ANATOMICAL

CHANGES DURING
PREGNANCY
o Reproductive Organ o Breast o Skin
REPRODUCTIVE
ORGAN
 oOvulation ceases during pregnancy, and
maturation of new follicles is suspended.
OVAR oThe single corpus luteum found in
pregnant women functions maximally

Y during the first 6 to 7 weeks of

pregnancy—4 to 5 weeks postovulation
—and thereafter contributes relatively
little to progesterone production
 Fallopian tube musculature
FALLOPI undergoes little hypertrophy
during pregnancy. However, the
AN TUBE epithelium of the tubal mucosa
becomes somewhat flattened.
UTERUS : GENERAL
Normal : Pregnancy :
oWeighted 70g oIncrease in weight into nearly 1100 g
oHave thick muscular wall with a cavity oTransformed into relatively thin walled
with maximum capacity 10mL because of muscle stretching to
accommodate fetus
oAverage total volume capacity of uterine
contet at term : 5 L
oMuscle cell : Hypertrophy, accumulation
of fibrous tissue particularly in external
muscle layer, increase elastic tissue
content to add strength to uterine wall
UTERUS : CHANGES IN UTERINE
SIZE,SHAPE, POSITION
oFor the first few weeks : the uterus maintains its original piriform or pear shape.

oOn 6 week of pregnancy, there is a softening of lower uterine segment just above cervix

which when examined with bimanual examination , the uterine compressed

between examining fingers feels paper thin (Hegar sign). This sign is noted until 12

week of pregnancy

oBut, as pregnancy advances, the corpus and fundus become more globular and almost

spherical by 12 weeks’ gestation. Subsequently, the organ increases more rapidly in

length than in width and assumes an ovoid shape.

o Palpable lateral bulge or soft prominence one of the locations where the uterine

tube meets the uterus can be noted in the seventh to eight week of gestation

(Piskacek's sign)
UTERUS : CHANGES IN
UTERINE SIZE,SHAPE,
POSITION
oBy the end of 12 weeks, the uterus has become too large to
remain entirely within the pelvis.
oAs the uterus enlarges, it contacts the anterior abdominal
wall, displaces the intestines laterally and superiorly, and
ultimately reaches almost to the liver.
oWith uterine ascent from the pelvis, it usually rotates to the
right. This dextrorotation likely is caused by the rectosigmoid
junction on the left side of the pelvis.
o Enlarged uterine may compress bladder and cause frequent
urination due to decrease in bladder capacity. Pregnancy may
also associated with urinary stress incontinence because
urethral closing pressures do not increase sufficiently to
compensate for the progressively increased bladder pressure
UTERUS : CHANGES IN UTERINE
BLOOD FLOW
oThe uterine arteries also undergo hypertrophy in the first half of pregnancy,
although in the second half increasing uterine distension is matched by arterial
stretching.
oProgesterone helps maintain lower myogenic tone in the uterine vessels despite the
increased blood flow.
oMaternal cortisol also regulates local uterine blood flow, through effects on
vascular endothelium and smooth muscle
oThe delivery of most substances essential for fetal and placental growth,
metabolism, and waste removal is dependent of adequate perfusion of the placenta.
Placental perfusion is dependent on total uterine blood flow
PLACENTA : NORMAL POSITION
oThe placenta can be situated anywhere
on the surface of the uterus. The front
wall is called anterior. The back wall is
called posterior.
oWhat matters most is how low the
lower edge of the placenta extends
because if it is too low in the uterus it
can prevent the descent of the fetal head
during labour. Low-lying placentas can
also lead to unusual bleeding during the
pregnancy or birth
PLACENTA : NORMAL POSITION
oPlacenta position can change during the pregnancy.
oIn mid-gestation the placenta occupies 50% of the uterine surface. By 40 weeks
gestation, the placenta only occupies 17 - 25% of the uterine surface. It doesn’t
shrink, but the rest of the pregnancy grows more and the uterine surface expands.
oIn the third trimester the baby’s head starts to descend into the pelvis in preparation
for labour. The pressure of the fetal head on the lower part of the uterus (the lower
uterine segment) causes it to stretch and become thinner. The site of the placental
attachment then appears to rise.
oBecause of these reasons many pregnancies have a low-lying placenta at 18-20
weeks gestation, but they do not have a low-lying placenta by the end of the
pregnancy. 
CERVIX
Can be seen as early as 1 month after conception:
oAppears bluer (Cyanosis) from increased vascularity
(Chadwick Sign)
oBecome swollen and softer due to edema of entire cervix
involving connective tissue remodeling that decreases
collagen and proteoglycan concentrations and increases
water content compared with the nonpregnant cervix (by
progesterine and estradiol)
oHypertophy and hyperplasia of cervical glands which
becomes visible on the ectocervix and is called an
ectropion, which is prone to contact bleeding. (by
estradiol)
oThe endocervical mucosal cells produce copious
tenacious mucus that obstruct the cervical canal soon
after conception.this mucus is rich in immunoglobulins
and cytokines and may act as an immunological barrier to
protect the uterine contents against infection.
oAt the onset of labor, if not before, this mucus plug is
expelled
VAGINA AND
PERNIEUM
oDuring pregnancy, increased vascularity and hyperemia
develop in the skin and muscles of the perineum and vulva

