Maternal

Physiology

By: Rachmad

Reproductive Tract

Breast

Skin

Metabolic Changes

Hematological changes

Cardiovascular System

Respiratory Tract

Urinary System

Gastrointestinal Tract

Endocrine System

Musculoskeletal System

Central Nervous System

Reproductive Tract
Uteru
s
Non Pregnant woman 70 gr with cavity
of 10 ml or less.
 Early in pregnancy estrogen and
perhaps progesterone.
 12 weeks the expanding products of
conception
 For the first few weeks pear shape.
And almost spherical by 12 weeks’gestation

Cervix
 1 month after conception softening and
cyanosis.
 By increased vascularity and edema of the entire
cervix, together with hypertrophy and hyperplasia of
the cervical glands.
 The endocervical mucosa cells produce copious
tenacious mucus immunoglobulins and
cytokines to protect the uterine contents against
infection.

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Ovaries  Ovulation ceases during pregnancy. and maturation of new follicles is suspended. .  The single corpus luteum found in pregnant women functions maximally during the first 6 to 7 weeks of pregnancy and thereafter contributes relatively little to progesterone production.

Fallopian Tubes  During pregnancy little hypertrophy. .

Vagina and Perineum  During pregnancy vascularity and hyperemia softening of the underlying abundant connective tissue. .  Increased vascularity prominently affects the vagina and results in the violet color characteristic of Chadwick sign.

 The vaginal walls undergo striking changes in preparation for the distention that accompanies labor and delivery. .  Increased volume of cervical secretions white discharge 3.5 to 6 lactic acid lactobacillus acidophilus.

Breasts  Early weeks of pregnancy tenderness and paresthesias. and more erectile. The nipples become considerably larger. and delicate veins become visible just beneath the skin.  Second month the breasts increase in size. .  Prepregnancy breast size and volume of milk production do not correlate. more deeply pigmented.

younger maternal age. and there are no definitive treatments. and family history. .  The etiology of striae gravidarum is unknown. Skin  Midpregnancy slightly depressed streaks commonly develop in the abdominal skin and sometimes in the skin over the breasts and thighs striae gravidarum or stretch marks  Risk factors weight gain during pregnancy.

 Hyperpigmentation a darker complexion  The midline of the anterior abdominal wall skin (linea alba) linea nigra.  Pigmentation of the areolae and genital skin may also be accentuated.  face and neck chloasma / melasma gravidarum mask of pregnancy. .

 levels of melanocyte-stimulating hormone are elevated remarkably through.out pregnancy. These pigmentary changes usually disappear after delivery.  Estrogen and progesterone also are reported to have melanocyte- stimulating effects. .

second. and 475 kcal/day during the first. Metabolic Changes  WHO 77. and third trimester. .  Increase weight during pregnancy the uterus and its contents.000 kcal or 85 kcal/day. the breasts. and increases in blood volume and extravascular extracellular fluid. 285 kcal/day.

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 Hytten reported that the average weight gain during pregnancy is approximately 12.5 kg or 27.5 lb .  Increased water retention physiological  By a fall in plasma osmolality of approximately 10 mOsm/kg induced by a resetting of osmotic thresholds for thirst and vasopressin secretion .

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the water content of the fetus.  Another 3.5 L.0 L accumulates from increases in maternal blood volume and in the size of the uterus and breasts. and amnionic fluid approximates 3. placenta. . At term.5 L.  the average woman accrues during normal pregnancy is approximately 6.

 This fluid accumulation. is caused by increased venous pressure below the level of the uterus as a consequence of partial vena cava occlusion. especially at the end of the day. . which may amount to a liter or so. pitting edema of the ankles and legs is seen in most pregnant women.

. the uterus. The products of conception.  At term. the fetus and placenta together 4 kg and contain approximately 500 g of protein or about half of the total pregnancy increase. and maternal blood are relatively rich in protein rather than fat or carbohydrate.

