Physiological changes durng

pregnancy
During pregnancy, a woman’s body changes in many
ways due to the effect of hormones.
These changes can sometimes be uncomfortable, but
most of the time they are normal and enable her to
nourish and protect the fetus, prepare her body for
labour, and develop her breasts for the production of
milk.
PREGNANCY AND FOETAL
DEVELOPMENT
 Pregnancy
The course that the embryo and the fetus grow in
the maternal body usually lasting about 40 weeks or
280 days
 Stages of pregnancy
1. Early pregnancy: ≤12 weeks
2. Mid pregnancy: ≥13 weeks,≤27 weeks
3. Late pregnancy:≥28 weeks
4. Term pregnancy:≥37 weeks,<42 weeks
 STAGES OF PRENATAL
DEVELOPMENT
 Pre embryonic stage - first 2
weeks. Products of conception are
called as conceptus.(all structures
that develop from the zygote).

 Embryonic stage - from the third

week until the end of the eight
week. From this period conceptus
is called embryo.

 Foetal period starts from the

beginning of the ninth week
through the full 41 weeks of
development.
 Implantation:
Process aattachment of the
 Fertilization
blastocyst on the 7th
 Zygote formation day into uterine wall
 Division of fertilized ovum called implantation.
 Morula formation
 Morula (day 3) → enter
uterine cavity (day 4) →
early blastocyst→ late
blastocyst (day 6-7) →
implantation
 Location→ adherence→
penetration
CORPUS LUTEUM
Morula produces human chorionic gonadotropin
(HCG)
To prevent mensturation
Involution of the corpus luteum in the ovary
 For 8 weeks, the corpus luteum is the principle
producer of the hormones progesterone, several
estrogens and relaxin.
Placenta
The disc-shaped placenta grows through pregnancy

It is an organ that connects the developing Fetus to the Uterine wall

The placenta functions as a fetomaternal organ with two

components: the fetal placenta (Chorion frondosum), which
develops from the same blastocyst that forms the fetus, and the
maternal placenta (Decidua basalis), which develops from the
maternal uterine tissue.

 During pregnancy the endometrium is known as the decidua

At term measures about 20cm in diameter, 3cm thick and weighs
about500–700g, approximately one-sixth of the baby’s weight
Function of Placenta
It maintains the foetal circulation
It is responsible for the vital exchange functions of respiration,
absorption of nutrition and excretion; it acts as both lungs and
gut to the foetus.
A major hormone-producing structure in pregnancy, producing
progestogens (synthetic forms of progesterone) and estrogens.
By raising the maternal levels of these hormones, menstruation
continues to be inhibited.
Early produces HCG, which reaches a peak around 8–10 weeks
and then declines by 18 weeks to a much lower level that is
maintained until after delivery
placenta acted as a barrier
date of delivery (EDD)
 Can be calculated if the date on which last menstrual
flow commenced is known, than can be calculated
 By adding7 days to the date and then adding 9
months;
 For example:
Date of commencement of last menstrual flow =8
January
8 january+7 days= 15 January
15 january+9 months=15 October
EDD=15 October
Pregnancy
It is divided into three 3-month periods or trimesters
3 trimesters
It culminates in labour
The delivery of the foetus and placenta
The puerperium, a period of 6–8 weeks during which
time the remaining changes of pregnancy revert
Definition
1. Embryo: ≤ 8 weeks
2. Fetus: ≥ 9 weeks, human shape
full term
A baby is said to be ‘full term’ at a gestational age of 37
or more weeks, providing it weighs more than 2500g
Survival is good over 34 weeks
 low birth weight if it weighs less than 2500g at birth.
 Very low birth weight infants (VLBW) are those below
1500g at birth
extremely low birth weight infants (ELBW) as less than
1000g at birth
 A ‘preterm’ baby is one when the gestational age is less
than 37 weeks.
Endocrine
Progesterone
Oestrogens
Relaxin
Progesterone
Progesterone is produced first by the corpus luteum, then by the
placenta.
Secrete up to 40 week
Effects of progesterone
1.Reduction in tone of smooth muscle
Food may stay longer in the stomach; peristaltic activity is
reduced
Water absorption in the colon is increased leading to tendency to
constipation
Uterine muscle tone is reduced; uterine activity is damped down
Detrusor muscle tone reduced
Progesterone
Dilatation of the ureters favoring urine stasis with
elongation to accommodate the increasing size of the
uterus; this may con-tribute to the likelihood of urinary
tract infections
Urethral tone reduced, which may result in stress
incontinence
Reduced tone in the smooth muscle of the blood vessel
walls leading to dilation of blood vessels, lowered
diastolic pressure
Progesterone
2.Increase in temperature (0.5–1°C).
3.Reduction in alveolar and arterial PCO2
tension, hyperventilation
4.Development of the breasts’ alveolar and
glandular milk-producing cells.
5.Increased storage of fat
Oestrogen
is produced primarily by the ovaries & during
pregnancy ,the placenta and corpusleuteum
Secrete up to 40 week
Effects of oestrogen
1.Increase in growth of uterus and breast ducts.
2.Increasing levels of prolactin to prepare breasts for
lactation; oestro-gens may assist maternal calcium
metabolism.
3.May prime receptor sites for relaxin (e.g. pelvic joints, joint
capsules,cervix).
4.Increased water retention, may cause sodium to be retained.
5.Higher levels result in increased vaginal glycogen,
predisposing to thrush
(Increased cervical fluid production is common during
pregnancy. You may have already noticed a thin, milky
discharge which is a result of your body's hormones
doing their job. If the discharge becomes thick, white
and creamy — like cottage cheese — and if you have
itching in your vaginal area, you may have thrush.
Thrush is a yeast infection, usually caused by a yeast-
like fungus called 'Candida albicans‘.
Relaxin
Relaxin is produced in the corpus luteum,
the placenta, and the uterus in females (decidua).
Function
1.Gradual replacement of collagen in target tissues (e.g.
pelvic joints, joint capsules, cervix) with a remodeled
modified form that has greater extensibility and
pliability.

