Maternal Changes

with Pregnancy

Dr. Ashraf fouda

Ob/Gyn. Specialist
Egypt – Domiatt General Hospital
Pregnancy is a period of
adaptation for :

• The needs of the fetus

• Meeting the stress of
pregnancy and labour
 THE
GE N I T A L
CHA N G E S
(A) The whole
uterus
 Size - 1
increase from 7.5 x 5 x 2.5
cm in nonpregnant states
to 35 x 25 x 20 cm at term
i.e. the volume increase
1000 time
 Weight - 2

increases from 50 gm
in nonpregnant state
to 1000 gm at term
 Shape - 3
pyriform in the
nonpregnant state ,
becomes globular at 8th
week , then pyriform by
16th week till term .
 Position - 4
with ascent from the pelvis , the
uterus usually undergoes rotation
with tilting to the right
(dextrorotation) due to the
presence of the rectosegmoid colon
on the left side.
 5 - Consistency :
becomes progressively
softer due to :
i - Increased vascularity
ii - Presence of amniotic fluid
 Contractility - 6
from the first trimester
onwards , the uterus
undergoes irregular painless
contractions
(Braxton Hicks contractions) .
They may cause some
discomfort late in pregnancy
and may account for false
labour pain .
 7- Capacity
increases from
4 ml in non-pregnant
state to
4000 ml at term
(B) Myometrial
changes
1 - Hypertrophy (estrogen
effect) rather than
hyperplasia (progesterone
effect) till 14th week, then
the fetus exerts a direct
stretch
 2 - Formation of
the lower uterine
segment (L.U.S.)
from the isthmus
and lower half
inch of the body
 Formation of lower
uterine segment
After 12 weeks, the isthmus
(0.5cm) starts to expand
gradually to form the lower
uterine segment which
measures 10 cm in length at
term
 Upper Uterine Segment
• Peritoneum: Firmly-attached
• Myometrium: 3 layers; outer
longitudinal, middle oblique and
inner circular.
• The middle layer forms 8-shaped fibers
around the blood vessels to control
postpartum hemorrhage
 Upper Uterine Segment
• Decidua: Well-developed
• Membranes: Firmly-attached
• Activity: Active, contracts,
retracts and becomes thicker
during labour.
Lower Uterine Segment

• Peritoneum: Loosely-
attached
• Myometrium : 2 layers;
outer longitudinal and inner
circular.
Lower Uterine Segment
• Decidua: Poorly-developed
• Membranes: Loosely-
attached.
• Activity: Passive, dilates,
stretches and becomes thinner
during labour
 The junction between the
upper uterine segment
(U.U.S.) which is thick and the
lower uterine segment which
is thin is called the
physiologic contraction ring
at the level of the symphysis
pubis (not seen or felt)
 (C) Uterine
blood vessels
1 - Uterine artery lumen:
is doubled and its blood flow
increases 5 times
2 - Myometrial and decidual
arteries (spiral arteries) undergo
fibrinoid degeneration due to 2
waves of trophoblastic migration ,
so they become dilated to be the
uteroplacental arteries
• Uterine blood flow
increases
progressively and
reaches about 500
ml / minute at term
(D) Changes in the cervix :

1 - It becomes
hypertrophied , soft and
bluish in colour due to
oedema and increased
vascularity.
2 - Soon after conception , a thick
cervical secretion obstructs the
cervical canal forming a
mucous plug .
3 - The endocervical epithelium
proliferates and or everted
forming cervical ectopy
(previously called erosion)
 (E) Changes in fallopian tubes
and ligaments (round and broad):

Inactive , elongated ,
marked increase in
vascularity
There may be broad
ligament varicose veins
(F) Changes in the vagina :

The vagina becomes soft ,

warm , moist with
increased secretion and
violet in colour
(Chadwick's sign) due to
increased vascularity
 (G) Changes in the vulva :

• It becomes soft, violet in

colour
• Oedema and
varicosities may develop
(H) Changes in the ovaries

1 - Both ovaries are

enlarged due to increased
vascularity and oedema
particularly the ovary
which conatins the corpus
luteum .
 (H) Changes in the ovaries

2 - Corpus luteum continues to

grow till 7 - 8 weeks , then it
stops growing
, It becomes inactive and starts
degeneration at 12 weeks
(degeneration is completed
after labour)
Corpus luteum secretes
1.estrogen ,
2.progesterone,
3.relaxin
hormones
(H) Changes in the ovaries

