FEMALE CHANGES IN

PREGNANCY
• Maternal changes during can be noticed in
various organs , body weight ,the metabolic
activities and the functional status of different
physiological systems in the mother.
• Maternal changes during can be studied under
the following-
• Changes in the external appearance of
pregnant female.
• Increase in body weight
• Structural changes
• Metabolic changes
• Changes in various physiological system
 CHANGES IN
EXTERNAL APPEARANCE OF
PREGNANT FEMALE
 EXTERNAL APPEARENCE
• The various hormones can cause marked
changes in a pregnant woman’s appearance,
resulting sometimes in the development of
• Edema
• Acne
• Masculine or acromegalic features.
• The extra fluid is excreted in the urine during
the first few days after birth, that is, after loss
of the fluid-retaining hormones from the
placenta.
 WEIGHT GAIN
OF
PREGNANT FEMALE
 WEIGHT GAIN

• The average weight gain during pregnancy is

about 24 pounds.
• Most of this gain occurring during the last
two trimesters.
 WEIGHT GAIN
• Without appropriate prenatal control of diet,
the mother’s weight gain can be as great as 75
pounds instead of the usual 24 pounds.
 WEIGHT GAIN
• The approximate weight of various structures
which adds to the weight gain.

1. 7 pounds is fetus .
2. 4 pounds is amniotic fluid,placenta, and
fetal membranes.
 WEIGHT GAIN
1. The uterus increases about 2 pounds .
2. The breasts another 2 pounds.
3. About 6 pounds of extra fluid in the blood
and extracellular fluid.
4. 3 pounds is generally fat accumulation.
 WEIGHT GAIN
• During pregnancy, a woman often has a
greatly increased desire for food.
1. Partly as a result of removal of food
substrates from the mother’s blood by the
fetus.
2. Partly because of hormonal factors.
STRUCTURAL CHANGES
DURING
PREGNANCY
• Various structural changes are observed in
the
1. Primary sex organs .
2. Accessory sex organs.
3. Mammary glands during pregnancy.
 CHANGES IN OVARIES

• Follicular changes do not appear in ovary and

ovulation does not occur.
• Secretion of FSH and LH from the anterior
pituitary is inhibited.
 CHANGES IN OVARIES
• 1ST 3 MONTHS
• Corpus luteum enlarges and secretes a large
quantity of progesterone and little estrogen,
which are essential for maintaining pregnancy.
• It continues for 3 months and then corpus
luteum degenerates.
 CHANGES IN OVARIES
• After 3 months
• Placenta develops fully and takes over the
function of secreting estrogen and
progesterone.
• It continues throughout the period of
pregnancy thus , inhibiting the secretion of
FSH and LH.
 CHANGES IN UTERUS
• When the fetus grows in the uterus, changes
occur in the volume , size , shape , weight
and histology of the uterus.
• The uterus increases from about 50 grams to
1100 grams.
 CHANGES IN UTERUS
• VOLUME
• Fetal growth increases the volume of uterus
gradually.
• From almost zero volume , uterus reaches
about 5-7 liters at the end of pregnancy .
• Out of this , 50% of the volume is due to the
fetus and rest is due to the placenta , amniotic
fluid , etc
 CHANGES IN UTERUS
• Size : Size of the uterus also increase . It is due
to:
A.Hyperplasia (increase in number of cells ) of
myometruim.
B .Hypertrophy (increase in size of the cells)of
myometrium .
C.Growth of fetus:
 CHANGES IN UTERUS
Shape :
• The shape of non pregnant uterus weighs
about 30-50 g.
• At the end of pregnancy , the uterine weight
alone increases to about 1000-1200 g.
.
 CHANGES IN UTERUS
Histological changes
• Endometrium shows the formation of decidua
,which is the bed for the fertilized ovum
during the initial stages of pregnancy.
 CHANGES IN UTERUS
• By the end of 3 months ,3 layers of decidua
are formed.
a. Decidua basalis which is the maternal part .
b. Decidua capsularis that surrounds the fetal
sac.
c. Decidua parietals which lines rest of uterine
wall.
 CHANGES IN VAGINA
• The vagina enlarges and the introitus opens
more widely.
Vaginal changes during pregnancy;
• Increase in size.
• Violet coloration due to increased blood
supply.
• Less cornification of superficial epithelial cells.
 CHANGES IN VAGINA
• Increase in deposition of glycogen in the
epithelial cells due to increased secretion of
estrogen,
• Decrease in PH below 3.5.
 CHANGES IN CERVIX
Changes in cervix during pregnancy ;
• Increase in number of cervical glands.
• Hypertrophy of endocervix which gives the
appearance of honeycomb.
• Increase in blood supply.
• Increase in mucus secretion.
 CHANGES IN CERVIX

