The document summarizes common physiological changes that occur during pregnancy and their implications. Key changes include: increased cardiac output and heart size, elevated blood volume and decreased blood pressure, respiratory changes like elevated tidal volume and decreased functional residual capacity due to diaphragm elevation, and gastrointestinal changes like increased appetite and risk of heartburn. Understanding these normal adaptations is important for managing pregnant women's health and education.

1. MUHIMBILI UNIVERSITY OF HEALTH
AND ALLIED SCIENCE
SCHOOL OF NURSING
MATERNAL AND CHILD HEALTH NURSING
PRESENTERS: JOHN, Songoma
MWASUBILA ,Fabian
NGUKA S MARIAM
MUTEI PETER
REGINA METHEW

2. • Common changes and adaptation that takes
place during pregnancy and their implication
on the pregnancy women and nursing
education during ANC VISITS

3. PHYISIOLOGICAL CHANGES DURING
PREGNANCY
• Maternal physiological changes in pregnancy are the
normal adaptations that a woman undergoes during
pregnancy to better accommodate the embryo or fetus.
They are physiological changes, that is, they are entirely
normal, and include cardiovascular, hematologic,
metabolic, renal and respiratory changes that become very
important in the event of complications. The body must
change its physiological and homeostatic mechanisms in
pregnancy to ensure the fetus is provided for. Increases in
blood sugar, breathing and cardiac output are all required.
Levels of progesterone and estrogens rise continually
throughout pregnancy, suppressing the hypothalamic axis
and subsequently the menstrual

4. Changes in the cardiovascular
• Profound changes takes place in cardiovascular
system that would normally be considered
pathological but in pregnancy are physiological.
• Understanding of these changes is importance in
care of women with normal pregnancies and
management of women with pre-existing
cardiovascular diseases whose health may be
seriously compromised with the increased
demand.

5. Heart
• The heart enlarges by about 12% between early
and late pregnancy
• Distension of the heart is chambers is due to
increasing the myometrial hypertrophy but
mainly due to increased diastolic filling in parallel
with the increase in blood volume.
• The wall thickness increases very little.
• cardiac enlargement does not appear to be
associeted with reduced myocardial efficiency as
proportion of blood ejected during systole
increases during early pregnancy.

6. • The improvement in myocardial contractility is
thought due to;
 lengthening of muscle fibers
 or to the reduction of in after load associated
with the marked peripheral vasodilatation
that is characteristics of pregnancy
• During the late pregnancy the degree of
vasodilatation decreases and the ejection
fraction also diminishes.

7. • By the mid pregnancy more than 90% of women
develop an ejection systolic murmur
• This lasts until the first week of postpartum
• If unaccompanied by any abnormality it reflects the
increased stroke output
• 20% develop a transient diastolic murmur
• 10% develop continuous murmurs heard over the base
of the heart, own to increased mammary blood flow
• The growing uterus elevate the diaphragm ,the great
vessels are unfolded and the heart is correspondingly
displaced upwards with the apex moved laterally to
the left by about 15 degrees

8. • This can give an exaggerated impression of the cardiac
enlargement and account for the left axial deviation
seen on electrocardiogram in pregnancy.
• And for the apex beat appearing in the fourth rather
than the fifth intercostals space
• These ECG and radiographic changes are similar to
those of ischemic heart diseases but are considered
normal for pregnancy women
• The atrial or ventricular extra systoles are frequent and
there is increased susceptibility to supraventricular
tachycardia

9. Cardiac output
• The increase cardiac output range from 35 to 50% in
pregnancy, from the average of 5% before pregnancy
to approximately 7l/min by 20th week of pregnancy
• Thereafter the changes are less dramatic
• The increased cardiac output allows blood flow to the
kidney,brain and coronary arteries to remain
unchanged, while the distribution to other organs
varies as the pregnancy advances e.g
• Uterus receives 3% co in early pregnancy and 17% co
at term(400mls extral)
• Breasts receives less than 1% of co early in gestation
and 2% co at term.

10. • The increased cardiac output is due to
 Increased stroke volume
 Heart rate, which begin in the 7th week and by the
third trimester it has increased by 10-20%
• The heart rate are typically 10 -15 b/min faster than
those of the non pregnancy.
• Increased from about 75 to 90b/min.
• Women with normal hearts are aware of
irregularities in heart beat in pregnancy
• Stroke vol increases by 10% during 1st half of
pregnancy and 20% week of gestation until term.

