PHYSIOLOGICAL CHANGE DURING PREGNANCY

( 1.)Cardio vascular system -:

                                       Circulatory blood volume ,plasma volume increased .

                                  Non –pregnancy             pregnancy near+           change 

Blood volume (ml)          4000                             5500                          +30 – 40%

Plasma volume (ml)        2500                             3750                          +40 – 50 %

RBC volume (ml)              1400                             1750                          +20 -  30%

Plasma protien (gm)        180                               230                             20 -  30%

 →  Psysiological   anemis occurs  -- plasma increase RBC production  increase iron  requirement are incresed.

→ Heart  size increased upwords and left -  because   -- uterus enlarge 

→pulse my increase  about 10 – 15 b/L minutes .

→ blood pressure decline in 2ed trimester due to decrease SVR  due to smooth muscle  relaxing effect of progestrone 

→ cardic out put increase .

⦁ Respiratory system :=)

   →oxygen consumption increse by 15 to 20 % 

 →diaphragm elevated because enlarge uterus

→ respiratory rate unchanged 

→ breathing become disphragmatic 

⦁ Gastro – intestinal system :=)

→ nausea & vomiting due to ( H.C.G.)

→poor appetite ( due to decresae gastric motility)

→alterstion in tast and smell 

→constipation 

→ heart burn / ptyalism ( excessive secrestion of saliva oestrogen )

⦁ Renal system :=)

→ frequency of urination occurs ( enlarge uterse ) (1&3 rd tm)

→GFR increase 50 %

→ decrease tone ( increase oestrogen progestrone )

⦁ Endocrine system :=)

 → BMR increase 

→ thyroid enlarge slightly & thyroid activity 

→ anterior  in lobe of pitutary enlages

→ parathyroid  increase  in size 

→ body water increase / water setension

⦁ Reproductive system :-

⦁ Uterus -: 

   Enlarge increase  in mass form 60mg. to 100ml.

→ irregular contraction occurs 

→ nulliparus  ==  7.5*5*2.5

→mulliparus  ==  8.2*6.2*2.5

→size of uterus  == 20*12*7.5 weight 1000gm

⦁ Cervix :-

           Increase vascularization causes  blue discoloured of the cervix .

Vagina :-

         →   Hypertrophy and thinking of muscles – chrdwick  sign (4w)

→ vaginal discharge (sec.thick ,white and audic)

⦁ Breast :-

→ breast size increase (effect of oestrogen progestrogen )

→nipple become pronounced 

→areola  become hyper trophoid called ‘’ mantogemeryes tubericld (there surrounding the nipple )

→ colostrum may leak form the breast 

⦁ Cutaneons changes :-

→ pigmantation increase 

→ a dark streak down midline  - liner nigra (20)

Chloasma ( pregnancy mask) :-

 Brownish pigmantation ones forcherd 

→ stretch marks ( strise ) ( raddish purple stretch marks )

⦁ Meta bolism :-

→ fasting hypoglycemia (due to fetal consulmption)

→ 3 – 4 kg fat is stored during pregnancy mostly abdomen wall breasts hips & thigh .

⦁ Acid base balance :-

→ arterial Pco2  , 40mm to 32 mm hg.

→arterial  Po2  95 mm hg  -- 105 mm hg .

→ pregnancy is a state of ‘’ respiratory alkalosis ‘’

Weight gain :-

→ in early pregnancy  -- weight loose becouse of nauses & vomiting .

→ total weight gain for a healthly women during pregnancy is average 11 kg.

       1st   --- 1 kg 

       2nd  --- 5 kg 

       3rd  ---  5 kg 

Reproductive weight gain :-

                                                  Fetus             ==  3.3kg.

                                                  Placenta        == .6 kg

                                                 Amnotic fluid == .8kg

                                                Uterus             == .9kg 

                                                Breat               == .4kg

→ regular weight checking is improtant to decet abnormalities.

→rapid weight gain .5kg a week (2kg in month )— Pre – enclempsis.

→falling weight suggest IUGR  & IUD of fetus.

→ideally weight gain is depends on (BMI)

→ weight gain for women with normal  BMI (20-25) = 11 to 16 kg.

                            Obese women >26     =  < 7kg

                 Under weight BMI <19    =  gain up to 18 kg 

                

                  Weight of person in kg

BMI   =    --------------------------------------

                        Height in metar 

Body water metabolism :- 

→ amount of water retained at term about  = 6.5 uter

→ pregnancy is state of hypervolemia 

Notes:-

Postural hypotension  or supine hypotension syndrome  → gravida uterus enlarge & compress the inferior vena care when pt. the ( supine position).