Knowledge about Structural and functional changes during pregnancy helps a mother to reduce anxiety and a midwife to understand the normal pregnancy and detect from abnormal deviations.

1. PREPARED BY:
SRUJANI SWETASINA DASH
NURSING TUTOR
G.N.M.INSTITUTE
A.N.M.M.C.H, GAYA
PHYSIOLOGICAL CHANGES
DURING PREGNANCY

3. OBJECTIVES
 To discuss the structural changes during
pregnancy.
 To explain the functional changes during
pregnancy.

4. STRUCTURAL
CHANGES

5. VULVA:
 Edematous
 Hyperaemic
 Superficial Varicosities
 Labia minora pigmented and hypertrophied
VAGINA:
 Edematous
 Hypertrophied
 Vascularised
 Bluish colouration due to increased blood supply called
Jacquemiers sign
 Secretions become more copious, thin and curdy white
 PH becomes acidic (3.5-6)

6. UTERUS:
 Weight- Increases from 60gm to 900-1000 gm at term. (20 times)
 Length- Increases from 7.5cm to 35cm at term.
 Breadth- Increases from 5cm to 22.5cm at term.
 Thickness- Increases from 2.5cm to 20-25cm at term.
 Layers- Increased growth of uterine muscles.
 Body of uterus- increased growth and enlargement, hypertrophy and
hyperplasia and stretching.
 Fundus - enlarges more than body.
 Isthmus- Hypertrophy and elongates to about 3 times its original length
(0.5cm to 1.5cm) and becomes softer.
 Cervix- Hypertrophy, Hyperaemic and it becomes soft called Goodells
sign
 Secretion -Copious
 Shape- Pear shape is maintained in early month and 12 weeks
globular, 28 weeks oval and 36 weeks spherical.
 Position- Normal anteverted position is maintained in early pregnancy
and after 8 weeks it becomes erect.
 Braxton Hick Contraction occurs throughout pregnancy.
 Endometrium of pregnant is called as decidua.

7. FALLOPIAN TUBE:
 Uterine end rises up.
 Length is increased.
 Hypertrophy and hyperaemic.
 Lumen becomes congested.
OVARY:
 Patchy sheets of decidual cells on the outer surface.
 Persistace of corpus luteum at 8 weeks and thereafter
regression occurs.
 Maturation of follicles is inhibited.
 Hormones estrogen and progesterone secreted by
corpus luteum maintains the environment for growing
fetus.

8. BREASTS:
 Increased size and weight due to marked hypertrophy.
 Increased vascularity.
 Axillary tail becomes enlarged and painful.
 Striae due to stretching.
 Nipples- Larger, erectile and pigmented.
 Areola- Montgomary tubercles and secondary areola
appears in 2nd trimester.
 Secretions can be squeezed out at about 12 weeks.

9. CUTANEOUS CHANGES:
 Chloasma Gravidarum- Pigmentation around cheek,
forehead and around eyes.
 Linea Nigra- Brownish black pigmented area in the
midline from xiphi sternum to symphysis pubis.
 Stria Gravidarum- Depressed linear marks found
below umbilicus in the abdominal wall, over thighs and
breasts.
 Palmer Erythema- Reddening of palms.
 Mild degree of hirsutism.

10. WEIGHT CHANGES:
Total average weight gain in singleton pregnancy is
11kg.
Trimester wise distribution: 1st- 1kg
2nd – 5kg
3rd – 5kg
0.4 kg/week or 1-2 kg per month after 1st trimester.
Weight loss in early pregnancy is due to nausea,
vomiting.
Distribution of weight gain-
Reproductive weight gain (6
kg)
Maternal weight gain (6 kg)
Fetus 3.3kg ECF 1.2 kg
Placenta 0.6 kg Blood Volume 1.3 kg
Amniotic Fluid 0.8 kg Accumalation of fat &
Uterus 0.9 kg Protein 3.5 kg
Breast 0.4 kg

11. FUNCTIONAL CHANGES

12. METABOLIC CHANGES:
 General metabolism is increased.
 BMR is increased 30% than the average.
 Daily calcium requirement averages 1-1.5g.
 Total Fe requirement is increased 1000mg/ day.
 Iron is absorbed in form of ferrous from duodenum
and jejunum.
 Serum Ferritin level reflects the body’s iron store.

13. HEMATOLOGICAL CHANGES:
 Blood volume is increased from about 6th week .
 RBC rises to the extent of 20-30%. (350ml)
 Leucocytes is increased. 10000-15000/cu.mm during
pregnancy and 20000/cu.mm at term.
 Total plasma protein increases from normal 180gm to
230gm at term.
 Fibrinogen level is increased. (200-400 to 500mg/dL)
 ESR is increased. (4 times) (0-20mm/hr)

14. HEART AND CIRCULATION:
 Heart is pushed upwards and outward with slight
rotation to left due to elevation of diaphragm.
 Pulse rate is increased, at times palpitation is seen.
 Continuous hissing murmur called mammary murmur
over the tricuspid area.
 Diameters – left and right atrium increases.
 Heat sensation, sweating or stuffy nose due to
increased blood flow through the skin.
 Cardiac output increases from 5th week onwards and
reaches it peak at 30-34 weeks.
 Diastolic B.P decreases by 5-10 mmHg.

15. RESPIRATORY CHANGES:
 Tidal volume increases by 30-40%. (400-500ml)
 Residual volume, total lungs capacity and functional
residual capacity decreases.
 Elevated diaphragm and breathing becomes
diaphragmatic.
URINARY CHANGES:
 Kidney enlarges in size by 1- 1.5cm.
 GFR is increased by 50%.
 Frequency of micturition.
 Ureters and urinary bladder – vascularity increases,

16. ALIMENTARY CHANGES:
•Motility diminishes due to high
progesterone level.
•Cardiac sphincter is relaxed.
•Atonicity of gut.
•Oral cavity- Increased salivation,acidic
saliva may cause tooth decay.
•Change in sense of taste.
•Alkaline phosphatase level is increased.

17. NERVOUS CHANGES:
 Sorts of temperamental changes occur.
 Mental irritability and sleep disorders are probably
due to some psychological background.
 Compression of the median nerve leading to pain
and paresthesia in the hands and arm (Carpal
Tunnel Syndrome)
SKELETAL CHANGES:
 Increased mobility of the pelvic joints due to
softening of the ligaments
 Backache and waddling gait.
 Gravid uterus leads to alteration in body posture.

18. ENDOCRINE CHANGES:
 Corpus luteum secretes about 40mg of
progesterone a day.
 Pituitary, thyroid, adrenal cortex, parathyroid and
pancreas is enlarged.
 Headache may occur due to enlargement of pituitary
gland.
 BMR increases due to enlarged thyroid gland.
 FSH, LH are low due to increased estrogens and
progesterone.
 Serum Prolactin level increases, ACTH, GH
increases while TSH, ADH remains unchanged.
 Serum Iodine level falls therefore increased
requirement of iodine from 100µg to 200µg.
 Blood glucose level is increased in the second half