2. Pregnancy is a period ofPregnancy is a period of
adaptation for :adaptation for :
• The needs of the fetusThe needs of the fetus
• Meeting the stress ofMeeting the stress of
pregnancy and labourpregnancy and labour
5. increase fromincrease from 7.5 x 5 x 2.57.5 x 5 x 2.5
cmcm in nonpregnant statesin nonpregnant states
toto 35 x 25 x 20 cm35 x 25 x 20 cm at termat term
i.e. the volume increasei.e. the volume increase
1000 time1000 time
11--SizeSize
6.
7. increases fromincreases from 50 gm50 gm
in nonpregnant statein nonpregnant state
toto 1000 gm1000 gm at termat term
22--WeightWeight
8. pyriform in the
nonpregnant state ,
becomes globular at 8th
week , then pyriform by
16th week till term .
33--ShapeShape
9. 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.
44--PositionPosition
10. 5 - Consistency :5 - Consistency :
becomes progressivelybecomes progressively
softersofter due to :due to :
i - Increased vascularityi - Increased vascularity
ii - Presence of amniotic fluidii - Presence of amniotic fluid
11. from the firstfrom the first
trimestertrimester
onwards , theonwards , the
uterus undergoesuterus undergoes
irregular painlessirregular painless
contractionscontractions
(Braxton Hicks(Braxton Hicks
contractions)contractions) ..
They may causeThey may cause
some discomfortsome discomfort
late in pregnancylate in pregnancy
66--ContractilityContractility
12. 7- Capacity7- Capacity
increases fromincreases from
4 ml4 ml in non-pregnantin non-pregnant
state tostate to
4000 ml4000 ml at termat term
14. 1 -1 - HypertrophyHypertrophy rather thanrather than
hyperplasiahyperplasia till 14th weektill 14th week,,
then the fetus exerts athen the fetus exerts a
direct stretchdirect stretch
16. Formation of lowerFormation of lower
uterine segmentuterine segment
After 12 weeks,After 12 weeks, the isthmusthe isthmus
(0.5cm)(0.5cm) starts to expandstarts to expand
gradually to form the lowergradually to form the lower
uterine segment whichuterine segment which
measuresmeasures 10 cm10 cm in length atin length at
termterm
17. Upper Uterine SegmentUpper Uterine Segment
• PeritoneumPeritoneum:: Firmly-attachedFirmly-attached
• Myometrium:Myometrium: 3 layers; outer3 layers; outer
longitudinal, middle oblique andlongitudinal, middle oblique and
inner circular.inner circular.
• The middle layer forms 8-shaped fibersThe middle layer forms 8-shaped fibers
around the blood vessels to controlaround the blood vessels to control
postpartum hemorrhagepostpartum hemorrhage
18. Upper Uterine SegmentUpper Uterine Segment
• Decidua:Decidua: Well-developedWell-developed
• Membranes:Membranes: Firmly-attachedFirmly-attached
• Activity:Activity: Active, contracts,Active, contracts,
retracts and becomes thickerretracts and becomes thicker
during labour.during labour.
20. Lower Uterine SegmentLower Uterine Segment
• DeciduaDecidua:: Poorly-developedPoorly-developed
• MembranesMembranes:: Loosely-Loosely-
attached.attached.
• ActivityActivity:: Passive, dilates,Passive, dilates,
stretches and becomes thinnerstretches and becomes thinner
during labourduring labour
21. The junction between theThe junction between the
upper uterine segmentupper uterine segment
(U.U.S.) which is thick and the(U.U.S.) which is thick and the
lower uterine segment whichlower uterine segment which
is thin is called theis thin is called the
physiologic contraction ringphysiologic contraction ring
at the level of the symphysisat the level of the symphysis
pubispubis (not seen or felt)(not seen or felt)
23. 11 -- Uterine artery lumen:Uterine artery lumen:
is doubled and its blood flowis doubled and its blood flow
increases 5 timesincreases 5 times
2 -2 - Myometrial and decidualMyometrial and decidual
arteriesarteries (spiral arteries) undergo(spiral arteries) undergo
fibrinoid degeneration due to 2fibrinoid degeneration due to 2
waves of trophoblastic migration ,waves of trophoblastic migration ,
so they become dilated to be theso they become dilated to be the
uteroplacentaluteroplacental arteriesarteries
24. •Uterine blood flowUterine blood flow
increasesincreases
progressively andprogressively and
reaches aboutreaches about 500500
ml / minute at termml / minute at term
25. (D) Changes in the cervix :(D) Changes in the cervix :
1 -1 - It becomesIt becomes
hypertrophied , soft andhypertrophied , soft and
bluishbluish in colour due toin colour due to
oedema and increasedoedema and increased
vascularity.vascularity.
