MENOPAUSE AND PREGNANCY.pptx/maternal changes during pregnancy

During pregnancy, a woman's body undergoes a variety of maternal changes to support the growth and development of the baby. These changes occur in virtually every system of the body and are vital for ensuring a healthy pregnancy. Here is a detailed overview of some of the key maternal changes that occur during pregnancy:

1. **Reproductive System**:
- **Uterus**: The most notable change is the expansion of the uterus to accommodate the growing fetus. The uterus increases in size and weight throughout pregnancy.
- **Cervix**: The cervix softens and lengthens in preparation for labor and delivery.
- **Placenta**: The placenta develops and plays a crucial role in providing oxygen and nutrients to the fetus.

2. **Cardiovascular System**:
- **Blood Volume**: Blood volume increases significantly to support the needs of the developing baby and maternal body.
- **Cardiac Output**: The heart works harder to pump the increased blood volume, leading to an increase in cardiac output.
- **Blood Pressure**: Blood pressure may decrease slightly in the first and second trimesters before returning to normal or slightly elevated levels in the third trimester.

3. **Respiratory System**:
- **Breathing**: As the uterus expands, it can push against the diaphragm, leading to shortness of breath in some women.
- **Oxygen Consumption**: Maternal oxygen consumption increases to meet the needs of the growing fetus.

4. **Gastrointestinal System**:
- **Digestive Tract**: Hormonal changes can lead to slowed digestion and potential issues with constipation.
- **Appetite**: Some women may experience changes in appetite or cravings due to hormonal fluctuations.

5. **Urinary System**:
- **Kidneys**: The kidneys work harder to filter waste from the body, leading to an increase in urine production.
- **Bladder**: The growing uterus can put pressure on the bladder, leading to more frequent urination.

6. **Hormonal Changes**:
- **HCG (Human Chorionic Gonadotropin)**: This hormone is produced by the placenta and is responsible for maintaining the early stages of pregnancy.
- **Progesterone and Estrogen**: These hormones play a crucial role in maintaining the pregnancy and supporting fetal development.

7. **Immune System**:
- **Immune Suppression**: The immune system is suppressed to prevent the body from rejecting the fetus, which is technically a foreign entity.

8. **Metabolic Changes**:
- **Glucose Metabolism**: Insulin sensitivity may decrease, leading to a temporary condition known as gestational diabetes in some women.
- **Nutrient Absorption**: The body becomes more efficient at absorbing nutrients to support fetal growth.

These maternal changes are necessary to support the growth and development of the baby throughout pregnancy. It's essential for pregnant women to receive regular prenatal care to monitor these changes and ensure a healthy outcome for both mother and baby.

1. MENOPAUSE AND PREGNANCY DR. ANEEKA EHSAN (PT)

2. CONTENTS MENOPAUSE PREGNANCY MATERNAL CHANGES DURING PREGNANCY Structural changes Increase in body weight Metabolic changes Changes in physiological systems

3. MENOPAUSE Normally, it occurs at the age of 45 to 55 years . It is caused by loss of ovarian follicular function and a decline in circulating blood estrogen levels . Menopause transition occurs gradually. CAUSES OF EARLY MENOPAUSE: Surgical removal of ovaries (ovariectomy) Surgical removal of uterus (hysterectomy)as a part of treatment for abnormal menstruation. Cigarette smoking. It is the period when permanent cessation of menstruation takes place . Due to advancement of age, atrophy of ovaries occurs. It leads to the cessation of menstrual cycle causing menopause.

4. CHANGES DURING MENOPAUSE- POSTMENOPAUSE SYNDROME Includes physical, psychological and physiological changes. Hot flashes Blood pressure increases suddenly and then comes back to normal automatically. Fatigue Nervousness Emotional outburst like crying and anger Mental depression and insomnia Palpitations, headache Numbness or tingling sensation Increased frequency of micturition (urinary disturbances) Osteoporosis and atherosclerosis due to lack of estrogen. TREATMENT: Most of the women manage it very well. But about 15% need treatment: Psychotherapy Hormone Replacement Therapy ( daily administration of estrogen in small quantities )

5. PREGNANCY Also known as GESTATION PERIOD. “The condition between conception (fertilization of egg by sperm) and birth, during which the fertilized egg develops into a fetus in the uterus.” Duration: 280 days or 40 weeks. MISCARRIAGE: Pregnancy ends before 28 th week. PREMATURE LABOR: Pregnancy ends before 37 th week.

