Physiological changes in pregnancy

Skin changes
• Striae gravidarum
• Spider angiomata
• Palmar erythema
• Chadwick sign (is a bluish discoloration of the cervix, vagina, and labia resulting
from increased blood flow)
• Linea nigra
• Cholasma
• Hyperpigmentation
• Hegar sign (softening of the junction between the corpus and cervix)
• Hair growth ( mainly on abdomen and face)

Cardiovascular changes

Vascular:
•  Tone, resistance
• Vasorelaxation
 SBP
•  Arterial BP (
 DBP
↔Venous BP
 femoral BP

Cardiac:
• Systolic murmurs
• Increase rate 20%
• Increase output 50%
• Left axis deviation

Dr Sara Otoum
 • Increase stroke volume

Hematological changes
• Blood volume  (volume 50% > RBC's 25%)
• RBC's 25%
• WBC's  (but still within normal range)
• MCV 
• TIBC , iron ferritin 
• All clotting factors increase
(factor 5 – 7 – 8 – 9 – 12 ) + VwF
except ( factor 11 – 13)
• Fibrinogen 
Fibrinolytic 
• Protein S 
• Plt unchanged
• ESR increase (due to increase in gamma globulin)

Gastrointestinal changes
•  motility → leading to increase emptying timed and stasis
→ and lead to over absorption of fluids so constipation
• Relaxation of lower esophageal sphincter
• Nausea and vomiting (related to HCG level)
•  Binding globulins
• Biliary stasis & stone formation
•  LDH
•  ALP
•  creatinine phosphokinase (CPK)

Respiratory changes

Minute ventilation = RR * TV
Dr Sara Otoum
 • Tidal volume increase 40%
• All other volumes decrease
• Minute ventilation increase 40% (hyperventilation)
• RR ↔
• Vital capacity 
• Residual volume  20% (due to compression by gravid uterus)

• Blood gases:
- Respiratory alkalosis (compensated)
- PCO₂ 
- PO₂ 
- PH 
- Renal loss of bicarbonate as compensation

Renal changes
• Kidney size 
• Ureters dilated
• GFR  50%
• GFR – Renal plasma flow – Creatinine Clearance : all  50%
• BUN, Creatinine, uric acid : all  25%
• Glucoseurea: normally increase
• Proteinurea not seen
•  Aldosterone
• Albumin  (dilutional), so the Calcium decrease
• Renal stasis

Endocrine changes
• Pituitary size increase 100%
• Adrenal size unchanged
• Cortisol 
• Thyroid size increase 15%
• Thyroid binding globulin
Dr Sara Otoum
 • Total T₃ / T₄ increase
• Free T₃ / T₄ unchanged
• TSH 

Others
• Joint laxity
• Lumber lordosis
• Cell-mediated immunity decrease

Dr Sara Otoum