26. 2 - Soon after conception , a thick2 - Soon after conception , a thick
cervical secretion obstructs thecervical secretion obstructs the
cervical canal forming acervical canal forming a
mucous plugmucous plug ..
3 - The endocervical epithelium3 - The endocervical epithelium
proliferates and or evertedproliferates and or everted
forming cervical ectopyforming cervical ectopy
(previously called erosion)(previously called erosion)
27. (E) Changes in fallopian tubes(E) Changes in fallopian tubes
and ligaments (round and broad):and ligaments (round and broad):
InactiveInactive ,, elongatedelongated ,,
marked increase inmarked increase in
vascularityvascularity
There may be broadThere may be broad
ligamentligament varicose veinsvaricose veins
28. (F) Changes in the vagina :(F) Changes in the vagina :
The vagina becomesThe vagina becomes softsoft ,,
warmwarm ,, moistmoist withwith
increased secretion andincreased secretion and
violetviolet in colourin colour
(Chadwick's sign)(Chadwick's sign) due todue to
increased vascularityincreased vascularity
29. (G) Changes in the vulva :(G) Changes in the vulva :
•It becomes soft, violet in
colour
• Oedema and
varicosities may develop
30. (H) Changes in the ovaries(H) Changes in the ovaries
1 - Both ovaries are1 - Both ovaries are
enlarged due to increasedenlarged due to increased
vascularity and oedemavascularity and oedema
particularly the ovaryparticularly the ovary
which conatins the corpuswhich conatins the corpus
luteum .luteum .
31. (H) Changes in the ovaries(H) Changes in the ovaries
2 - Corpus luteum continues to2 - Corpus luteum continues to
grow tillgrow till 7 - 8 weeks7 - 8 weeks , then it, then it
stops growingstops growing
, It becomes, It becomes inactive and startsinactive and starts
degeneration at 12 weeksdegeneration at 12 weeks
(degeneration is completed(degeneration is completed
after labour)after labour)
33. (H) Changes in the ovaries(H) Changes in the ovaries
3 -3 - Ovulation ceases duringOvulation ceases during
pregnancy due topregnancy due to
pituitary inhibition by thepituitary inhibition by the
high levels of oestrogenhigh levels of oestrogen
and progesteroneand progesterone
35. (A) Blood volume(A) Blood volume
The total blood volumeThe total blood volume
increases steadily fromincreases steadily from
early pregnancy to reachearly pregnancy to reach
a maximum ofa maximum of 35-45 %35-45 %
above the non-pregnantabove the non-pregnant
levellevel at 32 weekat 32 week ..
36. - Plasma volume :Plasma volume :
Increases fromIncreases from 26002600 ml byml by
±± 45 %45 % ((12501250 in the 1stin the 1st
pregnancy) andpregnancy) and 15001500 mlml
in subsequent pregnanciesin subsequent pregnancies
37. - Red blood cell massRed blood cell mass :
• Increases fromIncreases from 1400 ml1400 ml
(nonpregnant) by(nonpregnant) by 33 %33 % (± 450(± 450
ml) due to increased productionml) due to increased production
resulting fromresulting from erythropoeitin orerythropoeitin or
action of hCG or HPL .action of hCG or HPL .
• The increase is steady till fullThe increase is steady till full
term.term.
38. The increase in plasmaThe increase in plasma
volume is more than thevolume is more than the
increase in red blood cellincrease in red blood cell
mass (Hb mass) resultingmass (Hb mass) resulting
in haemodilutionin haemodilution
(physiologic anemia)(physiologic anemia)
40. Values of increased blood volumeValues of increased blood volume
1 - Meets increased demands1 - Meets increased demands
for uterus , baby .... etc .for uterus , baby .... etc .
