PHYSIOLOGICAL CHANGES

DURING PREGNANCY IN
REPRODUCTIVE SYSTEM
 ANATOMY & PHYSIOLOGY OF
FEMALE REPRODUCTIVE SYSTEM
 TERMINOLOGIES
• TERM – PREGNANCY ATLEAST 37 WEEKS TO 42WEEKS .
• PREGNANCY – GROWING FETUS OR EMBRYO IN THE WOMB OF
MOTHER BEGINS WITH FERTILIZATION & ENDS WITH DELIVERY.
• JACQUEMIERS SIGN- BLUISH DISCOLOURATION DUE TO
HYPERTROPHIED, HYPERPLASIA, ODEMATEOUS , VASCULAR &
INCREASED BLOOD SUPPLY TO VAGINAL WALLS.
• GOODELL’S SIGN – CERVIX UNDERGOES MARKED SOFTENING.
• BRAXTON – HICK CONTRACTION – PRESENT IN EARLY
PREGNANCY. UNDERGOES SPONTANEOUS CONTRACTION.
THESE ARE IRREGULAR, INFREQUENT, SPASMODIC, PAINLESS
WITHOUT ANY EFFECT OF DILATATION OF CERVIX
 Quickening – The 1st movement of the fetus felt by the
mother around 18th to 20th week.
Osiander’s sign – increased pulsation felt in the lateral
fornix from 8th week onwards.
 Palmar’s sign – regular & rhythmic uterine contractions
resembling systole & diastole of heart that can be elicited
during bimanual examination as early as 8 weeks.
Ballotment of fetus from 16th to 28th week- a sharp
upward pushing against the uterine wall with a finger
inserted into the vagina by feeling the return impact of the
displaced fetus.
 ORGANS
• EXTERNAL GENITAL ORGANS :-
• VULVA, VAGINA
• INTERNAL GENITAL ORGANS
• UTERUS : BODY, ISTHMUS, CERVIX
• FALLOPIAN TUBE
• OVARY
• BREASTS
 1.GENITAL ORGANS
VULVA
• BECOMES OEDEMATOUS
• MORE VASCULAR
• SUPERFICIAL VARICOSITIES MAY APPEAR (MULTIPARAE)

LABIA MAJORA
• PIGMENTED & HYPERTROPHIED

PERINEUM
• ENLARGED
• INCREASED VASCULATURE
• DEPOSITION OF FAT
VAGINA
ANATOMICAL CHANGES
• VAGINAL WALLS BECOMES HYPERTROPHIED,
OEDEMATOUS & MORE VASCULAR.
• INCREASED BLOOD SUPPLY OF THE VENOUS PLEXUS
SURROUNDING THE WALLS GIVES THE BLUISH-VIOLET
COLORATION OF THE MUCOSA 0R VAGINAL MEMBRANE
BY 8TH WEEK(JACQUEMIER’S SIGN/ CHADWICK’S SIGN).
• THE LENGTH OF THE VAGINAL WALL IS INCREASED.
• AMENORRHEA AT 4TH WEEK.
Secretion
•Becomes copious, thin & curdy white , due to marked
exfoliated cells & bacteria.
•The pH becomes acidic (3.5-6) due to more conversion of
glycogen into lactic acid by lactobacillus acidophilus
consequent on high oestrogen level.
• vaginal discharge –copious non – irritating mucoid discharge,
which appears at 6th week.

Cytology
•Navicular cells in cluster
•Plenty of lactobacillus.
 2. UTERUS

• THERE IS ENORMOUS GROWTH OF THE UTERUS

DURING PREGNANCY.
• NON PREGNANT STATE : WEIGHT- 60GM , CAVITY – 5-
10 ML , LENGTH – 7.5CM
• AT TERM : WT -900-1000GM , LENGTH- 35CM &
CAPACITY INCREASED BY 500-1000 TIMES.

