During pregnancy, the body undergoes many physiological changes to support the growing fetus. The uterus enlarges significantly in size and weight. The cervix softens and the vagina increases in blood flow. The breasts enlarge and develop features to support lactation. Throughout pregnancy, the cardiovascular and respiratory systems work to increase blood and oxygen supply for the mother and fetus. Hormone levels also change dramatically, with high levels of progesterone, estrogen, and placental hormones that prepare the body for childbirth and breastfeeding.
Anatomical & Physiological changes in Pregnancy, all the changes in balance, posture, stance, renal system, cardiovascular system, musculoskeletal system, Pulmonary system changes are described in this ppt. Thank You for choosing this.
Anatomical & physiological changes in pregnancy & their clinical implications...alka mukherjee
• Women undergo several changes during pregnancy, including cardiovascular, hematologic, metabolic, renal, and respiratory changes that provide adequate nutrition and gas exchange for the developing fetus.
• Progesterone and estrogen levels rise continually through pregnancy, together with blood sugar, breathing rate, and cardiac output.
• The body’s posture changes during pregnancy to accommodate the growing fetus and the mother will experience weight gain.
• Breasts grow and change in preparation for lactation once the infant is born. Once lactation begins, the woman’s breasts swell significantly and can feel achy, lumpy, and
heavy (engorgement). This is relieved by nursing the infant.
• Plasma and blood volume increase over the course of the pregnancy and lead to changes in heart rate and blood pressure. Women may also have a higher risk of blood clots, especially in the weeks following labor.
• During pregnancy, both protein metabolism and carbohydrate metabolism are affected. One kilogram of extra protein is deposited, with half going to the fetus and placenta, and another half going to uterine contractile proteins, breast glandular tissue, plasma protein, and hemoglobin.
• Circulatory Changes
• Plasma and blood volume slowly increase by 40–50% over the course of the pregnancy (due to increased aldosterone) to accommodate the changes, resulting in an increase in heart rate (15 beats/min more than usual), stroke volume, and cardiac output. Cardiac output increases by about 50%, primarily during the first trimester.
• The systemic vascular resistance also drops due to the smooth muscle relaxation and overall vasodilation caused by elevated progesterone, leading to a fall in blood pressure. Diastolic blood pressure consequently decreases between 12–26 weeks, and increases again to pre-pregnancy levels by 36 weeks.
• Edema (swelling) of the feet is common during pregnancy, partly because the enlarging uterus compresses veins and lymphatic drainage from the legs.
• The platelet count tends to fall progressively during normal pregnancy, although it usually remains within normal limits. In a proportion of women (5–10%), the count will reach levels of 100–150 × 109 cells/l by term and this occurs in the absence of any pathological process. In practice, therefore, a woman is not considered to be thrombocytopenic in pregnancy until the platelet count is less than 100 × 109 cells/l.
• Pregnancy causes a two- to three-fold increase in the requirement for iron, not only for haemoglobin synthesis but also for for the foetus and the production of certain enzymes. There is a 10- to 20-fold increase in folate requirements and a two-fold increase in the requirement for vitamin B12.
Changes in the coagulation system during pregnancy produce a physiological hypercoagulable state (in preparation for haemostasis following delivery).
Anatomical & Physiological changes in Pregnancy, all the changes in balance, posture, stance, renal system, cardiovascular system, musculoskeletal system, Pulmonary system changes are described in this ppt. Thank You for choosing this.
Anatomical & physiological changes in pregnancy & their clinical implications...alka mukherjee
• Women undergo several changes during pregnancy, including cardiovascular, hematologic, metabolic, renal, and respiratory changes that provide adequate nutrition and gas exchange for the developing fetus.
• Progesterone and estrogen levels rise continually through pregnancy, together with blood sugar, breathing rate, and cardiac output.
• The body’s posture changes during pregnancy to accommodate the growing fetus and the mother will experience weight gain.