2 - Protects against supine2 - Protects against supine
hypotension syndrome .hypotension syndrome .
3 - Protects against fluid loss3 - Protects against fluid loss
in labour .in labour .
41. Increased blood volumeIncreased blood volume
more than the increasemore than the increase
in red cell mass , leadsin red cell mass , leads
toto decreased blooddecreased blood
viscosityviscosity which leadswhich leads
toto decrease indecrease in
peripheral resistanceperipheral resistance
43. 1 - Decreased Hb % and
RBCs % :
• Erythrocytes decrease fromErythrocytes decrease from
4.5 million / mm3 to 3.74.5 million / mm3 to 3.7
million / mm3million / mm3 (due to the(due to the
relative increase in plasmarelative increase in plasma
volume more than red cellvolume more than red cell
mass) .mass) .
44. ErythrocytesErythrocytes contentscontents
fromfrom 2,3- DPG2,3- DPG increasesincreases
which competes for 02which competes for 02
binding sites in the Hbbinding sites in the Hb
molecule , thus releasingmolecule , thus releasing
more 02 to the fetusmore 02 to the fetus ..
46. 2 -2 - M.C.H.CM.C.H.C : no change: no change
3 -3 - M.C.V.M.C.V. :: ,, oror nono
changechange (depending on(depending on
the availability of Fe).the availability of Fe).
4-4- FragilityFragility of R.B.Cs:of R.B.Cs: ..
47. 5 -5 - ReticulocytesReticulocytes : mild: mild
6 -6 - E.S.RE.S.R :: from 12 tofrom 12 to
50 mm / hour50 mm / hour
7 –7 – FibrinogenFibrinogen:: fromfrom
200 - 400 mg / dl to 400 -200 - 400 mg / dl to 400 -
600 mg / dl.600 mg / dl.
48. 8 -8 - White blood cells:White blood cells:
(from 7.000 / mm3 to 10.500 /(from 7.000 / mm3 to 10.500 /
mm3 during pregnancy and upmm3 during pregnancy and up
to 16.000 / mm3 during labour :to 16.000 / mm3 during labour :
-- PNL & its enzymes .PNL & its enzymes .
- Lymphocytes : no change .- Lymphocytes : no change .
51. • PlateletsPlatelets oror . (controversial).. (controversial).
• FibrinogenFibrinogen doubled to 600 mg %doubled to 600 mg %
• Factor VIIIFactor VIII tripled .tripled .
• Factor VII & factor XFactor VII & factor X areare
doubleddoubled
• Factor XI & factor XIIIFactor XI & factor XIII slightslight
• Fibrinolytic activityFibrinolytic activity ..
52. • Therefore pregnancy is aTherefore pregnancy is a
hypercoagulative statehypercoagulative state ..
• All these changes areAll these changes are
reversed after labour withreversed after labour with
RBCs production (notRBCs production (not
destruction)& the excess Fedestruction)& the excess Fe
is stored .is stored .
55. As the diaphragm is elevatedAs the diaphragm is elevated
progressively during pregnancyprogressively during pregnancy
the apex isthe apex is displaced upwardsdisplaced upwards
and to the leftand to the left so that it lies in theso that it lies in the
4th intercostal space outside the4th intercostal space outside the
midclavicular line.midclavicular line.
Position:Position:
56. Pulse rate :Pulse rate :
- The resting pulse rateThe resting pulse rate
increases byincreases by 8 beats / min.8 beats / min.
(8 weeks) and(8 weeks) and 16 beats / min16 beats / min..
(full term).(full term).
-Some episodes of-Some episodes of ectopic beatsectopic beats
- Water hummer pulse .- Water hummer pulse .
57. Heart soundsHeart sounds
• The first heart soundThe first heart sound becomebecome
louder before midpregnancylouder before midpregnancy
and splitting of this sound mayand splitting of this sound may
occur due to earlier closer of theoccur due to earlier closer of the
mitral than the tricuspid valvemitral than the tricuspid valve
• The intensity of theThe intensity of the secondsecond
heart soundheart sound may increase.may increase.
