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1.Changes in the reproductive system

2.Changes in the breast

3. Skin changes

4. Changes in the cardio vascular system

5. Changes in the respiratory system

6. Changes in the G.I system7. Changes in the skeletal system

8. Metabolic changes

9. Changes in the urinary system10. Changes in the nervous system

11.Changes in the endocrine system

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UTERUS

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UTERUS

uterus

Fundus & body of theuterus

endometrium

Superficial compact/D.vera

Inter.Spongy/D.capsularies

Basal layer/D.basalis

Myometrium

Inner circular

Middle oblique/livingligature

Outer longitudinalPerimetrium

Isthmus

Cervix

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Changes in the shape of the uterus

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Changes in the breast

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Changes in the skin

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L

inea nigra & stria gravidarum

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The heart: due to increased workload the heart may

increase in size. Displaced upwards & to the left.Cardiac output: increases 5 to 7 ltrs/mt.

Blood volume: starts increasing from 10th wk. expands30% above the nonpregnent level at 30-32wks.

RBC:increases 18% by the end of pregnency.

Hb: 18-20%increase.

Plasma volume: increase from 10thwk.increases by 50%

by 32-34th

wk. total increaseis 1.25 ltrs.leads to dilutionof blood/ hemodilution.

Physiological anemia

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Iron metabolism: requirement is 725mg.

Plasma protien: increses from 180-230gms. Decrease in plasmaprotien concentration specially albumin leading to physiologicaledema.

As the albumin level drops in liver disease, there is insufficientoncotic pressure to hold f luids within cells. Fluid moves into theinterstitial spaces, causing generalized edema.

Clotting factors: fibrinogen level is increased by 50%. High risk forthrombosis, embolism, DIC.

WBC: slightly increased. Mainly neutrophils. Levels of Ig A,G,Mdecreases immune suppression.

B.P: remains almost the same. Due to diminished peripheralresistance by progestrone.

Venous pressure: gravid uterus exerts pressure on c. iliac

veins.leading to increased femoral vein pressure & tendency forvericose veins.

Supine hypotension syndrome/ postural hypotension: compressionof I. vena cava.

Blood flow: increased blood f low is directed to the heart & of this

80% to the placenta.

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With the enlargement of theuterus there is elevation of thediaphragm & the breathingbecomes diaphragmatic.

Respiration is made efficientby the progesterone acting onthe respiratory centere inhypothalamus.

Arterial PCO2

Arterial PO2This facilitates transfer of CO2from the fetus to the mother &

vise versa

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-gums become congested & spongy,gingivitis

-pica

-muscle tone, mobility, peristalsisdiminised due to progesterone.

-relaxed cardiac sphincter.

-constipation heamorrhoids

- Nausea & vomitting-due to raisedestrogenor HCG.

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Skeletal system

y Progesteron causes relaxation of ligaments& muscles.

y Lorosis.

y Daily requirement of calcium 1-1.5 gm.

Gain in weight

An average of 11kg -12kg.

Which is distribute as

-1kg I trimester- 5 kg II trimester

-5 kg III trimester

Or 2kg- first 20 wks & 0.5kg/wk until term.

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Changes in the metabolism

yProtien metabolism

yCarbohydrate metabolism

yFat metabolism

y

Iron metabolism

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Changes in the urinary system

yKidney: GFR is increased.

yUreter : dialated . Stasis

of urine. May lead topylitis.

yBladder : congestion withhypertrophy. Increasedfreqency of micturition.

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Some sort of temperamental changes seen.Carpel tunnel syndrome.

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C anges in t e en ocrine system

A.placental hormones

HCG

HPL

HCT

HCC PsBG

Protien H.

ESTROGEN

PROGESTERONESTEROID H.

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B. Pituitary hormones

yAnterior pituitary G:AdrenocorticotrophicH, melanocyte stimulating H,thyrotrophicH increase in their activity.

y

FSH & LH scretions are inhibited.yPosterior pituitary G: more amount of

oxytocin & active just before the onset oflabour.

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