1. ateefa Al Dakhyel FRCSC, FACOG
ateefa Al Dakhyel FRCSC, FACOG
Assistant professor & consultant
Assistant professor & consultant
Obstetric & gynecology department
Obstetric & gynecology department
Collage of medicine
Collage of medicine
King Saud University
King Saud University
2. Maternal physiologic adjustment to
pregnancy are designed to support the
requirements of fetal needs without
affecting maternal well-being.
The normal values of several
hematologic, biochemical, and
physiologic indices during pregnancy
differ markedly from those in the non
pregnant range and also according to
duration of pregnancy.
3. ALIMENTARY TRACT
.
STOMACH.
Tone and motility decreases because of
the effect the PROGESTERONE hormone
and emptying time of the stomach is
prolonged
Gastro esophageal junction sphincter
tone decreases leading to heart burns
Gastric acid secretion decreases and
peptic ulcer disease improved!!
4. Small & large bowel
motility decrease and increases iron
absorption .
Colon, there is decrease motility resulting
in constipation ,increase water and sodium
absorption and dilatation of hemorrohdial
veins .(40% have constipation)
Liver
Signs of normal pregnancy that may mimic
liver disease
5. Spider angiomata and palmer erythema
due to increase estrogen level .
Decrease albumin and increase alkaline
phosphatase .
Nausea and vomiting usually in first
trimester
6. Respiratory system .
Mechanical changes .
-Subcostal angles transverse chest
diameter, and chest circumference
increases and the diaphragm level is
pushed up .
Lung volume and pulmonary function .
-Tidal volume increase inspiratory
capacity increases, vital capacity
decreases but RR little chaged
7. Skin
Vascular changes , due to estrogen.
Spider angiomata ,palmer erythema.
Striae gravidarum (stretch marks)
Pigmentation changes ,increases
melanocyte- stimulating hormones
which cause:darkening of nipples,
areolae ,umbilicus, axillae , perineum
and linea nigra
8. melasma or mask of pregnancy.
Pigmented navi
Mild hirsitusm then postpartum telogen
effluvium.
10. Urinary system.
Anatomic changes.
Kidneys increase in both length and
weight.
Renal pelvis increase resulting in
physiological hydro nephrosis .
Right ureter is larger than the left
causing hydroureter in the abdominal
ureter.
11. Increase risk of pyelonephritis and
asymptomatic bacteriuria
Renal plasma flow, glomerular filtration
rate and creatinine clearance are all
increase more than 50%,
Blood urea creatinine and uric acid all
decrease due to increase in intravascular
volume.
12. Glucosuria is common in normal
pregnancy and has no correlation with
blood sugar level .
Increase excretion of water soluble
vitamin folate and vitamin B 12
13. Cardiovascular system.
There is a change in the position of the
heart.
Normal changes in heart sound include.
Exaggerated splitting of S1
Gallop pulse in 90% of normal
pregnancy
Systolic ejection murmur .
14. EKG is unchanged except for left axis
deviation.
Increase cardiac output by 40% due to
increase in both stroke volume and
heart rate (HR increase ~10bpm)
Cardiac output depends on maternal
position ,it is lowest when in supine
position ( Supine hypotension
syndrome)
15. Blood pressure changes due to
vasodilatation & intravascular volume
increase.
There is a progressive decrease in both
systolic and diastolic pressure mainly in
mid trimester, after 24 weeks the
pressure gradually increase and return to
non pregnant level by term.
Central venous pressure remain
unchanged .
16. Hematological changes .
Plasma volume increase 40-450% by term
it begins by 10 weeks and plateaus at 30
weeks gestation most of increase is in 2ed
trimester more increase in multiple
pregnancy or larger fetuses .
Red blood cell increases by 30% at term .
Physiological anemia result because the
plasma volume increases more than RBC.
HB @ midpregnancy ~11.5
gm/dl(anemia<10.5)
HB @ early & late ~ 12.3 gm/dl(anemia<11)
17. White blood cell mostly PMN granulocytes
increases progressively in pregnancy.
Platelets slightly decrease.
Coagulation system.
Pregnancy is a hyper coagulable state.
Fibrinogen increase by 50% .
Factors V11 ,V111,1X,and X all
increases
18. Iron metabolism .
Absorption depends on pregnancy
state and bone marrow iron stores ,40%
absorption in the iron deficient state .
The total iron requirement is 1000 mg
and the daily requirement is 3.5 mg .
Maternal iron deficiency does not affect
fetal iron stores because of active iron
transport across the placenta.
19. Endocrine and metabolic changes.
Thyroid gland .it increase in size.
Thyroid binding globulin increases as a
result of estrogen stimulation of the
liver .
The active unbound form remain
unchanged or slightly decrease.
The following thyroid hormones do not
cross the placenta T3, T4,and TSH ,
thyroid immunoglobulins crosses the
placenta as well ass anti thyroid
medication
20. Adrenal gland.
Total and free cortisol increase by two
fold
Aldosterone secretion is markedly
increase .
Deoxycortisone level increases.
Pancreas there hypertrophy and
hyperplasia .
Fasting blood glucose is lower than in
non pregnant state
21. placenta
Normal term placenta wt~450-508gm (~1/6 of fetal wt)
Placenta has 2 sides:
maternal-facing- side has 10-38 cotyledons
fetal-facing-side covered by transparent amnion, chorion
Placenta hormones: hCG, hPL….
Uteroplacental blood flow 450-650ml/min in late pregnancy
Placenta connect to the fetus through 3BV
