More Related Content
Similar to PHYSIOLOGICAL CHANGES IN PREGNANCY.pptx
Similar to PHYSIOLOGICAL CHANGES IN PREGNANCY.pptx (20)
More from KamauNDavid
Recently uploaded
Recently uploaded (20)
PHYSIOLOGICAL CHANGES IN PREGNANCY.pptx
- 1. Physiological Changes in Pregnancy PHYSIOLOGICAL CHANGES IN PREGNANCY
- 3. Uterus Pregnant Uterus Muscular Structure Non Pregnant Uterus Almost Solid Relatively thin – walled (≤ 1.5 cm) weight ≈ 70 gm Volume ≤ 10 mL Approx. 1100 gm by the end of pregnancy ≈ 5 L by the end of pregnancy
- 4. Mechanism Of Uterine Enlargement
- 5. Uterine size, shape & position • First few weeks, original peer shaped organ • As pregnancy advances, corpus & fundus assumes a more globular form. • By 12 weeks, the uterus becomes almost spherical . • Subsequently, uterus increases rapidly in length than in width & assumes an ovoid shape. • With ascent of uterus from pelvis, it usually undergoes Dextrorotation (caused by the rectosigmoid colon on the left side)
- 6. CERVIX • Estradiol + progesterone - swollen and softer during pregnancy • Estradiol - stimulates growth of columnar ep. of cervical canal ectropion (visible on ectocervix) - prone to contact bleeding • ↑ vascularity - look bluer • Mucous glands - distended + ↑ complexity - ↑ secretion - mucus thickened - operculum @ os (protective plug) • PG (remodelling of cervical collagen) + collagenase (from leukocytes) - softening
- 7. • Estrogen - vaginal epithelium thicker - ↑ desquamation rate ↑ vaginal discharge > acidic - protect against ascending infection • Vagina become more vascular CERVIX and VAGINA
- 8. BREAST • Deposition of fat around the glandular tissue • Estrogen > ↑ number of glandular ducts • Progesterone + hPL > ↑ number of gland alveoli • hPL > stimulate synthesis of alveolar casein + lactoglobulin + lactalbumin • [serum prolactin] in pregnancy > antagonized by estrogen > no lactation
- 9. • 48 hours after birth - rapid ↓ of [estrogen] - lactation • End of pregnancy and early puerperium - colostrum produced (thick yellow secretion + ↑ immunoglobulin) • Early + frequent suckling - stimulates ant. and post. Pituitary gland - prolactin + oxytocin - promotion of lactation • Stress + fear - ↑ dopamine - ↓ synthesis and release of prolactin BREAST
- 10. • 2-3 days of puerperium prolactin - alveoli distended by milk - breast engorgement • oxytocin - myoepithelial cells surrounding alveoli and small ducts contract - squeezes milk into larger ducts and subareolar reservoirs • Oxytocin - inhibit dopamine - ↑ prolactin - successful lactation BREAST
- 11. Endocrinological Changes in Pregnancy
- 12. • Peptide and steroid hormones produced by • Non-pregnant: endocrine glands • Pregnant: intrauterine tissues Endocrinological Changes in Pregnancy
- 13. Hormones Pregnancy specific • Human chorionic gonadotrophin (hCG) •α and β (pregnancy specific; produced by trophoblast - detectable w/in days of implantation) •production influenced by leukemia inhibitory factor (LIF) and isoform of GnRH • Maintain corpus luteum’s fx •peak values @10w - progesterone by placenta - ↓ to plateau @>12w •α hCG ≈ α of LH, FSH, TSH - supress FSH and LH secretion by ant. pituitary • Human placental lactogen (hPL) • Produced by placenta • partial homology with prolactin and hGH Endocrinological Changes in Pregnancy
- 14. Hormones Steroids • produced by placenta and fetus • Concentration ↑ earliest weeks of pregnancy - plateau •Effects upon myometrium and (+prolactin) breast tissue • effects on smooth muscle of vascular tree, GIT, GUT • estrogen • max ↑ 30-40mg/day (80% estriol) • encourages cellular hypertrophy (uterus, breast) -more pliable •Alter chemical constitution of con. tissue • Water retention • Reduce sodium excretion • progesterone • reduce smooth muscle tone • ↓ stomach motility - nausea • ↓ colon activity - delayed emptying - ↑ water reabsorb -constipation • ↓ uterine tone - prevent contraction • ↓ vascular tone - diastolic P ↓ - venous dilatation • ↑ temperature • ↑ fat storage • Induce over-breathing • Induce development of breast
- 15. Hormones Pituitary related • Prolactin •produced by lactotrophs of ant pituitary and cells of decidua •Rc in trophoblast cells and w/in amniotic fluid • Stimulated by estrogen and sleep •Inhibited by hPL and dopamine agonist • essential of lactation •Human growth hormone (hGH) •production by ant pituitary supressed in pregnancy • [hGH] ↓ • hPL supress hGH •Adrenocorticotrophic hormone (ACTH) • placental clock theory Pituitary gland increase 30% in weight in first pregnancy (50% in next pregnancy) - can produce headache Endocrinological Changes in Pregnancy