• Softening of tough cervix.

• Formation of mucus plug which closes the
cervical canal.
 CHANGES IN FALLOPIAN TUBES
Changes in fallopian tubes during pregnancy ;
• Hyperplasia of epithelial cells.
• Increase in blood supply.
• Movement of fallopian tubes upwards caused
by the large sized uterus.
CHANGES IN MAMMARY GLANDS
• The changes in breast during pregnancy are
• Development of more new ducts.
• Formation of more number of alveoli.
• Deposition of fat.
CHANGES IN MAMMARY GLANDS
• Increase in the size.
• Increase in vascularization.
• Pigmentation of nipple and areola.
CHANGES IN MAMMARY GLANDS
• The changes in breast during pregnancy are
due to the activity of estrogen and
progesterone ,which are secreted in large
quantities.
• The breasts approximately double in size.
 METABOLISM DURING PREGNANCY

• The metabolic activites are acclerated in the

following metabolic systems of the body .
• Basal metabolic rate
• Protein metabolism
• Carbohydrate metabolism
• Lipid metabolism
• Water and mineral metabolism
METABOLISM DURING
PREGNANCY
 BASAL METABOLIC RATE
• The basal metabolic rate of the pregnant
woman increases about 15 per cent during
the latter half of pregnancy.
• As a result, she frequently has sensations of
becoming overheated.
 BASAL METABOLIC RATE

• There is increased secretion of many

hormones during pregnancy, including
a. Thyroxine,
b. Adrenocortical hormones
c. The sex hormones,
• Greater amounts of energy than normal must
be expended for muscle activity,owing to the
extra load that she is carrying,
 BASAL METABOLIC RATE
• The basal metabolic rate of the pregnant
woman increases about 15 per cent during the
latter half of pregnancy.
• As a result, she frequently has sensations of
becoming overheated.
 PROTEIN METABOLISM
• The anabolism of proteins increases in
pregnency .
• Positive nitrogen balance occurs
• The depositon of proteins occurs in the
uterus.
 CARBOHYDRATE METABOLISM
• There is hyperplasia of beta cells of islets of
langerhans in pancreas leading to increased
insulin secretion.

• Blood glucose level increases.

• Hepatic glycogen is depleted and glucosuria
occurs.
 CARBOHYDRATE METABOLISM
• Ketosis develops either due to less food or
more vomiting.
• There is possibility of developing diabetes in
pregnancy or latent diabetes after delivery.
 LIPID METABOLISM
• There is deposition of about 3—4 kg of fat in
the maternal body.
• It also increases the blood cholesterol level
and ketosis.
 WATER AND MINERAL METABOLISM

• Oestrogen and progesterone are secreted by

the corpus luteum in the first trimester
and later by placenta.
These hormones increase the retention of
sodium and water.
 WATER AND MINERAL METABOLISM

• The secretion of aldosterone increases during

pregnancy.
• Aldosterone in turn increases the reabsorption
of sodium fro the renal tubules.
 WATER AND MINERAL METABOLISM

• There is retention of calcium and phosphorus

as well.
• Calcium and phosphorus are necessory for
growing fetus as well.
NUTRITION DURING PREGNANCY
 NUTRITION DURING PREGNANCY
• The greatest growth of the fetus occurs
during the last trimester of pregnancy;
• Its weight almost doubles during the last 2
months of pregnancy.
• The mother does not absorb sufficient
protein, calcium, phosphates, and iron from
her diet during the last months of pregnancy
to supply these extra needs of the fetus.
• These extra needs, the mother’s body has
already been storing these substances
• Some in the placenta.
• Most in the normal storage depots of the
mother.
• If appropriate nutritional elements are not
present in a pregnant woman’s diet,
• A number of maternal deficiencies can occur,
especially in calcium, phosphates,
iron, and the vitamins.
 IRON REQUIREMENT IN PREGNANCY