3 - Ovulation ceases during

pregnancy due to
pituitary inhibition by the
high levels of oestrogen
and progesterone
• Relaxin is a protein
hormone.
• Its exact role in pregnancy
is unknown.
• It may induce softness and
effacement of the cervix.
II - Haematological
Changes
 (A) Blood volume
The total blood volume
increases steadily from
early pregnancy to reach
a maximum of 35-45 %
above the non-pregnant
level at 32 week .
 - Plasma volume :
Increases from 2600 ml by
± 45 % (1250 in the 1st
pregnancy) and 1500 ml
in subsequent pregnancies
- Red blood cell mass :
• Increases from 1400 ml
(nonpregnant) by 33 % (± 450
ml) due to increased production
resulting from erythropoeitin or
action of hCG or HPL .
• The increase is steady till full
term.
 The increase in plasma
volume is more than the
increase in red blood cell
mass (Hb mass) resulting
in haemodilution
(physiologic anemia)
However, the
minimal Hb.
accepted is
10-11 gm%
Values of increased blood volume

1 - Meets increased demands

for uterus , baby .... etc .
2 - Protects against supine
hypotension syndrome .
3 - Protects against fluid loss
in labour .
Increased blood volume
more than the increase
in red cell mass , leads
to decreased blood
viscosity which leads
to decrease in
peripheral resistance
(B) Blood
indices
 1 - Decreased Hb % and
RBCs % :
• Erythrocytes decrease from
4.5 million / mm3 to 3.7
million / mm3 (due to the
relative increase in plasma
volume more than red cell
mass) .
 Erythrocytes contents
from 2,3- DPG increases
which competes for 02
binding sites in the Hb
molecule , thus releasing
more 02 to the fetus .
Hb concentrations
falls
from 14 gm / dl
To
12 gm / dl.
2 - M.C.H.C : no change
3 - M.C.V. :  ,  or no
change (depending on
the availability of Fe).
4- Fragility of R.B.Cs: .
5 - Reticulocytes : mild 
6 - E.S.R : from 12 to
50 mm / hour
7 – Fibrinogen:  from
200 - 400 mg / dl to 400 -
600 mg / dl.
8 - White blood cells:
(from 7.000 / mm3 to 10.500 /
mm3 during pregnancy and up
to 16.000 / mm3 during labour :
-  PNL & its enzymes .
- Lymphocytes : no change .
9 - Platelets:  or 
10-Total plasma proteins
: slightly 
(mainly  albumin)
resulting in  osmotic
pressure.
(C) Coagulation
system
• Platelets  or  . (controversial).
• Fibrinogen doubled to 600 mg %
• Factor VIII tripled .
• Factor VII & factor X are
doubled
• Factor XI & factor XIII slight 
• Fibrinolytic activity  .
• Therefore pregnancy is a
hypercoagulative state .
• All these changes are
reversed after labour with 
RBCs production (not 
destruction)& the excess Fe
is stored .
Ill - Cardiovascular
system changes
(A) Changes in the heart
 Position:
As the diaphragm is elevated
progressively during pregnancy
the apex is displaced upwards
and to the left so that it lies in the
4th intercostal space outside the
midclavicular line.
 Pulse rate :
- The resting pulse rate
increases by 8 beats / min.
(8 weeks) and 16 beats / min.
(full term).
-Some episodes of ectopic beats
- Water hummer pulse .
 Heart sounds
• The first heart sound become
louder before midpregnancy
and splitting of this sound may
occur due to earlier closer of the
mitral than the tricuspid valve
• The intensity of the second
heart sound may increase.
 Heart sounds
• The third sound becomes
louder before mid-
pregnancy and persists
as such till one week post
partum.
• The fourth sound may
be detectable by
phonocardiography.
 Murmurs
Systolic functional murmurs
develop in most of women, usually
early systolic, but mid systolic
murmurs may occur and heard over
the left sternal edge,
they are thought to be due to
functional tricuspid regurgitation
 ECG CHANGES
• The main features of ECG may be
attributed to the changes in the
position of the heart.
• The axis undergoes left shift by 15 -
28°.
• The QRS complexes become of low
voltage, and T wave becomes
flattened.
(B) Haemodynamic
changes
1 - Cardiac output
(C.O.P.)
 Cardiac output:
increases mainly by increased
stroke volume rather than
increased heart rate reaching a
maximum of 40% above the
non-pregnant level at 20 weeks
to be maintained till term.
 Cardiac output
Distribution :
• 400 ml to the uterus ,
• 300 ml to the kidneys ,
• 300 ml to skin ,
• 300 ml to GIT , breast &
heart
 • Values :
Distributes extra 02
• During labour :
C.O.P. increases more
particularly during the
second stage due to pain ,
uterine contractions , and
expulsive efforts pushing
the blood into the general
circulation
 • Postpartum :
the increased
C.O.P. is
maintained for up
to 4 days and
then declines
rapidly
2 - Arterial blood
pressure
Although C.O.P.
incease , yet
A.B.P. is
decreased in
midtrimester to
increase again in
3rd trimester
 This is due to:
i - Decreased Peripheral
resistance :
(mainly affect diastolic B.P.)
due to : vasodilatation +
increase metabolism +
arteriovenous shunt at
placenta .
 ii - Supine hypotension :
may develop in some women in
late pregnancy while lying supine
due to compression on the I.V.C.
by the large pregnant uterus ,
resulting in decreased venous
return  C.O.P. and low B.P.
to the extent that fainting may
occur
 iii - Decreased
sensitivity of blood
vessels to angiotensin II
which is vasoconstrictor
Vena Cava Syndrome
• The posture of the pregnant
woman affects arterial blood
pressure.
• Typically, it is highest when
she is sitting, lowest when lying
in the lateral recumbent position
and intermediate when supine.
 Peripheral
Vasodilatation
Peripheral Vasodilatation

