Physiology of Pregnancy

Dosen Pengampu :
Dr.dr.Citra Kesumasari, M.Kes, Sp.GK(K)

Oqti Rodia C175221004

Primalia Rosyidah H C175221003
Igus Ulfa Yaze C175221002
Styana Ria Jayanti C175221001
INTRODUCTION

Pregnancy
The course that the embryo and the fetus grow in the
maternal body

Stages of pregnancy
1. Early pregnancy: ≤12 weeks
2.Mid pregnancy: ≥13 weeks,≤27weeks
3.Late pregnancy:≥28 weeks
4.Term pregnancy:≥37 weeks,<42 weeks
 Physiologic changes in pregnant woman
Kidney
Renal plasma flow (RPF):↑35%
Glomerular filtration rate (GFR):↑50%
Ureter: dilated ( ↑ )
Bladder : frequent micturation
The urinary Cardiovascular
system system
• Heartmove upward, hypertrophy of
cardiac muscle
• Cardiac Output increase by 30%,
reach to peak at 32nd –34th week
• Blood pressureearly or mid
pregnancy Bp↓.late pregnancy
Bp↑ .Supine hypotensive syndrome
• Blood volume  Increase by 30%-45% at 32
–34th (peak)
• Relatively diluted
Composition
Red cells Hb:130→110g/L, HCT:38%→ 31%.
White cells: slightly increase
Coagulating power of blood: ↑
Albumin: ↓,35 g/L
The Respiratory
Hematology
system
R rate: slightly ↑
vital capacity: no change
Tidal volume: ↑ 40%
Functional residual capacity:↓
O2 consumption: ↑ 20%
Gastrointestinal system
Gastric emptying time is prolonged  nausea
The motility of large bowel is diminished  constipation
Liver function  unchanged

Increases in body weight

• The average weight gained by the body during pregnancy in about 12 kg
the approximate weight of various structures which adds to the weigth
gain
• Fetus 3.5kg
• Amniotic fluid 2.0 kg
• Placenta 1.5 kg
• Increases in matt. 5.0 kg
 Hormonal changes
Placenta mother aldosterone hypertension
CRH ACTH cortisol edema
insulin resistance

HCG hyperthyroidism
HC thyrotropin

gestational
diabetes
↑Calcium Hyperparathyroidism

demands
 CHANGES ARE DUE TO
ALTERATIONS IN

HORMONAL
PRODUCTION

CIRCULATION

METABOLISM
 HORMONAL PRODUCTION
HORMONAL PRODUCTION

ESTROGEN PROGESTERON

• Produced in corpus • Produced in corpus

luteum luteum and then the
• Produced by placenta placenta
after 12 weeks • Relaxes smooth muscle
• Responsible for • Inhibits uterine contractions
growth particularly of until uterus is prepared for
uterus and breasts labour
• Regulates storage of body
fat
Human chorionic gonadotrophic
• Secreted from trophoblast of the
developing embryo

• Maintains corpus luteum until

placenta takes over

• Used in tests to confirm pregnancy

Human placental lactogen

• Alters maternal metabolism

• Diverts glucose to fetus

• Mobilises free fatty acids from

maternal stores
RELAXIN
• Released by corpus luteum then the
Placenta

• Softens pelvic ligaments

• Reduces myometrial tone

 • Endometrium decidua
• becomes more vascular
Changes in the and thicker due to
oestrogen and
reproductive progesterone
system: Uterus • decidua provides
glycogen rich enviroment
to nourish fetus until
trophoblastic cells
develop into placenta
• decidual cells produce
prolactin and relaxin
 MYOMETRIUM

• Smooth muscle fibres embedded in a matrix of

connective tissue

• Grow 15 – 20 times normal size

PERIMETRIUM

• Stretches with uterus upwards and

outwards

• Can cause discomfort

• Spasm of broad ligament specially on right side

Changes in size

Uterus grows to 30x23x20 at term

weight increases to 900gms

Hypertrophy.. Estrogen causes cells to

increase until 20 weeks gestation

Hyperplasia:- number of cells increase

under the influence of oestrogen
 After 20 weeks
gestation.

• Uterine muscle tissue

stretches to allow
fetus to grow

• Progesterone relaxes
the smooth muscles
enabling it to stretch
 Changes in the cervix

• Length remains the same

• Increase in width
• Softening after third month due to
oestrogen
• Increased vascularity
• Increased cervical mucosa
• Increased glandular function
BY 12 WEEKS
Placenta now developed

Uterus is
upright and No longer a
leans pelvic organ
slightly to
the right

Uterus may Fetus now

be palpable occupies
above the most of the
pubic bone uterine
cavity
BLOOD CHANGES

• Increase in estrogen:
new blood vessels formed
growth of existing ones

• Therefore an increase in
blood volume.
 20% 50%

Red cell mass:

Blood volume:
rises constantly
throughout • from 5 litres to 7.5
pregnancy Up by total volume up by
20% by end of 40-50%
pregnancy
 Plasma Volume

