Physiological changes in

pregnancy + Placenta &

Parturition, Lactation + Neonatal
Physiology

Dr. Sidra Majeed

Physiological Changes in
PREGNANCY
CHANGES OF THE SKIN DURING PREGNANCY
a. Linea Nigra
. This is a dark line that runs from the umbilicus to the symphysis
pubis and may extend as high as the sternum.
b. Mask of Pregnancy (Chloasma).
This is the brownish hyper pigmentation of the skin over the face and
fore head.
c. Striae Gravidarum(Stretch Marks)
It reflects a separation within underlying connective tissue of the skin.
This occurs over areas of maximal stretch--the abdomen, thighs, and
breasts.
Sweat Glands
Activity of the sweat glands throughout the body usually increases
which causes the woman to perspire more profusely during pregnancy.
 Changes of the Circulatory system during
Pregnancy
Blood Volume
Blood volume increases gradually by 30 to 50 percent (1500 ml to 3
units). This is to compensate for the blood loss at birth.
Physiologic anemia occurs as the plasma increase, exceeds the
increase in red blood cell production.
Cardiac Output
Cardiac output increases about 25 to 50 percent during the first and
second trimester to accommodate for hyper-volemia.
Change in output is reflected in the heart rate. It usually increases by
10 beats per minute.
Heart size increases and is elevated upward and to the left side
because of the displacement of the diaphragm as the uterus enlarges.
 Cont…

• Blood Pressure
Normally, the patient's blood pressure will not rise. It will
decrease on the second trimester due to the expansion of
the placenta but it will rise again on the third trimester to
first trimester level.
• Venous Return.
The lower extremities are often hampered in the last months
of pregnancy due to the expanding uterus restricting
physical movement and interfering with the return of blood
flow. This results in swelling of the feet and legs.
 CHANGES OF THE RESPIRATORY SYSTEM
The respiratory rate rises to 18 to 20 to compensate for
increased maternal oxygen consumption, which is
needed for demands of the uterus, the placenta, and
the fetus.
Approximately 60% to 70% of pregnant women
experience shortness of breath; this is because the
diaphragm may be displaced by as much as 4cm as
the uterus enlarges.
Nasal stuffiness and epistaxis (nosebleeds) are also
common during pregnancy, secondary to vascular
congestion caused from the increased estrogen
levels.
 CHANGES OF BODY TEMPERATURE
DURING PREGNANCY

• A slight increase in body temperature in early

pregnancy is noted because of the secretion of
progesterone from the corpus luteum. The
temperature returns to normal at about the 16 th week
of gestation as the placenta takes over the function of
the corpus luteum.
• Metabolic changes, accompanied by fetal growth
result in an increase in weight of around 25% of the non-
pregnant weight.

• Approximately 12.5 kg in the average woman.

 CHANGES OF THE SKELETAL SYSTEM
• There is a realignment of the spinal curvatures during
pregnancy to maintain balance. It is due to the increase in
size of the uterus and pressure on the abdominal wall. The
patient walks with head and shoulders thrust backward and
chest protruding outward to compensate(lordosis). This gives
the patient a "waddling" gait.
• There is a slight relaxation and increased mobility of the
pelvic joints, which allows stretching at the time of delivery
of the infant, this is due to the production of relaxin
hormones by the placenta
• Changes occur due to relaxation of
smooth muscle & high
progesterone levels of pregnancy.
• Heartburn is common & is caused by
reflux of acidic secretions into lower
esophagus & decreased tone of sphincter.
 CHANGES OF THE GASTROINTESTINAL
SYSTEM DURING PREGNANCY
• Nausea and vomiting may occur as a result of the secretion of
Hcg
As the uterus enlarges. It rises up and out of the pelvic cavity.
This action displaces the stomach, intestines, and other adjacent
organs.
Peristalsis is slowed because of the production of the hormone
progesterone, which decreases tone and mobility of smooth
muscles. This slowing enhances the absorption of nutrients and
slows the rate of secretion of hydrochloric acid and pepsin.
 Slow emptying may increase nausea and heartburn (pyrosis).
Relaxation of the cardiac sphincter may increase regurgitation
and chance for heartburn. Movement through the large intestines
is also slowed due to an increase in water consumption from this
area. This increases the chance for constipation.
Hemorrhoids may occur as a result of increased venous pressure
• Frequency of micturition is a common symptom of early
pregnancy.
Musculoskeletal
• Increased mobility of sacroiliac, sacrococcygeal & pubic
joints.
• Relaxation of pubic symphysis.
Dental changes
• Gums may become hyperemic & soft during
pregnancy and may bleed if mildly traumatized as with a
toothbrush.
• Immunologic compentency decreases to prevent the
woman’s body from rejecting the fetus.
Immunologic G (IgG) is also decreased, which can
make a woman more prone to infection during the
pregnancy
 Placenta
Placenta is the mechanical and physiological connection
between fetal and maternal tissues for the nutrition,
respiration and excretion of the fetus.
Fetal Membranes and Placenta
In the placenta, the fetal blood comes into close contact
with the maternal blood, resulting in exchange of materials.
 Food and oxygen pass from the maternal blood into the
fetal blood and the wastes from the fetus pass into the
maternal blood
There is no mixing up of maternal and fetal blood.
 The umbilical cord connects the fetus to the placenta.
 Circulation of the Placenta: The inter-villous spaces of a
mature placenta contain approximately 150 ml of blood,
which is replenished about 3 or 4 times per minute.
 Functions of the Placenta
1. Nutrition
Placenta helps to transport nutrients from maternal blood into fetus
2. Respiration
It helps in getting oxygen from the maternal blood into the fetus and
CO2 from fetus blood into the maternal blood.
3. Excretion
Nitrogenous waste products produced in the embryo diffuse through
the placenta into the maternal blood stream.
4. Storage
Placenta stores some fats, glycogen and iron.
5. Secretion of hormones
Placenta secretes many hormones like estrogen, progesterone,
gonadotropin and placental lactogen, thus functioning as an endocrine
gland
6. Immunity
• Antibodies developed in the mother against certain diseases like
measles, small pox, diphtheria pass from mother into the fetal blood
through the placenta.
7. Transport of pathogens
• Pathogenic organisms like viruses diffuses through the placenta.
Viruses causing syphilis, measles, rubella, small pox may infect the
fetus, if the mother gets the disease during pregnancy. Some of these
diseases may even cause congenital deformities.
8. Transport of drugs
• Some of the drugs taken by the mother during pregnancy cross the
placental barrier and may even cause developmental deformities.
• E.g., The drug thalidomide used to avoid nausea and morning
sickness during early pregnancy by some women resulted in the
child born to such mothers to have deformities in the limb
development and heart. The children had flipper like limbs, a
condition called as phocomelia. Children born to drug addicts, are
born with addiction and withdrawal symptoms
Mechanism Substance Functions
Diffusion Oxygen, carbon dioxide, Homeostasis
(simple) water, Free fatty acids, Na, Substrates for growth
K, Cl
Drugs Toxic