• About 375 milligrams of iron is needed by the

fetus to form its blood.
• An additional 600 milligrams is needed by the
mother to form her own extra blood.
• The normal store of nonhemoglobin iron in
the mother at the outset ofpregnancy is often
only 100 milligrams -700 milligrams.
 IRON DEFICENCY IN PREGNANCY

• Without sufficient iron in her food,

a pregnant woman usually develops
hypochromic anemia.
CALCIUM REQUIREMENT IN PREGNANCY

• Although the total quantity of calcium used

by the fetus is small, calcium is normally
poorly absorbed by the mother’s
gastrointestinal tract without vitamin D.
• She must receive vitamin D and calcium.
VITAMIN K REQUIREMENT IN PREGNANCY

• Shortly before birth of the baby, vitamin K is

often added to the mother’s diet.
• So that the baby will have sufficient
prothrombin to prevent hemorrhage,
particularly brain hemorrhage, caused by the
birth process.
• LECTURE II
CHANGES IN
CARDIO-VASCULAR SYSTEM
DURING PREGNANCY
 CHANGES IN THE MATERNAL CIRCULATORY
SYSTEM

• Changes in blood volume.

• Changes in cardiac out put.
• Changes in blood pressure.
• Changes in bone marrow.
CHANGES IN THE BLOOD VOLUME
• The maternal blood volume shortly before
term is about 30 per cent above normal.
• This increase occurs mainly during the latter
half of pregnancy.
CHANGES IN THE BLOOD VOLUME
• The cause of the increased volume is likely
due,
1. To aldosterone and estrogens, which are
greatly increased in pregnancy,
2. To increased fluid retention by the kidneys.
CHANGES IN THE BLOOD VOLUME
• The blood volume increases by about 20%
about 1 litre.
• This increase is mainly because of increase in
plasma volume .
• It causes hemodilution .
CHANGES IN THE BLOOD VOLUME

• Because of great demand for iron by the

fetus , the mother usually develops
anemia.
 CHANGES IN THE CARDIAC OUTPUT

Uptill 27th week of pregnancy ;

• The mother’s cardiac output increases to 30
to 40 per cent above normal;
REASON Due to general increase in the
mother’s metabolism.
 CHANGES IN THE CARDIAC OUTPUT

• During the last month of pregnancy.

About 625 milliliters of blood flows through
the maternal circulation of the placenta each
minute.
 CHANGES IN THE CARDIAC OUTPUT

• During the last 8 weeks of pregnancy,

• The cardiac output falls to only a little above
normal despite the high uterine blood flow.
CHANGES IN THE BONE MARROW
• The bone marrow becomes increasingly active
and produces extra red blood cells to go with
the excess fluid volume.
At the time of birth of the baby
• The mother has about 1 to 2 liters of extra
blood in her circulatory system.
During delivery of the baby
• Only about one fourth of this amount is
normally lost through bleeding . Thereby
allowing a considerable safety factor for the
mother.
 CHANGES IN THE BLOOD PRESSURE

During 1ST TIMESTER

The arterial blood pressure remains
unchanged.
During 2nd TRIMESTER
• There is slight decrease in arterial blood
pressure .
• It is due to the diversion of blood to the
uterine sinuses.
 PRE-ECLAMPSIA
• It is the hypertensie disorder of pregnancy.
• Incidence 3-4% .
• There is sudden elevation of arterial blood
pressure.
 PRE-ECLAMPSIA
• 3 factors are suggested to cause elevation of
blood pressure.
1. Release of some vasoconstrictor substance
from placenta.
2. Hypersecretion of adrenal hormones and
other hormones which cause blood pressure
 PRE-ECLAMPSIA
• The development of some autoimmune
processes induced by the presence of
placenta. Or fetus.
• Preeclampsia is initiated by insufficient blood
supply to the placenta, resulting in the
placenta’s release of substances that cause
widespread dysfunction of the maternal
vascular endothelium.
• During normal placental development, the
trophoblasts invade the arterioles of the
uterine endometrium and completely
remodel the maternal arterioles into large
blood vessels with low resistance to blood
flow.
• In patients with preeclampsia, the maternal
arterioles fail to undergo these adaptive
changes.
• There is insufficient blood supply to the
placenta.
 PRE-ECLAMPSIA

