Maternal changes during pregnancy for undergraduate

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Information about Maternal changes during pregnancy for undergraduate

Published on March 5, 2014

Author: MBHRY


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:

Breast changes

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%

Gastrointestinal change

Skin changes  Chloasma  Striae gravidarum  Linea alba——linea nigra   Vascular spiders Skin nevi

Nervous system disorders

Muscloskeletal system

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

A quiz

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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