- 16. Hormones • Hypothalamus related • Gonadotrophin- releasing hormone (GnRH) • Corticotrophin-releasing factor (CRF) • Other peptides • Insulin-like growth factor I and II (IGF) •1,25-Dihydroxycholecalciferol • Parathyroid hormone-related peptide •Renin •Angiotensin II CRF - placental clock theory • IGF regulates fetal growth •IGF I and II: produced by fetal cells (in liver) and maternal cells (in uterus) • IGF II predominated in fetal circulation • 1,25-(OH)2D3: ↑ calcium absorption Endocrinological Changes in Pregnancy
- 17. Carbohydrate metabolism • but ↓ blood glucose value • Second half of pregnancy • Delay in reaching peak glucose value • ↑ glucose value + ↑ [plasma insulin] = relative insulin resistance (↓ sensitivity by 80%) • May involve hPL or other growth-related hormones • Reduced peripheral insulin sensitivity • Characteristic of insulin binding to Rc also altered (= obese and NIDDM) • First half of pregnancy • Fasting plasma glucose concentration ↓ • Little change in plasma insulin level • OGGT - enhance respond compared to non-pregnant, normal insulin release
- 18. • In pancreas: • ↑ size of Langerhans cell • ↑ number of β cell • ↑ Rc for insulin
- 20. Fat metabolism • 4kg fat is stored by 30 weeks of gestation • Mostly in orm of depot in abdominal wall, back and thighs. • Modest amount stored in breast • Three points to be noted • Total metabolism and energy demand ↑ • Glycogen stores are diminished • Although blood fat in greatly increase only a moderate amount stored
- 21. Thyroid function • hCG ≈ TSH - hCG maximal - suppress maternal TSH production @ trimester I • hCG or TSH - nausea and vomiting - improve after trimester I • Biochemical hyperthyroidism + ↑ free T4 + suppressed TSH - hyperemesis gravidarum • Iodine active transport to feto-placental unit + ↑ urine excretion -plasma level ↓ - ↑ uptake of iodine from blood by thyroid gland • Diet insufficiency of iodine - hypertrophy of thyroid gland - trap iodine • ↑ thyroid-binding globulin, bound T4 and T3 • Free T4 and T3 fall a little in trimester II and III
- 22. Calcium metabolism • 40% bound to albumin • Pregnancy: ↓ [plasma albumin] - ↓ [plasma calcium] • Little changes to unbound calcium • ↑ demand from fetus - transplacental flux 6.5 mmol/day (~ 80% absorbed in GIT by non-pregnant) • Mother: ↑ absorption and ↓ excretion - little changes in bone (failed = osteopenia)
- 23. • ↑ calcium absorption by 1,25-dihydroxycholecalciferol (metabolite of vit D3) which is influenced by PTH • PTH ↑ 1/3 in pregnancy • No changes in calcitonin or other D3 metabolites • [plasma calcium] fetus > maternal and independent regulation of PTH and calcitonin Calcium metabolism
- 24. Weight Increase in Pregnant Women
- 25. • Metabolic changes + fetal growth - ↑ increase weight ~25% of non-pregnant (~12.5 kg) • First half: weight increase is varied • Second half: ↑ 0.5kg/week (2kg/month) • At term the gain stopped • After 40 weeks, may fall • Weight increase due to: • Growth of conceptus • Enlargement of maternal organs • Maternal storage of fat and protein • ↑ maternal blood volume and interstitial fluid Weight Increase in Pregnant Women
- 26. Breast 1-1.5 kg Uterus 0.5-1 kg Fetus and placenta 5 kg Weight Increase in Pregnant Women
- 27. Hematologic Changes in Pregnancy
- 28. concentrations of estrogen & progesterone Directly act on kidney Causing release of renin Activates aldosterone-renin- angiotensin mechanism Renal sodium retention & in total body water in plasma volume (45%) Blood volume PREGNANCY hb ht Physiological Anaemia •To allow adequate perfusion of vital organs including placenta and fetus •To anticipate blood loss a/w delivery
- 29. Hypercoagulable State Increase in: Decrease in: PROCOAGULANT FACTORS •Factor VII •Factor VIII •Factor IX •Factor X •Factor XII •Fibrinogen ANTICOAGULANT •Protein S activity •Antithrombin IIIa •Activated Protein C resistance ESR
- 30. Increased production of: RBC mass (20%) WBC Platelet Due to increase in renal erythropoietin production Supports higher metabolic requirement for O2 during pregnancy BUT platelet consumption increase more Fall to low normal value Mild thrombocytopenia Mainly due to increase in no of PMN cells as early as 3 wks AOG Difficult to differentiate with infection Neutrophilia