 blood flow to the skin,

particularly in the hands
and feet generally giving
the pregnant women a
feeling of warmth
Peripheral Vasodilatation

Increases the congestion of

nasal mucosa leading to
a common complaint of
nasal obstruction and
bleeding (epistaxis).
3 - Venous pressure
 Increased venous pressure
in the lower limbs due to :
1. Back pressure from the compressed
I.V.C. by the pregnant uterus .
2.Mechanical pressure of the uterus
on pelvic veins .
3.Increased venous return from
internal iliac veins --> increase
pressure in external iliac veins .
Increased venous pressure
in the lower limbs
Predisposes to :
Oedema ,
varicose veins
and piles
 Oedema and varicose veins in the
lower limbs & vulva are due to
i -  Venous pressure .
ii - Relaxation of the smooth muscles in
the wall of the veins by progesterone
iii -  Osmotic pressure in blood .
iv -  Capillary permeability (due to
progesterone and aldosterone).
v -  Interstitial pressure (Na retention).
 Varicose Veins treatments
1. avoid long periods of
standing and encourage
active exercise.
2. avoid constricting clothes.
3. keep the legs elevated while
sitting and during sleep.
4. use of elastic stockings.
These should be removed at
night and applied with leg
elevated before getting out of
bed in the morning (empty
veins).
5. stretch panties may be
necessary for vulval varicosities.
IV - Respiratory
system
(A) Anatomically:
The enlarged
uterus displaces
the diaphragm up
to ± 4 cm .
 This result in :
1. The diaphragmatic mobility
is reduced and respiration
becomes mainly thoracic .
2. Widen the subcostal angle
and increases the transverse
diameter of the chest.
Respiratory functions
The respiratory rate
does not increase during
pregnancy from its
normal rate of 14 - 15 /
minute.
 Overbreathing
(deep respiration)
occurs due to the
effect of excess
progesterone
 Shortness of breath
(the need to breath becomes a
conscious one)
and dyspnea are common
complaint of the pregnant
women which may be due to
unfamiliarity with low C02
tension in the alveolar
capillaries.
The vital capacity
1.The inspiratory capacity
(Tidal volume +
inspiratory volume)
is decreased in late
pregnancy
2.The expiratory reserve
volume
(maximum amount of air
which can be expired after
normal expiration) is
reduced
3.The residual volume
is reduced .
 The reduction in:
1.The inspiratory capacity
2.The expiratory reserve
volume
3.The residual volume
is not significant .
 4.The tidal volume :
(amount of gas inspired
or expired in each
respiration) rises
through-out pregnancy
by about 40 % .
Hyperventilation
is due to
increased tidal
volume not
respiratory rate
V - Urinary system
 (A) Kidney and kidney
function tests