• Breasts grow and change in preparation for lactation once the infant is born. Once lactation begins, the woman’s breasts swell significantly and can feel achy, lumpy, and
heavy (engorgement). This is relieved by nursing the infant.
• Plasma and blood volume increase over the course of the pregnancy and lead to changes in heart rate and blood pressure. Women may also have a higher risk of blood clots, especially in the weeks following labor.
• During pregnancy, both protein metabolism and carbohydrate metabolism are affected. One kilogram of extra protein is deposited, with half going to the fetus and placenta, and another half going to uterine contractile proteins, breast glandular tissue, plasma protein, and hemoglobin.
• Circulatory Changes
• Plasma and blood volume slowly increase by 40–50% over the course of the pregnancy (due to increased aldosterone) to accommodate the changes, resulting in an increase in heart rate (15 beats/min more than usual), stroke volume, and cardiac output. Cardiac output increases by about 50%, primarily during the first trimester.
• The systemic vascular resistance also drops due to the smooth muscle relaxation and overall vasodilation caused by elevated progesterone, leading to a fall in blood pressure. Diastolic blood pressure consequently decreases between 12–26 weeks, and increases again to pre-pregnancy levels by 36 weeks.
• Edema (swelling) of the feet is common during pregnancy, partly because the enlarging uterus compresses veins and lymphatic drainage from the legs.
• The platelet count tends to fall progressively during normal pregnancy, although it usually remains within normal limits. In a proportion of women (5–10%), the count will reach levels of 100–150 × 109 cells/l by term and this occurs in the absence of any pathological process. In practice, therefore, a woman is not considered to be thrombocytopenic in pregnancy until the platelet count is less than 100 × 109 cells/l.
• Pregnancy causes a two- to three-fold increase in the requirement for iron, not only for haemoglobin synthesis but also for for the foetus and the production of certain enzymes. There is a 10- to 20-fold increase in folate requirements and a two-fold increase in the requirement for vitamin B12.
Changes in the coagulation system during pregnancy produce a physiological hypercoagulable state (in preparation for haemostasis following delivery).
Detailed account of the various changes that occur in maternal anatomy, physiology, and metabolism of pregnant women. These physiological changes are often very precise, and deviations of physiological responses can be a prelude to possible disease/infectious states. In this second part of Labor, we will examine the various systems of the human body,its altered states during pregnancy, and how those changes affect the woman preparing for delivery. Special care is imperative in properly determining the needs of an expecting mother, so developing an intimate, trusting relationship between the mother and fully understanding her physiological output will lead to the best chances of a successful delivery.
Detailed account of the various changes that occur in maternal anatomy, physiology, and metabolism of pregnant women. These physiological changes are often very precise, and deviations of physiological responses can be a prelude to possible disease/infectious states. In this second part of Labor, we will examine the various systems of the human body,its altered states during pregnancy, and how those changes affect the woman preparing for delivery. Special care is imperative in properly determining the needs of an expecting mother, so developing an intimate, trusting relationship between the mother and fully understanding her physiological output will lead to the best chances of a successful delivery.
Maternal Physiology & Related Conditions refers to the physiological changes that occur in a woman's body during pregnancy, childbirth, and the postpartum period. These changes include hormonal fluctuations, cardiovascular and metabolic changes, and structural changes in the reproductive system. Maternal physiology also encompasses the study of any potential complications that may arise during this time, such as gestational diabetes or preeclampsia.
Physiological changes during pregnancyDeepa Mishra
PHYSIOLOGICAL CHANGES DURING PREGNANCY
Deepa Mishra
Assistant Professor (OBG)
Pregnancy
Pregnancy usually occurs during 15-44 yrs of a woman.
