PHYSIOLOGY OF PREGNANCY

Physiological and psychological changes

that take place during pregnancy
 Physiological changes occuring during
pregnancy
• After fertilization certain hormones are produced
to help the body cope up with the pregnancy.
• The main ones are oestrogen and progesterone
• They bring about many physiological and
psychological changes in the body of the pregnant
woman
• These channges are felt in almost all body systems
 Physiological changes in the
reproductive system
• Body of the uterus
• The uterus develops to provide a nutritive and
protective environment for the growing fetus
• The endometrium
• During pregnancy oestrogen and progesterone
initially produced by the corpus luteum cause the
endometrium to become thicker, richer and more
vascular (spongy) especially in the upper segment
• This is in preparation for implantation
• The endometrium thickens 4 times of the normal
pregravid state to become the decidua
 Decidua
• It provides a glycogen rich environment for the blastocyst
untill the trophoblastic cells begin to form the placenta
• Once fully forms the placenta takes over the production of
these hormones
• The corpus luteum then atrophies to become corpus
albicans
• The decidua differentiates into three layers
1. The basal decidua (decidua basalis) next to the
myometrium- firm and highly vascularized
2. Capsular decidua (decidua capsularis) also known as the
functional layer and contain torturous gland rich in
secretions
3. Parietal decidua (compact/spongy layer) next to the
uterine cavity where the blastocyst embades/attaches
before burrying itself into the basal decidua
 Myometrium (muscle layer)
• Oestrogen is responsible for the growth of the
uterine muscles (hypertrophy and hyperplasia)
• Increase in the size of muscle fibres is called
hypertrophy
• Increase in the number of the cells and fibres is
called hyperplasia
• Uterus continues to grow for the first 20 weeks
• After this the muscles stretch to accommodate the
growing uterine contents
• Weight increases from 60g to 900g at term while
• Size increases from 7.5x5x2.5cm to 30x23x20cm at
term
 Myometrium cont.
• Stretching of the muscles is facilitated by
progesterone which encourages relaxation of
smooth muscles
• From 8 weeks gestation the mother starts
experiencing mild painless contractions lasting
60 seconds which continue throughout the
pregnancy
• These are called Braxton hicks
• In labour these increase to become labor
pains
 Myometrium cont.
• The myometrium differentiate into three
distinct layers:-
1.The inner layer has circular muscle fibres; they
cause stretching of the lower segment
2.Middle layer: has oblique muscle fibres which
are involved in contraction and retraction
during labour and in third stage to control
haemorrhage
3.Outer layer: has longitudinal muscle fibres
that stretch and contract during labour
 Perimetrium
• The outer thin membrenous layer of the
uterus
• Does not cover the entire uterus
• Does not change much during pregnancy
• Allows stretching and distention of the uterine
muscles during pregnancy
 Blood supply to the uterus
• Blood supply increases to keep pace with its growth
and the increased demands of the functioning
placenta
• During implantation, the chorionic villi erode
maternal spiral arteries to create a ‘lake’ of blood at
the placental bed where the chorionic villi float to
absorb oxygen and nutrients and discharge wastes
• The utero-placental circulation is at the rate of 400-
700ml/minute
• Oestrogen causes growth of new blood vessels
• This forms a torturous network of blood vessels
throughout the uterine walls
 Changes in uterine size
• Necessitated by the growing fetus and liquor which
requires more space
• Lower segment softens and elongates from its original
7mm to 25mm at 10 weeks
• This is the beginning of differetiation between upper and
lower segments
• At 12 weeks fundus palpated abdominally slightly above
the symphysis pubis
• At 18 weeks it is midway between the sympysis pubis and
the umbilicus
• 22-24 weeks it is at the umbilicus
• 30 weeks it is midway between the umbilicus and the
xyphysternum
• At 36 weeks it is at the xyphisternum
• At 40 weeks it is felt 2 fingers below the xyphisternum
 Cervix
• It acts as an effective barrier against infections
• It helps in retaining the pregnancy by closing firmly
• Under influence of progesterone the endocervical cells
secrete a thick plaque of mucus called operculum
• This seals off the external os preventing entry of any
ascending infections.
• Increased vascularity due to influence of oestrogen makes
it to have a purple color
• It remains 2.5cm long throughout pregnancy but widens
and shortens (ripens) at term due to effects of
prostaglandins and increasing painless contractions in
preparation for labour
 The vagina
• Under influence of oestrogen the muscle layer
and mucosa hypertrophies
• It becomes more elastic
• There is over-secretion of whitish vaginal
discharge called leucorrhoea
• There is increased glycogen content which reacts
with the doderlins bacillus (normal commensal)
to produce a more acidic environment
• It is more vascularized and color appears reddish
purple
 Vulva
• There is increased blood supply making it look
abit bigger (hypertrophy)
• Increased tendancy to fungal infections due to
lowered immunity and increased vaginal
secretions
• Tendancy to have some itchy feelings
resulting from candida albican (candidiasis)
which is common in pregnancy
 Changes in the cardiovascular system
• There is increased cardiac output from 5 to 7liters
(35-50%) per minute in late pregnancy
• This is due to increase in stroke volume and heart
rate to maintain blood flow to all vital organs while at
the same time supplying the uterus where blood flow
at the placental site is about 400-700mls/minute
• There is Increase in blood volume by 30-50% as result
of haemodilution which reduces blood viscosity and
increase capillary flow.
• This also helps to meet the increased demands of the
uterus and metabolic needs of the fetus
Changes in cardiovascular system cont.
• Heart enlarges (hypertrophies) about 12% due to
increased workload to meet the increasing
demands of the pregnancy
• The red cell mass also increases in response to extra
oxygen requirements of maternal and placental
tissues. This increases iron requirements
• Iron metabolism: iron is metabolized from body
stores to maintain circulating levels and supply to
the fetus. This helps raise haemoglobin levels
• There is need to enhance iron intake as its
metabolism is highest at 4th week.
• Increase iron intake through diet and supplements
 Blood pressure
• As cardiac output increases arterial pressure
decreases by 10%
• This is due to reduction in peripheral vascular
resistance as a result of vasodilation effect of
oestrogen and progesterone and increased utero-
placental circulation (400-700mls/minute)
• This leads to a slight drop in blood pressure during
pregnancy ie 5-10mmhg systolic and 10-15mmhg
reduction in diastolic blood pressure
• N/B; Failure of this vasodilation and poor
uteroplacental circulation leads to pregnancy-
induced hypertension
 Clotting factors
• Clotting factors 7 and 10 and platelets are also
increased
• This leads to increase in clotting time from 12
to 8 minutes
• Clotting tendencies may increase the risk of
thrombosis and embolism
 Immunity
• Human chorionic gonadotophic hormone
(HCG) and prolactin are known to suppress
the immune functions during pregnancy
• Lymphocyte function is depressed
• This causes decrease in resistance to viral
infections such as herpes, influenza, rubella
and even malaria which is parasitic (protozoa)
• There is therefore need to enhance immunity
through diet
 The breast (anatomy and physiology)
• The breasts, as known as mammary glands are accessory
reproductive organs
• They are made up of glandular, fibrous, and fatty tissues
arranged in lobes aprroximately 20 in number
• Each lobe is divided into lobules that consist of alveoli and
ducts that radiate around the nipple.
