Maternal changes during pregnancy for undergraduate

1. Maternal cahnges during Maternal cahnges during
pregnancypregnancy
DR Manal Behery
Professor Ob&Gyne
Zagazig University 2014

2. Reproductive tract (1)Reproductive tract (1)
UterusUterus: from 50g-1100g: from 50g-1100g
from <10ml – 5Lfrom <10ml – 5L
from pyriform to globularfrom pyriform to globular
Fundl levelFundl level
From 7.5cm -35cm From 7.5cm -35cm

3. Lower uterine segment Lower uterine segment

4. Braxton Hicks contraction:Braxton Hicks contraction:
sporadic, irregular, asymmetrical, and sporadic, irregular, asymmetrical, and
painless, low pressure, lasting < 30 painless, low pressure, lasting < 30
secsec
Reproductive tract (2)Reproductive tract (2)

5. Cervix and vulva —— Chadwick’s signCervix and vulva —— Chadwick’s sign
congestion of the pelvic vasculature, cause bluish congestion of the pelvic vasculature, cause bluish
or purplish discoloration of the cervix and vulva or purplish discoloration of the cervix and vulva
Leukorrhea:Leukorrhea: increase in vaginal discharge, rich in increase in vaginal discharge, rich in
glucose, lactic acid, low vaginal pHglucose, lactic acid, low vaginal pH
Ovary:Ovary: slightly enlarged, corpus luteum regresses slightly enlarged, corpus luteum regresses
after 10 weeks’ gestationafter 10 weeks’ gestation

Reproductive tract (2)Reproductive tract (2)

6. Breasts: Breasts: increase in circulationincrease in circulation
Engorgement and venous prominenceEngorgement and venous prominence
Mastodynia (breast ternderness):Mastodynia (breast ternderness): tingling tingling
to frank pain caused by hormonal responses of to frank pain caused by hormonal responses of
the mammary ducts and alveolar systemthe mammary ducts and alveolar system
Montgomery’s tubercles:Montgomery’s tubercles: enlargement of enlargement of
circumlacteal sebaceous glands of the areolacircumlacteal sebaceous glands of the areola
Colostrum secretion: Colostrum secretion:

7. Breast Breast
changeschanges

8. Montgomery tubercles
non pigmented nodules
(12-20) around the areola
in 2
nd
month (enlarged
sebaceous glands or
rudimentary lactiferous
ducts).

9. (2) Cardiovascular system (2) Cardiovascular system
changeschanges

10. Cardiovascular changes (2Cardiovascular changes (2))
Position and size of heartPosition and size of heart
ECG changesECG changes
Increased heart rate (+15%)Increased heart rate (+15%)
15-degree left axis deviation15-degree left axis deviation

11. Cardiovascular changes Cardiovascular changes
(2)(2)
Inferior vena cava syndrome: Inferior vena cava syndrome:

12. Cardiovascular changes Cardiovascular changes
(cont)(cont)
Stroke volume +30%Stroke volume +30%
Heart rate +15%Heart rate +15%
Cardiac output +40%Cardiac output +40%
Oxygen consumption +20% Oxygen consumption +20%
SVR SVR (systemic vascular resistance)(systemic vascular resistance) -5% -5%
Systolic BP -10mmHgSystolic BP -10mmHg
Diastolic BP -15mmHgDiastolic BP -15mmHg
Mean BP -15mmHgMean BP -15mmHg

13. Blood volume +30%Blood volume +30%
Plasma volume +40%Plasma volume +40%
Red blood cell volume +20%Red blood cell volume +20%
Delusional anemiaDelusional anemia
Increase cardiac outputIncrease cardiac output
Decrease blood viscosityDecrease blood viscosity
Vasodilatation Vasodilatation

Cardiovascular changes Cardiovascular changes
(4)(4)

