By: Rachmad

Reproductive Tract



Metabolic Changes

Hematological changes

Cardiovascular System

Respiratory Tract

Urinary System

Gastrointestinal Tract

Endocrine System

Musculoskeletal System

Central Nervous System

Reproductive Tract
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
 For the first few weeks pear shape.
And almost spherical by 12 weeks’gestation

 1 month after conception softening and
 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


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.


 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 .


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.


 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.


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.


 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.



 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.


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


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 .


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 .