Maternal cahnges Maternal cahnges during pregnancyduring pregnancy

DR Manal BeheryProfessor Ob&GyneZagazig University 2014

Reproductive tract (1)Reproductive tract (1)

UterusUterus: from 50g-1100g: from 50g-1100g

from <10ml – 5Lfrom <10ml – 5L

from pyriform to globularfrom pyriform to globular

Fundl levelFundl level

From 7.5cm -35cm From 7.5cm -35cm

Lower uterine segment Lower uterine segment

Braxton Hicks contraction:Braxton Hicks contraction: sporadic, irregular, asymmetrical, sporadic, irregular, asymmetrical, and painless, low pressure, and painless, low pressure, lasting < 30 seclasting < 30 sec

Reproductive tract (2)Reproductive tract (2)

Cervix and vulva —— Chadwick’s signCervix and vulva —— Chadwick’s sign

congestion of the pelvic vasculature, cause bluish congestion of the pelvic vasculature, cause bluish

or purplish discoloration of the cervix and vulva or purplish discoloration of the cervix and vulva

Leukorrhea:Leukorrhea: increase in vaginal discharge, rich in increase in vaginal discharge, rich in

glucose, lactic acid, low vaginal pHglucose, lactic acid, low vaginal pH

Ovary:Ovary: slightly enlarged, corpus luteum regresses slightly enlarged, corpus luteum regresses

after 10 weeks’ gestationafter 10 weeks’ gestation

Reproductive tract (2)Reproductive tract (2)

Breasts: Breasts: increase in increase in

circulationcirculation Engorgement and venous prominenceEngorgement and venous prominence

Mastodynia (breast ternderness):Mastodynia (breast ternderness): tingling tingling to frank pain caused by hormonal responses to frank pain caused by hormonal responses of the mammary ducts and alveolar systemof the mammary ducts and alveolar system

Montgomery’s tubercles:Montgomery’s tubercles: enlargement of enlargement of circumlacteal sebaceous glands of the areolacircumlacteal sebaceous glands of the areola

Colostrum secretion: Colostrum secretion:

Breast Breast changeschanges

Montgomery tubercles

non pigmented nodules (12-20) around the areola in 2nd month (enlarged sebaceous glands or rudimentary lactiferous ducts).

(2) Cardiovascular system (2) Cardiovascular system changeschanges

Cardiovascular changes Cardiovascular changes (2(2))

Position and size of heartPosition and size of heart

ECG changesECG changes

Increased heart rate (+15%)Increased heart rate (+15%)

15-degree left axis deviation15-degree left axis deviation

Cardiovascular changes Cardiovascular changes (2)(2)

Inferior vena cava syndrome: Inferior vena cava syndrome:

Cardiovascular Cardiovascular changes (cont)changes (cont) Stroke volume +30%Stroke volume +30% Heart rate +15%Heart rate +15% Cardiac output +40%Cardiac output +40% Oxygen consumption +20% Oxygen consumption +20% SVR SVR (systemic vascular resistance)(systemic vascular resistance) -5% -5% Systolic BP -10mmHgSystolic BP -10mmHg Diastolic BP -15mmHgDiastolic BP -15mmHg Mean BP -15mmHgMean BP -15mmHg

Blood volume +30%Blood volume +30%

Plasma volume +40%Plasma volume +40%

Red blood cell volume +20%Red blood cell volume +20%

Delusional anemiaDelusional anemia

Increase cardiac outputIncrease cardiac output

Decrease blood viscosityDecrease blood viscosity

Vasodilatation Vasodilatation

Cardiovascular Cardiovascular changes (4)changes (4)

unchanged in the upper bodyunchanged in the upper body

Significantly increases in the lower Significantly increases in the lower

extremities, extremities, esp. during supine, sitting or esp. during supine, sitting or

standing position, returns to near normal in standing position, returns to near normal in

lateral recumbent positionlateral recumbent position

Venous pressureVenous pressure:: Venous Venous blood flowblood flow

((3) Urinary system 3) Urinary system changeschanges

Increased frequency of micturationIncreased frequency of micturation

Kidney slightly Kidney slightly enlargedenlarged

Renal plasma flow +35%Renal plasma flow +35% Glomerular filtration rate +50% Glomerular filtration rate +50% Serum creatinine, uric acid Serum creatinine, uric acid

and urea nitrogenand urea nitrogen Renin, angiotensin I and IIRenin, angiotensin I and II

Renin substrateRenin substrate Glucosuria (50%) +Glucosuria (50%) +

Renal changesRenal changes

renal pelves dilatedrenal pelves dilated Ureters (esp. right side) dilatedUreters (esp. right side) dilated Bladder tone reducedBladder tone reduced Bladder capacity reducedBladder capacity reduced Residual volume increasedResidual volume increased Chance of pyelonephritis increaasedChance of pyelonephritis increaased

Pulmonary changesPulmonary changes

Mucosal hyperemia Mucosal hyperemia

Subcostal angleSubcostal angle

Chest circumference and diameterChest circumference and diameter

Diaphragmatic excursionDiaphragmatic excursion

Tidal volume +30-40%Tidal volume +30-40%

POPO22 is increased, PCO is increased, PCO22 is decreased. is decreased.

Total lung capacity decrease -15%Total lung capacity decrease -15%

Minute ventilation +30-40%Minute ventilation +30-40%

Mild respiratory alkalosisMild respiratory alkalosis

Gastrointestinal Gastrointestinal changechange

SkinSkin changeschanges

ChloasmaChloasma

Striae gravidarumStriae gravidarum

Linea alba——linea nigraLinea alba——linea nigra

Vascular spidersVascular spiders

Skin neviSkin nevi

Nervous system Nervous system disordersdisorders

MuscloskeletalMuscloskeletal systemsystem

MetabolismMetabolism

Basal metabolism rate, BMR +15-20%Basal metabolism rate, BMR +15-20% Weight gain 12.5Weight gain 12.5 Fetus 3400gFetus 3400g Placenta 650Placenta 650 Amniotic 800Amniotic 800 Uterus 960Uterus 960 Plasma, red cells 1450Plasma, red cells 1450 Mammary glands 405Mammary glands 405 Extracellular, extravascular water 1480Extracellular, extravascular water 1480 Deposition of fat and protein 3345Deposition of fat and protein 3345 Insulin resistanceInsulin resistance

A quizA quiz

1. In a normal singleton pregnancy, maternal blood volume

A. increases by 10-15%B. increases by 45%C. decreases by 10-15%D. decreases by 45%

Which of the following is not Which of the following is not characteristic of a normal characteristic of a normal pregnancy?pregnancy?

A. cardiac volume increases by 10%A. cardiac volume increases by 10%

B. the ECG shows deviation to the leftB. the ECG shows deviation to the left

C. the rest pulse rate increases by approximately C. the rest pulse rate increases by approximately 10-15% beats per min10-15% beats per min

D. arterial blood pressure and vascular resistance D. arterial blood pressure and vascular resistance increasesincreases

E. The heart is displaced upward and to the leftE. The heart is displaced upward and to the left

33. . Epulis is a pregnancy-related Epulis is a pregnancy-related vascular swelling of thevascular swelling of the

A. GumsA. Gums

B. NailbedB. Nailbed

C. LarynxC. Larynx

D. NaresD. Nares

E. EpiglottisE. Epiglottis

THANK THANK YOUYOU