11. -Increased cardiac output results to effects on:
 stroke volume increase, Heart rate increases and
Heart enlarges
• The cardiovascular system more than any other is
extremely sensitive to changes.
• Large variations in CO,PR,BP and regional blood flow
may follow trivial changes of
• i) posture
• Ii) activities
• III) anxiety

12. Blood volume
• The two major components are blood-plasma and red cell
• The total maternal blood vol increases 30-50% in singleton
pregnancy with a mean of 33%
• A higher circulating volume is required to:
• Protect the mother and fetus against the harmful effects of
impaired venous return in supine and erect position.
• Meet the demand of enlarged uterus ,hypertrophied
vascular system and placental perfusion
• Supply the extra metabolic needs of the fetus
• Perfuse other body organs
• Safeguard the mother against excessive blood loss at
delivery

13. • Plasma volume in corresponding with blood volume,
increased by 50% over the coarse of pregnancy
• In a normal first pregnancy it may increase by 1250mls
above non pregnancy levels and subsequent
pregnancies it may increases by about 1500mls
• The increase is related to the size of the fetus size,
being larger in multiple pregnancies.
• It start in the first trimester, expands rapidly up until
32-34 weeks gestation, then in the last week of
pregnancy it plateaus with very little changes.
• The increase in plasma volume reduces the viscosity of
blood, this increase capillary flow.

14. • Red cell mass which represent the total volume
of red cell in the circulation, increases during
pregnancy in response to oxygen requirements of
maternal and placental tissue
• Increase level of erythropoietin and other
hormones involves in erythropoiesis
• Increase of F cell during pregnancy and
reactivation of maternal hemoglobin
• The number of F cell reaches the a peak at 18-22
week usually retuning to normal by 8 week of
postpartum .

15. Changes caused by increase plasma
volume in pregnancy
in spite the increase in production of the red cells ,the
marked increase plasma volume causes dilution of
many circulating factors (hemoglobin conc and
haematocrit conc decrease ).
1.Haemodilution
 physiological anemia, decrease in concentration of
plasma protein and decrease in concentration of
immunoglobulin
2.Incraeased cardiac output
 stroke volume increase, Heart rate increases and
Heart enlarges

16. Immunity –HCG and prolactin suppress the immune response of
pregnancy women.
• Serum levels of immunoglobulin's IgA,IgG,IgM decreases from
10th week and reach the lowest levels at 30wk until term.
• Iron-The increased cell mass and needs of the developing
fetus and placental lead increase requirement for iron in
pregnancy
• Iron demands increase from 2 to 4 mg daily
• A healthy diet supply 10 to 14mg iron per day(5-10%) are
absorbed and provide sufficient iron.
• The purpose of iron supplementation is to maintain iron
stores in order to prevent the development of true anemia

17. Summary of common blood values
and their changes
Normal Changes in timing
range(nonpregnanc pregnancy
y
Protein(total) 65-85g/l 10g/l decrease By 20 week then stable
albumin 35-48g/l 10g/l decrease Mostly by 20 week then
gradual
fibrinogen 2.5-4 2g/l rise Progressively from3rd
month
platelates 150-400x 10 3/mm Slight decrease No significance change
Clotting factors 6-10min Little changes Little change until 3-5 days
of pregnancy
Wbc count 4-11x10 9/l 9x10 9/l From 2 month rises and
reach Peak at 30 week
then plateaus
Red cell 4.5x10 12/l 3.8x 10 12/l Decreanes progressively to
volume 30-40 week

18. Blood pressure
• As the co is raised but the arterial blood pressure is reduced
by 10%
• The decrease in peripheral vascular resistance begins at 5wks
gestation reaches maximum in the 2nd
trimester(21%reduction)
• And then gradually rises as the term approaches. but still
slightly remain low to compensate with increased co
• Reduced vascular resistance is thought due to mechanism
controlling vascular activities(vasodilatation)
• Agent responsible e.g. vasodilator( prostacyclin and nitric
oxide),vasoconstrictor thromboxane A2

19. • There decrease in diastolic BP but little changes in systolic
• The systolic BP falls an average of 5-10mmhg by 24wks
gestation
• Diastolic BP increases significantly during the 2nd half of
pregnancy to levels that are at least equivalent to those of
non pregnancy state
• Posture can have major effects in BP e.g. supine position
decrease CO 25%
• Compression of the inferior vena caver by the enlarging
uterus during 2nd and 3rd trimesters reduce venous return,
decrease stroke vol and CO
•

20. • If the paravertebral vessels and other venacaver are
not well developed and perfused the women may
suffer from supine hypotensive syndrome consisting
hypotension, bradcardia, dizziness, light headedness,
nausea and even syncope if she will remain too long.
• the proper management should immediately if the
conditions above happened eg changing Position,
take vital sign, manage hypotension.

