obstetrics

tony tagacay ii
maternal physiology
dra. marla llanto

REPRODUCTIVE TRACT
UTERUS

• MYOCYTE ARRANGEMENT
o 3 strata

§ Outer hood-like layer
• Nonpregnant
§ Middle layer of dense network
o Weight: 70g
of muscle fibers perforated by
o Almost solid with cavity of 10mL
blood vessels
• Pregnant § Internal layer with sphincter-
o Term: 1100g
like fibers around the fallopian
o 5L-20L volume
tube orifices and internal
o Thin- walled muscular organ
cervical cervical os
o Muscular sac with tin, soft and
o Most of the uterine wall is formed by
indentable walls
the middle layer
§ 1-2 cm at term § Each cell in this layer has a
§ Stimulated by Estrogen double curve à interlacing à
• Uterine hypertrophy early in pregnancy forming a figure of 8
o Stimulated by action of estrogen and § Crucial arrangement à after
perhaps progesterone delivery, cell contraction
• 12 weeks constrict penetrating blood
o Increase in size à pressure exerted by vessels à act as ligatures
products of conception • UTERINE SIZE, SHAPE AND POSITION
• Uterine enlargement o Piriform or pear- shape
o Marked in the fundus o 12 weeks – more globular and spherical
o After 12 weeks à abdominal organ
§ As it enlarges, comes in contact
with the anterior abdominal
wall, displaces the intestines
and dextrorotates
• UTERINE CONTRACTILITY
o Braxton Hicks contractions
§ Irregular painless
§ 5-25 mmHg intensity
§ Becomes more regular as
pregnancy progresses
§ False labor at term

• UTEROPLACENTAL BLOOD FLOW
o Indirect measures
 § Clearance rates ( Xenon and CERVIX
Androstenedione) • Connective tissue with small amount of smooth
• 450-650 mL/min at muscle
term • 1 month after conception – softening and
o Invasive methods cyanosis
§ 500-750 mL/ min o Increased vascularity and edema
o Uterine veins o Hypertrophy and hyperplasia of cervical
§ Remodelling à reduced elastin glands
content and adrenergic nerve • Cervical remodeling
density o Decrease collagen and proteoglycan
§ Increase venous caliber and o Increase water content
distensibility o Marked proliferation of cervical glands
o Uterine contractions § Eversion à red, velvety
§ Decrease uterine blood flow appearance of cervix which
• BLOOD FLOW REGULATION readily bleeds with trauma
o Uterine blood flow increases by • Cervical Mucus
vasodilation o Mucus Plug
o Uterine artery diameter – double by 20 § Copious, tencious mucus
weeks produced by endocervical
o Vessels that supply the corpus – widen mucosal cells
and elongate but preserves contractile § Rich in immunoglobulin and
function cytokines
o Spiral arteries – widen but loose § Bloody show at the onset of
contractility labor
o Cervical Mucus
§ Consistency change during
pregnancy
§ Progesterone à beadingà
poor crystallization
§ Ferning à arborization of
crystals
• Amniotic fluid leakage
• ARIAS – STELLA REACTION
o Endocervical gland hyperplasia and
hypersecretory appearance
o Stimulated by estrogen

PELVIC ORGAN PROLAPSE
• Cervical prolapse
• Cystocoele
• Rectocoele




o Normal pregnancy
§ Refractory to effects of
Angiotensin II and
Norepinephrine
o Nicotine and Cathecholamine
§ decreases uterine blood flow
and placental perfusion

OVARIES FALLOPIAN TUBES
• Ovulation and maturation of follicles are • Little hypertrophy
suspended • Epithelium becomes flattened
• Corpus lutuem à functions for 6-7 weeks/ 4-5 • Decidual cells may develop
weeks postovulation
• Decidual Reaction à elevated patches of tissue VAGINA & PERINEUM
in the ovary • Increased vascularity and hyperemia
o Progesterone stimulation • Chadwick sign
• Ovarian veins calibreà 0.9 cm to 2.6 cm at term o Violet discoloration of vaginal wall due
to increased vascularity
RELAXIN • Vaginal wall changes
• Protein hormone secreted by corpus luteum, o Increase in mucosal thichkness
decidua and placenta o Loosening of connective tissue
• Brain, heart and kidney o Smooth muscle cell hypertrophy
• Roles: • Epithelium
o Remodeling of reproductive tract o Hypertrophy to create fine, hobnailed
tissues to accomodate parturition appearance
o Initiation of augmented renal o Vaginal distention results in increased
hempdynamics fiber degradation and increase
o Decrease serum osmolality synthesis
o Increase uterine artery compliance o Vaginal discharge – acidic à due to
increased production of lactic acid from
THECA – LUTEIN CYSTS glycogen in the vaginal epithelium by L.
• Result form exaggerated physiological follicle acidophilus
stimulation à hyperreactio luteinalis
• Bilaterally enlarged cystic ovaries
• Due to elevated hCG
• Found in large placenta
o GDM
o Anti-D alloimmunization
o Multiple gestation
• Chronic renal failure
• Hyperthyroidism
• Normal pregnancy
• Usually asymptomatic but may bleed

