ANATOMICAL AND

PHYSIOLOGICAL CHANGES
DURING PREGNANCY

PHYSIOLOGICAL CHANGES 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 abdominal
cavity. In addition to the growing foetus, uterine
expansion is caused by an increase in connective tissue
and in the size and number of blood vessels supplying
the uterus

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
attaches the lateral aspect of the uterus to the supravaginal
area of the cervix.
3) Utero sacral ligaments attach the sacrum to the posterior
aspect of the cervix to support the cervix.

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 cerclage.

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 of the
broad ligaments

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.

RESPIRATORY SYSTEM
During pregnancy, the body is in a state of
hyperventilation due to high level of progesterone.
a. Breathing becomes more costal than abdominal.
Additionally, most women are mouth breathers
during pregnancy.
b. Anatomically. the diaphragm is progressively
elevated. Possibly because of expansion and
elevation of the rib cage. Uterine pressure during
the first and second trimesters does not appear to
be a factor in this phenomenon

METABOLIC AND ENDOCRINE CHANGES

1. Relaxin is a hormone secreted by the corpus
luteum. the endocrine body located in the ovary at
the site of the ruptured ovarian follicle.
a. Relaxin softens connective tissue during
pregnancy in preparation for labour and delivery.
when the pelvis must open to allow for the birth of
the foetus. Relaxin. However is not specific to the
pelvis. Other joints can also be affected.
b. Relaxin peaks in early and late pregnancy. Women
with chronic joint instability may notice an increase
in symptoms during these times.

c. Relaxin has also been speculated to increased in the

non pregnant
women after ovulation and throughout the menstrual
period. This may cause softening of the joints and pain
in affected women.
2. Other major hormones effecting a woman during
pregnancy include estrogen, progesterone. human
placental lactogen, and
3. Edema is present in the hands. feet. face and eyelids.
This is due in part to sodium and water retention.
Additionally. hormones circulating by the placenta.
ovaries, and adrenal cortex cause increased capillary
permeability, which contributes to the edema many
pregnant women experience.

MUSCULOSKELETAL SYSTEM

Abdominal muscles are stretched to the point of

their elastic limit by the end of pregnancy. Hormonal
influence on the ligaments is profound producing
systemic decrease in ligamentous tensile strength
and an increase in mobility of structures supported
by ligaments and may predispose the patient to
joint injury especially in the weight-bearing joints of
the back, pelvis and lower extremities. The pelvic
floor muscles must withstand the weight of the
uterus, the floor drops as much as 2.5 cm.

Postural changes:
During pregnancy, postural changes occur to
accommodate for abdominal growth.
a. These changes include forward head, rounded
shoulders, increased lumbar lordosis, hyperextended
knees, and pronated feet.
b. The center of gravity changes, resulting in changes in
balance.
c. Muscular changes are also typical. often noted
alterations include shortened hip flexors, lower back
musculature, and pectorals. Abdominal muscles, neck,
and upper back muscle groups elongate. This may
promote stretch weakness or adaptive shortening.

Postural changes in pregnancy

Bones and joints:

There is tendency to decalcification of bones,
sublaxation of joints due to softening of ligaments
by relaxin hormone. It is more marked in sacroiliac
joint and symphysis pubis, leading to waddling gait.

CUTANEOUS SYSTEM
Cutaneous system
Due to overstretching of the skin, the elastic fiber
may rupture together with small blood vessels and
so red streaks appear; known as striae gravida
rum. They are usually more marked below the
umbilicus, on the breasts and may appear on the
buttocks and thighs. In some women they are not
marked or even don't
appear during pregnancy. After labour, the red striae
become pale silvery white due to fibrosis and are
known as (striae albicantes).

Linea nigra

Pigmentation: It is due to suprarenal changes, it

usually begins to appear after
the 4th month. The pigmentation may appear
anywhere but the commonest sites
are:
1. Linea nigra: which is a line of pigmentation
between the umbilicus and the
symphysis pubis.
2. Increased pigmentation of the nipple as primary
areola and appearance of the
secondary areola.

Stria gravidarum

3. Cloasma gravidarum or mask face of pregnancy

which is butterfly
pigmentation of the forehead, nose, upper lip and the
adjoining parts of the
checks. This pigmentation may persist but the
cloasma gravidarum usually
disappears.
Falling of hairs and brittleness of nails may occur
during pregnancy.

Butterfly pigmentation

MATERNAL WEIGHT GAIN

There are no reliable data available for weight gain in
the first 12 weeks of
pregnancy. But in normal pregnancy the average gain is
0.3 Kg/week up to 18
weeks, 0.45 Kg/week from 18-28 weeks and a slight
reduction with a rate of 0.360.41 Kg/week until term.
Failure to gain weight and sometimes slight weight loss
may occur in the last 2
weeks. The average weight gain for primigravidae for the
inhal pregnancy is 12.5
Kg. and is probably about 0.9 Kg. less for multigravidae.
Acute excessive weight
gain is commonly associated with abnormal fluid retention.

Weight gain is produced by:

Fetus 3.63-3.88 Kg
Placenta 0.48-0.72 Kg
Amniotic fluid 0.72-0.97 Kg
Uterus and breasts 2.42-2.66 Kg
Blood and fluid 1.94-3.99 Kg
Muscle and fat 0.48-2.91 kg total= 9.70-14.55Kg

NERVOUS SYSTEM
Functional changes may appear especially in neurotic
women as :
-sleepy, depressed
-while others become irritable, excited and suffer from
insomnia.
-The nausea and vomiting may have a neurotic
element.
-Change of appetite such as refusal of some types of
food.
-Neuralgias