ANATOMICAL AND

PHYSIOLOGICAL CHANGES IN
NORMAL PREGNANCY

PRESENTED BY :
ANBU RAJ A/L KUMARAGURUBARAN (SUKD1600622)
ABDUL SALAM DOST (SUKD1901925)

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CONTENTS

Anatomical Changes in Normal Physiological Changes in Normal

Pregnancy Pregnancy

1. Changes in Reproductive Organs 1. Hormones

- Uterus 2. Skin changes
- Cervix 3. Cardiovascular changes
- Vagina 4. Haematological changes
1. Changes in Musculoskeletal 5. Respiratory changes
System 6. Gastrointestinal changes
2. Breast Changes 7. Endocrine changes
3. Respiratory Changes 8. Metabolic changes
4. Cardiovascular Changes
5. Changes in Weight
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ANATOMICAL CHANGES IN
NORMAL PREGNANCY

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INTRODUCTION

● The extensive metabolic demands of pregnancy require specific physiological and

anatomical changes.
● These changes affect almost all organ systems, including the cardiovascular,
respiratory, renal, gastrointestinal, and hematologic system.
● Early stages occur due to the metabolic demands of the foetus, placenta & uterus.
This includes the hormonal changes.
● Later changes occur due to the mechanical pressure from the growing foetus.

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 CHANGES IN REPRODUCTIVE ORGANS

Uterus

The uterus expands from a strictly pelvic organ before 12 weeks to become an abdominal organ
for the remainder of gestation.

● 6.5cm to 32cm in length.

● 2.5cm to 22cm in depth.
● 4.0cm to 24cm in width.
● Weighing from 60g to 1000g (20x its original weight).

The uterus expands to accommodate the fetus, placenta, umbilical cord & the amniotic fluids along
with the fetus membranes and increase in the size and number of blood vessels supplying the
uterus.

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The uterus shape changes from
elongated to oval by the 2nd month,
to round by midgestation, then back
through oval to elongated at term.

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 CERVIX
Position:

● Higher in the vagina

● Lower in the vagina (before menstruation)

Texture (in early pregnancy):

● If the woman has not conceived, the

cervix will feel firm to the touch, like

the tip of a nose.

● If she has conceived, the cervix will feel softer, more closely resembling the lips.

Discharge:

A mucus plug called “operculum” act as a seal for the uterus and protect it from ascending
infection, and act as a barrier between the vagina and cervix. 7
❏ Jacquemier’s sign: a purplish discoloration of the mucous membrane of
the vagina that occurs early in pregnancy (visible at 8th week). AKA
Chadwick’s sign.
❏ Goodell's sign: is an indication of pregnancy. It is a significant softening of
the vaginal portion of the cervix from increased vascularization.
❏ Hegar's sign: is a non-sensitive indication of pregnancy in women — its
absence does not exclude pregnancy. It is a softening in the consistency
of the uterus.
❏ If the cervix begins dilating prematurely, it is sometimes stitched together
during the 2nd trimester, until the fetus is mature. This procedure is
known as cerclage.

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Fig: A comparison between normal and pathologic cervical remodelling.
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CHANGES IN MUSCULOSKELETAL SYSTEM

Ligaments

● Placental production of the hormone relaxin causes pelvic ligaments and the
pubic symphysis to relax, widen, and become more flexible.
● This increased motility eases birth passage, but it may also result in a waddling
gait during pregnancy.

Lumbar region

● The expanding uterus causes a progressive lumbar lordosis.

● Lumbar lordosis leads to low back pain in 40 to 50 percent of all pregnant women.

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Centre of Gravity

The increasing bulkiness of the abdomen changes the woman's center of gravity
forward. This shift increases the stress on your joints and causes your back to curve
forward.

The change of the center of gravity location in late pregnancy is temporary and two
months after delivery the center of gravity is located as it was at the beginning of
pregnancy.

Postural Changes

● forward head,
● rounded shoulders,
● increased lumbar lordosis,
● center of gravity shift,
● hyperextended knees, and
● pronated feet.

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The natural tendency to anterior
displacement maybe
counterbalanced by correcting
the posture

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 BREAST CHANGES

● The breast increases in size due to the increase of estrogen dispositioning fat
around the glandular tissue & increasing the number of glandular ducts.
● The progesterone & human placental lactogen (hPL) also increases the number of
gland alveoli.
● Prolactin increases too but does not provide

lactation, yet.

● The nipples become larger, erectile & deeply

pigmented.