21. Changes in gastrointestinal system.
 The gums become oedematous , soft , and spongy
during pregnancy ,probably owing the effect oestrogen
, which can lead to bleeding when mildly traumatised
as with a toothbrush.
 epulis or gingivitis ( focal, highly vascular swelling )
develop ; it is caused by growth of gum capillary . It is
usually regress spontaneously after delivery .
 Profuse salivation or ptyalism is an occasional
complaint in pregnancy it is caused by stimulation of
salivary gland due to ingestion of starch .

22.  Dietary changes in pregnancy , such as aversion to
coffee, alcohol, and fried food is very common in
pregnancy as are craving for salted and spiced foods ;
these are perhaps due to a dulling of sense of taste in
pregnancy .
• pica the term given to bizarre craving for and
compulsive , secret chewing of food or ingestion of
non food substances (e.g. ice , coal , disfectants ) .
The mechanism of these for the dietary changes are
poorly understood and usually of no significance to
the pregnancy unless the material consumed inhibits
iron absorption

23. • Although in early pregnancy many women experience nausea , an
increase in appetite may also be noticed with the daily food intake
increasing by up to 200kcal .
• The hypothalamus , which controls the total body fat , reset by
progesterone so that the new of fat store is achieved both by
eating more and expending less energy . This facilitates the
women to enter the third trimester with some 3.5kg of fat store
accumulated , which provides an energy bank for the last
trimester when fat storage practically stop but energy is required
for the growth of the fetus .
• Many women notice an increase in thirst in pregnancy because of
the resetting of osmotic thresholds for thirst and vasopressin.
This contributes towards a fall in plasma osmolality , leading to
increase of water retention which is normal physiological
alteration in pregnancy .HCG may influence osmoregulation

24. • As pregnancy progress , the enlarging uterus displace the
stomach and intestine .
• As a result the appendix is displaced upwards and laterally
so that appendicitis can mistaken for pyelonephritis . At
term the stomach attain vertical position rather than
normal its normal horizontal ones .
• These mechanical forces lead to increased intragastric
pressure and change in the angle of the gastro-
oesophageal junction , leading to greater oesophageal
reflux .
• The upward displacement of the stomach when the uterus
is unusually large (as in multiple pregnancy or
polyhydramnios ) makes many of the most annoying
symptoms of pregnancy more difficult to treat

25.  Marked reduction of gastric and intestinal tone and
motility plus relaxation of the lower oesophageal sphincter
predispose to
- heartburn
- constipation and
- hemorrhoids
 Around 80% of women experience some degree of
heartburn during pregnancy , usually in the third trimester.
It is thought to be due to small increase in intragastric
pressure combined with decreased lower oesophageal
sphincter tone , allowing gastric acid to reflux into the
lower oesophagus. Although the true etiology remains
unclear ,the combined influence of progesterone and
oestrogen is probably responsible.

26. • Delayed emptying during labor Gastro
esophageal reflux disease (GERD) Esophageal
dysmotility Gastric compression due to enlarging
uterus Decrease sphincter tone
• Small bowel Motility is reduced due to
progesterone allowing for more efficient
absorption Large bowel
• Decreased transit times allows for both water
and sodium absorption Increased portal
hypertension leading to dilation wherever there
are portosystemic venous anastomoses

27.  The gall bladder become dilated during
pregnancy and the rate of emptying is sluggish
owing to the effect of progesterone.
 Bile may become thickened with the increase
risk obstetric cholestasis.
• Incomplete emptying of the gall bladder may
result in retention of cholesterol crystal
prerequisite for gall stone

28. Changes in respiratory system.
• Pregnancy is associated with marked change in
respiratory physiology.
• Increase in cardiac output lead to substantial increase
in pulmonary blood flow.
• The blood volume expansion and vasodilation of
pregnancy result in hyperaemia and oedema of the
upper respiratory mucosa which predispose
pregnancy women to nasal congestion , epistaxis and
change in voice
• Nasal decongestant spray should be used with caution
because of their long term effect on the mucosa.

29. • Knowledge of the changes in the mechanical
aspects of ventilation in normal pregnancy is
of particular importance for understand the
management chronic respiratory disease.
• Up to 70% of pregnancy women with no
underlying disease experience dyspnea which
caused by enlarging uterus .sensitivity of
respiratory centre to co2 increase due to
effect of progesterone and oestrogen.