58. Heart soundsHeart sounds
•The third soundThe third sound becomesbecomes
louder before mid-louder before mid-
pregnancy and persistspregnancy and persists
as such till one week postas such till one week post
partum.partum.
•The fourth soundThe fourth sound maymay
be detectable bybe detectable by
phonocardiography.phonocardiography.
59. MurmursMurmurs
Systolic functional murmursSystolic functional murmurs
develop in most of women, usuallydevelop in most of women, usually
early systolicearly systolic, but, but mid systolicmid systolic
murmursmurmurs may occur and heard overmay occur and heard over
the left sternal edge,the left sternal edge,
they are thought to be due tothey are thought to be due to
functional tricuspid regurgitationfunctional tricuspid regurgitation
60. ECG CHANGESECG CHANGES
• The main features of ECG may beThe main features of ECG may be
attributed to the changes in theattributed to the changes in the
position of the heart.position of the heart.
• The axisThe axis undergoesundergoes left shift by 15 -left shift by 15 -
28°.28°.
• TheThe QRSQRS complexes become ofcomplexes become of lowlow
voltagevoltage, and, and T waveT wave becomesbecomes
flattenedflattened..
63. Cardiac output:Cardiac output:
increases mainly by increasedincreases mainly by increased
stroke volume rather thanstroke volume rather than
increased heart rate reaching aincreased heart rate reaching a
maximum of 40%maximum of 40% above theabove the
non-pregnant levelnon-pregnant level at 20 weeksat 20 weeks
to be maintained till termto be maintained till term..
64. Cardiac outputCardiac output
Distribution :Distribution :
• 400 ml400 ml to theto the uterusuterus ,,
• 300300 mlml to theto the kidneyskidneys ,,
• 300 ml300 ml toto skinskin ,,
• 300 ml300 ml toto GITGIT ,, breastbreast &&
heartheart
65. • Values :
Distributes extra 02
•During labour :
C.O.P. increases moreC.O.P. increases more
particularly during theparticularly during the
second stage due tosecond stage due to pain ,pain ,
uterine contractions , anduterine contractions , and
expulsive effortsexpulsive efforts pushingpushing
the blood into the generalthe blood into the general
circulationcirculation
66. • Postpartum :
the increasedthe increased
C.O.P. isC.O.P. is
maintained for upmaintained for up
toto 4 days4 days and thenand then
declines rapidlydeclines rapidly
68. Although C.O.P.Although C.O.P.
incease , yet A.B.P.incease , yet A.B.P.
isis decreaseddecreased inin
midtrimestermidtrimester toto
increase again inincrease again in
3rd trimester3rd trimester
69. This is due to:
i -- Decreased PeripheralDecreased Peripheral
resistanceresistance ::
(mainly affect diastolic B.P.)(mainly affect diastolic B.P.)
due to :due to : vasodilatation +vasodilatation +
increase metabolism +increase metabolism +
arteriovenous shunt atarteriovenous shunt at
placenta .placenta .
70. ii -ii - Supine hypotensionSupine hypotension ::
may develop in some women inmay develop in some women in
late pregnancy while lying supinelate pregnancy while lying supine
due to compression on the I.V.C.due to compression on the I.V.C.
by the large pregnant uterus ,by the large pregnant uterus ,
resulting in decreased venousresulting in decreased venous
returnreturn C.O.P. and low B.P.C.O.P. and low B.P.
to the extent thatto the extent that faintingfainting maymay
occuroccur
71. iii -iii - DecreasedDecreased
sensitivity of bloodsensitivity of blood
vesselsvessels toto angiotensin IIangiotensin II
which is vasoconstrictorwhich is vasoconstrictor
73. • The posture of the pregnantThe posture of the pregnant
woman affects arterial bloodwoman affects arterial blood
pressure.pressure.
• Typically, it isTypically, it is highest whenhighest when
she is sittingshe is sitting,, lowest when lyinglowest when lying
in the lateral recumbent positionin the lateral recumbent position
and intermediate when supine.and intermediate when supine.
