Anatomical changes in Pregnancy

1. Anatomical changes in Pregnancy Prepared by Hazrat Bilal Malakandi 10 th semester, DPT, IPM&R KMU Peshawar

2. Group members Hazrat Bilal Heera Nawaz Asmat Saeed Bushra Bakht Atif Nazir

3. Pregnancy is the fertilization and development of one or more offspring, known as an embryo or fetus, in a woman's uterus. Pregnancy results in many anatomical changes Few of them are discussed shortly in next slides

4. Changes in Reproductive organs Uterus: The uterus expands from a strictly pelvic organ before 12 weeks to become an abdominal organ for the remainder of gestation . the uterus increases in weight from 60 to 1000g ( 20 times its original weight). In size, it changes from 6.5 to 32 cm.

5. Its shape changes from elongated to oval by the second month, to round by midgestation , then back through oval to elongated at term (the end of a normal nine-month pregnancy). Uterine expansion is caused by the growing fetus and an increase in connective tissue and in the size and number of blood vessels supplying the uterus

6. Cervix The portion of the uterus connecting the body of the uterus and the vagina. During pregnancy, the cervix is closed. A mucus plug forms over the cervix ,providing a protective barrier between the vagina and the uterine contents.

7. During labour and delivery, the cervix shortens and widens (or dilates). A 10 cm opening is left between the uterus and the vagina to allow for passage of the fetus into the birth canal. If the cervix begins dilating prematurely, it is sometimes stitched together during the second trimester, until the fetus in mature. This procedure is known as a cerclage .

8. Changes in Musculo-skeletal system Ligaments Placental production of the hormone relaxin causes pelvic ligaments and the pubic symphysis to relax, widen, and become more flexible. This increased motility eases birth passage, but it may also result in a waddling gait during pregnancy. Changes in joint laxity occurring during pregnancy. By M Calguneri, H A Bird, V Wright http://ard.bmj.com/content/41/2/126

9. Lumbar region The expanding uterus causes an progressive lumbar lordosis . Lumbar lordosis leads to low back pain in 40 to 50 percent of all pregnant women. Carlson HL, Carlson NL, Pasternak BA, Balderston KD. Understanding and managing the back pain of pregnancy. Curr Womens Health Rep 2003; 3:65. Pregnancy and Back Pain . . . . By Kristen Schott, PT, MPT http://www.sportspti.com/research/articles/pregnancy-and-back-pain.aspx

10. Increased lordosis in pregnancy due to increased anterior load.

11. Center of Gravity The increasing bulkiness of the abdomen changes the woman's center of gravity forward. This shift increases the stress on your joints and causes your back to curve forward. The change of the center of gravity location in late pregnancy is temporary and two months after delivery the center of gravity is located as it was at the beginning of pregnancy. Journal of Huan Kinetics. Volume 26, Issue -1, Pages 5–11, ISSN (Online) 1899-7562, ISSN (Print) 1640-5544, DOI:  10.2478/v10078-010-0042-1 , January 2011

12. Changes in Respiratory system The diaphragm is progressively elevated and compressed. Possibly because of expansion and elevation of the rib cage. The lungs are compressed due to growing uterus in later pregnancy making it more difficult to breathe deeply.

13. Postural changes: During pregnancy, postural changes occurred. These changes include forward head, rounded shoulders, increased lumbar lordosis , Center of gravity shift, hyperextended knees, and pronated feet.

14. Muscular changes are also typical. often noted alterations include shortened hip flexors, lower back musculature, and pectorals. Abdominal muscles, neck, and upper back muscle groups elongate. Functional Changes in Back Muscle Activity Correlate With Pain Intensity and Prediction of Low Back Pain During Pregnancy http://www.ncbi.nlm.nih.gov/pubmed/9779673

15. Changes in cutaneous system They are usually more marked below the umbilicus, on the breasts and may appear on the buttocks and thighs. In some women they are not marked or even don't appear during pregnancy. Falling of hairs and brittleness of nails may occur during pregnancy.

16. Pigmentation It is due to suprarenal changes, it usually begins to appear after the 4th month. The pigmentation may appear anywhere but the commonest sites are: 1. Linea nigra : which is a line of pigmentation between the umbilicus and the symphysis pubis. 2. Cloasma gravidarum or mask face of pregnancy which is butterfly pigmentation of the forehead, nose, upper lip and the adjoining parts of the checks.

17. Linea nigra butterfly pigmentation

18. Changes in weight In normal pregnancy the average gain is 0.3 Kg/week up to 18 weeks , 0.45 Kg/week from 18-28 weeks and a slight reduction with a rate of 0.36- 0.41 Kg/week until term. Slight weight loss may occur in the last 2 weeks. The average weight gain for primigravidae is 12.5 Kg. and is probably about 0.9 Kg. less for multigravidae.

19. Weight gain is produced by: Fetus ----------- ------3.63-3.88 Kg Placenta -------------- 0.48-0.72 Kg Amniotic fluid ------- 0.72-0.97 Kg Uterus and breasts - 2.42-2.66 Kg Blood and fluid ------ 1.94-3.99 Kg Muscle and fat ------ 0.48-2.91 kg Total= 9.70-14.55Kg

20. Anatomy comparison

21. Milk Ducts

22. Lungs

23. Diaphragm

24. Stomach

25. Liver

26. Intestines

27. Placenta

28. Umbilical Cord

29. Uterus

30. Bladder

31. cervix

32. Vagina