Physiological Changes in

Pregnancy
Terminolgy
Gestation- pregnancy or maternal condition of
having a fetus in the body
Embryo- human conceptus up to 10th week of
gestation
Fetus- human conceptus from the 10 th week of
gestation until delivery
Viability – capacity of livingusually accepeted as
24th week of gestation
Gravida- woman who is or has been pregnant
regardless of pregnancy outcome
Nulli gravida- women who is not now or never has been
pregnant
Primigravida- women pregnant for the first time
Multi gravida- women who has been pregnant more than
once
Para- refers to the past pregnancy that has reached
viability
Nulli para- women who has never completed the
pregnancy to the period of viability
Living children- refers to the number of children a
women has delivered who are living
PRESUMPTIVE SIGNS OF PREGNANCY

Amenorrhea
Nausea and vomiting
Excessive fatigue
Urinary frequency
Breast changes
Quickening or fluttering movement
OBJECTIVE CHANGES IN PREGNANCY

Changes in pelvic organs

Goodell’s and Chadwick’s sign
Hegar’s sign
Fundus palpable above symphysis pubis at
10-12 weeks and at the umbilicus at 20
weeks
OBJECTIVE CHANGES IN PREGNANCY

Braxton Hicks contractions

Uterine souffle
Fetal outline
Positive Pregnancy test
Urine
Serum
Over the counter
 DIAGNOSTIC SIGNS OF
PREGNANCY

Fetal Heartbeat

Fetal movement felt

Visualization by ultrasound
 Introduction
Changes are anatomical, physiological and
biomechanical

Early changes
metabolic demands
hormones

Late changes
mechanical pressure
Anatomical changes in pregnancy
Changes in the Reproductive organs
- Uterus
Uterus
By the end of pregnancy the uterus has achieved a
capacity that is 500 to 1000 times greater than in
non pregnant

1/6 OF TOTAL MATERNAL BLOOD VOLUME IS

CONTAINED IN UTERUS AT END OF PREGNANCY
 Uterus contd
Enlargement – stretching and hypertrophy of the
muscles due to the increased level of estrogen and
progesteron
Changes in the uterine shape- uterus changes to
globular he growing uterus accommodate

By 12th week of pregnancy the uterus rises to the

pelvis and become upright.it is about the size of
grape fruit and may palpated in the abdominally
above the symphysis pubis.
16th week- globular in shape,put pressure on the
isthmus
20th week- spherical in shape, the fundus of the
uterus palpated just below the umbilicus
30th week- lower uterne segment identifies,
uterus can be plapated in the midway between the
umbilicus and the xiphisternum.
38th week- uterus reaches at the level of
xiphisternum
Blood supply
Bloodvessels- increases in diameter aand new
vessels forms under the influence of estrogen
Blood supply increases to about 750ml per minute
at term
MYOMETRIUM-

HYPERTROPHY AND HYPERPLASIA- EFFECT OF

ESTROGEN AND PROGESTERON
BRAXTON HICKS CONTRACTION – Through out
the pregnancy the uterus generates small waves
of irregular and usually painless contractility
known as Braxton hicks contraction
A reduction in the fundal height because of the
engagement of fetus and softening of the tissues
of the pelvic floor known as lightening

DECIDUA
The decidua is the name given to the endometrium
during pregnancy. Estrogen and progesteron
produced by the corpus leuteum causes the
decidua to become thicker, richer and more
vascularwhich is the usual site for implantation
 Changes in the Reproductive organs
contd
 Cervix - softening (Goodell’s sign)
 thickened mucous plug called operculum which provides
protection from ascending infecti
 increased vascularity
 edema of the entire cervix
 Bluish discolouration (Chadick’s sign)
Ovaries - Ovulation ceases
progesterone production
Changes in the Reproductive organs
contd
Vagina/perineum
 hyperemia
 violet color
 thickness of the mucosa loosening of connective
tissue, hypertrophy of smooth muscle
white discharge ( leukorrhea) – the epithelium
becomes thicker with marked desquamation of the
superficial cells , which increases the amount of normal
vaginal white discharge
Skin - effect of melanin
stimulating hormone from the
pituitary
chloasma /melasma gravidarum

“mask of pregnancy”
The irregular brownish
discolouration of the
forehead, nose, cheeks
and neck usually
develops in the second
half of the pregnancy
Linea nigra
A narrow line of dark skin
pigmentation appears in
the midline of the abdomen
from the symphysis pubis
to the umbilicus called as
linea nigra.
Striae gravidarum
Reddish slightly depressed
streaks in the skin of the
abdomen and occassionally
over the breast and thighs
 Skin contd
VASCULAR CHANGES
1. Vascular Angiomas-
minute red elevations
2. Palmar erythema
BREAST CHANGES
Tenderness and tingling
Increase in the size
Veins become more prominent
Nipples become larger,more deeply pigmented and
more erectile
Secretion of colustrum
Areola become broader and more deeply pigmented
Montgomery tubercle- hypertrophic sebaceous
glands
METABOLIC CHANGES
WEIGHT GAIN - 12.5 kg
uterus, 1 kg
amniotic fluid, 1 kg
fetus and placenta, 4 kg
blood volume 2 kg
interstitial fluid 2 kg each
deposition of new fat/protein 4 kg