Collagen synthesis is greater than collagen degradation

and there is increased water content, so there is an
increase in volume.
Relaxin
2.Inhibition of myometrial activity during pregnancy up
to 28 weeks when women become aware of Braxton
Hicks contractions.
(Some women describe Braxton Hicks contractions
as tightening in the abdomen that comes and goes.
Many women say these “false” contractions feel
like mild menstrual cramps. Braxton Hicks contractions
may be uncomfortable, but they do not cause labor or
open the cervix.
3.May have a role in the remarkable ability of the uterus
to distend and in the production of the necessary
additional supportive connective tissue for the growing
muscle fibres.

4.Towards the end of pregnancy, rising levels of relaxin

effect softening of the collagenous content of the cervix.

5.May have a role in mammary growth.

6.Affects relaxation of the pelvic floor muscles

Changes during pregnancy
Amenorrhea
As pregnancy progresses a plug of thick mucus forms
in the cervical canal, sealing the uterus
Diagrammatic Representation of Physical changes during pregnancy
Fundal height. ... Fundal height, or
McDonald's rule, is a measure of the size of
the uterus used to assess fetal growth and
development during pregnancy. It is
measured from the top of the mother's uterus
to the top of the mother's pubic symphysis.
The uterus increases in size dramatically, The weight of
the uterine tissue itself increases from about 50 g to 1000
g at term

The muscle fibres of the uterus increase in activity, and

coordinated contraction of the uterus can be detected by
the woman about 20 weeks' gestation.

Bursts of irregular, short, usually painless contractions

become progressively more evident and systematic. They
are called Braxton Hicks contractions; they facilitate the
blood flow through the placental site and play a part in
the development of the lower uterine segment
 Average weight gain
10-12 kg may be distributed

Increased blood volume 1.2 kg  

Breasts 0.5 kg
 Foetus 3.3 kg
Placenta 0.6 kg
Amniotic fluid 0.8 kg
Increased uterus 0.9 kg
Fat deposits 4.0 kg  
Extracellular fluid 1.2 kg

 
 
 
 Changes during pregnancy
 Cardiovascular system
 Heart: move upward
 Heart rate ↑ 10 to 20 beats per
mint
 Cardiac Output increase by 30%,
reach to peak at 32nd –34th week
 Blood pressure early or mid
pregnancy Bp↓
 In 2nd trimester Aorta and inferior
vena cava compress by fetus
 Pregnancy hypotensive syndrome
Hematology

Blood volume increases by 40% or more (2 liters)