• May cause virilization
o Maternal balding
o Hirsutism
o Clitoromegaly














BREAST METABOLIC CHANGES
• Early pregnancy – tenderness and paresthesia WEIGHT GAIN
• 2nd month – increase in size and delicate veins • 12.5 kg or 27.5 lbs
become visible • Attributable to uterus and contents, breast,
• Nipples become larger anderectile increase in blood volume and extracellular fluid
• Colostrum – thick, yellowish fluid is produced • Maternal reserve
• Areola become broader and pigmented o Small fraction
• Glands of Montgomery – hypertrophic o Accumulation of cellular water, fat and
sebaceous glands in the areola protein
• GIGANTOMASTIA
o Pathologic enlargement of the breast WATER METABOLISM
• Increased water retention
SKIN • 3.5L – fetus, placenta, amniotic fluid
ABDOMINAL WALL • 3.0 L – maternal blood volume, uterus and
• STRIAE GRAVIDARUM breast
o Reddish, slightly depressed streaks in • Due to decrease in plasma osmolality
the abdominal wall • Pitting edema – ankles and legs
o Glistening, silvery lines – in multiparous o Due to increased venous pressure
o Risk factors: below the level of uterus
§ Weight gain
§ Young maternal age PROTEIN METABOLISM
§ Family history • Products of conception, uterus and maternal
• DIASTASIS RECTI blood – rich in protein
o Rectus muscle separate in the middle • Fetus and placenta – 4kg at term
due to increased abdominal tension o 500g protein
• Uterus(contractile proteins), breasts (glands),
HYPERPIGMENTATION maternal blood (hgb) and plasma proteins –
• Develops in 90% of women 500g proteins
• Accentuated in those with darker complexion • Amino acid – concentrations are higher in fetal
• Etiology unknown – estrogen and progesterone compartment
à melanocyte- stimulating effect • Nitrogen balance – increase with gestational
o MSH – elevated throughout pregnancy age
• Linea Nigra
o Linea alba takes dark brown–black color CARBOHYDRATE METABOLISM
• Chloasma/Melasma gravidarum • Normal pregnancy
o Mask of pregnancy o Mild fasting hypoglycemia
o irregular brownish patches of varying o Postprandial hyperglycemia
sizes that appear in the neck and face o Hyperinsulinemia
o Increase placental lactogen
VASCULAR CHANGES
• Angiomas FAT METABOLISM
o Vascular spiders • Increase levels of:
o 2/3 of white women and 10% of black o Lipids
o Minute, red skin elevations with o Lipoproteins
radicles branching out from a central o Apolipoproteins
lesion • Maternal hyperlipidemia
o Neck, face, upper chest, arms o Due to insulin resistance and estrogen
stimulation
o Most consistent and striking change of
lipid metabolism in late pregnancy
• 1 and 2nd trimester
st