oIncreased vascularity prominently affects the vagina and

results in the violet color characteristic of Chadwick sign.

oThe vaginal wall undergoes increase in mucosal thickness,

loosening of the connective tissue, and smooth muscle cell
hypertrophy in preparation for the distention that
accompanies labor and delivery.
 oThe considerably increased volume of
cervical secretions within the vagina during
pregnancy consists of a somewhat thick, white
discharge.
VAGINAL oThe pH is acidic, varying from 3.5 to 6. This
results from increased production of lactic acid
DISCHAR from glycogen in the vaginal epithelium by the
action of Lactobacillus acidophilus.
GE oPregnancy is associated with a 10- to 20-fold
increase in the prevalence of vulvovaginal
candidiasis Most episodes of
symptomatic vulvovaginal candidiasis (VVC)
occur during the second and third trimesters
BREAST
EXTERNAL
CHANGES oIn early weeks of pregnancy :
breast tenderness and paresthesia
oSecond month of pregnancy :
Breast increase in size, veins
become visible beneath the skin,
larger nipple and more deeply
pigmented and more erectile.
oAfter first few month : Areolae
become broader and more deeply
pigmented, presence of
hypertrophic sebaceous glands
(glands of Montgomery) scattered
through areolae
INTERNAL
CHANGES o Deposition of fat around glandular
tissue, increase in number of glandular
duct (by estrogen)
oIncrease number of gland alveoli (by
progesterone and human placental
lactogen)
oAlthough prolactin concentration
increases throughout pregnancy, it does
not then result in lactation since it is
antagonized at an alveolar receptor level
by estrogen.
oThe rapid fall in estrogen concentration
over the first 48 hours after delivery
allows lactation to begin.
oTowards the end of pregnancy, and in the
early puerperium, the breasts produce
colostrum, a thick yellow secretion rich
in immunoglobulin
SKIN
oSebaceous gland activity is increased during the second half of pregnancy with
greasy skin, especially on the face, a common complaint. Acne may also commence
during pregnancy.
oHirsutism is seen in many pregnant women, especially those with dark or abundant
hair. Women also often notice thickening of scalp hair during pregnancy However,
one to four months after delivery, there is increased hair shedding known. This
shedding may persist for several months postpartum and is most likely precipitated
by the sudden hormonal changes at delivery as well as the stress of labour.
ABDOMEN
oBy the end of the second trimester:
Appearance of reddish, slightly
depressed streaks
(Striae gravidarum)
commonly develop in the abdominal
skin and sometimes in the skin over the
breasts and thighs.
oIn multiparous women, in addition
to the reddish striae of the present
pregnancy, glistening, silvery lines that
represent the cicatrices of previous
striae frequently are seen
HYPERPIGMENTATI
ON
oThis develops in up to 90 percent of women, Usually more accentuated
in those with a darker complexion
oThe linea alba—takes on dark brown-black pigmentation to form the linea
nigra.
oOccasionally, irregular brownish patches of varying size appear on the
face and neck ( chloasma or a melasma gravidarum—the so-called mask
of pregnancy)
oPre-existing moles, freckles and recent scars also tend to become darker
oThese pigmentary changes usually disappear, or at least regress
considerably, after delivery
oLittle is known of the etiology of these pigmentary changes. However,
levels of melanocyte-stimulating hormone are elevated remarkably
throughout pregnancy. Estrogen and progesterone also are reported to have
melanocyte-stimulating effects
THANK YOU
Source :
Williams obstetrics. 24th edition
Obstetrics by Ten Teachers, 19th Edition