Nadrah binti Othman E5

Maternal physiology
Purposes:
1. To understand the changes & clinical scenarios associated with
pregnancy
2. To help us distinguish the physiologic & pathologic process during
pregnancy that can alter appreciably criteria for diagnosis & treatment
of disease
3. This knowledge can improve patients education about their pregnancy
Structures
Uterus

Cervix

Vagina &
perineum

Reproductive Tract
Changes
Total volume : 5L 20L or more
Pear shape globe shape
Braxton Hicks contraction : painless palpable
contractions occurring at irregular interval more
frequently felt after 28 weeks which can cause
false labour
Uterus weight approximately 1100g
Uterine enlargement involve :
- hypertrophy of muscle cells
- production of new myocytes limited
- accumulation of fibrous tissue in external
muscle layer & increase elastic tissues
f(x) : to add strength to the uterine wall
how? : from stimulation by the action of estrogen and
progesterone
softens
- why? : due to vascularity & changes in its
connective tissue mainly because of oestrogen
secretion from its gland mucus become
thickened thus form a protective plug , the socalled operculum in cervical os
at onset of labor , mucus plug is expelled result in
bloody show
vascularity , muscular hypertrophy & softening
of connective tissues are seen
- f(x) : allowing distension of the vagina at birth
volume of cervical secretions within vagina
which consist of :
- thick , white discharge
- pH acidic : 3.5 6
why? : result of production of lactic acid from
glycogen in vaginal epithelium by action of

Ovaries

Fallopian
tubes

Lactobacillus acidophilus
pelvic ligaments of the pelvic joints softening
- why? : due to oestrogen
- f(x) : to make the pelvis more mobile &
increase its capacity
ovulation cease during pregnancy & maturation of
new follicles suspended
diameter of the ovarian vascular pedicle : 0.9
cm 2.6 cm at term
musculature of fallopian tubes undergo little
hypertrophy
epithelium of tubal mucosa becomes flattened
Skin

skin pigmentations :
chloasma / melisma gravidarum [mask of pregnancy]
- brownish pigmentation appearing on face in butterfly pattern
in 50% - 70% f women
- it is usually symmetric & distributed on the forehead ,
cheeks , & nose
linea nigra
- dark vertical line on abdomen between sternum & symphysis
pubis
abdominal striae / striae gravidarum
- reddish / purplish linear marks sometimes appear on the
breast , abdomen , buttocks & thigh
- why? : because of stretching , rupture & atrophy of deep
connective tissues of the skin

Linea nigra

chloasma

Striae gavidarum

Breast

 anatomy : made up of 15 20 glandular lobules separated by fat

gland lead onto tubules then into ducts which open onto nipple
increase in size
why? : due to proliferation of glands & ducts under influence of
oestrogen & progesterone
secretion of colostrum begin in 1st trimester and continues to
term

Enlargement of breast

Weight

Metabolism

Carbohydrat
e
metabolism

Metabolic changes
in weight around 25% of the non-pregnant
weight , approximately 12.5kg in average women
main increase occurs in 2nd half pregnancy usually
0.5 kg per week , & diminishes after 40 weeks
why? : due to growth of conceptus , enlargement
of maternal organs , maternal storage of fat &
protein , increase in blood volume & interstitial
fluid
metabolic rate
why? :
1. in maternal O2 consumption around 20%
2. endocrine ; pituitary gland enlarges & 13%
increase in thyroid size
demand on the part of fetus for :
1. easily convertible source of energy
2. need to store energy for future demands such
as lactation & steadily growing pregnancy
3. provide steady source of energy in form of high
energy fuel by storage of fat
pregnancy is said to be diabetogenic and
associated with tissue sensitivity to insulin
why? : in specific antagonist to insulin ; human
placental lactogen (HPL)
steroid level produced by placenta less
glycogen deposited in liver & muscle higher

Protein
metabolism

Fat
metabolism

Weight gain

circulating blood sugar

1. more glucose available to fetus
2. glomerular filtration rate glycosuria
20% increase dietary protein intake
distribution :
1. 500g of protein retained by end of pregnancy
2. half accounted for by maternal gain
3. the rest by fetus & placenta
both chorionic gonadotropin & placental lactogen
reduce deamination process blood & urine urea
reduced
fat major form of stored energy during pregnancy
by 30 weeks some 4kg fat are stored mostly in
the form of depot fat in abdominal wall , back ,
thigh and modest in breast
relation to fat metabolism :
1. total metabolism & demand for energy
2. glycogen stores are diminished & therefore
energy obtained from direct carbohydrate
reduced
3. although blood fat greatly increase only
moderate amount is laid down in fat stores
Metabolism increase

Carbohydrate metabolism

Protein metabolism

Fat metabolism

Hematological changes
in red cell mass of 18%
plasma volume increase by 40 45 %
reduction in red cell count per mililitre from 4.5 million to 3.8
million
towards term plasma volume diminishes red cell count rises
slightly
hematocrit falls during pregnancy slight rise at term
total red cell volume increase
how? :
in total metabolism

in total O2 consumption

demand for increase in total O2 carrying capacity of blood

 in total red cell volume

plasma volume
1. hemoglobin concentration falls throughout pregnancy until
last 4 weeks
2. reduction in blood viscosity
in white cells from 7 x 109 /litre to 10.5 x 109 /litre in late
pregnancy
why? : due to in neutrophil polymorphonuclear cells
platelets decline from 275 000/mm3 to 260 000 /mm3 beyond 35
weeks
mean platelet size increase slightly
lifespan of platelets is shortened
risk of thrombo-embolism
why? : because fibrinogen & factors VII to X rise progressively
Blood volume changes :
- pressure exerted by enlarging uterus on pelvic veins 1/3 of
total circulating blood is distributed to lower limbs increase
venous pressure produce viscosities & oedema of vulva and
legs
- HYPOTENSION SYNDROME
Local vascular changes

Hypotension syndrome

Cardiovascular system
Resting cardiac output from 4.5 l/min to 6.0 l/min
- greatest increase : 1st trimester
- peak : 24 weeks
heart rate from 70 bpm(non-pregnant) 78 bpm at 20th weeks
85 bpm in late pregnancy
stroke volume from 64 ml 70 ml in midpregnancy , reduce

towards term
40% in pulmonary blood flow pulmonary vascular resistence
renal blood flow by 35%
blood
volume
& organ perfusion increase
Increase
blood
Reduced pulmonary vascular resistance
supply

Reference :
1. Williams Obstetrics ; 23rd edition ; Mc Graw Hill ; book 1 page :107 118
2. Obstetrics illustrated ; 6th edition ; Kevin P.Hanretty ; Churchill livingstone ;
page 19 24 , 26 30 , 34