PHYSIOLOGIC CHANGES ACCDG TO LOCATION

1. Uterus
o Increase growth
✔ Length – 6.5 to 32 cm
✔ Depth – 2.5 to 22 cm
✔ Width – 4 to 24 cm
✔ Weight – 50 to 1000g
o Formation of uterine muscles fibers
o Stretching of existing muscle fibers
o Growth – steady, constant and predictable
o 12th week – above symphysis pubis
o 16th week – midway between umbilicus and symphysis pubis
o 20-22nd week – level of umbilicus
o 36th week – xiphoid process
o Hegar’s sign (6 weeks)
o Braxton-Hicks contractions (begins at 12wks, occurs without cervical
changes)
o Ballottment (16-20weeks)
2. Cervix
o Cervix becomes vascular and edematous (estrogen)
o Increased fluids between cells leads to Goodell’s sign
o “Nose” consistency – non pregnant
o “Earlobe” consistency – pregnant
o Increased vascularity – pink to violet hue of the cervix
o Increased mucus production – Operculum
✔ This prevents infection in fetus and membrane
3. Vagina
o Hypertrophic and enriched with glycogen
o Loosen connective tissues in preparation for distention at birth
o Increased vascularity (Chadwick’s sign)
o Leukorrhea – increased white vaginal discharge
o pH – from 7 to 4 or 5 (Lactobacillus acidophilus)
o Candida albicans – fungi; Candidiasis or Moniliasis
o Manifestations – itching, burning, cream-cheese like discharge
o Management - Nystatin
4. Ovary
o Ovulation stops (estrogen & progesterone)
o Amenorrhea
5. Breast
o Increased breast stimulation due to estrogen
o Fullness, tingling, or tenderness
o Hyperplasia of mammary alevoli and fat deposits
o Breast size increases
o Areola – darkens; increases in diameter (2-3 inches)
 o Montgomery’s tubercles enlarge, become protuberant and produce
secretions (prevents dryness)
o Blue veins become prominent over the surface
o Colostrum – expelled by 16th week
6. Integumentary system
o Activation of melanocyte -stimulating hormone by the pituitary gland
o Striae gravidarum – pink or reddish streaks on abdominal wall
o Linea nigra – narrow brown line running from umbilicus to the symphysis
pubis
o Melasma /Chloasma – “mask of pregnancy”; darkened areas on the cheeks
and across the nose
o Vascular spiders at thighs (estrogen) - small, fiery-red branching spots
o Palmar erythema – redness and itchiness (estrogen)
o Increased perspiration by the increased activity of sweat glands
o Increased scalp hair growth
7. Respiratory system
o Congestion or stuffiness of nasopharynx
o Shortness of breath – late pregnancy due to displacement of the lungs by 4
cm upward
o Mild hyperventilation – progesterone decreased levels of PCO2 at
27-32mmHg (more of fetal C02 than maternal)
o 40% increased in total ventilation capacity
o Chronic respiratory alkalosis fully compensated by a chronic metabolic
acidosis (plasma bicarbonate in urine is excreted by the kidneys with
excretion of additional sodium and water)
o Polyuria – increased urination
o Unchanged vital capacity (maximum volume exhaled after maximum
inspiration)
o 20% decreased residual volume (amount of air remaining after expiration)
o 30-40% increased tidal volume (amount of air expired)
o 20% increased total oxygen consumption
o RR increased at 1-2 /minute
o From 94 mmHg to 104 -108mmHg increased PO2
8. Temperature
o Increases slightly due to progesterone (CL) then decreases back to normal
after 16 weeks
9. Cardiovascular system
o Blood volume is increase by 30-50% by 1st trimester to 28-32nd week
o Plasma volume : 3,600ml
o Blood volume: 5,250ml
o RBC mass: 4,650,000mm3
o Leukocytes: 20,500mm3
o Fibrinogen : 450mg/dl or increased at 50%
o Normal blood loss (300-500ml NSD;800-1000ml CS)
o Pseudoanemia – faster increase of plasma volume than RBC production (2nd
trimester : RBC increases)
o Decreased Iron
 o Fetal iron requirements about 350-400mg of RBC
o Increased maternal RBC from 500 to 800mg
o Decreased iron absorption due to decreased gastric acidity in
pregnancy
o Anemia – hgb is less than 11.5g/100ml; hct is less than 30%
o Increased need for folic acid
o * Megalohemoglobinemia
o large nonfunctioning RBC
o Increased risk for neural tube defects
o * Diet: Spinach, asparagus, legumes
o * Prenatal vitamins
o Heart
✔ 25-50% increased cardiac output
✔ increased blood volume increased cardiac workload
✔ Heart is shifted to a more transverse position
✔ presence of functional heart murmurs
✔ Palpitations are common due to sympathetic NS stimulation (early
pregnancy) and thoracic pressure of the uterus against the diaphragm
(late pregnancy)
✔ HR increased at 10bpm (80-90%)
o BP:
✔ 1st trimester – no change
✔ 2nd trimester – slight decrease
✔ 3rd trimester – return to pre-pregnancy level
o Decreased venous return due to pressure of expanding uterus on blood
vessels
o Leads to edema and varicosities of the vulva, rectum and legs