• CHANGES OCCURS IN ALL PART OF UTERUS: BODY,

ISTHMUS , CERVIX.
• ENLARGEMENTBODY OF THE UTERUS
CHANGES IN MUSCLES
1)HYPERTROPHY & HYPERPLASIA
2)STRETCHING

ARRANGEMENT OF THE MUSCLE FIBRES

3)OUTER LONGITUDINAL – ARRANGED OVER FUNDUS
4)INNER CIRCULAR – SCANTY & SPINCTURE LIKE
ARRANGEMENT
5)INTERMEDIATE – THICKEST & STRONGEST LAYER CRISS-
CROSS IN FASHION
Changes
• In depth from 2.5 to 22cm
• In width from 4 to 24 cm
• In thickness of walls from 1 to 0.5cm

Capacity
• fetus
• Placenta
• Umbilical cord
• 500ml to 1000ml amniotic fluids
• Fetal membranes

Hormones
• Oestrogen & progesterone
Shape
• Early month – pyriform (pear shape)
• 12 weeks – globular
• 28 weeks – dome shaped fundus round spherical
• 36 weeks – ovoid in manner

Position
• 12-16 weeks – palpate at the symphysis pubis.
• 22-24 weeks – at the level of umbilical
• Near term – xiphoid process
• With ascent from the pelvis , the uterus usually undergoes rotation with
tilting to the right (dextro-rotation) , probably due to presence of the
rectosigmoid colon on the left side. ( lateral obliquity of the uterus).
Vascular system
• Non pregnant stage – blood supply to the uterus is mainly through the uterine
& least through the ovarian.
• Pregnant stage – there is marked spiraling of the arteries, reaching the
maximum at 20 weeks; thereafter they straighten out.
• Uterine artery diameter becomes double &blood flow increases by 8th fold at
20 weeks.
• Vasodilation is mainly due to estradiol & progesterone.
• Veins become dilated & are valveless.
• The fundus enlarges more than the body.
Consistency
• Becomes progressively softer due to :
1. Increased vascularity
2. The presence of amniotic fluid

Braxton – hick contraction

• It is present in early weeks of pregnancy.
• These contractions are irregular, infrequent, spasmodic, painless without any
effect of dilatation of cervix.

Endometrium
• Endometrium during pregnancy is known as decidua.
• The increased structural & secreatory activity of the endometrium that is
brought about in response to progesterone following implantation is known as
decidual reaction.
• Differentiate into 3 layers-
1. Superficial compact layer.
2. Intermediate spongy layer.
3. Thin basal layer.

Perimetrium
• Thin layer protects the uterus, inelastic base, does not cover the
uterus bladder part as uterovesical pouch & rectum part as
pouch of Douglas..
• Uteroplacental blood flow – 500ml/min at term
• Formation of lower uterine segment – after 12 weeks isthmus
(0.5cm) starts to expand gradually & 12cm at term.
 ISTHMUS OF UTERUS
• DURING THE FIRST TRIMESTER, ISTHMUS HYPERTROPHIES &
ELONGATES TO ABOUT 3 TIMES ITS ORIGINAL LENGTH.
• IT BECOMES SOFTER.
• WITH ADVANCING PREGNANCY BEYOND 12 WEEKS, IT
PROGRESSIVELY UNFOLDS FROM ABOVE, DOWNWARDS UNTIL IT IS
INCORPORATED INTO THE UTERINE CAVITY.
• THE CIRCULARLY ARRANGED MUSCLE FIBRES IN THE REGION
FUNCTION AS A SPINCTER IN EARLY PREGNANCY & THUS HELP TO
RETAIN THE FETUS WITHIN THE UTERUS.
• INCOMPETENCY OF THE SPHINCTERIC ACTION LEADS TO MID
TRIEMESTER ABORTION & THE ENCIRCLAGE OPERATION DONE TO
RECTIFY THE DEFECT IS BASED ON THE PRINCIPLE OF
RESTORATION OF THE RETENTIVE FUNCTION OF THE ISTHMUS.
• HEGAR’S SIGN – SOFTENING & COMPRESSIBILITY OF THE
ISTHMUS FROM 6TH TO 12TH WEEK.
 CERVIX OF UTERUS
• STROMA
HYPERTROPHY & HYPERPLASIA
FLUIDS ACCUMULATE
VASCULARITY
GOODELL’S SIGN