Duration of pregnancy from LMP is 280 days or 40 weeks or 9 months and 7 days
Three trimester-
1st Trimester -0 -12 weeks
2nd trimester – 13-28 weeks
3rd trimester -29-40 weeks s
Physiological changes
Reproductive system
Hematological and Cardiovascular changes
Respiratory, Acid base balance, electrolyte changes
Urinary changes
GI changes
Metabolic changes
Skeletal and neurological changes
Skin changes
Endocrinal changes
Psychological changes
2. 2
Genital changes
• The body of the uterus
- Height and weight (hyperplasia)
the height increases from 7.5 cm to 35cm
the weight increases from 50g to 1000g at term
- Uterine ligaments
show hypertrophy
- Dextro-rotation
the uterus is tilted and twisted to the right in 80% of cases
- Lower uterine segment (LUS)
the LUS is formed from the isthmus
formed from the 4th month to reach 10 cm at full term
3. 3
Genital changes
• The cervix
- edema and congestion, and becomes soft
- mucus plug (operculum): cervical mucus closing the cervical
canal
- increased secretion from its glands
• The vulva
shows increased vascularity and varicosities
4. 4
Genital changes
• The vagina
- shows increased vascularity soft, moist and bluish
- distention of vagina at birth
• The ovary
shows increased vascularity and size
one ovary contains the corpus luteum
• Pelvic ligaments
- relaxation of the ligaments
- relaxation of the pelvic joints
- the pelvis become more mobile and increases in capacity
5. 5
Breast changes
• Increased size and vascularity
warm, tense and tender
• Increased pigmentation of the nipple and areola
• Secondary areola appear
(light pigmentation around the areola)
• Montgomery tubercules appear on the areola
(dilated sebaceous glands)
• Colostrum like fluid is expressed at the end of the 3rd month
6. 6
Skin changes
• Pigmentation
due to increased melanocyte stimulating hormone:
- linea nigra: pigmentation of the linea alba, more marked below
the umbilicus
- chloasma gravidarum: Butterfly pigmentation of the face (mask
of pregnancy)
• Striae gravidarum
- stretch of the abdominal wall
rupture of the subcutaneous elastic fibers
pink lines in flanks
- become white after labor
7. 7
Weight increase
• There is an increase weight of approximately 12.5 Kg at term
• The main increase occurs in the 2nd half of the pregnancy, 0.5
Kg/week
• Causes:
growth of the conceptus
enlargement of the maternal organs
maternal storage of fat
increase in maternal blood and interstitial fluid
8. 8
Skeletal changes
• Increased lumbar lordosis
• Relaxation of pelvic joints and ligaments
due to progesterone and relaxin
9. 9
Urinary changes
• Kidneys
- increase in size
- hydronephrosis
- effective renal plasma flow is increased
• Dilatation of the ureters
- Atony of the ureteric muscles caused by progesterone and relaxin
hydro-ureter
- vesico-ureteric reflux increased - pressure of the uterus on the ureter
affects more the right ureter due to the dextro-rotation of the uterus
Changes in the ureter in pregnancy leads to urinary stasis and pyelitis
10. 10
Urinary changes
• Frequency of micturation
causes: 1st trimester: pressure of the uterus on the bladder
late in pregnancy: engagement of the head
• Urinary output
- diminished on a normal fluid intake
- increase in tubular reabsorption
- 100 extra liters of fluid pass into the renal tubules each day
- extracellular water is increased by 6 to 7 liters during pregnancy
- this is due to increased amounts of
aldosterone progesterone and oestrogen
11. 11
Gastro-intestinal changes
• Increased salivation (ptyalism)
• Taste is often altered very early in pregnancy
• Increase appetite & thirst frequent small snacks
• Heart burn (reflux oesophagitis)
relaxation of the cardiac sphincter due to progesterone and relaxin
• Emesis gravidarum, morning sickness in 50 %
• Decreased gastric acidity, which interfere with iron absorption
• Constipation
reduced gut motility due to progesterone
increased water and salt absorption
12. 12
Gastro-intestinal changes
• Liver
- Hepatic synthesis of albumin, plasma globulin and fibrinogen
increases
- Total hepatic synthesis of globulin increases stimulated by
estrogen
- Hormone-binding globulins rise
- gall bladder increases in size and empties more slowly
- relaxation of gall bladder increases the tendency of stone
formation
- cholestasis is almost physiological
- secretion of bile is unchanged
13. 13
Cardiovascular changes
• Fall in total peripheral resistance by 6 weeks gestation to a nadir ~
40% by mid gestation
• Circulatory underfilling
activation of renin-angiotensin- aldosterone system
necessary expansion of the plasma volume
the bigger the expansion, the bigger the baby birthweight
• Total extracellular volume 16% by term
• Plasma osmolality by 10mOsm/Kg as water is retained
14. 14
Cardiovascular changes
• The heart
- the heart rate rises synchronously by 10-15 b.p.m.