75. blood flow to the skin,blood flow to the skin,
particularly in the handsparticularly in the hands
and feet generally givingand feet generally giving
the pregnant women athe pregnant women a
feeling of warmthfeeling of warmth
Peripheral VasodilatationPeripheral Vasodilatation
76. Peripheral VasodilatationPeripheral Vasodilatation
Increases the congestion ofIncreases the congestion of
nasal mucosa leading tonasal mucosa leading to
a common complaint ofa common complaint of
nasal obstruction andnasal obstruction and
bleedingbleeding (epistaxis).(epistaxis).
78. Increased venous pressureIncreased venous pressure
in the lower limbs due to :in the lower limbs due to :
1.1. Back pressure from the compressedBack pressure from the compressed
I.V.C. by the pregnant uterus .I.V.C. by the pregnant uterus .
2.Mechanical pressure of the uterus2.Mechanical pressure of the uterus
on pelvic veins .on pelvic veins .
3.Increased venous return from3.Increased venous return from
internal iliac veins --> increaseinternal iliac veins --> increase
pressure in external iliac veins .pressure in external iliac veins .
79. Increased venous pressureIncreased venous pressure
in the lower limbsin the lower limbs
Predisposes to :Predisposes to :
Oedema ,Oedema ,
varicose veinsvaricose veins
and pilesand piles
80. Oedema and varicose veins in theOedema and varicose veins in the
lower limbs & vulva are due tolower limbs & vulva are due to
i -i - Venous pressure .Venous pressure .
ii - Relaxation of the smooth muscles inii - Relaxation of the smooth muscles in
the wall of the veins by progesteronethe wall of the veins by progesterone
iii -iii - Osmotic pressure in blood .Osmotic pressure in blood .
iv -iv - Capillary permeability (due toCapillary permeability (due to
progesterone and aldosterone).progesterone and aldosterone).
v -v - Interstitial pressure (Na retention).Interstitial pressure (Na retention).
83. This result in :This result in :
1.1. The diaphragmatic mobilityThe diaphragmatic mobility
is reduced andis reduced and respirationrespiration
becomes mainly thoracicbecomes mainly thoracic ..
2.2. Widen the subcostal angleWiden the subcostal angle
and increases the transverseand increases the transverse
diameter of the chest.diameter of the chest.
84. Respiratory functionsRespiratory functions
The respiratory rateThe respiratory rate
does not increase duringdoes not increase during
pregnancy from itspregnancy from its
normal rate ofnormal rate of 14 - 15 /14 - 15 /
minute.minute.
86. Shortness of breathShortness of breath
(the need to breath becomes a(the need to breath becomes a
conscious one)conscious one)
andand dyspneadyspnea are commonare common
complaint of the pregnantcomplaint of the pregnant
women which may be due towomen which may be due to
unfamiliarity with low C02unfamiliarity with low C02
tension in the alveolartension in the alveolar
capillariescapillaries..
87. The vital capacityThe vital capacity
1.The inspiratory capacity1.The inspiratory capacity
(Tidal volume +(Tidal volume +
inspiratory volume)inspiratory volume)
isis decreaseddecreased in latein late
pregnancypregnancy
88. 2.The expiratory reserve2.The expiratory reserve
volumevolume
(maximum amount of air(maximum amount of air
which can be expired afterwhich can be expired after
normal expiration) isnormal expiration) is
reducedreduced
3.The residual volume3.The residual volume
is reduced .is reduced .
89. The reduction in:The reduction in:
1.The inspiratory capacity1.The inspiratory capacity
2.The expiratory reserve2.The expiratory reserve
volumevolume
3.The residual volume3.The residual volume
is not significantis not significant..
90. 4.4.The tidal volumeThe tidal volume ::
(amount of gas inspired(amount of gas inspired
or expired in eachor expired in each
respiration)respiration) risesrises
through-out pregnancythrough-out pregnancy
by about 40 % .by about 40 % .
93. (A) Kidney and kidney(A) Kidney and kidney
function testsfunction tests
•Renal blood flow and
glomerular filtration rate
increases by 50 % .