o Increase lipid synthesis

 o Fat accumulation HEMATOLOGICAL CHANGES
rd
• 3 trimester BLOOD VOLUME
o Fat storage decrease • 40-45% increase at 32-34 weeks (Hypervolemia)
o Enhanced lipolytic activity • Important functions:
o Decrease lipoprotein lipase activity o To meet the metabolic demand of
enlarged uterus and hypertrophied
LEPTIN vascular system
• Secreted by adipose tissue in nonpregnant o To provide nutrients and elements for
• Placenta the growing fetus
• Increases and peaks at 2nd trimester and o Protect mother and fetus to the effect
plateaus t 3rd trimester of impaired venous return
• Body fat and energy expenditure regulation o Safeguards mother during parturition
• Regulate fetal growth • Maternal blood volume begin to increase at 1st
• Abnormally high à preeclampsia and GDM trimester
• By 12 weeks à 15% inc
GHRELIN • Erythrocyte volume increase- 450 mL
• Seceted by stomach in response to hunger
• Energy hemeostasis modulation HEMOGLOBIN CONCENTRATION
• Placenta à fetal growth and cell proliferation • TERM : 12.5g/dL
• Increase and peak at midpregnancy o 5% : 11.0 g/dL
• Decrease in metabolic syndromes and GDM
IRON METABOLISM
ELECTROLYTE & MINERAL METABOLISM • Normal women : total iron content -2.0 -2.5g
Na & K o Most are incorporated in haemoglobin
• Retained: or myoglobin
o 1000 meq Na • Iron stores: 300mg
o 300 meq K • Iron requirements:
• Increased GFR, excretion unchanged o 1000mg à required for normal
• Increase total accumulation, decrease level due pregnancy
to expanded plasma volume o 300mg à actively transferred to the
fetus and placenta
Calcium o 200 mg à lost thru excretion routes
• Decline in prengnancy o Increase in erythrocyte volume= 450mL
• Albumin-bound nonionized – decrease level § Requires 500 mg of iron
§ 1 mL erythrocyte = 1.1 mg of
• Ionized – unchanged
iron
• 30g at term à by fetal skeleton
§ 6-7mg/day = iron requirement
• Dietary supplement
at midpregnancy

• Puerperium
Magnesium
o 500-600 mL – normal delivery
• Decline
o 1000 mL – CS and vaginal delivery of

twins
Phosphate

• Within nonpregnant state



Iodine

• Increase requirement during pregnancy

• To maintain euthyroid state
• To transfer thyroid hormone to fetus prior to
fetal thyroid functioning
• Due to increase rate of iodine secretion


