Reproductive health

1. Physical
Changes in
Pregnancy
1

2. Introduction
• During pregnancy, there is progressive
anatomical and physiological changes
2

3. REPRODUCTIVE SYSTEM
3

4. Uterus
• Size:
– increases from 7.5´ 5 ´ 2.5 cm in non-
pregnant state to 35 ´ 25 ´ 20 cm at term.
• Weight:
– increases from 70 gm in non-pregnant state
to 1100 gm at term.
• Capacity:
– increases from 10 ml in non-pregnant state to
5000 ml at term.
4

5. 5

6. Uterus
– Uterine enlargement involves stretching and
marked hypertrophy of muscle cells
– Accumulation of fibrous tissue
– Increase in size and number of blood vessels
and lymphatics
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7. Uterus
• Position:
– with ascent from the pelvis, the uterus usually
undergoes rotation with tilting to the right (dextro -
rotation), probably due to presence of the
rectosigmoid colon on the left side.
• Consistency:
– becomes progressively softer due to:
(i) increased vascularity,
(ii) the presence of amniotic fluid.
7

8. Uterus
• Contractility : from the first trimester onwards,
the uterus undergoes irregular contractions
called Braxton Hicks Contractions, which are
normally painless.
• They may cause some discomfort late in
pregnancy and may account for false labour.
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9. Uterus
• Uteroplacental blood flow: uterine and ovarian
vessels increase in diameter, length and
tortuosity. Uterine blood flow increases
progressively and reaches about 500 ml/ minute
at term.
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10. Cervix
• Softening and cyanosis of the cervix
– Increased vascularity and oedema
– Hyperplasia and hypertrophy of cervical glands - Cervical
eversion
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Cervical eversion of pregnancy as
viewed through a colposcope. The
eversion represents columnar
epithelium on the portio of the
cervix

11. Cervix
• A clot of very thick mucus obstructs the
cervical canal. At the onset of labour, this
mucus plug is expelled, resulting in a bloody
show.
11

12. Vagina
• Increased vascularity prominently affects the
vagina and results in copious secretions and in
the violet colour characteristic of the Chadwick
sign
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13. Vulva & Perineum
• There is increased vascularity and
hyperaemia in the skin and muscles of the
vulva and perineum.
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14. Ovaries
• Luteoma of Pregnancy - a solid ovarian tumour .
These represents an exaggerated luteinization
reaction of the normal ovary.
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Large luteoma of
pregnancy removed at
laparotomy postpartum

15. • Theca lutein cysts -these benign ovarian
lesions result from exaggerated physiological
follicle stimulation. The reaction is associated
with markedly elevated serum levels of hCG
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16. Skin
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17. Skin
Pigmentation
Hyperpigmentation is probably because of the
elevated concentrations of melanocyte
stimulating hormone and/or oestrogen and
progesterone effects on the skin.
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18. Skin
1. Chloasma gravidarum (pregnancy mask): A
butterfly pigmentation that appears on the
cheeks and nose.
2. Breasts : increased pigmentation of the
nipples and primary areolae and appearance
of the secondary areolae.
3. Linea nigra: A dark line extending from the
umbilicus to the symphysis pubis.
4. Other areas as axilla, vulva and recent scars.
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19. 19
Chloasma (Mask of Pregnancy)

20. 20
Linea Nigra
Linea nigra: A dark line extending from the umbilicus to the
symphysis pubis

21. Skin
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Striae Gravidarum:
• These reddish, slightly depressed streaks appear in
the later months of pregnancy in the abdomen and
sometimes breasts and thighs.
• 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.
• After delivery, they become white in colour but do
not disappear and are called " striae albicans".

22. 22
Striae Gravidarum

23. Skin
Angiomas, called vascular spiders,
 develop in about two thirds of white women and
approximately 10 percent of black women.
 These are minute, red elevations on the skin,
particularly common on the face, neck, upper chest,
and arms, with radicles branching out from a central
lesion.
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24. Skin
• Palmar erythema is encountered in pregnancy in about
2/3 of white women and 1/3 of black women.
• Nails become brittle
• Hair thicken
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25. Breasts
25

26. Breasts
• After the second month, the breasts increase in
size, and delicate veins become visible just
beneath the skin.
• The nipples become considerably larger, more
deeply pigmented, and more erectile.
• After the first few months, a thick, yellowish
fluid— colostrum —can often be expressed
from the nipples by gentle massage.
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27. 27

28. Breasts
• The areolae become broader and more deeply
pigmented.
• Scattered through the areolae are a number of
small elevations, the glands of Montgomery,
which are hypertrophic sebaceous glands.
• If the increase in size of the breasts is very
extensive, striations similar to those observed in
the abdomen may develop.
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29. 29
Scattered through
the areolae are a
number of small
elevations, the
glands of
Montgomery,
which are
hypertrophic
sebaceous glands
Glands of Montgomery

30. Metabolic
30

31. Metabolic
Weight gain ~12.5kg
• Uterus and its contents
• The breasts
• Blood volume
• Extra vascular extracellular fluid
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32. Metabolic
Pitting oedema of the
ankles and legs
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33. Cardiovascular Changes
33

34. Cardiovascular Changes
 Apex beat moves laterally
 Resting pulse rate increases about 10bpm
 Heart sounds may be altered- systolic ejection
murmurs, splitting of first heart sound
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35. Cardiovascular System
• Systemic arterial pressure declines slightly
during pregnancy, reaching a nadir at 24–28
weeks of gestation.
• Pulse pressure widens because the fall is
greater for diastolic than for systolic pressures.
• Systolic and diastolic pressures increase to pre-
pregnancy levels by about 36 weeks.
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36. Cardiovascular System
• Varicosities in the lower limbs and vulva may
occur due to:
– back pressure from the compressed
inferior vena cava by the pregnant uterus,
– relaxation of the smooth muscles in the
wall of the veins by progesterone.
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37. Varicose Veins
37

38. Musculoskeletal
38

39. Musculoskeletal
• Progressive Lordosis - compensating for
the anterior position of the enlarging
uterus, the lordosis shifts the centre of
gravity back over the lower extremities.
• The sacroiliac, sacrococcygeal, and pubic
joints have increased mobility during
pregnancy
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40. Progressive Lordosis
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41. Urinary System
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42. Urinary System
• Kidneys increase in size (1-1.5cm)
• The renal calyces and pelves are dilated in
pregnancy, with the volume of the renal pelvis
increased up to 6-fold compared to the
nonpregnant value of 10 mL
• The ureters are dilated above the brim of the
bony pelvis (R>L)
– Progesterone
42

43. Urinary System
– Lt ureter cushioned by the sigmoid colon
– Dextrorotation of the uterus
– Rt. ovarian vein complex lies obliquely over
the Rt ureter
– Hyperplasia of smooth muscle in the distal 1/3
of the ureter
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44. Gastrointestinal Tract
44

45. GIT
 The gums may become hypertrophic and
hyperaemic; often, they are so spongy and
friable that they bleed easily.
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46. GIT
 Haemorrhoids
– fairly common during pregnancy.
– caused in large measure by constipation
and elevated pressure in veins below the
level of the enlarged uterus.
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47. Haemorrhoids
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