculares lisas. O espessamento do muco cervical, determinado principalmente pela atuação da progesterona, é responsável pela formação da Rolha de Schröder, que isola o ambiente fetal do ambiente externo, como uma proteção contra infecções. A percepção materna do desprendimento desse muco é um sinal de abertura do colo uterino podendo estar associada à proximidade do parto.  <!--[if gte mso 9]>     Normal   0         21         false   false   false      PT-BR   X-NONE   X-NONE                                                     MicrosoftInternetExplorer4                                                   <![endif]--><!--[if gte mso 9]>  <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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 <![endif]-->  Vulva e vagina  vaginal torna-se espessa e esbranquiçada. A coloração torna-se mais acentuada devido ao aumento da vascularização nessas áreas. A vagina se adapta de acordo com o crescimento do feto, tornando-se extensa.<!--[if gte mso 9]>     Normal   0         21         false   false   false      PT-BR   X-NONE   X-NONE                                                     MicrosoftInternetExplorer4                                                   <![endif]--><!--[if gte mso 9]>  <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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 <![endif]-->  Seios  A região dos seios é uma das que primeiro sofre modificações. Os seios aumentam de volume e vasos sanguíneos podem ficar visíveis, formando a chamada Rede de Haller. A aréola fica com uma coloração mais escurecida e surge a aréola secundária (Sinal de Hunter). Glândulas sebáceas podem se hipertrofiar no mamilo e na aréola (Tubérculos de Montgomery). Ao final da gestação surgem as primeiras secreções de colostro, líquido fino e amarelado fundamental na alimentação do bebê em seus primeiros dias de vida, pois é rico em anticorpos e pró-vitamina A. &nbsp;  <!--[if gte mso 9]>     Normal   0         21         false   false   false      PT-BR   X-NONE   X-NONE                                                     MicrosoftInternetExplorer4                                                   <![endif]--><!--[if gte mso 9]>  <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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   UnhideWhenUsed="false" Name="Medium List 1 Accent 1"/>      <w:LsdException Locked="false" Priority="34" SemiHidden="false"
   UnhideWhenUsed="false" QFormat="true" Name="List Paragraph"/>   <w:LsdException Locked="false" Priority="29" SemiHidden="false"
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   UnhideWhenUsed="false" QFormat="true" Name="Intense Quote"/>   <w:LsdException Locked="false" Priority="66" SemiHidden="false"
   UnhideWhenUsed="false" Name="Medium List 2 Accent 1"/>   <w:LsdException Locked="false" Priority="67" SemiHidden="false"
   UnhideWhenUsed="false" Name="Medium Grid 1 Accent 1"/>   <w:LsdException Locked="false" Priority="68" SemiHidden="false"
   UnhideWhenUsed="false" Name="Medium Grid 2 Accent 1"/>   <w:LsdException Locked="false" Priority="69" SemiHidden="false"
   UnhideWhenUsed="false" Name="Medium Grid 3 Accent 1"/>   <w:LsdException Locked="false" Priority="70" SemiHidden="false"
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   UnhideWhenUsed="false" Name="Light Grid Accent 4"/>   <w:LsdException Locked="false" Priority="63" SemiHidden="false"
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   UnhideWhenUsed="false" Name="Medium Shading 2 Accent 4"/>   <w:LsdException Locked="false" Priority="65" SemiHidden="false"
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   UnhideWhenUsed="false" Name="Medium List 1 Accent 6"/>   <w:LsdException Locked="false" Priority="66" SemiHidden="false"
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   UnhideWhenUsed="false" QFormat="true" Name="Subtle Emphasis"/>   <w:LsdException Locked="false" Priority="21" SemiHidden="false"
   UnhideWhenUsed="false" QFormat="true" Name="Intense Emphasis"/>   <w:LsdException Locked="false" Priority="31" SemiHidden="false"
   UnhideWhenUsed="false" QFormat="true" Name="Subtle Reference"/>   <w:LsdException Locked="false" Priority="32" SemiHidden="false"
   UnhideWhenUsed="false" QFormat="true" Name="Intense Reference"/>   <w:LsdException Locked="false" Priority="33" SemiHidden="false"
   UnhideWhenUsed="false" QFormat="true" Name="Book Title"/>         <![endif]--><!--[if gte mso 10]> 
 /* Style Definitions */
 table.MsoNormalTable
 {mso-style-name:"Tabela normal";
 mso-tstyle-rowband-size:0;
 mso-tstyle-colband-size:0;
 mso-style-noshow:yes;
 mso-style-priority:99;
 mso-style-qformat:yes;
 mso-style-parent:"";
 mso-padding-alt:0cm 5.4pt 0cm 5.4pt;
 mso-para-margin-top:0cm;
 mso-para-margin-right:0cm;
 mso-para-margin-bottom:10.0pt;
 mso-para-margin-left:0cm;
 line-height:115%;
 mso-pagination:widow-orphan;
 font-size:11.0pt;
 font-family:"Calibri","sans-serif";
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 mso-hansi-theme-font:minor-latin;
 mso-bidi-font-family:"Times New Roman";
 mso-bidi-theme-font:minor-bidi;}