14. unchanged in the upper bodyunchanged in the upper body
 Significantly increases in the lower Significantly increases in the lower
extremities, extremities, esp. during supine, sitting or esp. during supine, sitting or
standing position, returns to near normal in lateral standing position, returns to near normal in lateral
recumbent positionrecumbent position
Venous pressureVenous pressure:: Venous Venous
blood flowblood flow

15. ((3) Urinary system changes3) Urinary system changes

16. Increased frequency of micturationIncreased frequency of micturation

17. Kidney slightly enlargedKidney slightly enlarged
Renal plasma flow +35%Renal plasma flow +35%
Glomerular filtration rate +50% Glomerular filtration rate +50%
Serum creatinine, uric acid Serum creatinine, uric acid
and urea nitrogenand urea nitrogen
Renin, angiotensin I and IIRenin, angiotensin I and II
Renin substrateRenin substrate
Glucosuria (50%) +Glucosuria (50%) +

18. Renal changesRenal changes
renal pelves dilatedrenal pelves dilated
Ureters (esp. right side) dilatedUreters (esp. right side) dilated
Bladder tone reducedBladder tone reduced
Bladder capacity reducedBladder capacity reduced
Residual volume increasedResidual volume increased
Chance of pyelonephritis increaasedChance of pyelonephritis increaased

19. Pulmonary changesPulmonary changes
Mucosal hyperemia Mucosal hyperemia
Subcostal angleSubcostal angle
Chest circumference and diameterChest circumference and diameter
Diaphragmatic excursionDiaphragmatic excursion
Tidal volume +30-40%Tidal volume +30-40%
POPO
22 is increased, PCO is increased, PCO
22 is decreased. is decreased.
Total lung capacity decrease -15%Total lung capacity decrease -15%
Minute ventilation +30-40%Minute ventilation +30-40%
Mild respiratory alkalosisMild respiratory alkalosis

20. Gastrointestinal changeGastrointestinal change

21. SkinSkin changeschanges
ChloasmaChloasma
Striae gravidarumStriae gravidarum
Linea alba——linea nigraLinea alba——linea nigra
 Vascular spidersVascular spiders
Skin neviSkin nevi

22. Nervous system disordersNervous system disorders

23. MuscloskeletalMuscloskeletal systemsystem

24. MetabolismMetabolism
Basal metabolism rate, BMR +15-20%Basal metabolism rate, BMR +15-20%
Weight gain 12.5Weight gain 12.5
Fetus 3400gFetus 3400g
Placenta 650Placenta 650
Amniotic 800Amniotic 800
Uterus 960Uterus 960
Plasma, red cells 1450Plasma, red cells 1450
Mammary glands 405Mammary glands 405
Extracellular, extravascular water 1480Extracellular, extravascular water 1480
Deposition of fat and protein 3345Deposition of fat and protein 3345
Insulin resistanceInsulin resistance

25. A quizA quiz

26. 1. In a normal singleton pregnancy,
maternal blood volume
A. increases by 10-15%
B. increases by 45%
C. decreases by 10-15%
D. decreases by 45%

27. Which of the following is not Which of the following is not
characteristic of a normal characteristic of a normal
pregnancy?pregnancy?
A. cardiac volume increases by 10%A. cardiac volume increases by 10%
B. the ECG shows deviation to the leftB. the ECG shows deviation to the left
C. the rest pulse rate increases by approximately 10-C. the rest pulse rate increases by approximately 10-
15% beats per min15% beats per min
D. arterial blood pressure and vascular resistance D. arterial blood pressure and vascular resistance
increasesincreases
E. The heart is displaced upward and to the leftE. The heart is displaced upward and to the left

28. 33. . Epulis is a pregnancy-related Epulis is a pregnancy-related
vascular swelling of thevascular swelling of the
A. GumsA. Gums
B. NailbedB. Nailbed
C. LarynxC. Larynx
D. NaresD. Nares
E. EpiglottisE. Epiglottis

29. THANK THANK
YOUYOU