from 70 to 85 b.p.m.
- stroke volume rises
- cardiac output begins to rise by 35-40% in a first pregnancy
and ~ 50% in later pregnancies
15. 15
Cardiovascular changes
• The blood pressure
- Korotkoff 5 used with auscultatory techniques
- slight drop in the 2nd trimester
small fall in systolic, greater fall in diastolic B.P.
opening of arterio-venous shunts at the placenta
increased pulse pressure
- supine hypotension syndrome in 8% of the women
2nd half of the pregnancy:
maternal hypotension occurs in the supine position due to pressure of
the uterus on the inferior vena cava
decreased venous return and cardiac output
16. 16
Cardiovascular changes
• Noradrenaline
- pressor response to angiotensin II reduced in normal pregnancy,
unchanged to noradrenaline
- plasma noradrenaline is not increased in normal pregnancy
• Pulmonary circulation
- able to absorb high rate of flow without an increase in pressure
- pressure in right ventricle, pulmonary arteries and capillaries
does not change
- pulmonary resistance falls in early pregnancy
- progressive venodilatation + rises in venous distensibility +
capacitance throughout a normal pregnancy
17. 17
Respiratory changes
• Tidal volume rises by 30% in early pregnancy
40-50% by term
• Fall in expiratory reserve and residual volume
decrease the threshold
increase the sensitivity of medulla oblongata to CO2
• Respiratory rate does not change
the minute ventilation rises by a similar amount
from 7.25L to 10.5L
• Elevation of the diaphragm in late pregnancy
dyspnea
Driven by
progesterone
18. 18
Respiratory changes
• Carbon dioxide production rises sharply during the 3rd trimester
as fetal metabolism increases
• The fall in maternal P CO2
- allows more efficient placental transfer of CO2 from the fetus
- results in a fall in plasma bicarbonate concentration
( from 24-28 mmol/L to 18-22 mmol/L)
fall in plasma osmolality
venous pH rises slightly ( from 7.35 to 7.38)
19. 19
Respiratory changes
• The increased alveolar ventilation small rise in PCO2
(from 96.7 to 101.8 mmHg)
• Rightward shift of the maternal oxyhaemoglobin dissociation curve
( due to an increase in 2,3-DPG in erythrocytes)
oxygen unloading to the fetus which has:
- lower PCO2 (25-30 mmHg, 3.3-4 KPa)
- marked leftward shift of the oxyhaemoglobin dissociation curve,
(due to lower sensitivity of fetal haemoglobin to 2,3-DPG)
20. 20
Respiratory changes
• Increase of 16% in oxygen consumption by term
• Fall in arterio-venous oxygen difference
• Pregnancy places greater demands on the cardiovascular than the
respiratory system
21. 21
Haematological changes
• Circulating red cell mass increases by 20-30%
( rises more in multiple pregnancies and iron supplement)
• Serum iron concentration falls
absorption from gut and iron-binding capacity rise
• Plasma folate concentration halves by term ( renal clearance)
red cell folate concentration falls less
• Mild maternal anaemia associated with
increased placental/birthweight ratio
decreased birthweight
22. 22
Haematological changes
• Erythropoietin rises especially if iron supplement not taken
• Human placental lactogen may stimulate haematopoiesis
• Fall in packed cell volume from 36% in early pregnancy to 32% in the 3rd
trimester ( normal plasma volume expansion)
• WBC count rises ( increase in polymorphonuclear leucocytes)
• Neutrophil number rises with oestrogen
peak at 33 weeks
stabilizing after that
until labour and the puerperium, when they rise sharply
23. 23
Haematological changes
• T and B lymphocyte counts do not change but their function is
suppressed
