Professional Documents
Culture Documents
Pregnancy Changes
Pregnancy Changes
with Pregnancy
increases from 50 gm
in nonpregnant state
to 1000 gm at term
Shape - 3
pyriform in the
nonpregnant state ,
becomes globular at 8th
week , then pyriform by
16th week till term .
Position - 4
with ascent from the pelvis , the
uterus usually undergoes rotation
with tilting to the right
(dextrorotation) due to the
presence of the rectosegmoid colon
on the left side.
5 - Consistency :
becomes progressively
softer due to :
i - Increased vascularity
ii - Presence of amniotic fluid
Contractility - 6
from the first trimester onwards , the
uterus undergoes irregular painless
contractions
(Braxton Hicks contractions) .
They may cause some discomfort late
in pregnancy and may account for
false labour pain .
7- Capacity
increases from
4 ml in non-pregnant
state to
4000 ml at term
(B) Myometrial
changes
1 - Hypertrophy (estrogen
effect) rather than
hyperplasia (progesterone
effect) till 14th week, then
the fetus exerts a direct
stretch
2 - Formation of the
lower uterine segment
(L.U.S.) from the
isthmus and lower half
inch of the body
Formation of lower
uterine segment
After 12 weeks, the isthmus
(0.5cm) starts to expand
gradually to form the lower
uterine segment which
measures 10 cm in length at
term
Upper Uterine Segment
• Peritoneum: Firmly-attached
• Myometrium: 3 layers; outer
longitudinal, middle oblique and
inner circular.
• The middle layer forms 8-shaped fibers
around the blood vessels to control
postpartum hemorrhage
Upper Uterine Segment
• Decidua: Well-developed
• Membranes: Firmly-attached
• Activity: Active, contracts,
retracts and becomes thicker
during labour.
Lower Uterine Segment
• Peritoneum: Loosely-
attached
• Myometrium : 2 layers;
outer longitudinal and inner
circular.
Lower Uterine Segment
• Decidua: Poorly-developed
• Membranes: Loosely-
attached.
• Activity: Passive, dilates,
stretches and becomes thinner
during labour
The junction between the
upper uterine segment
(U.U.S.) which is thick and the
lower uterine segment which
is thin is called the
physiologic contraction ring
at the level of the symphysis
pubis (not seen or felt)
(C) Uterine
blood vessels
1 - Uterine artery lumen:
is doubled and its blood flow
increases 5 times
2 - Myometrial and decidual
arteries (spiral arteries) undergo
fibrinoid degeneration due to 2
waves of trophoblastic migration ,
so they become dilated to be the
uteroplacental arteries
• Uterine blood flow
increases
progressively and
reaches about 500
ml / minute at term
(D) Changes in the cervix :
1 - It becomes
hypertrophied , soft and
bluish in colour due to
oedema and increased
vascularity.
2 - Soon after conception , a thick
cervical secretion obstructs the
cervical canal forming a
mucous plug .
3 - The endocervical epithelium
proliferates and or everted
forming cervical ectopy
(previously called erosion)
(E) Changes in fallopian tubes
and ligaments (round and broad):
Inactive , elongated ,
marked increase in
vascularity
There may be broad
ligament varicose veins
(F) Changes in the vagina :
3000
2500
2000 Fetus
1500 Placenta
Amniotic Fluid
1000
500
0
10 wk 20 wk 30 wk 40 wk
Pregnancy is potentially
diabetogenic
- Alimentary glucosuria may
occur in early pregnancy .
- Renal glucosuria may occur in
the middle of pregnancy .
(E) Fat metabolism
There is increase of
plasma lipids with
tendency to acidosis
(HPL action)
(F) Mineral metabolism
There is increased
demand for iron ,
calcium , phosphate
and magnesium
VIII - Musculoskeletal
changes
(a) Increased mobility of
pelvic joints due to
softening of the joints and
ligaments caused by
progesterone and relaxin
(b) Flattening of feets .
(c) Progressive lordosis
leading to lordotic gait &
backache ( by high
heals).
(d) Pendulous abdomen in
multigravida resulting in
many complications
Backache
• The majority of pregnant
women complain of low
backache which increases
as pregnancy advances.
• It is due to increased
lumbar lordosis to counter-
balance the forward
growth of the uterus
• This puts strain on
ligaments and muscles
leading to pain.
• Strain of sacroiliac joint
is relatively common.
• Progesterone causes
softening and relaxation
of ligaments.
Backache is treated by:
(a) more periods of rest.
(b) use of maternity corset.
(c) local heat in the form of
hot water bag or infrared
lamp
(d) analgesics given systemically
or as local creams,
Paracetamol is the drug of
choice, Non-steroidal anti-
inflammatory drugs as
indomethacin may be given
(e) physiotherapy may be
needed.
Orthopaedic
consultation is
indicated if pain is
severe, or radiates to
the legs, and in the
presence of
neurological signs
Leg cramps
• These are common in
the second half of
pregnancy particularly
at night.
• The exact cause is
unknown.
It may be related to shift of
blood away from the
muscle, i.e., ischaemic
cramp, or it may be tetanic
cramp caused by lack of
calcium, or increased
phosphorous, or both
• Treated by taking calcium
tablets, and reducing the intake
of phosphorous-containing
substances as milk, meat, and
cheese.
