Physiologic Adaptations to

Pregnancy
E.S.Prakash
Faculty of Medicine
AIMST University
dresprakash@gmail.com
 Intended learning outcome:
At the end of this lecture, we should be able to
• Briefly describe the physiologic changes in
various organs and organ systems
(cardiovascular, respiratory, gastrointestinal,
uterine, hematological) that occur during
pregnancy, and explain the underlying
mechanisms (wherever known).
 Changes in Reproductive Tract:
Uterus:
• Progressive increase in size and thickness of
uterus
• Enlargement involves stretching and
hypertrophy of smooth muscle cells
• Irregular painless uterine contractions called
Braxton-Hicks contractions (first trimester
onward)
• Uteroplacental blood flow –
– Increases to about 450-650 ml/min at term;
– Resistance to blood flow in the uterus and placenta
decreases considerably because of the effects of
estrogen
• Changes in uterine cervix -
– Cervix becomes soft, produces copious amounts of
mucus that can plug the cervical canal; details can
be studied later;
Ovaries –
• Ovulation ceases
• Maturation of new follicles suspended
• Corpus luteum of pregnancy critical until
about the 8th week for sustaining pregnancy
 Haematological changes
• Increase in blood volume due to an increase in RBC
volume as well as plasma volume
• However, plasma volume increases much more
• Thus, packed cell volume drops (i.e., because of
hemodilution)
• Also called physiologic anaemia of pregnancy
• However, a drop in Hb levels below 11 g/dL should be
considered abnormal.
• Iron requirements increase (dietary supplementation
necessary)
• Leukocyte count is slightly elevated
• During labour, it may increase to as high as
25000 per microlitre
• Erythrocyte sedimentation rate (ESR) is
increased because of an increase in plasma
levels of globulins and fibrinogen
• Pregnancy is characterized by increased levels
of most clotting factors
Cardiovascular
Changes in
Pregnancy (and the
effects of posture on
it)

Note the increase in

resting heart rate

Stroke volume
initially increases and
then decreases
toward term
Cardiac output in pregnancy
Changes in arterial blood pressure
Changes in cardiac outline in
pregnancy
Colored lines
indicate the
nonpregnant
state
 Pulmonary function
• Respiratory rate changes little
• Tidal volume increases
• Maximal voluntary ventilation not appreciably
altered
 Renal changes;
urinary tract changes
• Increase in the size of kidneys
• Increase in glomerular filtration rate
• Increase in renal plasma flow
• Increase in clearance of creatinine..
• Glycosuria not necessarily abnormal..
• Dilation of renal pelvicalyceal system
Normal intravenous
pyelogram in
pregnancy –

Note the dilated renal

pelvicalyceal system
and the dilated ureter
on the right side
(arrows)
 Gastrointestinal changes
• Displacement of stomach and intestines by the
enlarging uterus..
• Gastric emptying time essentially unchanged
during pregnancy but increased at the time of
labour..
• Heartburn due to gastro-oesophageal reflux
quite common
• Haemorrhoids quite common (reason -
pressure effects of an enlarged uterus)
 Gastrointestinal changes contd.
• Gall bladder contractility reduced..effect of
progesterone??
 Endocrine function during
pregnancy
• Pituitary gland enlarges by about 135%
• Plasma levels of prolactin increase about 10
fold
• Moderate enlargement of thyroid gland is
common
 Reference:
• Chapter on Maternal Physiology in Williams
Obstetrics, Mc Graw Hill.
• Access at http://www.accessmedicine.com
using institutional log in ID