CHANGES DURING PREGNANCY IS MORE IMPORTANT TO STUDY IN MIDWIFERY SUBJECT AS IT IS THE BASE OF PREGNANCY

1. Physiological
Changes During
Pregnancy
Presented by :-
Mansuri Asma

2. Weight gain
 First 20weeks – 2.0kg
 After 20weeks – 0.5kg per week
 Total weight increase 12kg

3. Weight Gain – 10-12 kg
 Fetus - 3.3kg
 Uterus - 0.9kg
 Placenta - 0.6kg
 Liquor amni -
0.8kg
 Breast - 0.4kg
 Increase in bld
volume – 1.3kg
 Increase in
extracellular fluid
– 1.2kg
 Accumulation of
fat & protein –
3.5kg
Reproductive
weight gain
Net maternal
weight gain

4. Breast Changes

5. Skin changes
Linea
Nigra
Straie
Gravidarum

6. CHANGES OF THE
CARDIOVASCULAR SYSTEM
DURING PREGNANCY
 Size of heart : increases about 12%.
 Cardiac Capacity :- increases 70-80ml.
 Cardiac Output :- increases by 30-40%
till 30weeks
increases15% till term

7.  White Blood Cells :- increases
 Clotting Time :- 8minute

8. POSITION OF HEART :-
 Due to elevation of diaphragm, the
heart pushed upward & outward with
slight rotation to left.

9. A. BLOOD VOLUME :-
o Increases gradually by 30 to 50
percent.
o This results in decrease concentration
of red blood cells and hemoglobin.

10. B. CARDIAC OUTPUT :-
o Increases about 30 percent during the
first and second trimester.
o Change in output is reflected in the
heart rate. It usually increases by 10
beats per minute.

11. C. BLOOD PRESSURE.
o Normally, the patient's blood pressure
will not rise.
 Systemic blood pressure declines
slightly.
 Diastolic blood pressure is reduced 5-
10mm of Hg from

12. D. VENOUS RETURN.
 The lower extremities are often
hampered in the last months of
pregnancy due to the expanding uterus
restricting physical movement and
interfering with the return of blood flow.
 This results in swelling of the feet and
legs.

13. CHANGES OF THE
RESPIRATORY SYSTEM DURING
PREGNANCY
 Respiratory Rate : - Not alter
 Amount of air exhaled per minute
increases from 7 to11 litres.
 Increased Vascularity :- Nasal
Congetion.
Nose bleed

14. CHANGES OF THE URINARY
SYSTEM DURING PREGNANCY
 Each Kidney :- Increases in length 1-
1.5cm
 Ureters :- Elongate, widen & curved
Increase urinary stasis
 Bladder : Increased Vascularity
Decreased muscle tone
Edamtous bladder Mucosa.
Increased Frequency of Urine
 G.F.R. :- Increases by 50%

15. CHANGES OF THE G.I. SYSTEM
DURING PREGNANCY
 Oral Cavity :-
 increaesed Saliva & saliva become
more acidic which promotes tooth
decay.
 Gums – more sensitive, swell easily &
bleed.
 Morning Sickness may present –
characterised by vomiting & poor
appetite.
Heart burn may present

16. CHANGES IN ENDOCRINE
SYSTEM
 Placental Hormones :-
 Human Chorionic
Gonadotrophin(hCG) : secreted by
syncytiotrophoblast.
 It can be detected in maternal urine
after 8-9days of fertilization.
 It helps in maintaining the secretion of
progesterone by the corpus luteum

17. Human placental lactogen
(HPL)
 Acts like growth hormone.
 Important for increasing maternal blood
free fatty acids, glucose & insulin
concentration, increasing lipolysis

18. Maternal Endocrine glands
 PITUITARY GLAND – enlarges &
cause headache.
 Secretion of FSH & LH inhibited.
 Posterior lobe secrets Oxytocin & it
increases in second stage of labour.

19. Thyroid gland
 Enlarged & palpated.
 Increased GFR.
 Rise in BMR by 3rd month onwards.
 Heart may beat faster causing
palpitation.
 PARATHYROID HORMONE increases
throughout pregnancy.

20. ADRENAL GLAND
 Slighlty enlarge.
 Rise in ACTH, aldosterone, cortisol.

21. PANCREASE
 Glucose level in blood may slightly
decreased in early pregnancy.
 In last half, level may increase.

22. Steroidal Hormone
 Main hormones are – progesterone &
oestrogen.
 Progesterone & oestrogen level
increase in early pregnancy.
 These hormones stimulate growth of
uterus.
 They help in starting of the normal
labour.
 Also help in development of breasts
during pregnancy.

23. CHANGES OF THE SKELETAL
SYSTEM DURING PREGNANCY
 There is alteration in the posture.
 Later in pregnancy, it can lead to
numbness, aching & weakness in arms.
 Hormones in pregnancy such as
progesterone , oestrogen & relaxin
helps in relaxation of pelvic joints.

24.  Oestrogen makes pelvic joints movable
 Progesterone relaxes & weaknes pelvic
ligamnets.
 Relaxin soften pelvic joints & ligaments.