This leads to increased
excretion
94. • Therefore:Therefore:
1.1. There isThere is serum creatinineserum creatinine (due to(due to
creatinine cleareance) ,the samecreatinine cleareance) ,the same
forfor uric aciduric acid..
2.2. blood ureablood urea ..
3.3. kidney excretion of glucose duekidney excretion of glucose due
toto filtration load andfiltration load and renalrenal
threshold leading tothreshold leading to renalrenal
glucosuriaglucosuria
95. (B) Ureters(B) Ureters
Dilatation of the uretersDilatation of the ureters
and renal pelvis due to :and renal pelvis due to :
i - Relaxation of thei - Relaxation of the
ureters by the effect ofureters by the effect of
progesterone .progesterone .
96. ii - Pressure against theii - Pressure against the
pelvic brim by the uteruspelvic brim by the uterus
particularly on the rightparticularly on the right
side due to dextroposedside due to dextroposed
uterus and dilatation ofuterus and dilatation of
the right ovarian vesselsthe right ovarian vessels
97. (C) Bladder and urethra(C) Bladder and urethra
• Frequency of micturitionFrequency of micturition
in early pregnancy due to :in early pregnancy due to :
i - Pressure on the bladderi - Pressure on the bladder
by the enlarged uterus .by the enlarged uterus .
ii - Congestion of theii - Congestion of the
bladder muscosa .bladder muscosa .
98. • Urinary stress incontinence
may develop for the first time
during pregnancy (due to
decreased intraurethral
pressure and decreased
length of the urethra)
and spontaneously relieved
later on
100. • The gums may becomeThe gums may become
hyperemic and soft and mayhyperemic and soft and may
bleedbleed when mildly traumatized,when mildly traumatized,
as with a tooth brush.as with a tooth brush.
• Epulis of pregnancyEpulis of pregnancy
may develop.may develop.
Treated by dental hygiene andTreated by dental hygiene and
cryosurgery for severe casescryosurgery for severe cases.
101. 3 - Nausea and vomiting3 - Nausea and vomiting
Nausea (morning sickness)Nausea (morning sickness)
and vomitingand vomiting
(emesis gravidarum)(emesis gravidarum)
occur in early monthsoccur in early months
102. 4 - Appetite changes4 - Appetite changes
(longing or craving)(longing or craving)
103. • The pregnant woman dislikesThe pregnant woman dislikes
some foods and odours whilesome foods and odours while
desires othersdesires others
• Reduced sensitivity of theReduced sensitivity of the
taste budstaste buds during pregnancyduring pregnancy
creates the desire forcreates the desire for
markedly sweet, sour , or saltmarkedly sweet, sour , or salt
foods .foods .
104. (pica)(pica)
Deviation may be soDeviation may be so
extreme to the extentextreme to the extent
of eating blackboardof eating blackboard
chalk , coal or mudchalk , coal or mud
106. This is probably due to :This is probably due to :
i - Decreased gastric acidityi - Decreased gastric acidity
caused by regurgitation ofcaused by regurgitation of
alkaline secretion from thealkaline secretion from the
intestine to the stomach .intestine to the stomach .
ii - Decreased gastric motilityii - Decreased gastric motility
(progesterone effect).(progesterone effect).
107. 6 - Heart burn6 - Heart burn
Due to reflux of acidicDue to reflux of acidic
gastric contents to thegastric contents to the
oesophagusoesophagus
108. 7 - Constipation7 - Constipation
due to :
i - Reduced motility of largei - Reduced motility of large
intestineintestine (progesterone effect).(progesterone effect).
ii - Increased water reabsorptionii - Increased water reabsorption
from large intestinefrom large intestine
(aldosterone effect).(aldosterone effect).
109. 7 - Constipation7 - Constipation
iii - Pressure on the pelvic
colon by the pregnant
uterus.
iv - Sedentary life during
pregnancy .