- 31. Physiological Changes in Cardiovascular System
- 32. Anatomic Changes
- 33. Blood volume changes Physiological Changes in Cardiovascular System
- 34. Physiological Changes in Cardiovascular System
- 35. Cardiac Output Physiological Changes in Cardiovascular System
- 36. Physiological Changes in Cardiovascular System
- 37. Blood Pressure Physiological Changes in Cardiovascular System
- 38. Clinical findings in cardiovascular system examination Physiological Changes in Cardiovascular System
- 39. Changes of the respiratory function in pregnancy
- 40. Airway Changes of the respiratory function in pregnancy
- 41. Ventilation Changes of the respiratory function in pregnancy
- 42. Oxygenation Changes of the respiratory function in pregnancy
- 43. Arterial Gases Changes of the respiratory function in pregnancy
- 45. Difference in Gastrointestinal tract in Pregnancy and Non pregnant state
- 46. Gastrointestinal • As the gestational age in pregnancy increase so does the size of uterus. • This increase in size of the uterus causes the stomach and the intestine to be displace upwards • The position of the appendix is usually displace upwards towards the right upper flank region. • Because of the alteration of the intra-abdominal structure this makes it very difficult to diagnose any disease associated with the intra abdominal
- 47. • Increase in progesterone level causes • Lower esophageal sphincter tone to be reduced (esophageal reflux) • Increase placenta production of gastrin, which increases gastric acidity. (heart burn) • Reduced motility of the gut which result in delay of the gastric emptying time. (constipation) Gastrointestinal
- 48. • During labour the motility of the gut decreases further and even during the pueriperium period, emptying of the gut is still delayed. • This increases the risk of pregnant women to develop aspiration of gastric content-especially if they are sedated after 16 weeks of gestation. Gastrointestinal
- 49. Liver • Liver may become more difficult to examine during pregnancy due to the expanding uterus. • Due to hyperoestrogeninc state in pregnancy, clinical findings such as telangiectasia and palmar erythema that are associated with liver disease in non pregnant state are found in 60% of the pregnant woman
- 50. • Despite of the increase of the portal vein pressure in pregnancy, the size of the liver and the hepatic blood flow remains unaltered. • Liver function also remains mostly the same. • Total alkaline phosphate serum increases up to double the normal amount due to fetal and placenta production. Liver
- 51. • Hepatic production of protein increases but because of the expanding maternal placenta volume serum albumin level still remain low. • Most important changes in pregnancy to the liver is the increased in production and plasma fibrinogen and the clotting factors Liver
- 52. Gall bladder • During pregnancy, contractility of the gallbladder is reduced. • Progesterone may impairs gallbladder contraction by inhibiting cholecystokinin-mediated smooth muscle stimulation (primary regulator of gallbladder contraction). • This impairment leads to stasis, and is associated with the increased cholesterol saturation of pregnancy • Intrahepatic cholestasis has been linked to high circulating levels of estrogen, which inhibit intraductal transport of bile acids
- 53. Gastrointestinal symptoms associated with Pregnancy • Constipation • Morning sickness • Gastroesophageal reflux • Haemorrhoids
- 54. Kidneys & Urinary Tract Changes
- 55. Kidney
- 56. Anatomic Changes • Increase in length for about 1 - 2 cm. • Calyces, renal pelvis & ureters dilate →impression of obstruction. • Anatomical changes predispose pregnant women to ascending UTI. • By 6 weeks postpartum, renal dimensions return to pre- pregnancy values.
- 59. Functional Changes • Renal vascular resistance decreases →renal plasma flow increases 50 – 85% above nonpregnant values during first half of pregnancy. • Renal perfusion increases →rise in GFR by approximately 50%. • GFR returns to normal within 12 weeks of delivery. • Renal clearance of creatinine increases as the GFR rises. • Urinary protein loss normally does not exceed 300 mg over 24 hours, which is similar to nonpregnant state. • Increase in GFR plus saturated ‘renal threshold’ in the proximal convoluted tubule explain the increase amount of glucose in urine →glycosuria. • More than 50% of women have glycosuria sometime during pregnancy.
- 60. THANK YOU.