Fisiologi Kehamilan

Diagnosis of Pregnancy
Divided into Trimester : First trimester- Abortus Spontaneous

• Confirmation of pregnancy
• Pregnancy test:
• measurement of human chorionic gonadotropin (beta-hCG)
• Serum beta-hCG test (quantitative, high sensitivity)
• Detectable 6–9 days (on average) after fertilization

• Gestational age: the age (in weeks and days) of the fetus calculated from the first day of
the last menstrual period
• Embryonic age: the age (in weeks and days) of the fetus calculated from the day of
conception (fertilization)
Endometrium dan Desidua
• 3 days to move to uterus
• 3 -5 days in uterus before implantation
Organ system Changes

Cardiovascular  ↑ Progesterone → ↓ vascular tone → ↓ peripheral vascular resistance

 ↑ Cardiac output (by up to 40%)
 ↑ Stroke volume (by ∼ 10–30%)
 ↑ Heart rate (by ∼ 12–18 bpm)
 ↓ Mean arterial pressure
 Innocent systolic murmur 
 The apex beat is displaced upward. 
 Varicosity and edema of lower limbs 

Respiratory  ↑ Oxygen consumption (by ∼ 20%)

 The diaphragm is displaced upwards → ↓ total lung capacity, residual volume, 
functional residual capacity, and expiratory reserve volume; increased intra-
abdominal pressure through uterine growth → dyspnea
 Progesterone stimulates the respiratory centers in the brain → physiological, chronic
compensated respiratory alkalosis
 ↑ Tidal volume (by ∼ 40%) → ↑ minute ventilation
 ↓ PCO2 (∼ 30 mm Hg)
 Renal  ↑ GFR  → ↓ BUN and creatinine
 ↑ Aldosterone  → ↑ plasma volume + hyponatremia
 ↑ Glucose levels in urine 
 Pollakiuria 

Endocrine  ↑ Insulin 
 ↑ Triglycerides and cholesterol

Hematologic  ↓ Hematocrit particularly towards the end of pregnancy (30–34th week of

gestation); dilutional anemia ; minimal value is 11 g/dL)
 ↑ RBC count  (increases from 8–10th week of gestation until the end
of pregnancy by approx. 15–30%)
 ↑ Platelet count 
 ↑ WBC count 
 ↓ Albumin 
 ↑ Fibrinogen and factor VII, VIII, decreased protein S → reduced prothrombin and
partial thromboplastin times 
 ↑ Alkaline phosphatase (placental isoenzyme)
 Gastrointestinal  ↑ Salivation
 ↓ Motility  → constipation
 Hemorrhoids 

Musculoskeletal  Increased lumbar lordosis; relaxation of the ligaments supporting the joints of the pelvic girdle in
preparation for childbirth → can cause lower back pain

Skin  Spider angioma

 Palmar erythema
 Striae gravidarum
 Hyperpigmentation: chloasma, linea nigra, hyperpigmentation of the nipples 

Mammary glands  ↑ Size 

Uterus  ↑ Size 

Vulva and vagina  Vaginal discharge 

 Formation of varicose veins 
Refferences: