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1.1B MATERNAL PHYSIOLOGY
OBSTETRICS
REPRODUCTIVE TRACT
UTERUS
Non Pregnant
- 70g
- Solid
- Cavity of 10 mL or less
Pregnant
- 1100g
- 5-20 L or more
- Hypertrophy of muscle cells
- Fundus becomes globular, almost spherical by 12 weeks
- Braxton Hicks
- Increased blood flow
CERVIX
Non Pregnant
- Firm
- Closed
- Pinkish
Pregnant
- Softening
- Cyanosis
- Increased vascularity
- Hypertrophy and hyperplasia of cervical glands
- Produce copious tenacious mucus (mucus plug)
OVARIES
Non Pregnant
- Ovulation
Pregnant
- Ovulation ceases
- Corpus luteum
- Decidual reactions
- Theca lutein cysts
VAGINA AND PERINEUM
• Increased vascularity and hyperemia
• Softening of underlying abundant connective tissue
• Chadwick sign
• Increased volume of cervical secretions, pH is acidic
• Increase in mucosal thickness
• loosening of connective tissues
• Smooth muscle hypertrophy
BREASTS
• Breast tenderness
• Parestheisas
• Increase breast size (After the 2nd month)
• Delicate veins become visible
• Nipples become larger, more erectile
• Areola become darker
• Colostrum can be expressed from the nipples
• Glands of Montgomery - Hypertrophic sebaceous glands
SKIN AND VASCULAR CHANGES
• Striae gravidarum (stretch marks)
• Diastasis recti
• Hyperpigmentation
• Linea nigra
• Chloasma or melasma gravidarum aka mask of
pregnancy
• Vascular spiders or angiomas No clinical
• Palmar erythema significance
- Consequence of hyperestrogenemia
METABOLIC CHANGES
Metabolic changes are numerous and intense
No other physiologic event induces such profound alterations
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1.1B MATERNAL PHYSIOLOGY
Obstetrics
WEIGHT GAIN
• Increase in weight - uterus and its contents, the breasts and
increases in blood volume & extravascular extracellular fluid.
• Maternal reserves - accumulation of cellular water, fat and
protein
WATER METABOLISM
Plasma osmolality/ term: 3.5 L from fetus, placenta and
amnionic fluid, 3.0 L from maternal blood volume and size of
the uterus and breasts: TOTAL 6.5 L
PROTEIN METABOLISM
• Increased amino acid concentration
• Increased protein metabolism
• 500 g protein, products of conception, uterus, maternal blood
CARBOHYDRATE METABOLISM
• Mild fasting hypoglycemia
• Postprandial hyperglycemia
• Hyperinsulinemia
• Accelerated starvation
FAT METABOLISM
• Lipids
• Lipoproteins
• Apolipoproteins
• Leptin - secreted by adipose tissue
- For body fat & energy expenditure regulation
• Ghrelin - secreted by the stomach in response to hunger
- Has a role in fetal growth and cell proliferation
• Maternal hyperlipidemia
ELECTROLYTE & MINERAL METABOLISM
• Sodium 1000 mEq is retained
• Potassium 300 mEq is retained
• Total serum calcium declines
• Magnesium level declines
• Iodine requirements increase
HEMATOLOGICAL CHANGES
BLOOD VOLUME
• Hypervolemia averages 40-45 percent above the non pregnant
blood volume
• Functions:
- Meet metabolic demands
- Provides nutrients
- Protection
• Hematocrit and hemoglobin decreases during pregnancy
• Iron metabolism
- Of the approximate 1000mg of iron required for normal
pregnancy, 300 mg are actively transferred to the fetus &
placenta and another 200 mg are lost through excretion.
- Most iron is used during the latter half of pregnancy
- Mother can have anemia while the baby is normal
• Puerperium - Not all maternal iron in the form of hemoglobin is
lost with normal delivery. Normal losses are from the placental
implantation site, episiotomy, or lacerations.
IMMUNOLOGICAL FUNCTION
• Pregnancy is both proinflammatory and antiinflammatory
• Inflammatory markers cannot be used reliably during
pregnancy
COAGULATION & FIBRINOLYSIS
• Augmented during pregnancy but remain balanced to maintain
homeostasis
• Increased concentration of clotting factors EXCEPT XI and XIII
• Platelets are slightly decreased
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1.1B MATERNAL PHYSIOLOGY
Obstetrics
CARDIOVASCULAR SYSTEM
• Change in cardiac radiographic outline that occurs in pregnancy. The blue lines represent the relations between
the heart and thorax in the nonpregnant woman, and the black lines represent the conditions existing in pregnancy. These are based on radiographic findings in 33 women. (Redrawn from
Klafen, 1927.)
• Changes in cardiac function become apparent during the first 8
weeks of pregnancy.
• Cardiac output is increased as early as 5th week.
RESPIRATORY TRACT
A B
• Chest wall measurements in nonpregnant (A) and pregnant women (B). With pregnancy, the subcostal angle increases, as does the anteroposterior and transverse diameters of the chest
wall and chest wall circumference. These changes compensate for the 4-cm elevation of the diaphragm so that total lung capacity is not significantly reduced.
URINARY SYSTEM
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1.1B MATERNAL PHYSIOLOGY
Obstetrics
GASTROINTESTINAL TRACT
• Pregnancy Gingivitis
• Pyrosis aka heartburn
• Gastric emptying time is unchanged
• Hemorrhoids
• Reduced Gallbladder contractility -> Increased residual volume
ENDOCRINE SYSTEM
Pituitary gland Enlarges by about 135%
Increased growth hormone
secretion
Prolactin increases
Increased oxytocin
Thyroid gland Increased thyroid homrmone
production
Moderate enlargement of thyroid
gland
Parathyroid gland Increase in secretion of PTH
during the later part of pregnancy
Calcitonin Increased levels
CENTRAL NERVOUS SYSTEM
• Memory
- Changes are few and mostly subtle.
- Problems with attention, concentration and memory
throughout pregnancy and early puerperium
• Eyes
- Intraocular pressure decreases during pregnancy ->Increased
vitreous outflow
- Krukenberg spindles - brownish-red opacities on the posterior
surface of the cornea
- Visual function is unaffected
• Sleep
- Difficulty with going to sleep, frequent awakening,s fewer
hours of night sleep and reduced sleep efficiency - beginning
as early as approx 12 weeks' gestation up to first 2 months
postpartum.
- Greatest disruption of sleep is encountered postpartum and
may contribute to Postpartum blues or frank depression
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END OF TRANX
"Opportunities don't happen, you create them." -Chris Grosser