o Hemorrhoids
o Varicose Veins
o Supine hypotension syndrome
✔ Pressure on the inferior vena cava
✔ Can cause fetal hypoxia
✔ Lightheadedness, faintness, palpitations
✔ Turn to left side
o Blood Constitution:
✔ RBC – 4,200,000 to 4,650,000 mm3
✔ Leukocytes – 7,000 to 20,500 mm3
✔ Fibrinogen, factor VII, VIII, IX, X and platelet increases 50%
✔ Total protein level – decreases
✔ Blood lipids – increase by 1/3
✔ Cholesterol – increase by 90% to 100%
10. Gastrointestinal system
o Pressure of the uterus:
o slow peristalsis
o Decreased emptying time of the stomach
o heartburn (reflux of GI contents due to relax cardiac sphincter by relaxin)
o constipation
 o flatulence
o hemorrhoids
o Relaxin produced by the ovary decreases gastric motility together with
progesterone
o Nausea and vomiting (increased estrogen and decreased glucose levels)
relieved after 3 months
o Decreased gastric motility 🠖Decreased emptying of bile 🠖 absorption of
bilirubin to maternal blood 🠖 generalized itching and subclinical jaundice
o Increased plasma cholesterol and bile 🠖 stone formation
o Hypertrophy of the gum lines – gingival bleeding
o Hyperptyalism – increased saliva formation
o Low pH of saliva lead to tooth decay
o Weight gain pattern:
✔ First trimester – 1.5-3 lbs (.5-1lb/month)
✔ Second trimester – 10-12 lbs (1lb/week)
✔ Third trimester – 10-12 lbs (1lb/week)
✔ Minimum wt gain – 20-25 lb
✔ Optimal wt gain – 25-35 lbs
o Metabolic changes
✔ 24-28 lbs/ 11-12 kgs weight gain
✔ 3,400gm fetus
✔ 450gm placenta
✔ 900gm amniotic fluid
✔ 1 gm uterus
✔ 1400gm breast
✔ 1800gm blood volume
✔ 1800-3600gms maternal stores
✔ Retains 6.5 L extra water
✔ Fetus, uterus and maternal blood rich in CHON
✔ May initiate DM or aggravate DM
✔ Fats are more absorbed during pregnancy
✔ Plasma lipid levels increased during second half
✔ Iron requirements increased to 20-40mg daily
✔ * 2nd half – iron transfer to fetus (fetal liver)
11. Urinary system
o Effects of high estrogen and progesterone
o Compression of the bladder and ureters
o Increased blood volume
o Postural influences
o Increased total body water by 7.5 L
o Increased sodium reabsorption
o Progesterone
o potassium-sparing 🠖 maintains potassium level
o increased response of angiotensin-renin system 🠖 increased aldosterone
production which aids in reabsorption of sodium
o Increased size of the kidneys
o Increased urine output 60 to 80%
 o Decreased specific gravity
o Increased GFR and renal plasma flow by 30 to 50% (2nd trimester)
o Increased GFR 🠖 Low BUN (15mg/100ml) and low Creatinine (1mg/100mL)
o Creatinine level : 90-180ml/min (24hr urine sample)
o Traces of glucose in urine – lactose from the mammary glands spilled into
urine
o Frequency of urination
o Increased in 1st trimester last 2 weeks of pregnancy ( 10-12 times / day)
o Progesterone effect causes:
o Bladder capacity increased by 1,000-1,500ml
o Diameter of ureter increased by 25%
o Displacement of uterus at the right side 🠖pressure on right ureter 🠖 urinary
stasis and pyelonephritis
o Pressure on urethra 🠖 poor bladder emptying 🠖UTI – preterm labor
12. Skeletal system
o Increased calcium and phosphorus 🠖 fetal skeleton
o Relaxin and Progesterone 🠖 softening of pelvic ligaments (birth
preparation)
o Waddling gait
o Walks with difficulty (wide separation of symphysis pubis by 3-4mm
by 32nd week)
o Lordosis (“pride of pregnancy”)
✔ to change center of gravity
✔ makes ambulation easier
✔ may also lead to backache
13. Endocrine system
o Placenta – additional endocrine organ
o Pituitary gland
✔ FSH and LH production halted
✔ Increased growth hormone and melanocyte-stimulating hormone
✔ Oxytocin by PPG (late in pregnancy)
✔ Prolactin late in pregnancy
o Thyroid gland
✔ enlarges as BMR increases by 20%
✔ Insufficient iodine 🠖 thyroid hypertrophy (goiter)
o Parathyroid:
✔ Necessary for the metabolism of calcium
o Adrenal gland:
✔ Increased level of corticosteroids
✔ Suppress inflammatory reaction
✔ Reduce the possibility of rejection
✔ Regulate glucose metabolism
✔ Increased aldosterone
✔ Aid in sodium reabsorption
✔ Maintain osmolarity
o Pancreas:
 ✔ Increase production of insulin due to increased glucocorticoids
production by adrenals
✔ Progesterone, estrogen and HPL are antagonists to insulin
✔ Increase insulin intake by diabetics
✔ To avoid hypoglycemia:
✔ high caloric diet
✔ never go 12 hours between meals
14. Immune system
o Decreased immunologic competency
o Decreased IgG production 🠖 susceptibility to infection 🠖 counteracts by
increase in WBC
o No to live vaccines to increase immunity
o Decreased immunologic competency
o Decreased IgG production 🠖 susceptibility to infection 🠖 counteracts by
increase in WBC
o No to live vaccines to increase immunity