• The alveoli contain acini cells which produce milk and are
surrounded by myoepithelial cells which contract and
propel milk out through the lactiferous ducts
• The lactiferous ducts join to form the lactiferous sinus
(ampulla) which stores the milk before ejection through the
lactiferous tubule of niple during suckling
Breast changes and physiology of lactation
• During pregnancy they increase in size due to estrogen and
progesterone and there’s prickling/tingling sensation
• New ducts, alveoli spaces and acini cells are produced
• Prolactin hormone production starts in small quantities
from early pregnancy
• After the birth more prolactin is released by the anterior
lobe of the pituitary gland which stimulates the production
of milk by the acini cells
• Oxytocin from the posterior lobe stimulates release of milk
by causing contraction of the myoepithelial cells
surrounding the alveoli spaces in response to stimulation of
the nipple through sucking by the baby
• The first milk is called colostrum which is watery and can be
 The nipple
• A small conical eminence at the center of the
breast made up of erectile tissues
• It is surrounded by a pigmented area called areola.
• On the surface of the areola are numerous
sebaceous glands called montgomery’s tubercles
which secrete sebum for lubricating the nipple
during lactation
• During pregnancy the areola becomes more
darkened/pigmented
• The tip of the nipple becomes more prominent to
 Human milk production
• Unlike other mammals a lactating human female is
able to maintain adequate milk production largely
independent of her nutritional status, body mass
index and fluid intake
• The main determining factor is mental state of
relaxation of the mother during breast feeding and
attachment of the baby to the breast
• An average lactating mother who is relaxed can
produce upto 1500mls of breast milk daily
irrespective of the size of the breasts
• Exclussive breastfeeding is therefore encouraged
 Advantages of breast milk
• It is pure and natural ie not contaminated with any
other thing
• It is balanced in its nutrient content i.e proteins,
fats, carbohydrates (lactose), vitamins and minerals
eg calcium, iron and zinc
• It contains immunoglobulins (immune factors)
which increase the baby’s immunity
• It is easily digestible by the baby’s digestive system
• It is not costly to the mother
• It increases mother to child bonding
 Assignment
• Draw and label a diagram of the female breast
Group work assignment (5groups)
• Discuss in groups for presentation on the
following:
• Group 1. changes in the respiratory system
• Group 2. changes in the musculosketal system
and skin
• Group 3. changes in the metabolism and
maternal weight
• Group 4. changes in the gastrointestinal system
• Group 5. changes in the urinary system
 Changes in the endocrine system
• There is excessive production of both placental and pituitary
hormones
• Placental hormones production include:
Human chorionic gonadotrophic hormone (HCGH), Human
placental lactogen (HPL), Oestrogen and Progesterone
• Pituitary hormones
1. Follicle stimulating hormone and Luteinizing hormone are
inhibited by high levels of oestrogen and progesterone
2. There is increased production of thyroid stimulating
hormone (TSH), adrenocorticotropic hormone (ACTH),
prolactin and oxytocin
 Diagnosis of pregnancy
• Several signs and symptoms are manifested by
the woman which are suggestive of pregnancy
and are categorized as:
1.Presumptive signs
2.Probable signs
3.Positive/confirmatory signs
 Presumptive/possible signs
• Early breast changes 3-4weeks +
• Amenorrhea of >4weeks
• Morning sickness 4-14 weeks
• Bladder irritability 6-12 weeks
• Quickening 12-20 weeks
 Probable signs
• Presence of HCGH in blood and or urine 9-14days
• Softened isthmus (hegar’s sign) 6-12 weeks
• Blueing of vagina (Chadwick’s sign) 8weeks +
• Pulsation of fornices (Oiender’s sign) 8weeks +
• Uterine growth 8weeks +
• Changes in skin pigmentation 8 weeks+
• Braxton hicks contractions 16 weeks
• Ballotment of fetus 16-28 weeks
 Positive/confirmatory signs
• Visualization of gestational sac by transvaginal
ultrasound or transabdominal ultrasound
• Visualization of fetal heart pulsation by
ultrasound
• Fetal heart sounds by dopler 11-12 weeks +
• Fetal heart sounds by fetoscope 20 weeks +
• Fetal movements visible or palpable 22weeks+
• Palpation of fetal parts 24 weeks +
• Visualization of fetus by xray/ultrasound