PHYSIOLOGICAL CHANGES IN

PREGNENCY

PRESENTED
BY
DR. SANGEETA TIWARI
 INTRODUCTION
• Pregnancy and the associated changes are a normal
physiological process in response to the development of the
fetus that affect virtually every organ system in the mother.
• These changes happen in response to many factors; hormonal
changes, increase in the total blood volume, weight gain, and
increase in foetus size as the pregnancy progresses.
• All these factors have a physiological impact on the pregnant
woman: the musculoskeletal, endocrine, reproductive ,
cardiovascular, respiratory, nervous, urinary, gastrointestinal
and immune systems are affected, along with changes to the
skin and breasts.
• These physiologic changes allow the pregnent women to
support the growing uterus and fetus and to withstand labor
and the postpartum course
 Reproductive System Changes
During pregnancy, the internal genital tract undergoes anatomical and
physiological changes to accommodate the changes and development of the
foetus.
Uterus
• With pregnancy progression, the uterus leaves the pelvis and ascends to the
abdominal cavity.
• The abdominal content displaced in response to the increased size of the
uterus which is five times more than normal.
• This increase in the size of uterus is associated with an increase of blood
supply to the uterus and uterine muscle activity,.
• Uterus increases in size till the 38 weeks after that the fundus level starts to
descend preparing for delivery.
• Its weight increases from 50mg to 1000mg at 40 weeks and stretches to
accommodate the foetus size, which is associated with an increase in the
thickness and length of the fundus.
 Endocrine System Changes
• Pregnancy is associated with changes in hormone
levels.
• These hormones work together to control the growth
and development of the placenta and the foetus, and
act on the mother to support the pregnancy and
prepare for childbirth.
• Many organs of the body secrete hormones which
affect the expectant mother.
• When the placenta is developed it then takes over the
production of many of these hormones, including:
oestrogen, progesterone, human chorionic
gonadotrophin (HCG), human placental lactogen,
placental growth hormone,
 cont.
• HCG is the first hormone to be released from the developing
placenta and is the hormone that is measured in a pregnancy
test.
• It acts as a signal to the mother’s body that pregnancy has
occurred by maintaining progesterone production.
• Progesterone is initially produced by corpus luteum, a
temporary endocrine gland found in the ovary.
• Progesterone maintains the pregnancy, by supporting the
lining of the uterus and preventing premature uterine
contractions.
• Oestrogen, is also initially produced by the corpus luteum and
later by the placenta. Oestrogen levels rise towards the end of
pregnancy.It prepares the uterus for labour. Oestrogen also
stimulates the growth and development of the breasts.
 Musculoskeletal Changes-Postural Changes
• The overall equilibrium of the spine and pelvis alters
as the pregnancy progresses
• The centre of gravity no longer falls over the feet, but
instead shift posteriorly, and women may need to lean
backwards to gain equilibrium resulting in
disorganisation of spinal curves.
• There will be compensatory changes to posture in the
thoracic and cervical spines, and this combined with
the extra weight of the breasts
• These changes may be still similar for 8 weeks after
delivery.
Articular Change
The symphysis pubis and sacroiliac joints are
particularly affected to allow for the birth of the baby.
Pelvic joint loosening begins around 10 weeks, with
maximum loosening near term.
Joints should return to normal at 4–12 weeks
postpartum.
The sacrococcygeal joints also loosen. By the last
trimester.
As the uterus rises in the abdomen the rib cage is
forced laterally and the diameter of the chest may
increase by 10–15 cm.
 Nervous System
• Anxiety, increased mood lability, vivid nightmares and insomnia
are well documented throughout preganancy, although the
exact aetiology is unknown.
• Cardiovascular changes-
• The heart adapts to the increased cardiac demand that occurs
during pregnancy in many ways.
• Cardiac output increases throughout early pregnancy, and
peaks in the third trimester, usually to 30-50% above baseline.
• The heart rate increases, but generally not above 100 beats/
minute.
• Overall, the systolic and diastolic blood pressure drops 10–15
mm Hg in the first trimester and then returns to the baseline in
the second half of pregnancy.
• Women may suffer from supine hypotension due to uterine
compression of the vena cava.
 Respiratory Changes
• Respiratory changes during pregnancy are important
to accommodate and meet the demands of mother
and foetus,
• There are changes in all lung volumes, changes in
the upper airway respiratory tract, and breathing
pattern.
• The diaphragm is elevated by about 4cm due to the
enlarged uterus.
• We will find an increase in oxygen consumption by
30%.
• Pregnant women are more prone to hypoxia,
hyperventilation and dyspnea than non-pregnant
women.
 Gastrointestinal changes
• Progesterone causes smooth muscle relaxation which slows
down GI motility .
• Nausea and vomiting of pregnancy, commonly known as
“morning sickness”, is one of the most common GI symptoms of
pregnancy.
• It begins between the 4 and 8 weeks of pregnancy and usually
subsides by 14 to 16 weeks.
• The exact cause of nausea is not fully understood but it
correlates with the rise in the levels of human chorionic
gonadotropin, progesterone, and the resulting relaxation of the
smooth muscle of the stomach.
• Constipation and haemorrhoids can occur during pregnancy,
and are attributed to the smooth muscle relaxation, decreased
motility of the bowel and increased water absorption of the
colon.
 Renal changes
• A pregnant woman may experience an increase in the size of
the kidneys and ureter due to the increased blood volume and
vasculature.
• There is also an increase in sodium retention from the renal
tube so oedema and water retention is a common sign in
pregnant women.