Greater increase in plasma than in red cells;
consequently the hemoglobin level falls to about 80%.
This leads to physiological anemia
Progesterone acts on the smooth muscle of blood
vessel walls to produce slight Hypotonia, and causes a
small rise in body temperature.
Venous pressure in lower extremities increase as
standing
Pulmonary Changes
Edema and tissue congestion of upper respiratory in
early pregnancy
Anterioposterior and transverse chest diameter each
increase
Diaphragm elevated by 4cm
Total chest circumference increases
Increase in oxygen consumption to meet increase O2
demand
Dyspnea is common with mild exercise by 20 weeks
of pregnancy
Physical changes during pregnancy
Changes during pregnancy
 The Respiratory system
1. R rate: slightly ↑
2. Tidal volume: ↑ 40%
3. O2 consumption: ↑ 20%
Towards term diaphragm displace upto 4cm upward
Mid costal and apical work more in third trimester
Relaxin relax the costochondral joint
Changes during pregnancy
 Gastrointestinal system
1) Gastric emptying time is prolonged→ nausea.
2) The motility of large bowel is diminished →
constipation
BREASTS
As early as 2-4 weeks of pregnancy, unusual
tenderness and tingling may be experienced in the
breasts and enlargement begins soon, with the breasts
becoming nodular and lumpy.

The rise in oestrogens is responsible for the growth of

the duct system and progesterone for that of the alveoli
This growth continues through pregnancy and results
in an increase of total breast weight of some 400-800 g
 
NERVOUS SYSTEM
Mood lability: marked fluctuation of mood or mood swings
Anxiety
Insomnia: inability to sleep.
Nightmares: a frightening or unpleasant dream
food fads: characterized by highly restrictive or
unusual food choices.
Amnesia: a partial or total loss of memory.
neuro-praxia-Water retention quite frequently causes
unusual pressure on nerves—CTS
Recent work has shown a real decrease in brain size in
pregnancy (Holdcroft 1997, Oatridge et al 2002)
URINARY SYSTEM
Kidneys increase in length by 1 cm
An increased urinary output
Supportive fascia and ligaments of the tract and pelvic
floor may become more lax and elastic.
Urethro vesical angle may be altered (ureter enter the
bladder at perpendicular angle) due to uterine
enlargement and the intra-abdominal pressure this
raised may cause urine, to flow back into ureter and
may cause infection UTI
MUSCULOSKELETAL SYSTEM
Generalised increase in joint laxity
Generally joint laxity returns postpartum to near its pre pregnancy
state, but this may take up to 6 months.
Joints hypermobile due to change in relaxin and progesterone level
Pelvic floor drop by 1 inch and may be stretched, torn during birth
process.
Pudendal nerve get stretched during delivery.
Postural changes
Change of COG
Diastasis recti: The distance between the two rectus abdominis
muscles can be seen to widen throughout a pregnancy and the
linea alba may even split under the strain
Thermoregulatory System
Basal metabolic rate and heat production to 300
kilocalories per day metabolic needs of pregnancy
Posture and Balance Changes
CENTER OF GRAVITY

COG shift upward and forward because of enlargement of

uterus and breast
Shoulder girdle gets protracted and internally rotated
Pectoralis gets tight and scapular weak
Cervical lordosis increases in upper cervical
Forward head posture develop
Lumbar lordosis increases for shift of COG
Knees hyper extended for change in LOG
Weight shift towards the heels and brings COG posteriorly
BALANCE
Women walks with wider base of support
Increased external rotation at hips
Activities like walking, Stooping, Stair climbing,
lifting and reaching will become difficult.
Things to remember

Physiotherapists involved in training

programmes that a standard amount of
exercise will produce a greater increase in
cardiac output in pregnant women than in
non-pregnant ones
Things to remember
Second trimester -care should also be taken when
getting up from a lying position.(second trimester of
pregnancy, so women may easily feel faint from
prolonged standing; care should also be taken when
getting up from a lying position.
In the third trimester - ‘pregnancy hypotensive
syndrome’.(In the third trimester the weight of the
foetus may compress the aorta and inferior vena cava
against the lumbar spine when the woman is lying
supine, causing dizziness and even unconsciousness;
this is called the ‘pregnancy hypotensive syndrome’)
Exercise in heat should be avoided
Changes of pregnancy
Chiefly the direct result of the interaction of four
factors:
The hormonally mediated changes in collagen
and involuntary muscle
The increased total blood volume with increased
blood flow to the uterus and the kidneys
The growth of the foetus resulting in consequent
enlargement
Displacement of the uterus
finally the increase in body weight and adaptive
changes in the centre of gravity and posture.