IMMUNOLOGICAL FUNCTIONS PLATELETS
• 3 distinct immunologic phases of pregnancy: • Slight decrease in pregnancy
o Proinflammatory – early gestation • 213,000/uL from 250,000 /uL
o Antiinflammatory - midgestation • Thrombocytopenia = 116,000 /uL
o Inflammatory- parturition • Hemodilutional effect
• Anti–inflammatory component • Increased platelet consumption
o Suppression of T-helper (Th) 1 and T-
cytotoxic (Tc) 1 cells SPLEEN
§ Decreases the secretion of • Enlarge by 50% during pregnancy
interleukin 2, interferon-γ and • Cause is unknown
tumor necrosis factor β
§ Requisite for pregnancy CARDIOVASCULAR SYSTEM
continuation • Remarkable physiological daptations
§ Failure to suppress: • Cardiac function changes – apparent at 8 weeks
preeclampsia dev’t AOG
• Increase secretion of: • 5th week – cardiac output increases
o IL-4 o Reflects reduced vascular resistance
o IL-6 and increased in heart rate
o IL-13 • 6th – 7th week
• Cervical and vaginal mucus o Decrease blood pressure
o Interleukin-1β • Resting pulse rate – increase by 10bpm
o IgA and IgG • 10-20 weeks AOG
o Plasma volume expansion begins
LEUKOCYTE o Preload is increased
• 15,000/uL
• May reach 25,000/uL HEART
• Average: 14,000 – 16,000 /uL • Displaced to the left and upward
• Larger cardiac silhouette on xray
INFLAMMATORY MARKERS • ECG à left axis deviation
• Leukocyte alkaline phosphatase à • Cardiac sounds:
myeloproliferative disorders o Splitting of the first heart sound and
• C- reactive protein à acute –phase serum increased loudness on both
reactant components
• ESR o No definite changes in the aortic and
• C3 pulmonary component
• C4 o Loud and easily heard 3rd sound
• Procalcitonin • No change:
o Septal thickness
COAGULATION & FIBRINOLYSIS o Ejection fraction
• Augmented but remain balanced
• All clotting factors increase except factors XI CARDIAC OUTPUT
and XIII • Increase due to:
• Factor I: PLASMA FIBRINOGEN o Decrease in mean arterial pressure
o 300 mg/dL, ranges of 200-400 mg/dL = o Decrease vascular resistance
nonpregnant o Increase in blood volume
o Increase by 50% in pregnancy o Increase in metabolic rate
o Late pregnancy: 450mg/dL, ranges from • Late pregnancy
300mg/dL -600 mg/dL o Supine position
o Cardiac filling and output are reduced
• At term, cardiac output increases at 1.2L/min
(20%) when a woman is move from back to her
left side
 • Twin gestation • Angiotensinogen
o Cardiac output is augmented further by o Renin substrate produced by maternal
almost 20% because of greater stroke and fetal liver
volume and heart rate o Increased estrogen in normal pregnancy
o Increase in left atrial diameter and left o Important in 1st trimester BP
ventricular end-diastolic diameter maintenance
• During labor: • Angiotensin II
o 1st stage à increase moderately o Normal pregnancy – refractory to its
o 2nd stage à greater increase pressor effect
o Loss of refractorinessà hypertension
HEMODYNAMIC FUNCTION IN LATE PREGNANCY § Maybe related to progesterone
• Increase
o Heart rate CARDIAC NATRIURETIC PEPTIDES
o Stroke volume • Atrial Natriuretic peptide (ANP)
o Cardiac output • B – type Natriuretic Peptide (BNP)
• Decrease o Secreted by cardiomyocytes in response
o Systemic vascular resistance to chamber wall stretching
o Pulmonary vascular resistance o Regulate blood volume
o Colloid osmotic pressure § Provoking natriuresis
• No change § Diuresis
o Pulmonary capillary wedge pressure § Vascular smooth muscle
o Central venous pressure relaxation
• ANP and BNP
CIRCULATION & BLOOD PRESSURE o Normal pregnancy – nonpregnant levels
• Posture o BNP : <20pg/mL
o Brachial artery pressure is lower in o Increased in severe preeclampsia
sitting than in lateral recumbent supine • CNP
position o Secreted by noncardiac tissues
• Arterial pressure o Major regulator of fetal bone growth
o Decreases to a nadir at 24-26 weeks
than increase thereafter PROSTAGLANDINS
• Antecubital venous pressure – unchanged • Central role in vascular tone, blood pressure
• Femoral venous pressure – in supine, rises and sodium balance
steadily except in lateral recumbent position • Prostaglandin E2
o Dependent edema, varicosities and o Increased in late pregnancy
hemorrhoids o Natriuretic
• Supine hypotensive syndrome • Prostacyclin (PGI2)
o Supine compression of the uterus to the o Principal endothelial prostaglandin
great vessels causes arterial o Regulates BP and platelet function
hypotension o Implicated in angiotensin resistance in
o Decrease in uterine artery pressure and normal pregnancy
blood flow
ENDOTHELINS
RENIN, ANGIOTENSIN & PLASMA VOLUME • Endothelin – 1
• Renin-Angiotensin-Aldosterone axis o Potent vasoconstrictor produced by
o Involved in blood pressure control via endothelial and vascular smooth muscle
sodium and water balance cells
o All components of this system is o Regulates local vasomotor tone
increased in normal pregnancy o Stimulates secretion of ANP,
• Renin aldosterone and catecholamines
o Produced by maternal kidney and o Vascular sensitivity to endothelin is not
placenta altered in normal pregnancy

NITRIC OXIDE
• Potent vasodilator
• Released by endothelial cells
• Modifies vascular resistance during pregnancy
• One of the most important mediators of
placental vascular tone and development

RESPIRATORY TRACT
• Diaphragm
o Rises about 4 cms
• Subcostal angle
o Widens by 2 cms
• Thoracic circumference
o Increase by 6 cms
OXYGEN DELIVERY
PULMONARY FUNCTIONS • Exceeds oxygen requirement
• Functional Residual Capacity(FRC) • Oxygen consumption = increase by 20%
o Decrease by 20-30%, 400-700mL o 10% higher in multifetal gestation
• Expiratory Reserve Volume (ERV) • During labor = consumption increase by 40-60%
o Decrease by 15-20%, 200-300mL
• Residual Volume (RV) ACID-BASE EQUILIBRIUM
o Decrease by 20-25%, 200-400mL • Increase awareness of a desire to breath à
• FRC and RV à decline is due to rise of common even in early pregnancy
diaphragm
o Significant reductions are observed by PHYSIOLOGIC DYSPNEA
6th month • Result from increased tidal volume that lowers
• Inspiratory Capacity blood PCO2
o Maximum volume that can be inhaled • Induced largely by progesterone and lesser
from FRC degree by estrogen
o Increase by 5-10%, 200-250 mL • Progesterone acts centrally, and lowers the
• Total Lung Capacity threshold and increase the sensitivity of
o FRC + IC = unchanged chemoreflex response to CO2
o Decrease by 5% at term
• Respiratory Rate à unchanged
• Tidal volume à increased
o 0.66 to 0.88 L/min
• Resting minute ventilation à increased
o 10.7 to 14.1 L/min
o Enhanced respiratory drive by
progesterone
o Low expiratory reserve volume
o Compensated respiratory alkalosis

