03/30/2025 1
Anatomical and
physiological
Yonas . A
changes during
pregnancy
Yonas A.
Anatomical and
physiological
changes during
pregnancy
Normal
Pregnancy
Physiological changes
during pregnancy
There are physiological,
biochemical and anatomical
changes that occur during
pregnancy.
These changes may be
systemic or local.
Most of the systemic changes
return to pre-pregnancy
Physiologic status 6 weeks after delivery.
al changes
during These changes occur during
pregnancy.. pregnancy to maintain a
healthy environment for the
fetus with out compromising
the mother’s health.
And prepare for the
process of delivery and
Physiologic care of the newborn.
al changes
during Understanding of the
pregnancy.. normal changes helps
to understand
coincidental disease
processes.
Secretion of Estrogen and
HCG progesterone
hormone by are produced
placenta at in larger
A. Changes 12 weeks. amount
in
Endocrine The size and
System the acidity is
Thyroid influenced
gland because of
circulating
estrogens.
Uterus
Grows and increase in weight
B. Changes in from 60g to about 600-1000
the gram at term
Reproducti Size increase from 7.5x 5x2.5
ve Organs cm to 30x30x20cm volume
10ml to 5 liter
The cervix becomes softer and
the glands secrete thick
mucus.
Because of estrogen
and increased blood
supply to it:
2. Vagina • The vaginal tissue soften
and more elastic which
allows easier dilatation in
labor .There is increase of
normal white vaginal
discharge called
Leucorrhoea
• Appear reddish purple
Ripening of the ovum
stops ,function taken
by the placenta.
3. Ovaries
Ovulation ceases
during pregnancy and
the maturation of new
follicles is suspended.
Estrogen develops the ducts system
Progesterone the glandular system
4. Breasts
The breast enlarge due to increase
tissue growth blood supply and fat
deposition.
Breast increases in size with
enlargement of the nipple and increased
vascularity and pigmentation of areola.
There is an increase in blood
volume amounting to an extra
1.5-2 liters (45-50%)by the 34th
week of pregnancy
C. Change in
Cardiovascu RBC increase by 33%
lar System
Iron need increases because of
increases in RBC
An increase in plasma is
greater than blood cells due
to this the Hg level falls
Change in and the pregnant women
Cardiovasc may become anemic.
ular There is little change in SBP
System... but DBP decrease by 5-
10mmHg from 12 -26 weeks
then increases to none
pregnant level by term.
Change in
Cardiovascular
System cont’d
• Cardiac out put
Increase by 49% during
pregnancy at 20-24 weeks of
gestation the constant until
term.
Heart slightly shift in position.
• Venous pressure
No change in the upper body
venous return to the heart
increases pressure and
results in edema.
D. Changes in Respiratory System
In late
pregnancy
At the end
the large
of
uterus
pregnancy
presses
oxygen
the lower
requireme
lobes of
nt will
the lung
increase
and causes
by 20%
difficult
breathing.
E. Change in the Renal System
Early in pregnancy (6-
12 weeks) and
The enlarged uterus
compress on the
bladder and causes
frequency of
micturition; At the end of the
Because of pregnancy when the
progesterone urethra head engaged
become dilated and
kinked, slow emptying
may cause tendency
for UTI and stone
formation
F. Changes in the GIT
Gums hypertrophy and hyperemic, easily bleed.
Gastrointestinal mobility may be reduced due to
increased progesterone hence gastric emptying is
slowed and similarly in other part of GIT constipation.
Oral cavity feels salivation
Changes in the GIT cont’d
Stomach production of gastrin increase,
increase gastric volume and decrease PH.
Mucus production increased so PUD usually
improve or disappear.
But enlarging uterus causes heart burn which
is common due to reflux and relaxation of
cardiac sphincter.
Changes in the GIT cont’d
Pica (craving for unnatural substance) women often
experiences changes in their sense of test and leading
to dietary changes and food craving
Nausea and vomiting is usually between 4-14 week
(occur in the mornings)
Abdominal wall
• The skin of abdomen is stretched
and small tears of the deeper layers
occur, this is called striae
G. Changes in the gravidarum "stretch marks” and
skin produce line in the abdomen may
occur on breasts and thighs.
• The sebaceous and sweat glands
become more active (women often
feels hot )
Hyperpigmentation over some part
of the body Irregular brownish
patches of varying size appear on
Changes the face and neck, giving rise to
chloasma or melasma gravidarum,
in the also-called mark of pregnancy.
skin • A dark line, Linea nigra is often
seen extending from the symphysis
cont’d pubis to the umbilicus
• Increased activity of stimulating
melanin hormone cause darkening
of the areola
H. Changes • The activity of all body function
in increase to meet the growing
general demands of the fetus and maternal
metaboli tissue
sm
• Fetus---------------3-4 Kg
• Fat------------------3-5Kg
Weight • Placenta-----------0.6 Kg
• Breast--------------0.5 Kg
increase • Amniotic fluid-----0.6Kg
due to • Uterus--------------1Kg
• Blood volume-----1.5 liter
increase in • At full term the weight should not exceed
9 -12 kilos totally
Slight movement of the
pelvic joints may cause
backache.
