Anatomical changes in pregnancy and.pptx

The ppt describes about the anatomical changes in the pregnant women. It gives a clear picture of anatomical changes that happenes during the pregnancy. You can have a clear understanding on the topic. It shows some pictures with most accurate sense of description and everyone make use of it.

1. ANATOMICAL CHANGES IN PREGNANCY BY ARCHANA UDAY ASWATHY R M

2. Anatomical changes in pregnancy includes changes in Reproductive system Cardiovascular system Respiratory system Gastrointestinal system Urinary system

3. EXTERNAL GENITALIA The vulva becomes edematous and hypertrophied. The vaginal mucosa can be seen pouting through the introitus . Elongation of the anterior vaginal wall. Sometimes vulval varicosities can also be seen. Vaginal pH becomes more acidic due to increase in lactobacilli.

4. UTERUS SIZE AND SHAPE At term the uterus weighs about 1000kg and measures 36 cm. The fundus enlarges more than the body. The uterus enlarges and becomes softer ,rising out of the pelvis at 12 weeks. It then grows in a linear fashion and in doing so pushes the intestines laterally and superiorly . The globular shape at 10-12 weeks slowly changes to a longitudinal ovoid as term approaches .

5. UTERINE MUSCLE The uterus undergoes a tremendous degree of growth as a result of both hyperplasia and hypertrophy of uterine smooth muscle. Hyperplasia => Early pregnancy,where as both hyperplasia and hypertrophy are seen in the second trimester. Uterus has 3 muscle layers. Middle layer is the thickest and consist of muscle fibers running in a crisscross fashion with vessels traversing in between. The contraction of these muscles during delivery results in clamping down of the vessels thereby decreasing the bleeding.Hence they are called LIVING LIGATURES.

6. VASCULARITY AND TROPHOBLASTIC INVASION There is also a tremendous increase in vascular supply. The uterine and spiral arteries become dilated channels pumping blood into the fecoplacental unit. The endovascular trophoblastic cells penetrate the lumen and causes remodeling of the vessel wall. The myometrial segments of spiral artery are transformed into wide mouthed vessels . Thus the blood supply is changed from high resistance low flow system to lower resistance high flow system to meet the need of the growing fetus.

7. ISTHMUS The isthmus elongates almost 3 times in early pregnancy. By the 12 th week it starts progressively unfolding and opening up and eventually forms the lower uterine segment. In the process,the inner muscle fibres are incorporated into the uterine cavity, leaving the lower part intact with its intrinsic sphincteric action to retain the fetus within.

8. CERVIX The ectocervix appears bluish and feels soft to touch. Proliferation of the endocervical mucosa and glands leads to increased secretion and discharge per vaginum . The discharge is clear not foul smelling and not pruritic. The glands also secrete thick mucus which blocks the cervical canal .

9. FALLOPIAN TUBE The tube appears more congested ,fairly low placed due to exaggerated growth of the fundus of the uterus

10. OVARY The corpus luteum reaches its maximum at 8 weeks of gestation both in its structure and function. The corpus luteum then becomes yellow and eventually white and atretic . Ovarian changes specific to pregnancy are pregnancy luteoma and hyperreaction luteinalis . Both represent excessive luteinisation .

11. BREASTS Breasts enlarge in pregnancy. The heaviness and tenderness of breast during early period is due to both hypertrophy of alveoli and increase in vascularity. Fine veins appear under the skin seen more clearly in fair skinned women. The nipple and areola also enlarge in the later months and become more darkly pigmented. Sebaceous glands called Montgomery’s tubercles appear as elevations on the areola. Also colostrum can be expressed from the breast.

12. OTHER ORGANS SKIN Abdominal wall Skin over the abdomen undergoes some amount of stretching and in the later months appears shiny. Reddish streak appears on the skin of abdomen breast and thigs => striae gravidarum . White coloured striae albicans represents previous pregnancy. Recti muscles may separate in the midline due to tension => Diatasis recti.

13. Pigmentation Skin undergoes varying degree of pigmentation which varies among individuals. Dark line running centrally below the umbilicus => linea nigra . The skin over the face becomes blotchy with brownish areas interspersed between normal skin => chloasma or melisma of pregnancy which is transient and disappears wih delivery. This pigmentation is thought to be due to: Increased levels of endorphins melanocyte stimulating hormone in pregnancy

14. CHLOASMA LINEA NIGRA

15. Vascular changes Vascularity increases in the skin like the other parts of the body. In some women estrogen excess causes reddish rounded elevations of skin surrounded by radially arranged branching => spider naevi [disappears with delivery]. Palmar erythema may also seen

16. Eyes Eye sight remains same. There is a fall in IOP and cornea sensitivity. There is also some degree of corneal thickening due to edema. Krukenberg spindles => hyper pigmented patches in the cornea[abate after delivery].

17. MUSCULOSKELETAL SYSTEM Progesterone induced relaxation of joints contributes to change in posture in pregnancy. Progressive lordosis with a waddling gait puts more strain on the back and lower extremities. There may be tingling and numbness in the fingers and toes. There is a total weight gain of about 11 to 15 kg. 1kg => first trimester 5kg => second trimester 5kg => third trimester

18. RESPIRATORY SYSTEM The lower ribs flare out, the subcoastal angle increases from 68 degree to 103 degree. The transverse diameter of the chest increases by 2 cm. Diaphragm rises by about 4cm. There may be hyperaemia and edema of respiratory tract mucosa and increased mucous secretion.

19. GIT The enlarging uterus compresses the rectum resulting in an increased sensation of a need to defaecate . It also displaces the bowels upwards and sideways. Hence, in pregnancy complicated by acute appendicitis tenderness may not be over McBurney’s point [it is usually periumbilical or epigastric]. Intra abdominal position of lower esophageal sphincter is defunct resulting in reflex oesophagitis . The gums may become hyperaemic and soft and bleeds likely when traumatised [raised level of hormones, especially estrogen]

20. Haemorrhoids are common due to pressure by the gravid uterus.

21. URINARY SYSTEM Small enlargement in size of kidney. Dilation of the renal pelvis. Uterus become atonic and dilated both due to pressure of gravid uterus and high progesterone levels. This makes the woman more prone to ascending infection and pyelonephritis. Hence it becomes important to detect asymptomatic bacteriuria in pregnancy. In early months the bladder muscle become congested and hyperaemic due to pressure of the uterus and due to pressure of the presenting parts in later months of pregnancy

22. CARDIOVASCULAR SYSTEM The heart is pushed upwards and rotated by elevation of the diaphragm, so that the apex beat is felt in the left 4 th intercostal space lateral to the midclavicular line. Chest X-ray may show straightening of the left border and increased prominence of the pulmonary conus . Lateral displacement of the left border of the heart gives an exaggerated impression of cardiac enlargement.

23. Echocardiography also shows a mild increase in size due to an increase in venous filling rather than muscle hypertrophy .

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