6. MATERNAL CHANGES DURING PREGNANCY ~STRUCTURAL CHANGES OVARIES Follicular changes and ovulation does not occur due to inhibition of FSH and LH hormone. Corpus luteum enlarges and secretes a large quantity of progesterone and estrogen and after 3 months these hormones are secreted by placenta as corpus luteum degenerates. These hormones are secreted through out the pregnancy period as they are essential for maintaining the pregnancy. UTERUS From almost zero volume it reaches 5 to 7 liters at the end of pregnancy. Size increases Attains globular shape At the end of pregnancy the uterine weight increases to about 1000 to 1200 gram.

7. VAGINA Increases in size Color changes to violet due to increased blood supply. CERVIX Becomes soft MAMMARY GLANDS The size of mammary glands increases because of development of new ducts and alveoli ,deposition of fat and increased vascularization. ~ INCREASE IN BODY WEIGHT Average weight gained during pregnancy is 12 kg. fetus: 3.5 kg Amniotic fluid: 2.0 kg Placenta: 1.5 kg Increase in maternal body weight: 5.0 kg

8. ~METABOLIC CHANGES The metabolic activities are accelerated in the body due to increased secretion of various hormones such as thyroxine, cortisol and sex hormones. 1. BASAL METABOLIC RATE It increases by 15% in the later stages of pregnancy. 2. PROTEIN METABOLISM Protein anabolism increases during pregnancy, the deposition of protein increases in the uterus. 3. CARBOHYDRATE METABOLISM Blood glucose level increases leading to glucosuria. Ketosis develops either due to less food or vomiting. 4 . LIPID METABOLISM During pregnancy, there is deposition of fat i.e. 3 to 4 kg in maternal body. It also increases the blood cholesterol level.

9. 5. WATER AND MINERAL METABOLISM Apart from water and sodium retention , there is retention of calcium and phosphorus as well as they are necessary for the growth of fetus. ~CHANGES IN PHYSIOLOGICAL SYSTEMS 1.BLOOD Blood volume increases by about 20% or by 1L . Because of great demand for iron by the fetus, the mother usually develops anemia. It can be rectified by proper prenatal care and iron replacement, folic acid consumption . Secretion of estrogen and progesterone Retention of sodium and water increases Increased secretion of aldosterone during pregnancy Increases reabsorption of sodium from renal tubules of kidney.

10. 2.CARDIOVASCULAR SYSTEM Cardiac output: it generally increases in the first trimester. Cardiac output starts decreasing and reaches almost the normal level in the later stages of pregnancy Blood pressure: it remains unchanged during the first trimester. During the second trimester, there is slight decrease and it is due to diversion of blood to uterine sinuses. 3.RESPIRATORY SYSTEM Overall activity of respiratory system increases slightly. 4.EXCRETORY SYSTEM Renal blood flow and GFR increase resulting in increase in urine formation . It is because of increase in fluid intake and the increased excretory products from fetus and the micturition increases due to pressure exerted by uterus on the bladder.

11. 5.DIGESTIVE SYSTEM During the initial stages of pregnancy, the morning sickness occurs in mother. It involves nausea, vomiting and giddiness . This is because of hormonal imbalance . Constipation and indigestion also occur. 6.ENDOCRINE SYSTEM Anterior Pituitary During pregnancy, its size increases by 50%. The secretion of FSH and LH decreases very much. It is because of negative feedback control by estrogen and progesterone , which are continuously secreted from corpus luteum initially and then by placenta later on. Adrenal cortex There is moderate increase in secretion of cortisol , which helps in the mobilization of amino acids to the fetus . Aldosterone secretion also increases, responsible for retention of sodium and water partly.

12. iii. Thyroid gland The increased secretion of thyroxine helps in the preparation of mammary glands for lactation and increases basal metabolic rate. iv. Parathyroid gland Parathormone is responsible for maintenance of calcium level in mother’s blood in spite of loss of large amount of calcium to fetus. 7.NERVOUS SYSTEM Psychological imbalance occurs such as mood swings, excitement or depression.

13. ANY QUESTIONS