• Renal blood flow and

glomerular filtration rate
increases by 50 % .
This leads to increased
excretion
 • Therefore:
• There is  serum creatinine (due to
creatinine cleareance) ,the same
for uric acid.
2.  blood urea .
3. kidney excretion of glucose due
to filtration load and  renal
threshold leading to renal
glucosuria
Therefore , in interpretating
the results of kidney
function test you should take
into consideration that
the highest normal values in
pregnancy = the lowest
normal values in non-
pregnant state
 (B) Ureters
Dilatation of the ureters
and renal pelvis due to :
i - Relaxation of the
ureters by the effect of
progesterone .
ii - Pressure against the
pelvic brim by the uterus
particularly on the right
side due to dextroposed
uterus and dilatation of
the right ovarian vessels
(C) Bladder and urethra
• Frequency of micturition
in early pregnancy due to :
i - Pressure on the bladder
by the enlarged uterus .
ii - Congestion of the
bladder muscosa .
• Urinary stress incontinence
may develop for the first time
during pregnancy (due to
decreased intraurethral
pressure and decreased
length of the urethra)
and spontaneously relieved
later on
VI - Gastrointestinal
tract
& liver
 1 - Gingivitis :
There is increased
vascularity and tendency
for bleeding as well as
hypertrophy of the
interdental papillae
 • The gums may become
hyperemic and soft and may
bleed when mildly traumatized,
as with a tooth brush.
• Epulis of pregnancy
may develop.
Treated by dental hygiene and
cryosurgery for severe cases.
cases
 2 - Ptyalism:
• It is excessive salivation which is
more common in association with
oral sepsis .
• It is due to failure to swallow saliva
and not due to increase in amount.
• Smoking is stopped and
anticholinergic drugs may help.
3 - Nausea and vomiting

Nausea (morning sickness)

and vomiting
(emesis gravidarum)
occur in early months
4 - Appetite changes
(longing or craving)
• The pregnant woman dislikes
some foods and odours while
desires others
• Reduced sensitivity of the
taste buds during pregnancy
creates the desire for
markedly sweet, sour , or salt
foods .
 (pica)
Deviation may be so
extreme to the
extent of eating
blackboard chalk ,
coal or mud
5 - Indigestion
and flatulence
 This is probably due to :
i - Decreased gastric acidity
caused by regurgitation of
alkaline secretion from the
intestine to the stomach .
ii - Decreased gastric motility
(progesterone effect).
 6 - Heart burn
Due to reflux of acidic
gastric contents to the
oesophagus
The treatment includes :
(a) small frequent meals to
prevent overdistension of
the stomach ,The evening
meal should be taken at
least 3 hours before going
to bed
 (b) avoid fatty foods,
chocolate, and smoking, as
these relax the lower
esophageal sphincter.
(c) the bed should be raised
at the head (15-20 cm), and
an extra pillow is used.
 (d) Antacid
Preparations
containing aluminium
hydroxide are
favoured.
 7 - Constipation
due to :
i - Reduced motility of large
intestine (progesterone effect).
ii - Increased water reabsorption
from large intestine
(aldosterone effect).
 7 - Constipation
iii - Pressure on the pelvic
colon by the pregnant
uterus.
iv - Sedentary life during
pregnancy .
It is treated by
(a) evacuation of the
bowel at the same
time each day
(bowel training)
(b) diet rich in fiber in
the form of vegetables,
fruits, and bran
(c) milk and avoid
dehydration by
increasing fluid intake.
(d) minimize coffee and
tea as they are diuretics
and cause dehydration.
(e) increase physical
activity and avoid
sedentary life.
(f) a mild laxative may
be needed. Liquid
paraffin is better
avoided as it prevents
absorption of fat
soluble vitamins.
In some women
iron
supplementation
may be the cause
 8 - Gall stones

More tendency to stone

formation due to atony
and delayed emptying
of the gall bladder
9 - Haemorroids
 due to :
i - Mechanical pressure on
the pelvic veins.
ii - Laxity of the walls of
the veins by progesterone
iii - Constipation.
 10 - Appendix
Is displaced upwards and
laterally (pain and
tenderness due to
appendicitis is higher than
in nonpregnant state)
Appendix
 Liver
i - Decreased albumin and
increased globulin resulting
in decreased A/G ratio
ii - Increased heat labile serum
alkaline phosphatase .
 Therefore both A/G
ratio and heat labile
alkaline phosphatase
are not reliable as liver
function tests during
pregnancy
VII - Metabolic
changes
(A) Weight gain
The average
weight gain in
pregnancy is
10 - 12 kg
 The increase
occurs mainly in
the second and
third trimester at a
rate of 350 - 400
gm/ week
Out of the 11 kg weight gain
6 kg is composed of
maternal tissues (breast,
fat, blood and uterine
tissues), and
5 kg of fetal tissue , placenta
and amniotic fluid
 Maternal Tissues
Increases during weeks of Pregnancy
1600
1400
1200
1000
Uterus
800
Mammary Gland
600 Plasma Volume
400
200
0
10 wk 20 wk 30 wk 40 wk

King JC. Am J Clin Nutr 71 (5(S));2000.

