Physiological Change During

Pregnancy

dr.Rara
Resident of Obstetric and Gynecology
Medical Faculty of Sebelas Maret University
Dr. Moewardi Hospital Surakarta
2018
 Physiological Changes During Pregnancy
• Changes in the uterus
- Small, pear-shaped organ before pregnancy
- Grows to accommodate growing fetus,
placenta, amniotic sac, and amniotic fluid
during pregnancy

3
 Physiological Changes During Pregnancy

• Changes in the cervix

– Chadwick’s Sign
• Cervix and vagina take on a bluish-violet hue due
to local venous congestion
– Goodell’s Sign
• Cervix softens in consistency in preparation for
childbirth

4
 Physiological Changes During
Pregnancy
• Changes in the vagina
– Vagina takes on same bluish-violet hue of the
cervix during pregnancy
– Increase of glycogen in vaginal cells
• Causes increased vaginal discharge and heavy
shedding of vaginal cells
– Leukorrhea
• Thick, white vaginal discharge during
pregnancy

5
Physiological Change

Cardiovascular Respiratory

Hematology Renal
CARDIOVASCULAR SYSTEM
Cardiovascular system: Introduction
• Improves fetal oxygenation and
nutrition
• Heart is displaced upward and to the
left
• Apex is moved laterally
• Increase ventricular muscle mass and
sizes increase
 Cardiovascular system: Functional changes
• Marked increase in cardiac output (CO).
– Overall – Increases from 30% to 50%
– Half of the increment occur by 8 weeks of gestation
– Maximum reached between 20 and 24 weeks’ gestation –> maintained until
delivery
– Cause by
• Stroke volume
• Heart rate (↑10-18 bpm over the non-pregnant at term)
• Distribution of cardiac output
• First trimester - uterus receives about 2% of the cardiac output in the first
• At term – increasing to up to 20% at term
About one-fifth of the cardiac output goes through the uterus
at term increasing the risk from postpartum hemorrhage
substantially.
Cardiovascular system: Functional changes
• Systemic vascular resistance decreases during pregnancy - > decrease arterial blood
pressure
– Cause by
• Elevated progesterone.
• Increase production of vasodilatory substance -> PG, NO, ANP

Article · April 2014 · Journal of the American Heart Association

Cardiovascular system: Functional changes
• Blood pressure decrease ->Lowest at 24 weeks
• ↓ SBP of 5 - 10 mm Hg
• ↓ DBP of 10 - 15 mm Hg
• Gradually returns to non-pregnant values by
term.
RESPIRATORY SYSTEM
Respiratory System: Introduction
• Pregnancy is associated with an increase in total body oxygen consumption of
approximately 50 mL O2/minute, which is 20% greater than nonpregnant
levels.
• Increased oxygen demand of the mother and fetus.
– These changes are primarily mediated by progesterone.
• Diaphragm is elevated approximately 4 cm by late pregnancy due to the
enlarging uterus.
• Subcostal angle widens as the chest diameter and circumference
increase slightly
Respiratory System: Functional Changes
• Total body oxygen consumption is 20% greater than non-
pregnant levels.
– 50% of this increase is consumed by the gravid uterus and its
contents
– 30% by the heart and kidneys
– 18% by the respiratory muscles
– Remainder by the mammary tissues
Respiratory System: Symptoms
• Dyspnea
– A relative hyperventilation occurs in the
first trimester of pregnancy
– Pregnant women with normal respiratory
rates often complain of dyspnea.
Respiratory System: Diagnostic Tests
• ABG – Normally shows compensated
respiratory alkalosis.
• CXR - Prominent pulmonary vasculature due to
the increased circulating blood volume (if
performed)
RENAL SYSTEM
SISTEM PENCERNAAN
PROGESTERON PENURUNAN MOTILITAS
MENINGKAT USUS

SISA MAKANAN

GAS

MUAL, MUNTAH,
KEMBUNG
HEMATOLOGY SYSTEM
INTEGUMEN SYSTEM
 PROGESTERON

STRECTH
MSH
ABDOMINAL WALL

MELANOSIT SUBCUTANEUS
ELASTIC FIBER

PIGMENTATION
 Skeletal changes

• Increased lumbar
lordosis

• Relaxation of pelvic
joints and
ligaments due to
progesterone and
relaxin