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OBSTETRICS
1.1B MATERNAL PHYSIOLOGY

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

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

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)

METABOLIC CHANGES
Metabolic changes are numerous and intense
No other physiologic event induces such profound alterations

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Obstetrics

1.1B MATERNAL PHYSIOLOGY

WEIGHT GAIN

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

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

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.

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

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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Obstetrics

1.1B MATERNAL PHYSIOLOGY


RESPIRATORY TRACT

CARDIOVASCULAR SYSTEM

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.

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.)

URINARY SYSTEM

Changes in cardiac function become apparent during the first 8


weeks of pregnancy.
Cardiac output is increased as early as 5th week.

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Obstetrics

GASTROINTESTINAL TRACT
Pregnancy Gingivitis
Pyrosis aka heartburn
Gastric emptying time is unchanged
Hemorrhoids
Reduced Gallbladder contractility -> Increased residual volume

Pituitary gland

Thyroid gland

Parathyroid gland
Calcitonin

1.1B MATERNAL PHYSIOLOGY

ENDOCRINE SYSTEM
Enlarges by about 135%
Increased growth hormone
secretion
Prolactin increases
Increased oxytocin
Increased thyroid homrmone
production
Moderate enlargement of thyroid
gland
Increase in secretion of PTH
during the later part of pregnancy
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

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