Physiology of Pregnancy

Asheber Gaym M.D.

January 2009
 Outline

• Discuss the importance of the physiological

changes of pregnancy
• Discuss the mechanisms of regulation of the
physiological changes of pregnancy
• Discuss the physiological alterations in the
maternal organ systems

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 Physiological changes of pregnancy

• The physiological changes of pregnancy refer to the physiological, biochemical

and accompanying anatomical alterations in the maternal organ systems
geared towards catering to the increased demand of sustaining the pregnancy,
delivery and puerperium.
• A normal maternal anatomical and physiological system can sustain the
physiological alterations of pregnancy without any problems
• Mothers with underlying medical or surgical illnesses may sustain exacerbation
of their underlying disease due to the physiological alterations of pregnancy
e.g. congestive heart failure in mothers with cardiac illness; exacerbation of
anemia; diabetic ketoacidosis in mothers with pregestational diabetes
• In some mothers with underlying genetic predisposition to certain diseases,
the physiological changes may result in temporary appearance of disease
states during pregnancy e.g. gestational diabetes, gestational hypertension and
deep vein thrombosis

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 Regulation of Physiological Changes of Pregnancy
• The physiological alterations of pregnancy are regulated
by the feto-placental unit through hormones produced
by the placenta and the fetal adrenals.
• Thus the conceptus( fetus and placenta) acts to induce
changes in the maternal physiology, biochemistry and
anatomy of the mother in order to create a conducive
environment for its growth and maturity
• The relationship is of a symbiotic nature in which the
fetus manipulates the maternal physiology to induce
changes favorable to its survival while at the same time
ensuring that the changes are not detrimental to the
mother

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 Hormonal milieu of pregnancy and their physiological effects
Hormone Physiological action in pregnancy

Estrogen Uterine growth; Breast growth; liver enzyme changes; increased

peripheral insulin resistance; increased proliferation of blood vessels in
uterus; hematopoiesis
Progesterone Uterine smooth muscle relaxation; peripheral arteriolar and other blood
vessels relaxation; Increased peripheral blood flow due to vascular
relaxation; increased respiratory rate due to effect on respiratory center
Human Increased peripheral insulin resistance; Increased lipolysis and ketone
placental body production
lactogen
Growth Increased peripheral insulin resistance
hormone
Cortisol Fluid and electrolyte retention leading to increased total body water and
electrolytes; Increased insulin resistance
Mellanocyte Dark coloration of the breast, areola, linea nigra
stimulating
hormone

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 Physiological Changes of Pregnancy
Maternal organ Physiological Significance of Secondary
system change change to symptoms and
pregnancy signs

Cardiovascular •Increased heart •Increased blood •Palpitation

System rate -10-15 bpm flow to important •Feeling of heat and
•Decreased organs including sweating
peripheral vascular the uterus, kidneys, •Headache
resistance lungs, breasts, GIT occasionally
•Increased cardiac and skin •S3 gallop
output -50% •Apical beat lateral
•Stable blood to mid-clavicular
pressure with slight line
reduction at mid •ECG- left axis shift
pregnancy •10-15%
•Increased cardiomegally on
peripheral blood echocardiography
flow •Functional systolic
•Establishment of murmurs
uteroplacental
circulation

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 Physiological Changes of Pregnancy

Maternal organ Physiological Significance of Secondary

system change change to symptoms and
pregnancy signs
Respiratory system •Increased •Increased oxygen •Dyspnoea and a
respiratory rate (4 delivery to the fetus feeling of air hunger
breaths per •Increase oxygen •Decreased
minute); tidal delivery to all diaphragmatic
volume; minute maternal organs to excursion
ventilation meet the increasing
•Reduced metabolic demand
functional residual of pregnancy
capacity; residual
volume

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 Physiological Changes of Pregnancy
Maternal organ Physiological Significance of Secondary
system change change to symptoms and
pregnancy signs
Renal and urinary •Increased renal •Increased capacity •Glycosuria
system blood flow for excretion of •Proteinuria
•Increased waste ( increased from
glomerular filtration •Increased capacity 15mg/L in the non-
rate (50%) for retention of pregnant to 300
•Increased tubular electrolytes and mg/L in the
water and water pregnant woman
electrolyte •Hydronephrosis
absorption and hydroureters
•Relaxation and on ultrasonography
dilatation of the (partly due to the
ureters obstruction of the
gravid uterus as
well)

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 Physiological Changes of Pregnancy
Maternal organ Physiological Significance of Secondary
system change change to symptoms and
pregnancy signs
Gastrointestinal •Increased •More time for •Heartburn
tract relaxation of digestion of food •Constipation
smooth muscle of •More time for •Increased risk of
entire GI tract absorption in the aspiration during
•Increased gastric small intestines anesthesia
emptying time •More time for •Bloating
•Increased water absorption in
transition time in the colon
the small and large •More nutrients
intestines available to the
•Increased appetite fetus and mother
•Increased glycogen for growth and
deposition in the preparation for
liver breast feeding

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 Physiological Changes of Pregnancy

Maternal organ Physiological Significance of Secondary

system change change to symptoms and
pregnancy signs
Hematologic system •Increased plasma •Increased oxygen •Increased risk for
volume (50%) carrying capacity deep vein
•Increased RBC •Increased capacity thrombosis and
(33%) for coagulation to embolism if other
•Decreased Hgb reduce blood loss at risks are also
•Increased clotting delivery present
factors II, VIII, IX, X
•Increased platelets
after delivery
•Increased WBC
count ( <16,000/dl)
•No change in
immune system
profile

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 Physiological Changes of Pregnancy
Maternal organ Physiological Significance of Secondary
system change change to symptoms and
pregnancy signs

Reproduction and •Amenorrhea and •To prevent •Supine

reproductive tract anovulation abortion and hypotension
•Increased uterine preterm labor syndrome due to
size from 60 grams •Uteroplacental the pressure of the
to 1 kgs circulation expands enlarged uterus on
•Decreased uterine from insignificant to the inferior vena
contractility until 20% of cardiac cava and aorta
labor output at term with
•Increased uterine blood flow
vascularization and at term being 500-
establishment of 700ml/minute
the utero placental •Prevent
circulation
•Relaxation of the
vaginal and perineal
wall structures

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 Physiological Changes of Pregnancy
Maternal organ Physiological Significance of Secondary
system change change to symptoms and
pregnancy signs

Musculoskeletal •Increased •Increased capacity •Back pain

system relaxation and of pelvis during •Joint pains in the
elasticity of delivery pelvic region
ligaments
•Increased mobility
of joints

Breast changes •Increased •Preparation for

proliferation of lactation
glandular and •Milk production
connective tissue begins after
•Increased fat delivery
deposition
•Begin colostrum
secretion (>16
weeks)

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