• EPITHELIUM
MARKED PROLIFERATION
CIN
•Secretion
It is copious & tenacious physiological leucorrhoea of pregnancy
Mucous is rich in immunoglobulins & cytokines.
Beading

•Anatomical
• Length unaltered
• Bulky
• After engagement, directed in line of vagina.
• No alteration in relation of cervix.
• Unfolding of isthmus
• Viable amount of effacement (primigravidae)
• Canal is slightly dilated (multiparae)
 3. FALLOPIAN TUBE
• AS THE UTERINE END RISES UP & THE FIMBRIAL END IS
HELD UP BY THE INFUNDIBULOPELVIC LIGAMENT, IT IS
PLACED ALMOST VERTICAL BY THE SIDE OF THE UTERUS.
• AT TERM : ITS ATTACHMENT TO THE UTERUS IS PLACED AT
THE LOWER END OF THE UPPER 1/3RD (BECAUSE OF MARKED
GROWTH OF THE FUNDUS).
• THE TOTAL LENGTH IS SOMEWHAT INCREASES.
• THE TUBE BECOMES CONGESTED.
• MUSCLES UNDERGO HYPERTROPHY.
• EPITHELIUM BECOMES FLATTENED & PATCHES OF
DECIDUAL REACTION ARE OBSERVED.
 4. OVARY
CHANGES
• 8TH WEEK :
THE GROWTH & FUNCTION OF THE CORPUS LUTEUM
REACHES ITS MAX.
SIZE: MEASURES 2.5CM
BECOMES CYSTIC
LOOKS BRIGHT ORANGE, LATER ON BECOMES YELLOW
& FINALLY PALE.
DECLINE IN SECRETION OF HCG FROM PLACENTA.
• 12TH WEEK :
COLLOID DEGENERATION ( CALCIFIED AT TERM )
• HORMONES
OESTROGEN & PROGESTERONE SECRETED BY THE CORPUS
LUTEUM MAINTAIN THE ENVIRONMENT FOR THE GROWING
OVUM BEFORE THE ACTION IS TAKEN OVER BY THE PLACENTA.
THESE HORMONES NOT ONLY CONTROL THE FORMATION &
MAINTENANCE OF THE DECIDUA OF PREGNANCY, BUT ALSO
INHIBITS RIPENING OF THE FOLLICLES.
THUS BOTH THE OVARIAN & UTERINE CYCLES OF THE
NORMAL MENSTRUATION REMAIL SUSPENDED.
LUTEOMA OF PREGNANCY RESULTS FROM EXAGGERATED,
LUTEINISATION REACTION OF THE OVARY.
 Decidual reaction
•Patchy sheet of decidual cells on the outer surface of the ovary.
•These are metaplastic changes due to high hormonal
stimulation.
•The same stimulus may also produce luteinisation of atretic or
partially developed follicles.
 5. BREASTS
• THE CHANGES IN THE BREASTS ARE BEST EVIDENT IN A PRIMIGRAVIDA.
• TINGLING, TENSENESS & ENLARGEMENT OF BREASTS FROM 3 RD TO 4TH WEEK.
• BREAST CHANGES – DARKENING OF NIPPLES, PRIMARY & SECONDARY
AREOLAR CHANGES & APPEARANCE OF MONTGOMERY’S TUBERCLES.
SIZE :
• HYPERTROPHY
• PROLIFERATION OF THE DUCTS AND ALVEOLI
• AXILLARY TAIL
NIPPLES & AREOLA :
• NIPPLES BECOME LARGER, ERECTILE, & DEEPLY PIGMENTED.
• PRESENCE OF COLOSTRUM IN THE NIPPLE.
• VARIABLE NO. OF SEBACEOUS GLANDS (5-15), BECOME HYPERTROPHIED
(MONTGOMERY’S TUBERCLES )
• THEIR SECRETION KEEPS THE NIPPLE & AREOLA MOIST .
• SECONDARY AREOLA : AN OUTER ZONE OF LESS MARKED &
IRREGULAR PIGMENTED AREA APPEARS IN SECOND
TRIMESTER.