Diffusion Glucose Fetal Nutrition

(facilitated)

Active transport Amino Acids Fetal nutrition

Ca, P, Zn

Endocytosis Transferrin (carries Fe) Source of fetal Fe

Pinocytosis Antibodies (species specific) Immunity

• Human chorionic gonadotropin (HCG) is produced
by the placenta soon after implantation of the embryo.
• A pregnancy test is the analysis of the presence of HCG
in a woman’s urine.
 Parturition (Birth)
• The process of childbirth is known as parturition. The
steps involved in parturition are:

• Stage 1 : effacement & dilatation of cervix

• Stage 2 : delivery of fetus
• Stage 3 : delivery of placenta & fetal membranes
i) Onset of childbirth is followed by the opening of the
cervix.
ii) Powerful contractions ruptures the amnion and the
amniotic fluid flows out through the vagina.
iii) This is followed by the baby coming out through the
vaginal opening.
iv) The umbilical cord is then cut. The infants lungs expand
and it starts breathing. Shortly after child birth, the placenta
and the remains of the umbilical cord are expelled out.
 Mechanism of parturition
Stretch of uterus & Cervix Inc uterine contractility.:
1. Size of uterus provide distension of the uterus
2. Cervix become greatly distended as the fetus descend downward.
3. It will causes release of Oxytocin from posterior pituitary.
• Hormone increasing uterine contractility :
• 7th month: progesterone=constant Estrogen= increases (inc
contractility of uterus)
• Final weeks: Oxytocin begin to rise ( inc uterine contractility)
Onset of labour :
At 6th Month… Braxton-hicks Contraction occur..
As pregnancy proceeds the frequency and intensity of these
contractions also increases
The cycle of these contractions one after the other causes more
severe uterine contractions and then delivery finally occur.
 Lactation
Definition: Feeding the baby with the mother's milk is
known as lactation.
Milk production is achieved by Prolactin.
The mechanial stimulus for milk ejection is sucking reflex.
Sucking reflex….release Oxytocin…. Contraction of
myoepithelial cells…inc the pressure of milk filling the
ducts…..cause milk to flow from nipple to baby.
Role of Prolactin: promote milk secretion
Role of Estrogen and Progesterone: inhibit milk secretion
Role of Oxytocin: works with prolactin in milk secretion
under influence of hypothalamus
 CLOSTRUM
. The first milk which comes out from the mother's
mammary glands just after child birth is known as
colostrum.
Human milk is composed of
1.Water = 88.5%
2.Fat = 3.3%
3.Lactose = 6.8%
4.Casein = 0.9%
5.Other protein ,minerals & antibodies.
 Neonatal physiology
• CHANGES THAT OCCUR IN BABY AT BIRTH
• Onset of breathing : 40 b/min
• Expansion of lungs
• Closure of foramen ovale
• Closure of ductus arteriosus
• Closure of ductus venosus
• Blood volume: 300ml
• Cardiac out put: 550ml/min
• RBC count: 4million/mm3
• WBC count: 45,000/mm3
 ONSET OF BREATHING
It begins within seconds of delivery.
Two factors are responsible for it

1.Hypoxia during delivery

2.Sudden cooling of face on exposure to air.

A normal pattern of breathing develop after 1 minute of

delivery
Babies & infacts can tolerate without breathing for 8-10
min.
Adult can tolerare without breathing for only 4-5 min
 EXPANSION OF LUNGS
• Surface tension of fluid filled lungs keep the alveoli
in collapse state
• Approx. 25mmHg of negative inspiratory pressure is
needed to overcome surface tension
• At birth first inspiration is powerful & generate
60mmHg negative intra pleural pressure.
 Circulatory Readjustments
Two primary changes occur:
1.Doubling of systemic vascular resistance….It will inc
Aortic pressure, left ventricular & left atrial pressure
2.Five folds decrease in pulmonary vascular resistance….it
will dec. pulmonary aterial, right ventricular & right
atrial pressure.
• Other Changes
• Closure of foramen Ovale
• Closure of ductus arteriosus (btw pulmonary artery &
descending aorta)
• Closure of ductus venosus ( btw umbilical vein , fetal
bed & inferior vena cava)