 Products of Conception
Increases during weeks of Pregnancy
3500

3000

2500
2000 Fetus
1500 Placenta
Amniotic Fluid
1000

500
0
10 wk 20 wk 30 wk 40 wk

King JC. Am J Clin Nutr 71 (5(S));2000.

 Out of the 11 kg
:weight gain
, kg are water 7
kg fat and 3
kg protein 1
)B) Water metabolism
There is tendency to
water retention
secondary to
sodium retention
(C) Protein metabolism

There is tendency for

nitrogen retention
(+ ve nitrogen balance)
for fetal and maternal
tissue formation
(D) Carbohydrate metabolism

Pregnancy is potentially
diabetogenic
- Alimentary glucosuria may
occur in early pregnancy .
- Renal glucosuria may occur in
the middle of pregnancy .
(E) Fat metabolism

There is increase of
plasma lipids with
tendency to acidosis
(HPL action)
(F) Mineral metabolism

There is increased
demand for iron ,
calcium ,
phosphate and
magnesium
VIII - Musculoskeletal
changes
(a) Increased mobility of
pelvic joints due to
softening of the joints and
ligaments caused by
progesterone and relaxin
(b) Flattening of feets .
(c) Progressive lordosis
leading to lordotic gait &
backache ( by high
heals).
(d) Pendulous abdomen in
multigravida resulting in
many complications
Backache
• The majority of pregnant
women complain of low
backache which increases
as pregnancy advances.
• It is due to increased
lumbar lordosis to counter-
balance the forward
growth of the uterus
• This puts strain on
ligaments and muscles
leading to pain.
• Strain of sacroiliac joint
is relatively common.
• Progesterone causes
softening and relaxation
of ligaments.
 Backache is treated by:
(a) more periods of rest.
(b) use of maternity corset.
(c) local heat in the form of
hot water bag or infrared
lamp
(d) analgesics given systemically
or as local creams,
Paracetamol is the drug of
choice, Non-steroidal anti-
inflammatory drugs as
indomethacin may be given
(e) physiotherapy may be
needed.
 Orthopaedic
consultation is
indicated if pain is
severe, or radiates to
the legs, and in the
presence of
neurological signs
 Leg cramps
• These are common in
the second half of
pregnancy particularly
at night.
• The exact cause is
unknown.
It may be related to shift of
blood away from the
muscle, i.e., ischaemic
cramp, or it may be tetanic
cramp caused by lack of
calcium, or increased
phosphorous, or both
 • Treated by taking calcium
tablets, and reducing the intake
of phosphorous-containing
substances as milk, meat, and
cheese.
• Vitamin B complex may be tried.
• Leg massage and
hyperextension of foot help
during the attack.
 Round ligament strain
• Pain is felt along the round
ligament and in the groin.
• Pain unilateral and left-sided,
(dextroflexion ).
• It is due to stretching of the
nerve fibres in the round
ligaments.
IX - Endocrine
system
1 - Anterior pituitary
 i - Increase in size
more than increase in
vascularity
This renders anterior
pituitary liable for
ischaemia
ii - Pregnancy cell (modified
chromophobe) appears due
to increased hCG .
iii - Prolactin level increases
up to 150 ng /ml at term to
ensure lactation .
2 - Posterior pituitary

Does not hypertrophy ,

but increase its
oxytocin secretion
near term
3 - Thyroid gland

There is diffuse
slight enlargement
of the gland
 Gland activity is  as
evidenced by normal free T4
(although total T4  ) due to
 thyroid binding globulin
(TBG) ,
 BMR 20 % ,  total T3 , 
protein bound iodine and 
TSH
4 - Parathyroid gland

