Published on March 5, 2014
Maternal cahnges during pregnancy DR Manal Behery Professor Ob&Gyne Zagazig University 2014
Reproductive tract (1) Uterus : from 50g-1100g from <10ml – 5L from pyriform to globular Fundl level From 7.5cm -35cm
Lower uterine segment
Reproductive tract (2) Braxton Hicks contraction: sporadic, irregular, asymmetrical, and painless, low pressure, lasting < 30 sec
Reproductive tract (2) Cervix and vulva —— Chadwick’s sign congestion of the pelvic vasculature, cause bluish or purplish discoloration of the cervix and vulva Leukorrhea: increase in vaginal discharge, rich in glucose, lactic acid, low vaginal pH Ovary: slightly enlarged, corpus luteum regresses after 10 weeks’ gestation
Breasts: increase in circulation Engorgement and venous prominence Mastodynia (breast ternderness): tingling to frank pain caused by hormonal responses of the mammary ducts and alveolar system Montgomery’s tubercles: enlargement of circumlacteal sebaceous glands of the areola Colostrum secretion:
Montgomery tubercles non pigmented nodules (12-20) around the areola in 2nd month (enlarged sebaceous glands or rudimentary lactiferous ducts).
(2) Cardiovascular system changes
Cardiovascular changes (2 ) Position and size of heart ECG changes Increased heart rate (+15%) 15-degree left axis deviation
Cardiovascular changes (2) Inferior vena cava syndrome:
Cardiovascular changes (cont) Stroke volume +30% Heart rate +15% Cardiac output +40% Oxygen consumption +20% SVR (systemic vascular resistance) -5% Systolic BP -10mmHg Diastolic BP -15mmHg Mean BP -15mmHg
Cardiovascular changes (4) Blood volume +30% Plasma volume +40% Red blood cell volume +20% Delusional anemia Increase cardiac output Decrease blood viscosity Vasodilatation
Venous pressure : Venous blood flow unchanged in the upper body Significantly increases in the lower extremities, esp. during supine, sitting or standing position, returns to near normal in lateral recumbent position
( 3) Urinary system changes
Increased frequency of micturation
Kidney slightly enlarged Renal plasma flow +35% Glomerular filtration rate +50% Serum creatinine, uric acid and urea nitrogen Renin, angiotensin I and II Renin substrate Glucosuria (50%) +
Renal changes renal pelves dilated Ureters (esp. right side) dilated Bladder tone reduced Bladder capacity reduced Residual volume increased Chance of pyelonephritis increaased
Pulmonary changes Mucosal hyperemia Subcostal angle Chest circumference and diameter Diaphragmatic excursion Tidal volume PO2 is increased, PCO2 is decreased. Total lung capacity decrease Minute ventilation Mild respiratory alkalosis +30-40% -15% +30-40%
Skin changes Chloasma Striae gravidarum Linea alba——linea nigra Vascular spiders Skin nevi
Nervous system disorders
Metabolism Basal metabolism rate, BMR +15-20% Weight gain 12.5 Fetus 3400g Placenta 650 Amniotic 800 Uterus 960 Plasma, red cells 1450 Mammary glands 405 Extracellular, extravascular water 1480 Deposition of fat and protein 3345 Insulin resistance
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%
Which of the following is not characteristic of a normal pregnancy? A. cardiac volume increases by 10% B. the ECG shows deviation to the left C. the rest pulse rate increases by approximately 1015% beats per min D. arterial blood pressure and vascular resistance increases E. The heart is displaced upward and to the left
3 . Epulis is a pregnancy-related vascular swelling of the A. Gums B. Nailbed C. Larynx D. Nares E. Epiglottis
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