URINARY SYSTEM URETERS
• Kidney size – increase by 1.5 cm • Uterus rises out of the pelvis, it rests on the
• GFR ureters
o 25% increase by 2nd week • Lateral displacement and compression at the
o 50% increase by 2nd trimester level of the pelvic brim
o Urinary frequency • Ureteral dilation occurs above this level
• Renal plasma flow • Greater on the right side
o Increase
• Increased excretion of amino acids and water BLADDER
soluble vitamins • Hyperplasia of bladder muscle and connective
tissue
RELAXIN • Marked deepening and widening of trigone at
• Mediates increase in both GFR and renal blood the end of pregnancy
flow • Bladder pressure :
• Increases endothelin and nitric oxide o 8cm H2O early in pregnancy to 20cm
production H2O at term
o Renal vasodilation
o Decrease renal afferent and efferent
arteriole resistance
• Increase renal gelatinase activity
o Renal vasodilation
o Glomerular hyperfiltration
o Reduced myogenic reactivity of small
renal arteries

RENAL FUNCTION TESTS
• Serum Creatinine levels – decrease
o Mean of 0.7 to 0.5 mg/dL
o >0.9 mg/dL à warrants evaluation
• Creatinine Clearance
o 30% higher than in nonpregnant state

URINALYSIS
• Glucosuria
o May not be abnormal
o Due to impaired tubular reabsorptive
capacity
• Hematuria
o Contamination
o Infection
• Proteinuria
o Nonpregnant = 150mg/day
o Significant proteinuria = 300mg/day
• Urine Protein Measurement
o Qualitative dipstick method
o 24-hour urine collection
o Protein – creatinine ratio






GASTROINTESTINAL TRACT GALLBLADDER
• PREGNANCY GINGIVITIS • Contractility is reduced with increased residual
o Hyperemic, softened gums that easily volume
bleed with mild trauma • Progesterone
o Subsides postpartum o Impairs contraction gallbladder by
• EPULIS GRAVIDARUM inhibiting cholecystokinin à stasis à
o Focal, highly vascular swelling of the increase bile cholesterol saturation à
gums cholesterol gallstones
o Pyogenic granuloma • Estrogen à intrahepatic cholestasis by
o Regress spontaneously postpartum inhibiting intraductal bile acid transport
• STOMACH AND INTESTINES
o Displaced by the uterus
• PYROSIS
o Heart burn
o Reflux of acidic secretions into the
lower esophagus
o Decreased lower esophagel sphincter
tone
o Intraesophageal pressure is lower than
intrgastric pressure
• GASTRIC EMPTYING TIME
o Unchanged in pregnancy
o During labor
§ Prolonged especially after
analgesic administration
• HEMORRHOIDS
o Common during pregnancy

LIVER
• No increase in size
• Increase hepatic arterial and portal venous
blood flow
• No morphological changes
• Hepatic function tests
o AST*
o ALT*
o GGT*
o Bilirubin*
o Alkaline phosphatase - doubles
o NOTE: *slightly lower than non
pregnant
• Serum Albumin
o Decreases
o Late pregnancy – 3.0g/dL
o Non-pregnant – 4.3g/dL

• Leucine aminopeptidase
o Proteolytic liver enzyme
o Increased in liver diseases
o Elevated in pregnant women
o Has oxytocinase and vassopresinase
activity