( women become more susceptible to viral infections, malaria and
leprosy)
• Platelet count and platelet volume are largely unchanged
24. 24
Haematological changes
• Coagulation
- factors VII, VIII and X rise
- absolute plasma fibrinogen doubles
- antithrombin III falls
- erythrocyte sedimentation rates increase
- Protein C unchanged
- Protein S concentrations, co-factor of protein C, fall in 1st & 2nd
trimesters
- plasma fibrinolytic activity decreases during pregnancy & labour
returns to normal values within an hour of delivery of placenta
26. Endocrinal changes
• Pituitary
- anterior pituitary increases in size and activity
- posterior pituitary releases oxytocin on the onset of labor
• Thyroid
- increases in size and activity: physiological goiter
- most pregnant women are euthyroid
- thyroid binding globulin concentrations double (not other thyroid
binding proteins)
- total T3, T4 are increased (not the free T3 ,T4)
• Parathyroid
increases in size and activity to regulate calcium metabolism
27. 27
Endocrinal changes
• Adrenals
- increases in size and activity
- total cortisol is increased (free cortisol unchanged)
• Placental hormones
Progesterone
- produced by the corpus luteum
- levels rise steadily during pregnancy, output reaches 250mg/day
- actions:
colon activity reduced, nausea, constipation
reduced bladder and ureteric tone
diastolic pressure reduced, venous dilatation
raises temperature
28. 28
Endocrinal changes
• Placental hormones
Oestrogens
- source:
ovary in early pregnancy
later, oestrone and oestradiol produced by the placenta
increased a hundredfold
oestriol produced by the placenta and fetal adrenals
increased thousandfold
- levels: output of oestrogens reaches a maximum of at least 30-40mg/day
oestriol accounts 85%
levels increase up to term
29. 29
Endocrinal changes
• Placental hormones
Oestrogens
- possible actions:
1- induce growth of uterus and control its function
2- responsible for the development of breasts ( with progesterone)
3- alter chemical constitution of connective tissue, become more pliable
4- cause water retention
5- reduce sodium excretion
31. Metabolic changes
• Carbohydrate metabolism
- pregnancy is hyperlipidaemic and glucosuric
- after mid-pregnancy, resistance of insulin develops
- plasma glucose concentrations rise, maintained between 4.5-5.5 mmol/L
- glucose crosses the placenta, the fetus uses glucose as primary energy
substrate, transport occurs by carrier mediated mechanism
- the insulin resistance is endocrine-driven, via increase in cortisol and hPL
- concentrations of glucagons and the catecholamines are unaltered
32. 32
Metabolic changes
• Carbohydrate metabolism
- carbohydrate deposited in the liver as glycogen
- some escapes to general circulation
- portion metabolised by the tissues:
converted to depot fat
stored as muscle glycogen
- first noticeable change occurs in blood sugar
- tested by giving a load of oral glucose (glucose tolerance test)
- the blood sugar, after meal, remains high facilitating placental
transfer
33. 33
Metabolic changes
• Carbohydrate metabolism
- with increased placental production of steroid, less glycogen
deposited in liver and muscles
- the effect of fasting is pronounced in pregnancy
overnight fast of 12hrs
hypoglycaemia, production of ketone bodies
34. 34
Metabolic changes
• Protein metabolism
- positive nitrogen balance
- on average 500 g of protein retained by the end of pregnancy
- blood and urine urea are reduced
• Fat metabolism
- by 30 weeks, 4Kg are stored in form of
depot fat in the abdominal wall, back and thights
modest amount in breasts