REFERAT

PHSYLOGICAL PREGNANCY

Oleh :
Djero Aryadi Soemerep
Supervisor:
dr. Dony Rosmana Bimantara, SpOG

CLINICAL WORK OBSTETRIC AND GYNECOLOGICAL

MEDICAL FACULTY OF AL-AZHAR UNIVERSITY
 Introduction

The anatomical, physiological, and

biochemical adaptations to pregnancy are
profound.
Many of these remarkable changes begin
soon after fertilization and continue
throughout gestation, and most occur in
response to physiological.
REPRODUCTIVE TRACT

Uterus
During pregnancy, the uterus is transformed into
a relatively thin-walled muscular organ of su
cient capacity to accommodate the fetus,
placenta, and amnionic fluid.
Uterine enlargement involves stretching and
marked hypertrophy of muscle cells, whereas
the production of new myocytes is limited
Uterine hypertrophy early in pregnancy probably
is stimulated by the action of estrogen and
perhaps progesterone
Cervix

As early as 1 month after

conception, the cervix begins to
undergo pronounced softening
and cyanosis.

These changes result from

increased vascularity and edema
of the entire cervix, together with
hypertrophy and hyperplasia of
the cervical glands

And by the end of pregnancy,

they occupy up to one half of the
entire cervical mass
 Ovaries

Ovulation ceases during pregnancy, and

maturation of new follicles is suspended.
The single corpus luteum found in pregnant
women functions maximally during the first
6 to 7 weeks of pregnancy 4 to 5 weeks
postovulation and thereafter contributes
relatively little to progesterone production
 Fallopian Tubes

Fallopian tube musculature undergoes little

hypertrophy during pregnancy
 Vagina & Perineum

During pregnancy, increased vascularity

and hyperemia develop in the skin and
muscles of the perineum and vulva, with
softening of the underlying abundant
connective tissue.
Increased vascularity prominently afects the
vagina and results in the violet color
characteristic of Chadwick sign
BREAST

In the early weeks of pregnancy,

women often experience breast
tenderness and paresthesias.

After the second month, the

breasts increase in size, and
delicate veins become visible
just beneath the skin.

After the first few months, a

thick, yellowish fluid colostrum
can often be expressed from the
nipples by gentle massage.

During the same months, the

areolae become broader and
more deeply pigmented.
 SKIN

Abdominal Wall
These are called striae gravidarum or stretch marks.

Hyperpigmentation
is develops in up to 90 percent of women. It is
usually more accentuated in those with a darker
complexion

Vascular Changes
Angiomas, called vascular spiders, develop in
approximately two thirds of white women and
approximately 10 percent of black women
 METABOLIC CHANGES

In response to the increased demands of

the rapidly growing fetus and placenta, the
pregnant woman undergoes metabolic
changes that are numerous and intense.
Certainly no other physiological event
induces such profound metabolic
alterations.
By the third trimester, maternal basal
metabolic rate is increased by 10 to 20
percent compared with that of the
nonpregnant state.
 HEMATOLOGICAL
CHANGES
Blood Volume
Maternal blood volume begins to increase
during the first trimester. By 12 menstrual
weeks, plasma volume expands by
approximately 15 percent compared with that
of prepregnancy
Maternal blood volume expands most rapidly
during the second trimester. It then rises at a
much slower rate during the third trimester to
plateau during the last several weeks of
pregnancy.
CARDIOVASCULAR SYSTEM

During pregnancy and

the puerperium, the
heart and circulation
undergo remarkable
physiological
adaptations.

Changes in cardiac
function become
apparent during the
first 8 weeks of
pregnancy
 RESPIRATORY TRACT
The diaphragm rises about 4
cm during pregnancy. The
subcostal angle widens
appreciably as the transverse
diameter of the thoracic cage
lengthens approximately 2
cm.

The physiological changes in

lung function during
pregnancy

Functional residual capacity

(FRC) decreases by
approximately 20 to 30
percent or 400 to 700 mL
during pregnancy
 URINARY SYSTEM

The physiological changes in renal hemodynamics

induced during normal pregnancy have several
implications for the interpretation of renal function
tests
Serum creatinine levels decrease during normal
pregnancy from a mean of 0.7 to 0.5 mg/dL. Values
of 0.9 mg/dL or greater suggest underlying renal
disease and should prompt further evaluation.
There are few significant anatomical changes in the
bladder before 12 weeks.
GASTROINTESTINAL TRACT

During pregnancy, the gums may become

hyperemic and softened and may bleed
when mildly traumatized, as with a tooth
brush. is pregnancy gingivitis typically
subsides postpartum
As pregnancy progresses, the stomach and
intestines are displaced by the enlarging
uterus.
 ENDOKRINE SYSTEM

Pituitary Gland
During normal pregnancy, the pituitary gland enlarges by approx-
imately 135 percent
Pituitary enlargement is primarily caused by estrogen-stimulated
hypertrophy and hyperplasia of the lactotrophs
Growth Hormone
During the first trimester, growth hormone is secreted predom-
inantly from the maternal pituitary gland, and concentrations in
serum and amnionic fluid are within nonpregnant values of 0.5 to
7.5 ng/mL
As early as 8 weeks ges- tation, growth hormone secreted from
the placenta becomes detectable
Growth hormone in amnionic fluid peaks at 14 to 15 weeks and
slowly declines thereafter to reach baseline values after 36 weeks.
MUSCULOSKELETAL
SYSTEM

Progressive lordosis is
a characteristic feature
of normal pregnancy.

Compensating for the

anterior position of the
enlarging uterus,
lordosis shifts the
center of gravity back
over the lower
extremities
 CENTRAL NERVOUS
SYSTEM
Memory
Changes in the central nervous center are relatively
few and mostly subtle. Women often report
problems with attention, concentration, and memory
throughout pregnancy and the early puerperium.

Sleep
Beginning as early as approximately 12 weeks
gestation and extending through the first 2 months
postpartum, women have di culty with going to
sleep, frequent awakenings, fewer hours of night
sleep, and reduced sleep eficiency