Changes in
the
Musculoskel Poor posture puts the
etal System
additional strain on the
muscle and ligaments of
the back and backache
may follow.
The changes need to be
understood by not only the
health workers but also by
J. Emotion the woman and her families.
al
change The news of the pregnancy
s may be received in many
ways depending on the
circumstances of the woman
and the family.
There may be some emotional
instability during early months .At
moment the woman may be happy
Emotion and the next moment in tears.
al A usually calm woman may become
irritable and an anxious. The
changes husband may become confused
cont’d Physical and emotional support
during last months needed.
Whatever the reaction,
the woman needs
Emotion support, love and
reassurance particularly
al from her husband and
changes She also needs to build
family.
cont’d up confidence in the
medical staff who cares
for her.
Physiologic change summary
Cardiovascular Cardiac output Increased (20%–45%)
Heart rate Increased (10 to 20 bpm)
Stroke volume Increased (20% to 30%)
Plasma volume Increased (30% to 50%)
Blood Pressure
Systolic No change
Diastolic Decreased (10 mmHg)
Respiratory Respiratory rate No change
Residual volume Decreased
Tidal volume Increased (up to 40%)
Minute ventilation Increased (up to 50%)
Functional Residual Capacity Decreased (20%)
Oxygen Consumption Increased (20%)
FEV1 Unchanged
Gastrointestinal Serum Albumin Decreased (20% to 40%)
Gastric Emptying Prolonged
Hepatic artery blood flow No change
Renal Glomerular filtration rate Increased (up to 50%)
Renal Plasma Flow Increased (up to 50%)
Total Body Water Increased (up to 20%, 75% in ECF and 25%
in blood)
Summary
Minor
Disorder • Minor disorders are only disorders that
s of occur during pregnancy and are not life
threatening.
Pregnan
cy
1. Nausea
and
vomiting
• This presents between 4
and 12 weeks gestation.
Hormonal influences are
listed as the most likely
causes. It usually occurs in
the morning but can occur
any time during the day,
aggravated by smelling of
food.
Management
Reassure the mother
Nausea
and Small frequent meals(dry
vomitin meals)
Reduce fatty and fried contain
g cont’d foods
Rest
It is a burring sensation in
the mid chest region.
Progesterone relaxes the
cardiac sphincter of the
stomach and allows reflex of
2. Heartbu gastric contents into
rn Heartburn
esophagus.is most trouble at
30 -40 weeks gestation
because at this stage is
under pressure from the
growing uterus.
Heartbu Management
• small and frequent meals ,sleeping with
rn extra pillows than usual
• for persistence/sever case /prescribe
cont’d antacids.
3. Pica
• This is the term when mother craves certain foods of
unnatural substance such as coal soil etc. the cause is
unknown but hormones and changes in the metabolism
are blamed
Management
• Seek medical advice if the substance craved is
potentially harmful to the unborn baby
4. Constipati
on
• Progesterone causes
relaxation and decreases
peristalsis of the gut which is
also displaced by the growing
fetus
Management
• Increase the intake of water,
fresh fruits, vegetables and
roughages in the diet
• Exercise is helpful especially
walking
• The hormones sometimes soften the
ligaments to such a degree that some
support is needed
5.Backac Management
• Advice the mother to sleep on firm bed
he • Advice support mechanism of the back
In early pregnancy fainting may be due
to the vasodilatation occurring under
the influence of progesterone; before
6.Faintin there has been a compensatory
increase in blood volume .the weight of
g the uterine content presses on the
inferior venacava and slows the return
of the blood to the heart
Management
• Avoid long period of standing
Fainting • Sit or lie down when she feels slight
dizziness
cont’d • She would be wise not to lie on her back
except during abdominal examination
Progesterone relaxes the smooth
muscles of the vein and result in
7. Varicosit sluggish circulation. The valves of the
dilated veins become inefficient and
ies varicosities result. it occurs in leg,
anus(hemorrhoids) and vulva
Management
• Exercising the calf muscle by rising on
the toes
Varicosit • Elevate the leg and rest
ies • Support the thigh and legs
• Avoid constipation and advise adequate
cont’d fluid in take
• Sanitary pad give support for vulva
varicosities
Conclusio • Most minor disorder can be
advanced to a more serious
n… complication of pregnancy. The
disorders that require the
immediate actions are as follows
(Danger signs of pregnancy)
Danger • Vaginal bleeding
• Reduced fetal movement
signs of • Frontal or recurrent headaches
• Sudden swelling
pregnanc • Rupture of the membrane
y • Premature onset of contractions
• Maternal anxiety for whatever
reason.
Pregnancy is mainly diagnosed on the
symptoms reported by the woman and signs
elicited by a health care provider.
Signs and symptoms are divided into 3
Diagnos Presumptive sign
is of
pregnan Probable sign
cy Positive sign
1. Presumpti a) Amenorrhea sudden stopping of
menstruation is correct in 98% of
ve cases but it can happen in change
of environment, distress, serious
(Possible) illness, severe anemia
• In women with irregular cycles,
sign amenorrhea is not a reliable sign.
