PHYSIOLOGICAL

CHANGES DURING
PREGNANCY
Physiological Changes in the reproductive
system
 A.UTERUS
NONPREGNANT PREGNANT

WEIGHT 50gm – 60 gm 900-1000gm

LENGTH 7.5-8cm 35cm

BODY OF
THE
UTERUS

ISTHMUS

CERVIX
 1. CHANGES IN THE MUSCLES

• Hypertrophy & hyperplasia under the influence

of oestrogen & progestrone

• Stretching of the muscle fibres due to distention

of the growing fetus

• Uterus feels soft and elastic

2. ARRANGEMENT OF MUSCLE FIBRES
OUTER Follows a hood like arrangement over the fundus
LONGITUDINAL

INNNER It is scanty and have sphincter like arrangement around

CIRCULAR
the tubal orifices and internal os

INTERMEDIATE Thickest and strongest layer through which the blood

CRISS CROSS
vessels run. Apposition of two double curved muscle
fibres give the FIGURE OF 8 form. When the muscle
contracts, they occlude the blood vessel & hence called
LIVING LIGATURE.
 3. VASCULAR SYSTEM

• In non pregnant state the blood flow is mainly through

the uterine artery and least through the ovarian artery.

• In pregnancy both carries the same amount of blood.

• Marked spiralling of the arteries reaching the maximum

at 20 wks and thereafter straightens out and becomes
dilated.

• Veins are very much dilated as they have no valves.

 4. WEIGHT
NONPREGNANT PREGNANT
WEIGHT 50gm 900-1000gm
 5. SHAPE
UPTO 12 WKS PYRIFORM SHAPE

12-28 WKS GLOBULAR SHAPE

28-36 WKS PYRIFORM/OVAL SHAPE

BEYOND 36 WKS SPHERICAL SHAPE

 6. POSITION
• Up to 12 wks- anteverted antiflexed position

increased frequency of mituration.

• Afterwards it becomes erect

• At it reaches term anteverted antiflexed (in multi

becoz of lax abdominal muscles)

• In primi with good tone of the abdominal muscles, it is

held firm against the maternal spine.
 7. LATERAL OBLIQUITY

• As the uterus enlarges it rotates on its long axis to

the right (dextro – rotation) due to the occupation
of recto-sigmoid in the left posterior quadrant of
the pelvis.

• The cervix as a result deviates to the left side

(levo - rotation)
 8. UTERINE PERITONEUM

• Maintains the relationship proportionately to the

growing uterus.

• Deepening of pouch of douglas

• Large areas of lower lateral walls remains

uncovered by peritoneum.
 9. CONTRACTIONS (BRAXTON – HICKS)

• Irregular, infrequent, spasmodic and painless

contractions without any effect on the

dilatation of the cervix.

• Starts at the early weeks of pregnancy

• Felt by bimanual palpation

 10. ENDOMETRIUM
• DECIDUA – endometrium of the pregnant
uterus.
Superficial compact layer

Intermediate spongy layer

Thin basal layer

• During the first trimester the isthmus hypertrophies

and elongates to 3 times its original length (1.5 cm)

• It becomes soft

• Beyond 12 wks it forms the lower uterine segment

• It dilates during the last trimester and measures 7.5-

10cm.
CERVIX
• Hypertrophy and hyperplasia of the elastic and
connective tissues.

• Vascularity increases + hypertrophy &

hyperplasia softening of cervix (goodell’s
sign)

• Copious and tenacious secretions from the cervix

because of the effect of progesterone called
physiological leucorrhoea of pregnancy
• The mucous secretions fills up the cervical
glands and forms a thick plug effectively sealing
the cervical canal called operculum.
 B. VAGINA

• Vaginal walls become hypertrophied, edematous

and more vascular.

• Increased circulation causes purple blue

discolouration ( CHADWICK’S SIGN)

• Vaginal secretions becomes acidic

 C. VULVA

• Edematous and hyperaemic

• Superficial varicosities may appear. Specially in

multipara

• Labia minora are pigmented and hypertrophied.

 D . FALLOPIAN TUBE

• Will be almost placed vertically by the sides of

the uterus.

• The tubes become hypertrophied and congested

 E. OVARY

• There is persistence and growth of corpus leuteum

• It looks bright orange, later on becomes yellow,

and finally pale.

• Corpus leuteum produces progesterone which

help to maintain pregnancy.

 Breast
Changes
 SIZE

NIPPLES &
AREOLA

SECREATIONS
Weight Gain
NORMAL BMI 20-26 11-16 kg

OBESE BMI > 29 7 kg

UNDERWEIGHT BMI < 19 18 kg

UP TO 20 WKS 20 WKS - TERM TOTAL

2 KG 0.5KG/ WK 12 KG

I TRIMESTER 1kg

II TRIMESTER 5kg

III TRIMESTER 5kg

TOTAL 11kg
Skin changes
• Linea nigra
• Striae gravidarum
• Palmar erythema
• Mask of pregnancy (Chloasma)
• Vascular spiders
• BODY WATER METABOLISM
Changes in the
cardiovascular
system
 ANATOMICAL CHANGES

• The heart is pushed upwards and outwards with

slight rotation to the left.

• Palpitation due to displacement.

• Apex beat: 4th ICS 2.5 cm outside the

midclavicular line.
• Pulse rate increased.(15 bpm)

• Systolic murmur at apical & pulmonary area ( due to

decreased blood viscosity & torsion of great vessels)

• Mammary murmur: (continuous hissing murmur over

the tricuspid area in the left 2nd & 3rd ICS due to
increased blood flow through the internal mammary
vessels.

• ECG normal with left axis deviation.

• Cardiac output

• Blood pressure

• Venous pressure

• Supine hypotension syndrome

• Regional distribution of blood flow

• Blood volume
Urinary system
• Respiratory

system
• Gastrointestinal system
• Skeletal system
• Nervous system
 Metabolic changes

• General metabolic changes

• Protein metabolism

• Carbohydrate metabolism

• Fat metabolism

• Lipid metabolism

• Iron metabolism
 Endocrine changes

• Placental hormones

• Pituitary gland & its hormones

• Thyroid function

• Adrenal glands