Hypertrophy due to
increased demand
for Calcium
5 - Suprarenal gland
Hypertrophy particularly the
cortex resulting in increased
glucocorticoids (cortisone)
and increased
mineralocorticoids
(aldosterone)
 6 - Insulin
increased mainly
due to HPL (anti -
insulin hormone)
 7 -Ovaries
corpus luteum of
pregnancy
functions till 8-12 wks.
when its function is taken
by the placenta
XI - Skin changes
1 - Persistance of basal
body temperature
(BBT) elevation beyond
the expected day of
menstruation
(due to increased
progesterone).
2 - Spider telangiectasis
& palmar erythema
due to
increased estrogen
or
cutaneous vasodilatation
3 - Cutaneous
vasodilatation
(hyperaemia)
 leads to :
i - Masks pallor due to
anaemia with or without
palmar erythema .
ii -  Glandular activities
(sweat & sebaceous
glands).
iii - Sensation of heat and
nasal congestion
4 - Pigmentation
due to increased estrogen
or
melanocyte stimulating hormone
or
ACTH
• In the face = chloasma
graviderom = mask of
pregnancy
a butterfly pigmentation
on the cheeks and nose .
It usually disappears few
months after labour .
 •In abdomen:
Linea Nigra=
pigmentation in
midline below the
umbilicus
Linea nigra
 Stria gravidarum
pigmentation in the lower
abdomen ,
flanks , inner thighs ,
buttocks & breast and
increase as pregnancy
advances
It starts bluish (stria rubra) ,
then becomes pale to become
white (stria albicans) after
delivery , which persists
(primigravida has stria rubra
only ,while multigravida has
both S.R and S.A)
It It may be due to mechanical
stretching or increased
glucocorticoids which results
in rupture of the elastic
fibres in the dermis and
exposure of the vascular
subcutaneous tissues
5 - Secretions
increase in sweat
and sebaceous
glands activity
(B) Breast signs
• Diagnostic in primigravida and
may persist after delivery .
• In multigravida it may be due
to the previous pregnancies .
• They may occur with any
hyperestrogen , so they are
not diagnostic for pregnancy
 i - First month :
increased size & vascularity
(dilated veins) , mastodynia
may be present which ranges
from tingling to frank pain
due to hormonal responses of
the mammary ducts and
alveolar system
 ii - Second month :
increased pigmentation of
the nipple & areola and
prominence of
Montgomery tubercles
(nonpigmented nodules
around the primary
areola (12 - 20)
 Montgomery tubercles
They were thought to be
enlarged sebaceous
glands, but recently they
are found to be the lips of
orifices of peripheral
active lacteal ducts
Breast changes
iii - Third month :
secretion of colostrum
(thick yellowish
fluid) which can be
expressed from the
nipple
iv - Fourth month :
a pigmented area
appears around the
primary areola called
the secondary areola
Lower limbs signs

i - Edema :
bilateral and pitting
ii - Varicose veins
XII. Neurologic
System
• Sensory changes from
compression of nerves
• Tension headaches
• Carpal tunnel syndrome due
to edema
• Numbness and tingling
related to postural changes
 1. Headache
It is relatively common, and
attributed to intracranial
vasodilatation caused by
oestrogen and
progesterone
 1. Headache
• It is most troublesome in the
second trimester, but may
persist throughout pregnancy.
• However, headache may be due
to lack of sleep, or overwork.
• An analgesic is prescribed.
prescribed
 2. Fainting

It results from lowering

of blood pressure due to
vasodilatation which
occur in pregnancy
 3. Insomnia
During pregnancy some
women are sleepy and
depressed, others may be
irritable and suffer
insomnia
4.Carpal tunnel syndrome

Caused by compression of
the median nerve as it
passes through its fibrous
tunnel at the wrist, as a
result of fluid retention
and oedema in pregnancy
There is tingling,
numbness and
burning sensation
affecting the radial
side of the hand
 • Treatment:
includes reassurance, use of a
wrist splint, diuretics, non
steroidal anti-inflammatory
drugs, and local injection of
hydrocortisone in the tunnel
below the fibrous roof
(retinaculum)
 Operation is rarely
needed during
pregnancy by incising
the retinaculum to
relieve compression
 Other compression
neuropathies affect
the lateral cutaneous
nerve of the thigh ,
obturator and
peroneal nerves
 LEUCORRHOEA
The normal vaginal
discharge increases
during pregnancy because
of excess oestrogen and
may form a complaint
However, a pathological
discharge, e.g.,
monilial infections
which is common in
pregnancy must be
excluded.
THANK
YOU