ENDOCRINE SYSTEM o Promote mammary alveolar cell RNA
PITUITARY GLAND synthesis, galactopoiesis, production of
• Enlarges by 135% casein, lactalbumin and lipids
o Estrogen – stimulated hypertrophy and • Present in amniotic fluid at high concentrations
hyperplasia of lactotrophes • 10,000 ng/mL at 20-26 weeks, nadir at 34 weeks
o Gonadotrophes – decline in number • Uterine decidua – site of synthesis
o Corticotrophs and thyrothrops – remain • Prevents fetal dehydration
o Somatotrophs - suppressed
• Peak size: 12mm THYROID GLAND
• Involutes postpartum and reaches normal size • Moderate gland enlargement
after 6 months o Glandular hyperplasia
o Increased vascularity
GROWTH HORMONE • Thyroid hormone production increase by 40-
• 1st Trimester : maternal pituitary 100%
• 8th week: GH from placenta becomes detectable • Thyroid volume= 12 mL in 1st trimester to 15 mL
• 17th week : placenta is the principal source at delivery
• 3.5 ng/dL at 10 weeks to plateau at 28 weeks at
14 ng/dL THYROXINE-BINDING GLOBULIN
• GH in amniotic fluid peaks at 14-15 weeks • Principal carrier protein
slowly declines until baseline values are reached • Increase due to:
at 36 weeks o Higher hepatic synthesis – stimulated
by estrogen
PLACENTAL GROWTH HORMONE o Lower metabolism due to TBG
• Differs from maternal pituitary GH by 13 amino sialylation and glycosylation
acid residues • Increase total thyroxine (T4) and
• Secreted by syncytiotrophoblast, nonpulsatile triiodothyronine (T3) levels but do not affect
fashion free T3 and T4
• Major determinant of maternal insulin
resistance after midpregnancy TOTAL SERUM T4
• Maternal serum levels • Increases sharply between 6-9 weeks
o Positive correlation with Birthweight • Plateau at 18 weeks
o Negative correlation with IUGR and • Free T4 – rise slightly and peak with hCG then
uterine artery resistance return to normal

PROLACTIN NORMAL FETAL THYROID FUNCTION
• Increased levels • Relies on maternal thyroxine
o Increase in lactotrophs • Fetal thyroid begins to concentrate iodine at 10-
o By action of TRH 12 weeks AOG
o Serotonin • Synthesis and secretion of thyroid hormone
• Term: 150ng/mL ensues at 20 weeks
• Decreases after delivery
• Early lactation = pulsatile burst in response to THYROTROPIN-RELEASING HORMONE
suckling • Secreted by the hypothalamus
• Dopamine – inhibits secretion • Stimulates thyrotropes of anterior pituitary to
• Functions: secrete TSH
o Ensure lactation • Crosses the placenta
o Early gestation: initiates DNA synthesis
and mitosis of glandular epithelial cells IODINE STATUS
and presecretory alveolar cells of the • Iodine requirements increase with pregnancy
breast • Early exposure to thyroid hormone is essential
o Increase number of estrogen and to the nervous cystem
prolactin receptors • Cretinism – severe deficiency in iodine
PARATHYROID HORMONE ANDROGENS
• Release is stimulated by decrease in Calcium ANDROSTENEDIONE & TESTOSTERONE
and Mg level • Increased in pregnancy
• Action on bone resoprtion, intestinal absorption • Converted into estradiol in the placenta
and kidney reabsorption à increase serum
levels of calcium and decrease phosphate levels MUSKULOSKELETAL SYSTEM
• Fetal skeleton mineralization – requires 30g of • Progressive lordosis
calcium • Shifts the center of gravity over the lower
• 3rd trimester = 400mg/day absorbed extremities
• Absorption is mediated by increased levels of • Sacroiliac, sacrococcygeal and pubic joints –
maternal 1,25 dihydroxyvitamin D3 increased mobility
o Produced in the kidneys
o Stimulated by placental production of CENTRAL NERVOUS SYSTEM
PTH or PTH-rP • Few, subtle changes
• Memory decline in 3rd trimester
CALCITONIN
• Oppose actions of PTH and Vit D EYES
• Protect maternal skeletal calcification during Ca • Decrease intraocular pressure
stress • Decrease corneal sensitivity
• Secreted by the C cells at the perifollicular areas • Increase Krukenburg spindles
of the thyroid gland o Brown –red opacities on posterior
• Ca and Mg – increase secretion surface of cornea
• Gastrin, pentagastrin, glucagon and o Hormonal effects
pancreozymin – increase secretion o Unaffected visual function

ADRENAL GLANDS
• Little morphologic change

CORTISOL
• Serum concentration is increased but mostly
are bound to Transcortin- cortisol binding
globulin
• Increase is due to decrease metabolic clearance
rate

ACTH (ADRENOCORTICOTROPIC HORMONE)
• Corticotropin
• Decreased in early pregnancy but increases
strikingly with gestation
• Elevated progesterone = increase free cortisol
for hemeostasis

ALDOSTERONE
• Secreted at 15 weeks AOG
• 1mg/day – 3rd trimester
• Secretion is stimulated by decrease Na
• Protection against Natriuretic effect of
progesterone and ANP
• Play role in modulating trophoblast growth and
placental size