• In the third trimester when the foetus starts to engage in the

pelvis, there is an increased frequency of urination. The uterus
compresses the ureters at the pelvic brim, causing a slowing of
urine flow which combined with an increase in urine output
results in frequent trips to the toilet.

• Stress and urge incontinence are common amongst pregnant

women
 Nutrition
• One kilogram of extra protein is deposited, with half
going to the fetus and placenta, and another half
going to uterine contractile proteins, breast glandular
tissue, plasma protein, and haemoglobin.
• Pregnant women require a caloric increase. There is
an increased requirement for nutrients due to foetal
growth and fat deposition.
• A pregnant woman can expect to agin between 20 to
30 lb (9.1 to 13.6 kg)depending on the pre-pregnancy
weight.
• Weight gain or weight loss is a poor indication of
foetal well-being.
 Skin
• Pigmentation changes occur during pregnancy
including darkening of the areola on the breasts and
the linea nigra, increased colouring on the vulva and
increased facial pigmentation.
• Stretch marks (striae gravidarum) occur on the
abdomen, breasts, thighs and buttocks to varying
degrees. They may occur due to ruptures and
overstretches the epidermis, causing the scarring.
• During pregnancy there is a marked reduction in
normal hair loss, due to an increased growth phase of
the hair follicles.
 Breasts
• Breast tenderness is common in the early stages of
pregnancy due to enlargement under the influence of ,
progesterone and oestrogen. Breasts increase in
weight by aproximately 500-800g.
• Montgomery's tubercles developing form enlarging
sebaceous glands around the areolar.
• Immunity
• Mother has some general depression of immunity so
that she does not reject the foetus.
• Slightly increased risk of latent viruses reactivating
e.g. influenza, pneumococcal pneumonia.
 Body water homeostasis
• Maternal blood volume expands during pregnancy to
allow adequate perfusion of vital organs, including the
uteroplacental unit and fetus, and to prepare for the
blood loss associated with pregnency.
• Total body water increases from 6.5 L to 8.5 L by the
end of gestation.
• Changes in osmoregulation and the renin-angiotensin
system result in active sodium reabsorption in renal
tubules and water retention. The water content of the
fetus, placenta, and amniotic fluid accounts fo r
 Clinical Significance
• Medication use is common in pregnancy.This is important for physicians
and pharmacists to remember, as many maternal changes in pregnancy
can affect the pharmacodynamic (absorption, distribution, metabolism, and
elimination) properties of certain medications.
• Failure to consider the maternal physiologic adaptations during pregnancy
can lead to maternal morbidity due to over or under-treating the pregnant
individual.
• As soon as pregnancy is confirmed, hypothyroid patients requiring
levothyroxine should increase their dose by 30%, and serum thyrotropin
levels should be closely monitored.
• Additionally, physiologic hypotension of pregnancy is essential to
understand when dealing with pregnant patients who are already
hypertensive and taking hypertension medication.
• Whether family medicine, cardiology, or obstetric anesthesia, clinicians in
every medical specialty should understand the physiologic changes
pregnant individuals undergo and adapt accordingly within their practice
and care of that patient.