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Anatomical changes

Uterus:

Physiologic Adaptation of Reproductive System to Pregnancy:

Changes from an almost solid organ to a thinwalled, hollow organ & can hold 15-20 liters. Increased production of estrogen & progesterone initiates the process of uterine growth. (hypothesis) After the 12th week of gestation, growth is attributed to mechanical distention.

Physiologic Adaptation of Reproductive System to Pregnancy:


Cervix:
The prepregnant cervix is firm (like top of ear). At 4 weeks biochemical changes occur & cause the cervix to become edematous & congested with blood. Occurs in conjunction with the hypertrophy & hyperplasia of the cervical glands. Provides support to maintain an intact pregnancy. As delivery approaches, it softens and opens to allow delivery of the infant.

Physiologic Adaptation of Reproductive System to Pregnancy:


Vagina, Perineum, & Vulva:
Increased vascularization, softening of the connective tissue & hypertrophy of the smooth muscle (in preparation for delivery). Vaginal mucosa thickens & the rugae (vaginal folds) become pronounced (to allow expanding without trauma during delivery). Increased vaginal discharge, and acidic environment (to prevent growth of many bacterial infections).

Physiologic Adaptation of Reproductive System to Pregnancy:


Ovaries:
Production and release of follicles from ovaries ceases with pregnancy. The corpus luteum is formed within the ovary & secretes progesterone, peaking at 8 days (necessary for maintenance of pregnancy). At 6-7 wks the placenta begins manufacturing progesterone, & involution of the corpus luteum begins.

Physiologic Adaptation of Reproductive System to Pregnancy:


Breasts:
Changes are due to increased production of estrogen & progesterone. Become full & tender early in pregnancy. The number of mammary alveoli increase & breasts become larger (in preparation of breastfeeding). The prepregnant size of the breasts has no effect on the ability to breastfeed!

Role of Estrogen in Pregnancy:


Increasing blood flow to the uterus by promoting vasodilation. Changing the sensitivity of the respiratory system to carbon dioxide. Softening of the cervix, initiating uterine activity, and maintaining labor. Developing the breasts in preparation for lactation and secretion of prolactin by the pituitary gland.

Role of Progesterone in Pregnancy:


Ready the uterus for implantation. Relaxes smooth muscle to prevent spontaneous abortion. Works to prevent a maternal immunologic response to the fetus. Relaxes smooth muscle
to decrease motility & improve absorption of nutrients. Enlarges the ureters & bladder to increase capacity.

Plays a role in development of the alveoli & ductal system to prepare for lactation.

The anatomical physiological and biochemical adaptation to pregnancy that take place in women are profound.

Many of these change begin soon after fertilization and continue throughout gestation and most I these remarkable adaptations occur in response to physiological stimuli provided by the fetus or fetal tissues.

Uterus
Hypertrophy And Dilatation
Before pregnancy: Before weighty about 70 gm Cavity 10 ml

Weighty 1100 gm Total value of contents 15 L - 20 L Early hypertrophy until 12 week effect of estrogen and progesterone. After 12 week due to mechanical distension by the products of concept.

Al term

Early the uterine wall thick Later the uterine wall thick about 1-5 em Uterine enlargement is not symmetrical more in the fundus.
Arrangement of the muscle cell: 1) An external hood like Layer. 2) An internal layer. 3) Lying between. Changes in the uterine size shape (pear shape globule ovoid) position.

Change in contractility Uteroplacental blood flow


There is progress increase in Uteroplacental blood flow during pregnancy (450 650 ml / min late in pregnancy). Change in the cervix: Softening. Cyanosis. Proliferate of glands. Formation of mucus plug. Cervical mueus fragmentary crystallization or beading (effect of progesterone ). In some woman arborization of the erystals or ferning (effect of estrogen).

Ovaries and fallopian tubes


Ovaries:
Ovariesn function. Relaxin. Pregnancy luteoma. Hyperreuctio luteinales Fallopian tubes.

Vaginu and perineum


Vaginal secretions. Vaginal cytology.

Abdominal wall and skin


Striate gravid arum. Diastases recti. Pigmentation. Cutaneous vascular changes.

Metabolic changes
* Weight gain. * Average weight gain 10- 12.5 kg.

Breasts

IN PREGNANCY
Reproductive organs
I. Uterus: The muscular organ holding the fetus during pregnancy, nourishment of the fetus through the placenta. It is divided into the body (Corpus, and fundus)and the cervix. During pregnancy, the uterus increases in weight from 60 to 1000g. In size, it changes from 6.5 to 32 cm. In a non pregnant state, the uterus is situated in the pelvic cavity. During pregnancy, it expands into the

Uterine change during pregnancy

:
b) Ligamentous supports:
1) Round ligaments are fibrous cords attaching to the uterus and libia majora During pregnancy, they become elongated and hypertrophied. They supportthe uterus in its move from the pelvic cavity into the abdominal cavity. 2) Broad ligaments are large folds of peritoneum separating the pelvis into the anterior and posterior divisions. The lower portion of the ligament is known asthe cardinal ligaments, it

c) Cervix: The portion of the uterus connecting the body of the uterus and the vagina. 1) The internal os joins the body of the uterus with the cervix. 2) The external os opens into the vagina. 3) During pregnancy, the cervix is closed. A mucus plug forms over the cervix ,providing a protective barrier between the vagina and the uterine contents.

4) During labour and delivery, the cervix shortens (or effaces) and widens (or dilates), effectively disappearing. A 10 cm opening is left between the uterus and the vagina to allow for passage of the foetus into the birth canal. 5) If the cervix begins dilating prematurely, it is sometimes stitched together during the second trimester, until the foetus in mature. This procedure is known as a

II. Ovaries: The organs storing ova. Through hormonal influence , one ovum is developed per month. It then travels into the fallopian tube and has the potential to be fertilized. One ovary is located on either side of the uterus, encased in the posterior aspect of the broad ligaments.

III. Fallopian tubes: The ducts bringing mature ova from the ovaries to the uterus via peristaltic action. a) The fallopian tubes connect the uterine cavity to the abdominal cavity, near to the ovary. The opening at the abdominal site is lined with cilia to promote the peristalsis necessary to convey the ovum into the tube. b) They are situated in the superior margin

IV. Vagina: The connecting passage between the uterus and the perineum, serving as the birth canal a) The anterior borders include the bladder and the urethra. b) Laterally, the ureters and broad and round ligaments lie. c) Posteriorly, the peritoneum and the rectovaginal fascia.