Reaches maximum level

Variable related to Increases from approx 50% above non-
parity, fetal weight 10th week of pregnant levels at 32-34
and number pregnancy weeks then maintained
.
 Month nine

Lightening – Fetus descends to pelvic cavity Cervix – Dilation,

Effacement (softening, thinning)
False Labor – Contractions initiate then diminish
Labor:
Cervical effacement – dilation to 10 cm
Bloody Show – mucus plug of the cervix – blood-colored Breaking Water Bag –
rupturing of the amnion Contractions – shorter intervals, longer, stronger
 Uterine Contraction
• Uterine musculature becomes progressively more excitable
Estrogen / progesterone ratio changes increases excitability
Progesterone inhibits contraction
• Estrogen increases gap junctional communication between
smooth muscle cells  increases contractility
• Oxytocin (maternal posterior pituitary gland)
increases excitability

01
• Mechanically stretching uterine smooth muscle increases
contractility
• Cervical stretching elicits uterine contractions
• Fetal effects –glucocorticoids  placenta
inhibits progesterone
• Fetal oxytocin is also produced
 Labor and Parturition

Parturition
Process by which the baby is born

Labor
Strong uterine contractions, Cervix stretching, Forcing the fetus through the
birth canal Rhythmic strong uterine contractions expel the fetus, Positive-
Feedback regulation of labor

Contractions push baby  stretch cervix

Stretched c e r v i x  Stronger uterine contraction
Cycles until parturition is complete
 Contractions
30 minutes  1-3 minutes Contractions strongest at
top of uterus – forcing baby toward cervix (25
lbs/contraction)

Continuous contractions (tetanus) can stop blood flow

and lead to death of the baby
 After Birth
10-45 minutes after parturition
The placenta is Delivered

Separation and Expulsion

Separation - Uterine cavity reduces in size 
shearing the placenta from the uterine wall

Limited bleeding
controlled by local production of vasoconstrictors
(prostaglandins) Expulsion is by uterine contraction
Estimated Fetal Weight Percentile
Conditions During Pregnancy

CONSTIPATION
– Affects half of pregnant women
– Causes:
• increase in progesterone
• the colon absorbing more water
• worse in first 13-14 weeks
– Treatment:
• Drink plenty of fluids
• Eat high fiber foods
• Take fiber supplements – psylium husks, Metamucil, Ex-Lax
 Cardiovascular change

• Displaced to left and upward Apex is move laterally

• Apparent cardiomegarty on chest x- ray
• Increase of left ventricular end diastolic dimension
• increase of left ventricular wall mass c/w mild
hypertrophy
• increase in preload increase
1st semester PEAK DURING FIRST SEMESTER

Nausea and
POSITIVE CORRELATION WITH BIRTH Vomiting during
WEIGHT
Pregnancy (NVP)
(Morning Sickness)
NEGATIVE CORRELATION WITH
SPONTANEOUS ABORTIONS

NAUSEA 50-70% AND VOMITTING 40-

50% OF PREGNANT WOMEN

LESS THAN 2% IS SOLELY IN THE

MORNING
 Breast Development
Pregnancy
• Hormone-Dependent Growth Estrogen
• Growth Hormone Prolactin
• Adrenal glucocorticoid Insulin
• Growth and branching of the ductal system Fat Deposition
• Progesterone: Final stages – synergistic with other hormones – growth of
lobules, budding of alveoli, secretory characteristics, but not secretion
Lactation
Lactation (lak-tā′shŭn) is the production of milk by the mammaryglands. It
normally occurs in women following par-turition and may continue for up
to 2 or 3 years.
https://www.brainkart.com/article/Lactation_22009/
 FIGURE 1. BREAST FEEDING FEEDBACK LOOP
The prolactin-mediated synthesis of milk changes with time.
Frequent milk removal by breastfeeding (or pumping) will
maintain high circulating prolactin levels for several months.
However, even with continued breastfeeding, baseline prolactin
will decrease over time to its pre-pregnancy level. In addition to
prolactin and oxytocin, growth hormone, cortisol, parathyroid
hormone, and insulin contribute to lactation, in part by facilitating
the transport of maternal amino acids, fatty acids, glucose, and
calcium to breast milk.

https://courses.lumenlearning.com/suny-ap2/chapter/
lactation/
 BREAST FEEDING FEEDBACK LOOP
• Suckling of baby stimulates nerves in the areola of breast
• This stimulates the pituitary to release prolactinandoxytocin
• The prolactin initiates milk production and moves milkinto ducts
• Oxytocin causes weak contractions in the breastto move the milk
• Oxytocin also causes weak contractions in the uterus to return the uterus to its
normal size and shape, thus breast-feeding mothers regainuterine musclecontrol
quicker
• •Hear baby cry à release oxytocin à start to move milk "milk let down“
• • Stress à lowers milk release à lots of milk à no release à increased pressureà pain
(thus it is important to be relaxed and in a quiet area to feed)