SECRETION :
• 12TH WEEK : COLOSTRUM CAN BE SQUEEZED OUT , AT FIRST
BECOMES STICKY.
• 16TH WEEK : IT BECOMES THICK & YELLOWISH.
• THE DEMONSTRATION OF SECRETION FROM THE BREAST OF A
WOMAN WHO HAS NEVER LACTATED IS AN IMPORTANT .
 CUTANEOUS CHANGES
• PIGMENTATION: THE DISTRIBUTION OF
PIGMENTARY CHANGES IS SELECTIVE
1)FACE
2)BREAST
3)ABDOMINAL
 1. FACE
• FACE (CHLOASMA GRAVIDARUM
OR PREGNANCY MASK): IT IS AN
EXTREME FORM OF
PIGMENTATION AROUND THE
CHEEK, FOREHEAD AND AROUND
THE EYES. IT MAY BE PATCHY OR
DIFFUSE; DISAPPEARS
SPONTANEOUSLY AFTER
•ABDOMINAL
LINEA NIGRACHANGES
IS A
PHYSIOLOGICAL FORM OF
HYPERPIGMENTATION COMMONLY
SEEN IN THE FIRST TRIMESTER OF
PREGNANCY .
• IT IS A DARK VERTICAL LINE THAT
RUNS DOWN THE MIDDLE OF THE
ABDOMEN AND IT CAN BE ONE OF
THE EARLIEST INDICATORS OF
PREGNANCY
• . IT IS ALSO KNOWN AS THE
‘PREGNANCY LINE’.
 ABDOMINAL CHANGES
• STRIAE GRAVIDARUM, STRETCH MARKS IN
PREGNANCY, OCCUR IN ABOUT 90% OF ALL PREGNANT
WOMEN. THEY ARE PRIMARILY DUE TO THE RAPID RATE AT
WHICH THE SKIN IS BEING STRETCHED, COMBINED WITH THE
INFLUENCE OF HORMONES.
• STRETCH MARKS LOOK LIKE LIGHT PINK TO RED TO PURPLE
LINES THAT MOSTLY OCCUR ON THE BELLY BUT CAN APPEAR
ON THE BUTTOCKS, BREAST, THIGHS, AND UPPER ARMS.
 WEIGHT GAIN
• IN NORMAL PREGNANCY, VARIABLE AMOUNT OF
WEIGHT GAIN IS A CONSTANT PHENOMENON. IN
EARLY WEEKS, THE PATIENT MAY LOSE WEIGHT
BECAUSE OF NAUSEA OR VOMITING. DURING
SUBSEQUENT MONTHS, THE WEIGHT GAIN IS
PROGRESSIVE UNTIL THE LAST 1 OR 2 WEEKS,
WHEN THE WEIGHT REMAINS STATIC. THE TOTAL
WEIGHT GAIN DURING THE COURSE OF A
SINGLETON PREGNANCY FOR A HEALTHY WOMAN
AVERAGES 11 KG (24 LB). THIS HAS BEEN
 IMPORTANCE OF WEIGHT
CHECKING:
• SINGLE WEIGHT CHECKING IS OF
LITTLE VALUE EXCEPT TO IDENTIFY
THE OVERWEIGHT OR UNDERWEIGHT
PATIENT. PERIODIC AND REGULAR
WEIGHT CHECKING IS OF IMPORTANCE
TO DETECT ABNORMALITY
RAPID GAIN IN WEIGHT
• RAPID GAIN IN WEIGHT OF MORE
THAN 0.5 KG (1 LB) A WEEK OR MORE
THAN 2 KG (5 LB) A MONTH IN LATER
MONTHS OF PREGNANCY MAY BE THE
EARLY MANIFESTATION OF PRE-
ECLAMPSIA AND NEED FOR CAREFUL
SUPERVISION.
STATIONARY OR FALLING
WEIGHT

• STATIONARY OR FALLING WEIGHT

MAY SUGGEST INTRAUTERINE
GROWTH RETARDATION OR
INTRAUTERINE DEATH OF FETUS
THANK YOU