First trimester - 1 to 2 kg
Second and third - 5 to 6 kg
 Cardiovascular System
To meet the increased
metabolic demands of the
Blood Volume mother and fetus
Blood Constituents

Cardiac Output Cardiac Size/Position/ECG

Blood Pressure
Aortocaval Compression
Clinical Implications
 Blood Volume
from 6-8 weeks gestation (pregnancy)
maximum at approximately 32-34 wk PHYSIOLOGICA
L
plasma volume expansion (40-50%) ANEMIA OF
red cell mass (20-30%) PREGNANCY

hemodilution and a decrease in hb conc

supplemental
iron and
folic acid
 Blood Volume contd
The increased blood volume serves two purposes
facilitates maternal and fetal exchanges of
respiratory gases,
nutrients and
metabolites

reduces the impact of maternal blood loss at

delivery – “autotransfusion”
 Blood Constituents
red cell mass is increased 20-30%
Fibrinogen- increase markedly
Factors VII, X and XII - increased
number of platelets – increased
hypercoagulable state

these changes tend to prevent

excessive bleeding at delivery
 Cardiac Output
d y n a m ic
hype r
first trimester - 30-40% l a t ion
cir c u
Second/ third trimester 50%
After delivery 80%
Returns to pre pregnant levels after 1- 2 week
increase in stroke volume (35%)
heart rate (15%)
reduction in syst vascular resistance (SVR)
Increase in aortic compliance
 Aortocaval Compression
Supine Hypotension Syndrome

Inferior vena cava and the lower aorta gets compressed

because of growing uterus in supine position from 20
weeks

Cuase fall in cardiac output (24%)  signs of shock

(hypotension, pallor, vomiting, sweating, nausea, vomiting,
disorientation)

Obstruction of the lower aorta - diminished blood flow to

kidneys, uteroplacental unit and lower extremities
 Respiratory Tract
Hormonal changes - capillary engorgement and swelling
of the mucosa
Symptoms of nasal congestion, voice change and upper
respiratory tract infection
Airway resistance is reduced –progesterone
 Ventilation/ Respiratory Gases

40% rise in tidal volume

15% rise in respiratory rate
PaCO2 - 32 mmHg
PaO2 - 105 mmHg
 compensatory decreases in serum bicarbonate
Oxygen consumption increases in response to the
needs of the growing fetus -20%
 Gastrointestinal System

Mechanical Changes- smoothening of cardiac

sphincter causes oesophageal reflux and heart burn
Raised risk of aspiration due to an increase of
oesophageal reflux and decreased pH of gastric
contents.
Gums become edematous and hyperemic( epulis of
pregnancy)
Tone and motility decreases- constipation due to the
effect of progesterone
GASTROINTESTINAL SYSTEM

Nausea and vomiting

Increase saliva
Bloating and constipation
Heartburn
Hemorrhoids
Constipation
Renal
 RPF and GFR increases
Ureters dilated and elongated because of
mechanical pressure and effect of progesteron
Aldosterone increases- salt and water retention
sr creat decreases
Glycosuria is evident because of increased GFR1-
10 g/d
Proteinuria upto 300 mg/d
 Endocrine

Placental hormones- estrogen and

progesterone,responsible for breastt changes, skin
changes and uterine enlargement
Human chorionic gonadotropin- basis for
immunologic pregnancy test
Human placental lactogen- for lactation
Pituitary hormones
FSH and LH Secretion is inhibited by palcental
estrogen and progesteron
posterior pitutary secretes oxytocin in low
frequency through out pregnancy and frequency
of pulse increases in labor
Thyroid hormone
Rising levels of T3and T4 contribute to the
increased metabolic rate
Adrenal glands
Adrenal gland is stimulated by estrogen to produce
cortisol and other corticosteroids including ACTH
Raised level of cortisol have an antagonist action to
insulin , thus more glucose made availsble to the fetus
by raising he level of glucose in the blood.
Increase in the level of renin by adrenal cotex- renin
angiotensin system – regulates blood pressure
MUSCULOSKELETAL

Joints of pelvis relax due to hormone-relaxin

Symphysis pubis widens by about 4mm by 32
weeks and sacrococcygeal joints loosens,allowing
the coccyx to displaced backwards
Waddling gait - Center of gravity changes
Lordosis- an abnormal curvature of the spinal
column with convexity towards the front.
PSYCHOLOGIC RESPONSES
Ambivalence
Introversion
Mood swings
Altered body image
Mood swings
Acceptance and excitement