110. In some womenIn some women
ironiron
supplementationsupplementation
may be the causemay be the cause
111. 8 - Gall stones8 - Gall stones
More tendency to stoneMore tendency to stone
formation due to atonyformation due to atony
and delayed emptyingand delayed emptying
of the gall bladderof the gall bladder
116. LiverLiver
i - Decreased albumin andDecreased albumin and
increased globulin resultingincreased globulin resulting
inin decreased A/G ratiodecreased A/G ratio
ii - Increased heat labile serumii - Increased heat labile serum
alkaline phosphatase .alkaline phosphatase .
117. Therefore bothTherefore both A/GA/G
ratioratio andand heat labileheat labile
alkaline phosphatasealkaline phosphatase
are not reliable as liverare not reliable as liver
function tests duringfunction tests during
pregnancypregnancy
119. (A) Weight gain
The averageThe average
weight gain inweight gain in
pregnancy ispregnancy is
10 - 12 kg10 - 12 kg
120. The increaseThe increase
occurs mainly inoccurs mainly in
the second andthe second and
third trimester at athird trimester at a
rate ofrate of 350 - 400350 - 400
gm/ weekgm/ week
121. Out of the 11 kg weight gainOut of the 11 kg weight gain
6 kg is6 kg is composed ofcomposed of
maternal tissuesmaternal tissues (breast,(breast,
fat, blood and uterinefat, blood and uterine
tissues), andtissues), and
5 kg of fetal tissue , placenta5 kg of fetal tissue , placenta
and amniotic fluidand amniotic fluid
122. Out of the 11 kgOut of the 11 kg
weight gainweight gain::
77kg are waterkg are water,,
33kg fat andkg fat and
11kg proteinkg protein
123. )B) Water metabolismB) Water metabolism
There is tendency toThere is tendency to
water retentionwater retention
secondary tosecondary to
sodium retentionsodium retention
124. (C) Protein metabolism(C) Protein metabolism
There is tendency forThere is tendency for
nitrogen retentionnitrogen retention
(+ ve nitrogen balance)(+ ve nitrogen balance)
for fetal and maternalfor fetal and maternal
tissue formationtissue formation
125. (D) Carbohydrate metabolism(D) Carbohydrate metabolism
Pregnancy is potentiallyPregnancy is potentially
diabetogenicdiabetogenic
-- Alimentary glucosuriaAlimentary glucosuria maymay
occur inoccur in earlyearly pregnancy .pregnancy .
-- Renal glucosuriaRenal glucosuria may occur inmay occur in
thethe middlemiddle of pregnancy .of pregnancy .
126. (E) Fat metabolism(E) Fat metabolism
There is increase of
plasma lipids with
tendency to acidosis
(HPL action)
127. (F) Mineral metabolism
There isThere is
increasedincreased
demanddemand
for iron ,for iron ,
calcium ,calcium ,
129. (a)(a) Increased mobility ofIncreased mobility of
pelvic jointspelvic joints due todue to
softening of the joints andsoftening of the joints and
ligaments caused byligaments caused by
progesteroneprogesterone andand relaxinrelaxin
(b)(b) Flattening of feetsFlattening of feets ..
130. (c)(c) Progressive lordosisProgressive lordosis
leading to lordotic gait &leading to lordotic gait &
backache (backache ( by highby high
heals).heals).
(d)(d) Pendulous abdomenPendulous abdomen inin
multigravida resulting inmultigravida resulting in
many complicationsmany complications
131. Leg crampsLeg cramps
•These are common inThese are common in
thethe second halfsecond half ofof
pregnancy particularlypregnancy particularly
at nightat night..
•The exact cause isThe exact cause is
unknown.unknown.
132. It may be related to shift ofIt may be related to shift of
blood away from theblood away from the
muscle, i.e.,muscle, i.e., ischaemicischaemic
cramp, or it may becramp, or it may be tetanictetanic
cramp caused by lack ofcramp caused by lack of
calcium, or increasedcalcium, or increased
phosphorous, or bothphosphorous, or both
134. 1 - Persistance of basalPersistance of basal
body temperaturebody temperature
(BBT) elevation(BBT) elevation beyondbeyond
the expected day ofthe expected day of
menstruationmenstruation
(due to increased(due to increased
progesterone).progesterone).