 <![endif]-->  Pele  É comum haver hiperpigmentação da pele com o aparecimento de cloasma e da linha nigrans no abdome. O incremento da vascularização de folículos pilosos pode promover hipertricose com o surgimento de pêlos finos na face (Sinal de Halban). O acúmulo de tecido adiposo e o crescimento das mamas e do útero distendendo o abdome podem provocar o aparecimento de estrias nessas regiões e nas coxas.&nbsp;  <!--[if gte mso 9]>     Normal   0         21         false   false   false      PT-BR   X-NONE   X-NONE                                                     MicrosoftInternetExplorer4                                                   <![endif]--><!--[if gte mso 9]>  <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
  DefSemiHidden="true" DefQFormat="false" DefPriority="99"
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 <![endif]-->  Coração e vasos sanguíneos  Por meio de diversos mecanismos ocorre aumento da perfusão sistêmica e uteroplacentária. O volume plasmático aumenta progressivamente a partir da sexta semana e o volume de hemácias aumenta depois da oitava semana. Ambos os volumes tornam-se estáveis nas últimas semanas, mas, como o aumento do volume plasmático é mais precoce e tende a ser mais acentuado do que o aumento do volume de hemácias, ocorre um efeito dilucional responsável pela chamada anemia fisiológica da gravidez. Para se adaptar a essas alterações também o coração se hipertrofia, desviando-se para frente e para a esquerda, havendo também o aumento do débito cardíaco. O nível rebaixado da pressão arterial é conseqüência da diminuição da resistência vascular periférica por ação do estrógeno sobre a gênese de vasos, da progesterona sobre o relaxamento e dilatação dos mesmos, mas também pela diminuição da reatividade vascular aos vasoconstritores endógenos. As alterações envolvendo os fatores de coagulação preparam o organismo da mulher para o momento do parto para que haja um rápido controle de hemorragias, mas, em contrapartida, predispõem a um risco aumentado de trombose durante a gestação e, principalmente, durante o puerpério. A compressão da veia cava inferior pelo útero diminui o retorno venoso e predispõe ao surgimento de varizes nos membros inferiores. &nbsp;  <!--[if gte mso 9]>     Normal   0         21         false   false   false      PT-BR   X-NONE   X-NONE                                                     MicrosoftInternetExplorer4                                                   <![endif]--><!--[if gte mso 9]>  <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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 <![endif]-->  Digestão  A fome, o apetite, a sede e a salivação aumentam durante a gestação. Pode haver perversão do apetite, que é a vontade de comer substâncias não convencionais como terra, giz, argila, carvão, etc. Por outro lado pode ocorrer aversão a certos alimentos. Os episódios de vômitos e os desejos de comer alimentos específicos podem estar relacionados às ações da gonadotrofina coriônica humana, produzida na placenta. Os efeitos relaxantes da progesterona sobre as fibras musculares lisas, presentes em todo o sistema gastrointestinal, determinam a predisposição da gestante a refluxo gastroesofágico e regurgitação, por diminuição da função do cárdia, sensação de plenitude gástrica e saciedade, por aumento do tempo de esvaziamento gástrico e da diminuição da contratilidade da vesícula biliar, e constipação intestinal e aparecimento de hemorróidas por diminuição dos movimentos peristáticos intestinais. &nbsp;  <!--[if gte mso 9]>     Normal   0         21         false   false   false      PT-BR   X-NONE   X-NONE                                                     MicrosoftInternetExplorer4                                                   <![endif]--><!--[if gte mso 9]>  <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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 <![endif]-->  Excreção urinária  Em decorrência do aumento do fluxo sanguíneo, há uma elevação da taxa de filtração glomerular e o aumento da função renal. O organismo passa a reter mais sódio e água, o que arredonda as formas corporais da gestante. A dilatação do sistema coletor urinário principalmente do lado direito, em decorrência da dextrorrotação uterina, mas também por relaxamento de fibras musculares lisas, induzido pela progesterona, predispõe à formação de cálculos renais e a infecções do trato urinário.  Respiração  O crescimento do útero em direção ao tórax e o aumento volumétrico do coração diminuem o volume pulmonar. Isto é parcialmente compensado pelo aumento do diâmetro da caixa torácica. Além disso, a progesterona atua nos centros respiratórios do bulbo raquidiano, elevando a freqüência respiratória, o que contribui para o aumento das trocas gasosas na placenta. Nas vias aéreas superiores pode haver rinite vasomotora com conseqüente obstrução nasal, devido à retenção hídrica e aumento do aporte sanguíneo nessa região.  Ossos e articulações  A mudança do eixo da coluna vertebral na gestação relaciona-se à acentuação da lordose lombar e à mudança do padrão de marcha materna, chamada de anserina por se assemelhar ao andar de um pato. Com a retenção hídrica, os ligamentos e as cartilagens tornam-se mais elásticos, o que prepara a pelve para o momento do parto, mas aumento o risco de luxações, entorses e fraturas em membros e outras regiões.  Alterações neuropsíquicas  Pode haver aumento da sonolência, dificuldade de concentração, labilidade emocional, ansiedade, insegurança e falta de libido. As alterações hormonais podem estar relacionadas com a origem dessas alterações. Desmaios podem ocorrer em virtude das alterações na distribuição sanguínea.