ANATOMY AND PHYSIOLOGY

Physiological Changes of Pregnancy

During pregnancy, there is an increase happened in the blood supply to the

vagina, that is why there’s changes of color from pink to purple, and it becomes

more elastic during second trimester until the end of trimester. In addition, Once

the mother given a birth, typically the color and the size will return as blood flow

goes back to normal. According to Hickman (2021), the hormonal and physical

changes that happen during pregnancy and childbirth it can cause the vagina and

labia to change. Moreover, it is recommended to have a Kegel’s exercise before and

after birth it can help your labor and delivery go smoother and prevent pelvic floor

problems.

Figure 1. Changes in Pregnancy

Vagina changes during the pregnancy:

a. Swelling- The labia majora and minora may increase slightly in size and

look puffy or swollen for the duration of the pregnancy.

b. Discoloration- The color of the skin on both inner and outer labia may
temporarily

darken to a bluish or purplish color due to increased blood flow.

c. Labia shape- Sometimes the outer lips may slightly retract, which can

make the inner lips look bigger or expose them for the first time.

d. Varicose veins. -Varicose veins are common during pregnancy,

including the vulva (or external genitalia).

e. Infections- Hormonal changes can increase the risk of yeast infections

during pregnancy and the corresponding itchiness and discomfort.

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f. Increased discharge- Extra discharge during pregnancy helps to maintain

a healthy balance of bacteria in the vagina. Discharge should be thin,

milky and mild- smelling. If it’s lumpy, thick or accompanied by other

symptoms (like itchiness or a fishy odor), let your doctor know.

g. Spotting- Light spotting during pregnancy is relatively common and

usually benign.

Vaginal changes due to childbirth:

a. Stretches and Tears-You may experience tears to the vagina during

labor and delivery, and the labia minora (but not majora) can sometimes

slightly stretch or tear. Tears to your vagina and labia will usually heal
 within seven to 10 days.

b. Soreness- The amount of postpartum perineal pain you’ll experience

depends on how you delivered and whether you had any tears. Vaginal

and labial soreness should resolve within a few weeks.

Anatomical Changes of Uterus & Fetal Changes

Women that are pregnant undergo serious anatomical and physiological

changes. It helps their body to cope with the increased physical and metabolic

demands of their pregnancies. The body systems such as, cardiovascular,

respiratory, hematological, renal, gastrointestinal and endocrine, all undergo

important physiological alterations and adaptations. It is a need so that to allow

development of the fetus and to allow the mother and fetus to survive the

demands of childbirth (Tan & Tan, 2018).

Figure 2. Uterus During Pregnancy

Uterus
 Uterus, is also known as womb, an inverted pear-shaped muscular organ of

the female reproductive system, that located between the bladder and the rectum.

Typically, uterus has a multiple role which is to nourish the fetus and house a

fertilized egg until the fetus, is ready to be delivered and after the pregnancy, the

uterus shrinks down to almost its normal size. Furthermore, the shaped that

formed like an inverted pear, the uterus sits behind the bladder and in front of the

rectum. It has four main section discussed below in accordance to the study that

conducted (Whitlock, 2020).

a. Fundus- The broad curved area at the top and widest portion of the organ

that connects to the fallopian tubes.(Whitlock,2020) • .

b. Corpus-The main part of uterus that starts directly below the level of

fallopian tubes and continues downward, becoming increasingly narrower.

c. Isthmus-The lower narrow part of the uterus.

d. Cervix-The lowest two inches of the uterus. Tubular in shape, the cervix

opens into the vagina and dilates (widens) to allow

Three distinct layers of tissue these are the following:

a. Perimetrium- It is the outer layer of the tissue that was made of epithelial
cells.

b. Myometrium –It is the middle layer of smooth muscle tissue.

c. Endometrium –It is the the inner lining that builds up. over the course of

month and shed if pregnancy does not occur.

