1.

Cardiovascular system
 ↑ Progesterone → ↓ vascular tone → ↓ peripheral vascular esistance (↓ afterload)
o ↑ Cardiac output by up to 40% (↑ preload)
o ↑ Stroke volume (by 10–30%)
o ↑ Heart rate (by ∼ 12–18 bpm) → ↑ uterine perfusion
o ↓ Mean arterial pressure
 ↑ Plasma volume → ↓ oncotic pressure → edema of lower limbs
 The gravid uterus can compress the inferior vena cava and pelvic veins thereby
decreasing venous return.
 A physiological systolic murmur may be heard due to increased cardiac output and
increased plasma volume.
2. Respiratory system
 ↑ Oxygen consumption
 ↑ Intraabdominal pressure through uterine growth → dyspnea
 Progesterone stimulates the respiratory centers in the brain
→ hyperventilation → physiological, chronic compensated respiratory alkalosis
3. Endocrine system
 Progesterone
o Responsible for pregnancy maintenance
o Produced by the corpus luteum until the 10–12 weeks of gestation, after which it is
produced by the fetoplacental unit
 Human placental lactogen: a hormone synthesized by syncytiotrophoblasts of
the placenta, which promotes the production of insulin-like growth factors.
 Thyroid hormones
o ↑ hCG → ↓ TSH
o ↑ TBG → ↑ T4 and T3
 ↑ SHBG and corticosteroid-binding globulin
 ↑ Triglycerides and cholesterol
 Hyperplasia of lactotroph cells in the anterior pituitary → physiological enlargement of
the pituitary gland.
4. Hematologic system
 ↑ Plasma volume → ↓ hematocrit, especially towards the end of
pregnancy → dilutional anemia.
 Hypercoagulability is due to an increase in fibrinogen, factor VII, and factor VIII and a
decrease in protein S
 Physiological hypercoagulability during pregnancy leads to an increased risk
of thrombosis. Patients with thrombophilia should receive
adequate thrombosis prophylaxis.
5. Gastrointestinal system
 ↑ Salivation
 ↓ Lower esophageal sphincter tone → gastroesophageal reflux
 ↓ Motility → constipation and bloating
 Gallbladder stasis → gallstones
 Hemorrhoids
6. Musculoskeletal system
 ↑ Body weight → forward shift in center of gravity → ↑ lumbar lordosis
 ↑ Intraabdominal pressure → diastasis recti; meralgia paresthetica
 Relaxation of the pelvic girdle ligaments and symphysis pubis → pelvic girdle pain,
coccygeal pain
 Fluid retention in tissue → carpal tunnel syndrome
7. Skin
 Spider angioma
 Palmar erythema
 Striae gravidarum: scarring that manifests as erythematous, violaceous,
and/or hypopigmented linear striations on the abdomen
 Hyperpigmentation: chloasma, linea nigra, hyperpigmentation of the nipples
8. Reproductive system
 Uterus: increase in size
 Vulva and vagina
 Vaginal discharge
  Formation of varicose veins
 Mammary glands: increase in size; breast fullness and tenderness.

9. Renal system

 ↑ Renal plasma flow → ↑ GFR

 Progesterone and intraabdominal pressure → dilation of kidney, pelvis, and
calyceal systems → reduced tone and peristalsis
 ↑ Urinary frequency
 ↑ Glucose levels in urine.
 Mild proteinuria.

Probable signs in early pregnancy:

Signs Physical findings Weeks of pregnancy

Goodell Cervical softening First 4 weeks
Hegar Softening of the lower segment of the uterus Between 6–8 weeks
Ladin Softening of the midline of the uterus First 6 weeks
Chadwick Bluish discoloration of vagina and cervix Between 6–8 weeks
Telangiectasias and palmar erythema Small blood vessels and redness of the palms First 4 weeks
Chloasma Hyperpigmentation of the face (forehead, cheeks, nose) First 16 week

D/D of Hematological case

1) Immune thrombocytopenic purpura (ITP).

2) Drug-induced thrombocytopenia.
3) Thrombotic thrombocytopenic purpura (TTP).
4) Myelodysplastic syndromes.
5) Hypersplenism.

D/D of CV case
Irregular Heartbeat (Arrhythmias):

1) Atrial fibrillation.
2) Atrial flutter.
3) Ventricular tachycardia.
4) Supraventricular tachycardia.
5) Bradycardia.

Hypertension (High Blood Pressure):

Primary hypertension.

Secondary hypertension (e.g., renal artery stenosis, adrenal gland disorders).

White coat hypertension.

Medication-induced hypertension.

Obstructive sleep apnea.

Shortness of Breath (Dyspnea):

Heart failure.

Chronic obstructive pulmonary disease (COPD).

Asthma.

Pulmonary embolism.

Interstitial lung disease.

D/D of respiratory case

Cough:

Acute bronchitis.

Pneumonia.

Asthma.

Chronic obstructive pulmonary disease (COPD).

Gastroesophageal reflux disease (GERD).

Shortness of Breath (Dyspnea):

Chronic obstructive pulmonary disease (COPD).

Asthma.

Heart failure.

Pulmonary embolism.

Interstitial lung disease.