• Vitamin B complex may be tried.
• Leg massage and
hyperextension of foot help
during the attack.
Round ligament strain
• Pain is felt along the round
ligament and in the groin.
• Pain unilateral and left-sided,
(dextroflexion ).
• It is due to stretching of the
nerve fibres in the round
ligaments.
IX - Endocrine
system
1 - Anterior pituitary
i - Increase in size
more than increase in
vascularity
This renders anterior
pituitary liable for
ischaemia
ii - Pregnancy cell (modified
chromophobe) appears due
to increased hCG .
iii - Prolactin level increases
up to 150 ng /ml at term to
ensure lactation .
2 - Posterior pituitary
There is diffuse
slight enlargement
of the gland
Gland activity is as
evidenced by normal free T4
(although total T4 ) due to
thyroid binding globulin
(TBG) ,
BMR 20 % , total T3 ,
protein bound iodine and
TSH
4 - Parathyroid gland
Hypertrophy due to
increased demand
for Calcium
5 - Suprarenal gland
Hypertrophy particularly the
cortex resulting in increased
glucocorticoids (cortisone)
and increased
mineralocorticoids
(aldosterone)
6 - Insulin
increased mainly
due to HPL (anti -
insulin hormone)
7 -Ovaries
corpus luteum of
pregnancy
functions till 8-12 wks.
when its function is taken
by the placenta
XI - Skin changes
1 - Persistance of basal
body temperature
(BBT) elevation beyond
the expected day of
menstruation
(due to increased
progesterone).
2 - Spider telangiectasis
& palmar erythema
due to
increased estrogen
or
cutaneous vasodilatation
3 - Cutaneous
vasodilatation
(hyperaemia)
leads to :
i - Masks pallor due to
anaemia with or without
palmar erythema .
ii - Glandular activities
(sweat & sebaceous
glands).
iii - Sensation of heat and
nasal congestion
4 - Pigmentation
due to increased estrogen
or
melanocyte stimulating hormone
or
ACTH
• In the face = chloasma
graviderom = mask of
pregnancy
a butterfly pigmentation
on the cheeks and nose .
It usually disappears few
months after labour .
•In abdomen:
Linea Nigra=
pigmentation in
midline below the
umbilicus
Linea nigra
Stria gravidarum
pigmentation in the lower
abdomen ,
flanks , inner thighs ,
buttocks & breast and
increase as pregnancy
advances
It starts bluish (stria rubra) ,
then becomes pale to become
white (stria albicans) after
delivery , which persists
(primigravida has stria rubra
only ,while multigravida has
both S.R and S.A)
It It may be due to mechanical
stretching or increased
glucocorticoids which results
in rupture of the elastic
fibres in the dermis and
exposure of the vascular
subcutaneous tissues
5 - Secretions
increase in sweat
and sebaceous
glands activity
(B) Breast signs
• Diagnostic in primigravida and
may persist after delivery .
• In multigravida it may be due
to the previous pregnancies .
• They may occur with any
hyperestrogen , so they are
not diagnostic for pregnancy
i - First month :
increased size & vascularity
(dilated veins) , mastodynia
may be present which ranges
from tingling to frank pain
due to hormonal responses of
the mammary ducts and
alveolar system
ii - Second month :
increased pigmentation of
the nipple & areola and
prominence of
Montgomery tubercles
(nonpigmented nodules
around the primary
areola (12 - 20)
Montgomery tubercles
They were thought to be
enlarged sebaceous
glands, but recently they
are found to be the lips of
orifices of peripheral
active lacteal ducts
Breast changes
iii - Third month :
secretion of colostrum
(thick yellowish
fluid) which can be
expressed from the
nipple
iv - Fourth month :
a pigmented area
appears around the
primary areola called
the secondary areola
Lower limbs signs
i - Edema :
bilateral and pitting
ii - Varicose veins
XII. Neurologic
System
• Sensory changes from
compression of nerves
• Tension headaches
• Carpal tunnel syndrome due
to edema
• Numbness and tingling
related to postural changes
1. Headache
It is relatively common, and
attributed to intracranial
vasodilatation caused by
oestrogen and
progesterone
1. Headache
• It is most troublesome in the
second trimester, but may
persist throughout pregnancy.
• However, headache may be due
to lack of sleep, or overwork.
• An analgesic is prescribed.
prescribed
2. Fainting
Caused by compression of
the median nerve as it
passes through its fibrous
tunnel at the wrist, as a
result of fluid retention
and oedema in pregnancy
There is tingling,
numbness and
burning sensation
affecting the radial
side of the hand
• Treatment:
includes reassurance, use of a
wrist splint, diuretics, non
steroidal anti-inflammatory
drugs, and local injection of
hydrocortisone in the tunnel
below the fibrous roof
(retinaculum)
Operation is rarely
needed during
pregnancy by incising
the retinaculum to
relieve compression
Other compression
neuropathies affect
the lateral cutaneous
nerve of the thigh ,
obturator and
peroneal nerves
LEUCORRHOEA
The normal vaginal
discharge increases
during pregnancy because
of excess oestrogen and
may form a complaint
However, a pathological
discharge, e.g.,
monilial infections
which is common in
pregnancy must be
excluded.
THANK
YOU