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RESPIRATORY CHANGES

❏ Elevated diaphragm for about 4 cm is a clinical presentation with pregnant women

because of the enlarged uterus.
❏ The thoracic circumference increases by 5 to 7 cm and the transverse diameter of
the chest by about 2 cm in response to the increased intraabdominal pressure.
❏ The subcostal angle progressively increases from 68 to 103 degrees in late gestation
due to relaxation of the ligamentous rib attachments, mediated by relaxin.
❏ The lungs are compressed due to growing uterus in later pregnancy making it more
difficult to breathe deeply.

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These changes compensate for
the 4-cm elevation of the
diaphragm so that the total lung
capacity is not significantly
reduced.

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 CARDIOVASCULAR CHANGES

❏ The heart is displaced more laterally and

to the upper left of the chest by the effect
of the progressively elevated diaphragm.
❏ The left ventricle muscle wall is enlarged
to accommodate the increase in blood
volume.

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 CHANGES IN WEIGHT

❏ In normal pregnancy the average gain is

● 0.3 kg/week up to 18 weeks,
● 0.45 kg/week from 18-28 weeks and
● a slight reduction with a rate of 0.36- 0.41 kg/week
until term.

❏ Slight weight loss may occur in the last 2 weeks. The

average weight gain for primigravidae is 12.5 kg and
is probably about 0.9 kg less for multigravidae.

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References

1. Kazma, J., van den Anker, J., Allegaert, K., Dallmann, A. and Ahmadzia, H., 2020. Anatomical and
physiological alterations of pregnancy. Journal of Pharmacokinetics and Pharmacodynamics, 47(4),
pp.271-285.
2. Nott, J., Bonney, E., Pickering, J. and Simpson, N., 2016. The structure and function of the cervix
during pregnancy. Translational Research in Anatomy, 2, pp.1-7.
3. Kenhub. 2022. Anatomical changes during pregnancy. [online] Available at:
<https://www.kenhub.com/en/library/anatomy/anatomical-changes-during-gestation> [Accessed
22 June 2022].
4. Medicalnewstoday.com. 2022. Cervix in early pregnancy: What changes to expect. [online] Available
at: <https://www.medicalnewstoday.com/articles/325544#cervix-changes> [Accessed 22 June
2022].
5. Clinical Gate. 2022. Respiratory system. [online] Available at: <https://clinicalgate.com/respiratory-
system-11/> [Accessed 22 June 2022].

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PHYSIOLOGICAL CHANGES IN
NORMAL PREGNANCY

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 PHYSIOLOGICAL CHANGES IN NORMAL PREGNANCY

● Changes that takes places in maternal

system in response to pregnancy

● Changes are due to alterations in

hormone production , circulation and
metabolism

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HORMONES

● Human Chorionic Gonadotropin

(hCG)

● Human Placental Lactogen (hPL)

● Progesterone

● Estrogen

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SKIN CHANGES

● Linea Nigra

● Striae gravidarum

● Spider angioma and palmar

erythema

● Chadwick sign

● Chloasma

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SKIN CHANGES

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CARDIOVASCULAR CHANGES

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CARDIOVASCULAR CHANGES

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HAEMATOLOGICAL CHANGES

● Red blood cell mass increases

● White blood cell count increases

● Erythrocycte sedimentation rate increases

● Platelet count

● Coagulation factors increases

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RESPIRATORY CHANGES

● Increase in minute ( or pulmonary )

ventilation

● Due to increase in tidal volume and

respiratory rate

● Blood gases

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RESPIRATORY CHANGES

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GASTROINTESTINAL CHANGES

● Gastric motility decreases

● Gastric emptying time increases

● Colonic motility decreases and transit

time increases

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URINARY SYSTEM CHANGES

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ENDOCRINE CHANGES

● Pituitary gland

● Thyroid gland

● Parathyroid gland

● Adrenal gland

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METABOLIC CHANGES

● Carbohydrate metabolism

● Protein metabolism

● Fat metabolism

● Iron metabolism

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 “ PREGNANCY IS A GREAT SACRIFICE AND A
WONDERFUL GIFT. WE SHOULD CELEBRATE THIS
PROCESS AND EMBRACE THE IMPERFECTIONS ”

~ THANK YOU ~

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REFERENCES

1. Lauralee Sherwood. Human Physiology: From Cells to Systems. 5th

EditionBrooks/Cole
2. Arthur C. Guyton, M.D. John E. Textbook of Medical Physiology, 11th edition
Arthur C. Guyton, M.D. John E. Hall.
3. Principles of Anatomy and Physiology, 13th Ed. 2011. Gerard J. Tortora. Wiley.
4. Fundamentals of Anatomy & Physiology 9th Ed. 2012. Frederic H Martini.
Pearson/Benjamin Cummings.
5. Human anatomy & physiology 8th ed. 2006, Elaine N. Marieb. Pearson/Benjamin
Cummings.

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