 The remaining 500 g is added to the uterus as contractile protein. . and to maternal blood as hemoglobin and plasma proteins. to the breasts primarily in the glands.

postprandial hyperglycemia. and hyperinsulinemia. Normal pregnancy is characterized by mild fasting hypoglycemia.  Response is consistent with a pregnancy induced state of peripheral insulin resistance. .  The mechanism(s) responsible for insulin resistance is not completely understood.

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 Enhanced lipolytic activity. 136± 33 mg/dL. HDL-C. and triglyceride levels are approximately 267 ± 30 mg/dL. average total serum cholesterol. and decreased lipoprotein lipase activity. 81 ± 17 mg/dL. and 245± 73 mg/ dL. and apolipoproteins in plasma increase. LDL.  During the third trimester. . lipoproteins. The concentrations of lipids.C.

nearly 1000 mEq of sodium and 300 mEq of potassium tubular resorption. a consequent decrease in the amount of circulating protein.bound nonionized calcium.  Total serum calcium levels lowered plasma albumin concentrations and. During normal pregnancy. in turn. .

Hematological changes  Hypervolemia 40 to 45 % after 32 to 34 weeks.  Provides abundant nutrients and elements to support the rapidly growing placenta and fetus. .  The metabolic demands of the enlarged uterus and its greatly hypertrophied vascular system.

 Safeguards the mother against the adverse effects of parturition-associated blood loss. and in turn the fetus. . Protects the mother. against the deleterious effects of impaired venous return in the supine and erect positions.

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0 g/dL abnormal iron deficiency rather than hypervolemia. hemoglobin and hematocrit decrease.  Average 14.000/µL or more.  Hemoglobin  12.  Leukosit  25. Because of great plasma augmentation.000 to 16.000/µL  unknown .5 g/dL  HB 11.

000/µL.  Decreased platelet concentrations are partially due to hemodilutional effects. Platelet  213. .

. Cardiovascular System  Changes in cardiac function  the first 8 weeks of pregnancy.  Cardiac output is increased  the fifth week and reflects a reduced systemic vascular resistance and an increased heart rate.

 Supine compression of the great vessels by the uterus causes significant arterial hypotension supine hypotensive syndrome  Uterine arterial is significantly lower than that in the brachial artery. . The heart  left and upward and is rotated on its long axis.

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 increased tidal volume that lowers the blood Pco2. . which should not interfere with normal physical activity. Respiratory Tract  The diaphragm rises about 4 cm during pregnancy.  This physiological dyspnea.

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 GFR and renal plasma flow increase early in pregnancy  increases 25 % (second week after conception) and 50 % (the second trimester). Urinary System  Kidney size increases approximately 1. .5 cm.

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.9 mg/dL  underlying renal disease  evaluation. Serum creatinine  decrease 0.  Values of 0.5 mg/dL.7 to 0.

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it may reach the right flank. . at times.Gastrointestinal Tract  As pregnancy progresses  the stomach and intestines are displaced by the enlarging uterus.  The appendix  displaced upward and somewhat laterally as the uterus enlarges.

. Hemorrhoids  common  constipation and elevated pressure in veins below the level of the enlarged uterus.

Endocrine System  Pituitary enlargement is primarily caused by estrogen-stimulated hypertrophy and hyperplasia of the lactotrophs .

 the thyroid gland to increase production of thyroid hormones by 40 to 100 percent to meet maternal and fetal needs  caused by glandular hyperplasia and increased vascularity. .

.  Compensating for the anterior position of the enlarging uterus  shifts the center of gravity back over the lower extremities.Musculoskeletal System  Lordosis  normal .

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concentration.Central Nervous System  Reportedproblems with attention. . and memory .

 Intraocular pressure decreases during pregnancy  Corneal sensitivity is decreased  Increase in corneal thickness .

frequent awakenings. fewer hours of night sleep. women have difficulty with going to sleep. Beginning as early as approximately 12 weeks’ gestation and extending through the first 2 months postpartum. and reduced sleep efficiency .