Breast change 3-4th weeks:
prickling sensation
6th week enlargement and
Presumpti sometimes tender, visible
surface veins
ve Sign 12th weeks primary areola
cont’d becomes darker and larger.
16th week colostrum appears in
breast (can be expressed).
Morning sickness 50% of
the mother experience this
but other condition can
raise to vomiting
Presumpti
ve Sign Is most marked at 2–12
cont’d weeks' gestation
• Frequency of micturition
without burning sensation or pain
occurs before the 12th week
Skin change there is chloasma,
linea nigra, striae graviderium are
due to stretching of the skin.
Presumpti Quickening; the first fetal
movement felt by the
ve Sign mother ,and it occurs around the
cont’d 16th -20th week
Note: slight tingling can be
experienced by non-pregnant
women and chloasma can be
present in ovarian cyst or fibroid
Hegar’s sign:
Is widening of the softened area of the
2. Probab isthmus, resulting in compressibility of
the isthmus on bimanual examination.
le This occurs by 6–8(12) weeks;
signs
Is one of the early sign and detected
by an examination carried out by the
Professionals.
2. Abdominal enlargement
• There is progressive abdominal
Probable enlargement from 7–28 weeks. At 16–22
weeks, growth may appear more rapid as
signs the uterus rises out of the pelvis and into
the abdomen.
cont’d
• No other condition makes the uterus
enlarge so quickly and progressively.
• Can also due to fat, flatus, full bladder,
fluid or fibroid
Probable 3. Changes in the uterus
• From 8th week onwards the uterus
signs enlarge;
• The consistency is soft, the shape
cont’d
globular
4. Braxton Hicks
Probable
• Painless intermittent contraction of the
uterus, during pregnancy felt on
palpation from the 16th week onwards
signs (28).
• The contraction help in the circulation of
cont’d blood to the placenta site and in the
formation of the lower uterine segment.
5. Uterine souffle
Probable • From 12 - 16th week, soft sound heard on
auscultation.
signs • It is the same rate as maternal pulse
also heard in fibroid due to increased
cont’d blood flow to uterus.
6. Internal ballottement: The
Probable sensation of an object rebounding after
being pushed by an examining hand.
signs
• May be felt by the 16th week on
examination carried out by the
professional.
cont’d
7. Softening of the cervix
• The cervix undergoes increased
Probable softening as pregnancy advances.
• Felt from the 10th week (normally the
signs cervix feels like cartilage)
• As pregnancy progresses, the cervical
cont’d canal may become sufficiently patulous
to admit the fingertip.
8. Chadwick's Sign(Blue
Probable discoloration)
• Congestion of the pelvic vasculature
signs causes bluish or purplish discoloration of
the vagina and cervix starting from 8th
cont’d week onward.
Probable 9. Leukorrhea
signs • An increase in vaginal discharge
consisting of epithelial cells and cervical
cont’d
mucus is due to hormone stimulation.
3. Positive signs
• A positive diagnosis must be made on objective findings.
a) Hearing the fetal heart beat/Fetal Heart Tones (FHTs)
• It is possible to detect FHT by hand held Doppler as early as 10 weeks'
gestation.
• The normal fetal heart rate is 120–160 beats per minute. It may be
detected by fetoscope by 18–20 weeks' gestation, although this device
is rarely used at present.
b) Feeling fatal parts like hand or
limbs on Palpation
Positive • After 22 weeks, the fetal outline can be
palpated through the maternal
signs abdominal wall.
• Fetal movements may be palpated after
cont’d 18 weeks. This may be more easily
accomplished by a vaginal examination.
Positive
signs cont’d
c) Seeing Fetal Movement on
Inspection
d) Seeing Fetal Parts on x-ray
e) Ultrasound Examination of Fetus
• Sonography is one of the most useful
technical aids in diagnosing and
monitoring pregnancy.
• Cardiac activity is discernible at 5–6
weeks,
• Limb buds at 7–8 weeks, and finger and
limb movements at 9–10 weeks.
• At the end of the embryonic period (10
weeks by LMP), the embryo has a human
appearance.
Positive f) Pregnancy Tests
• Sensitive, early pregnancy tests measure
signs changes in levels of hCG.
• Presence of human chorionic
cont’d gonadotrophic (hCG) in blood from 9 -10
and in urine starting from 14 days.
• hCG is produced by the
Positive syncytiotrophoblast 8 days after
fertilization and may be detected in the
maternal serum after implantation
signs occurs, 8–11 days after conception.
• hCG levels peak at approximately 10–12
cont’d weeks of gestation.
Urine Pregnancy Test
• This is the most common method used to
confirm pregnancy. Is qualitative- +ve or
Positive –ve.
• Using antibodies, the test identifies the
signs subunit of hCG, minimizing cross-
reaction with similarly structured
hormones.
cont’d • Affordable, reliable and fast (1–5 minutes
to obtain results) tool to diagnose
pregnancy in the office
