Maternal Anatomical & Physiological Changes

Maternal Anatomy & Physiology

Uterus Uterus weights of 70g in non-pregnancy state; increased to 1.1Kg by end of pregnancy Involved stretching & hypertrophy of muscle cells Probably stimulated by actions of oestrogen & progesterone Shape: pear - golbular & spherical Rotated position to right (dextroposition) due to rectosigmoid Cervix Undergoes pronounced softening & cyanosis Due to hypertrophy & hyperplasia Produces copious tenacious mucus rich in immunoglobulins & cytokines for infection protections in pregnancy Chadwick's sign: bluish due hypervascularization Goodell's sign: softening of cervix due to hypervascularization Hegar sign:

Breast Often tenderness & paraesthesia Nipples: enlarged, deeply pigmented & erectile Montmogery glands: hypertrophic sebaceous glands Colostrum: thick, yellowish fluids - secretory IgA, lactoferrin, leukocytes Weight Gain Recommended weight gain Normal : 11-16 Kg Overweight : 7 -11 Kg Obese : 5- 9 Kg Average weight gain is 12.5 Kg Heart Pushed upwards, forwards and laterally displaced Respiratory May have dyspnoea due to decreased residual volume, effect of uterus pressure Capillary engorgement cause nasal stuffiness

Maternal Anatomy & Physiology

Skin Changes At least 1 in 87 will have skin changes Striae gravidarum : reddish, slight depress stretch marks Multiparity can have silvery, glistening stretch lines Linea alba - linea nigra Irregular brownish patches - chloasma or melasma gravidarum Possibly due to melanocyte-stimulating hormone Spider naevi can be observed Palmar erythema - hyperproduction of oestrogens Increase warmth due to hypervascularizations GUT Kidney size increase GFR increase GFR increase due to hypervolemia & increase PRF Increase micturition Right ureter more affected bc of dextrorotation of uterus & rectosigmoid colon

Vascular Changes Increased water retention Effects of gravid uterus pressuring the vessels - oedema Reduced venous return - reduced cardiac output Resolved by lying down in lateral position Maternal erythopoietin levels rises in pregnancy - produced more RBC Plasma volume expands at significantly higher rate Hypervolemia - 40-45% more than non-pregnancy To compensate hypervascularizations Coagulations & fibrins are augmented but balanced in pregnancy Platelet levels decreased slightly in pregnancy

Maternal Anatomy & Physiology

GIT Gums may become hyperemic & soften - pregnancy gingivitis Heartburn due to position and more relax lower oesophageal sphincter Haemorrhoids & constipations are common Endocrine Pituitary enlargement due to oestrogen & hyperplasia of lactotrophs Thyroid are moderately enlarged to accomodate needs of maternal & fetal throughout pregnancy Fetal depends on maternal thyroxine to maintain normal TFT Thyroid is important for neurodevelopment of fetus Thyroid increase because of similarity structure of TSH and HCG (alpha same, beta different amino acid arrangement)

Musculoskeletal System Sacroiliac, sacrococcygeal and pubic joints have increased mobility More than 1cm pubic separation will caused problems like symphisis pubis dysfunction