137. leads to :leads to :
ii -- Masks pallorMasks pallor due todue to
anaemia with or withoutanaemia with or without
palmar erythema .palmar erythema .
ii -ii - Glandular activitiesGlandular activities
(sweat & sebaceous(sweat & sebaceous
glands).glands).
iii -iii - Sensation of heat andSensation of heat and
nasal congestionnasal congestion
138. 44 - Pigmentation- Pigmentation
due to increased estrogendue to increased estrogen
oror
melanocyte stimulating hormonemelanocyte stimulating hormone
oror
ACTHACTH
139. •In the faceIn the face == chloasmachloasma
graviderom = mask ofgraviderom = mask of
pregnancypregnancy
a butterfly pigmentationa butterfly pigmentation
on the cheeks and nose .on the cheeks and nose .
It usually disappears fewIt usually disappears few
months after labourmonths after labour ..
140. •In abdomenIn abdomen::
Linea Nigra=Linea Nigra=
pigmentation inpigmentation in
midline below themidline below the
umbilicusumbilicus
142. Stria gravidarumStria gravidarum
pigmentation in the lowerpigmentation in the lower
abdomen ,abdomen ,
flanks , inner thighs ,flanks , inner thighs ,
buttocks & breast andbuttocks & breast and
increase as pregnancyincrease as pregnancy
advancesadvances
143. It starts bluishIt starts bluish (stria rubra)(stria rubra) ,,
then becomes pale to becomethen becomes pale to become
whitewhite (stria albicans)(stria albicans) afterafter
delivery , which persistsdelivery , which persists
(primigravida has stria rubra(primigravida has stria rubra
only ,while multigravida hasonly ,while multigravida has
bothboth S.RS.R and S.A)and S.A)
144.
145. It It may be due toIt It may be due to mechanicalmechanical
stretching or increasedstretching or increased
glucocorticoidsglucocorticoids which resultswhich results
in rupture of the elasticin rupture of the elastic
fibres in the dermis andfibres in the dermis and
exposure of the vascularexposure of the vascular
subcutaneous tissuessubcutaneous tissues
147. i - First month :i - First month :
increased size & vascularityincreased size & vascularity
(dilated veins)(dilated veins) , mastodynia, mastodynia
may be present which rangesmay be present which ranges
from tingling to frank painfrom tingling to frank pain
due to hormonal responses ofdue to hormonal responses of
the mammary ducts andthe mammary ducts and
alveolar systemalveolar system
148. ii - Second month :ii - Second month :
increased pigmentation ofincreased pigmentation of
the nipple & areola andthe nipple & areola and
prominence ofprominence of
Montgomery tuberclesMontgomery tubercles
(nonpigmented nodules(nonpigmented nodules
around thearound the primaryprimary
areola (12 - 20)areola (12 - 20)
149. iii -iii - Third month :Third month :
secretion ofsecretion of colostrumcolostrum
(thick yellowish(thick yellowish
fluid) which can befluid) which can be
expressed from theexpressed from the
nipplenipple
150. iv -iv - Fourth month :Fourth month :
a pigmented areaa pigmented area
appears around theappears around the
primary areola calledprimary areola called
thethe secondary areolasecondary areola
152. • Sensory changes fromSensory changes from
compression of nervescompression of nerves
• Tension headachesTension headaches
• Carpal tunnel syndrome dueCarpal tunnel syndrome due
to edemato edema
• Numbness and tinglingNumbness and tingling
related to postural changesrelated to postural changes
153. 4.Carpal tunnel syndrome4.Carpal tunnel syndrome
Caused byCaused by compressioncompression ofof
thethe median nervemedian nerve as itas it
passes through its fibrouspasses through its fibrous
tunnel at the wrist, as atunnel at the wrist, as a
result of fluid retentionresult of fluid retention
and oedema in pregnancyand oedema in pregnancy
154. There is tingling,There is tingling,
numbness andnumbness and
burning sensationburning sensation
affecting the radialaffecting the radial
side of the handside of the hand
155. Other compressionOther compression
neuropathies affectneuropathies affect
the lateral cutaneousthe lateral cutaneous
nerve of the thigh ,nerve of the thigh ,
obturator andobturator and
peroneal nervesperoneal nerves