• Decreased blood flow to kidney and

thickening of glomerular capillary membrane
leading to reduction of GFR and reduction of
urinary output.
• Retention of sodium and water.
 PRE-ECLAMPSIA
• Decreased urinary output along with retention
of sodium and water results in increased
extracellular fluid volume and edema.
• Excretion of proteins in urine.
 ECLAMPSIA
• Eclampsia is a serious condition of pre-
eclampsia.it is characterized by
• Severe muscle spasm.
• Dangerous hypertension.
• Convulsive muscular contractions almost like
seizures.
 ECLAMPSIA
• It occurs just before, during or imediately
after delivry.
• It leads to death , if timely treatment is not
given.
 FEATURES OF ECLAMPSIA
• Very severe hypertension.
• Spasm of blood vessels.
• Renal failure.
• Liver failure.
• Heart failure.
• Convulsions.
• Coma .
 CHANGES IN THE
RESPIRATORY SYSTEM
DURING PREGNANCY
• Changes in respiratory system occurs due to
following reasons;
1. The increased basal metabolic rate of a
pregnant woman .
2. Because of her greater size.
 CHANGES IN THE RESPIRATORY SYSTEM

• The total amount of oxygen used by the

mother shortly before birth of the baby is
about 20 per cent above normal.
• A commensurate amount of carbon dioxide is
formed.
 CHANGES IN THE RESPIRATORY SYSTEM

The mother’s minute ventilation increases.

• The high levels of progesterone during
pregnancy increase the minute ventilation
because progesterone increases the
respiratory center’s sensitivity to carbon
dioxide.
 CHANGES IN THE RESPIRATORY SYSTEM

• The net result is an increase in minute

ventilation of about 50 per cent .
• A decrease in arterial PCO2 to several
millimeters of mercury below that in a
nonpregnant woman.
 CHANGES IN THE RESPIRATORY SYSTEM

The total excursion of the diaphragm is

decreased.
• The growing uterus presses upward against
the abdominal contents.
• These press upward against the diaphragm.
 CHANGES IN THE RESPIRATORY SYSTEM

• The respiratory rate is increased to maintain

the extra ventilation.
 CHANGES IN THE URINARY SYSTEM

• The rate of urine formation by a pregnant

woman is usually slightly increased because
of
1. Increased fluid intake.
2. Increased load on excretory products.
 CHANGES IN THE URINARY SYSTEM

• Several special alterations of urinary functions

may occur.
 CHANGES IN THE URINARY SYSTEM

• First, the renal tubules’ reabsorptive capacity

for sodium, chloride, and water is increased
as much as 50 per cent.
• As a consequence of increased production
of steroid hormones by the placenta and
adrenal cortex.
 CHANGES IN THE URINARY SYSTEM

• Second, the glomerular filtration rate

increases as
• much as 50 per cent during pregnancy, which
tends to
• increase the rate of water and electrolyte
excretion in the urine.
 CHANGES IN THE URINARY SYSTEM

• When all these effects are considered, the

normal pregnant woman ordinarily
accumulates only about 6 pounds of extra
water and salt.
CHANGES IN THE AMNIOTIC FLUID

• Normally, the volume of amniotic fluid (the

fluid inside the uterus in which the fetus
floats) is between 500 milliliters and 1 liter.
CHANGES IN THE AMNIOTIC FLUID
• Water in amniotic fluid is replaced once every
3 hours.
• The electrolytes sodium and potassium are
replaced an average of once every 15 hours
CHANGES IN THE AMNIOTIC FLUID
• A large portion of the fluid is derived from
renal excretion by the fetus.
• A certain amount of absorption occurs by way
of the gastrointestinal tract and lungs of the
fetus.
• Some of the fluid is formed and absorbed
directly through the amniotic membranes