 Figure 2. Anatomy of Uterus

According to Patil et. al (2020), after conception the uterus immediately

provides a nutritive and protective environment after conception that helps the

fetus to grow and develops. In non-pregnant state it increases from the size of a

small pear to accommodate a full-term baby at 40 weeks gestation. The tissues

from which the uterus is produced continue to develop for the first 20 weeks, and

it increases in weight from about 50 to 1,000 gm (grams) does not get any heavier

after this time, but extends to accommodate the growing baby, placenta, and

amniotic fluid. The uterus will have grown to about five times its normal size. The

time pregnancy is complete, the uterus has approximately height from

7.5 to 30 cm (top to bottom), width from 5 to 23 cm (side to side) and 2.5 to 20

cm in depth (front to back).

Figure 2. Uterus changes of size

Anatomical Changes & Physiology of Placenta

Placenta

The placenta is a unique fetal organ that performs a number of physiologic

functions. Paramount is the placenta's interrelationship between the mother and

fetus in the delivery of oxygen and nutrients and in the removal of waste. The

health and growth of the fetus are dependent on this complex interaction

(Mcnanley, 2008).

Chorion

The chorion forms the placenta and consists of the syncytiotrophoblast,

cytotrophoblast, and extraembryonic mesoderm. The cytotrophoblast grows into

the syncytiotrophoblast as finger-like projections, which are called the primary

chorionic villi (Guttmacher, 2014).

Amniotic sac

Commonly called the bag of waters, sometimes the membranes, is the sac

in which the fetus develops in amniotes. It is a thin but tough transparent pair of

membranes that hold a developing embryo (and later fetus) until shortly before

birth (Guttmacher, 2014).

 Figure 3. Labeled Parts

PRE-ECLAMPSIA DO DURING PREGNANCY

Preeclampsia is a pregnancy complication characterized by high blood pressure and signs of

damage to another organ system, most often the liver and kidneys. Preeclampsia usually
begins after 20 weeks of pregnancy in women whose blood pressure had been normal.

Left untreated, preeclampsia can lead to serious — even fatal — complications for both you
and your baby. If you have preeclampsia, the most effective treatment is delivery of your
baby. Even after delivering the baby, it can still take a while for you to get better. If you're
diagnosed with preeclampsia too early in your pregnancy to deliver your baby, you and
your doctor face a challenging task. Your baby needs more time to mature, but you need to
avoid putting yourself or your baby at risk of serious complications.

Symptoms

Preeclampsia sometimes develops without any symptoms. High blood pressure may
develop slowly, or it may have a sudden onset. Monitoring your blood pressure is an
important part of prenatal care because the first sign of preeclampsia is commonly a rise in
blood pressure. Blood pressure that exceeds 140/90 millimeters of mercury (mm Hg) or
greater documented on two occasions, at least four hours apart is abnormal.
 Figure 4. Signs and Symptoms of Preeclampsia

Causes

The exact cause of preeclampsia involves several factors. Experts believe it begins
in the placenta the organ that nourishes the fetus throughout pregnancy. Early in pregnancy,
new blood vessels develop and evolve to efficiently send blood to the placenta. In women
with preeclampsia, these blood vessels don't seem to develop or function properly. They're
narrower than normal blood vessels and react differently to hormonal signalling, which
limits the amount of blood that can flow through them. Causes of this abnormal
development may include: Insufficient blood flow to the uterus, Damage to the blood
vessels, A problem with the immune system, and Certain genes

Other High Blood Pressure Disorders during Pregnancy

Preeclampsia is classified as one of four high blood pressure disorders that can occur during
pregnancy. The other three are:
Gestational hypertension. Women with gestational hypertension have high blood pressure
but no excess protein in their urine or other signs of organ damage. Some women with
gestational hypertension eventually develop preeclampsia.

Chronic hypertension. Chronic hypertension is high blood pressure that was present
before pregnancy or that occurs before 20 weeks of pregnancy. But because high blood
pressure usually doesn't have symptoms, it may be hard to determine when it began.

Chronic hypertension with superimposed preeclampsia. This condition occurs in

women who have been diagnosed with chronic high blood pressure before pregnancy, but
then develop worsening high blood pressure and protein in the urine or other health
complications during pregnancy.