30. RESPIRATORY CHANGES
Alteration in sub division of the lung volume are largely
due to alter in thoracic anatomy during pregnancy .
As uterus enlarges , the of diaphragm rises 4cm and
the rib cage displaced upward . The shape of the
chest changes as the anteroposterior and transverse
diameter each increase by about 2cm resulting in
expansion chest Chest circumference expands 5-7
cm Subcostal angle increases from 68 to 103 degrees
Transverse diameter increases 2cm Level but
excursion is not impeded Respiratory muscle
function is not affected by pregnancy

31. • LUNG VOLUME AND PULMONARY FUNCTION
Elevation of the diaphragm decreases the volume of
the lungs in the resting state, reducing Total Lung
Capacity by 5% and FRC by 20% FRC mainly
decreased by RV Vital capacity does not change
Spirometry is not changed in pregnancy FEV1 is
unchanged Peak flow is unchanged . Chronic
hyperventilation Progesterone induced Minute
volume is increased . Tidal volume is increased by
30-40% Respiratory rate is unchanged Increased
early in the first trimester

32. URINARY SYSTEM
• Anatomic Changes Renal hypertrophy Dilation of
renal pelvis/calyces 15mm on the right in 3 rd
trimester 5mm on the left Predisposition to
pyelonephritis in the presence of asymptomatic
bacteriuria Dilation of ureters to 2 cm . Mechanical
compression Progesterone-induced smooth muscle
relaxation
BLADDER CHANGES Bladder trigone elevation occurs
with increased vascular tortuousity throughout the
bladder leading to microhematuira
Decrease bladder capacity Increased frequency of
urinary incontinence

33. • . RENAL HEMODYNAMICS Renal blood flow
increases 50% GFR increases 50% (120cc/min
◊ 180cc/m) Serum Creatinine and BUN levels
decrease Glycosuria occurs due to exceding of
maximum tubular reabsorptive capacity No
increase in proteinuria UTI Pre-existing renal
disease PET

34. ENDOCRINE CHANGES
Endocrine changes in pregnancy is complex
Thyroid Physiology Euthyroid state Increase in thyroxine-binding
globulin . Decrease in circulating pool of extra-thyroidal
iodide Slight thyromegaly
Free T4 and T3 remain normal Small amounts of TRH eachT4
cross the placenta Fetal thyroid active by 12 weeks gestation
Adrenal function Increases in corticosteroid-binding globulin
Increases in free cortisol Zona fasciculata is increased Marked
increase in CRH from placental sources Delayed plasma
clearance of cortisol due to renal changes Resetting of
hypothalamic-pituitary sensitivity to cortisol feedback on
ACTH production

35. • Pituitary gland Enlarges due to proliferation of
prolactin-secreting cells Enlargement makes it more
susceptible to alterations in blood flow, ie PPH
Prolactin levels are increased (ten times higher at
term) to prepare breasts for lactation
Pancreas and Fuel Metabolism Physiologic glucose
intolerance to insure continuous transport of
nutrients from mother to fetus Fasting hypoglycemia
Postprandial hyperglycremia Hyperinsulinemia

36. CHANGES IN METABOLISM
• Pregnant prolonged fasting Increased utilization of
fat stores Lipolysis generates glycerol, fatty acids and
ketones for gluconeogenesis and fuel More HPL, less
insulin results in increased utilization of fat stores
Maternal response to starvation Hypoglycemia,
hypoinsulinemia Hyperlipidemia, hyperketonemia
Maternal response to feeding Hyperglycemia,
Hyperinsulinemia, Hyperlipidemia, Resistance to
insulin Insulin secretion increases throughout Insulin
resistance increases to 50-80% in third trimester
Borderline pancreas function leads to GDM

37. Diabetogenic effects of pregnancy HPL ◊ lipolytic and
anti-insulin Cortisol Prolactin Estrogen and
progesterone Fetal glucose levels are 20 mg/dl less
than maternal values Placental glucose transport is
carrier mediated facilitated transport that is energy
independent
Lipids and lipoproteins increase in pregnancy Total
cholesterol, LDL, HDL and triglycerides all increase
Necessary as precursors for steroid genesis does not
appear to lead to atherosclerosis unless pre-existing
hyperlipidemia

38. WEIGHT GAIN
• A gain of about 12kg is to be expected in the pregnant woman of
average build and can be accounted for by the following:
• Fetus…………………..3.4kg
• Placenta……………..0.6kg
• Amniotic fluid……..0.8kg
• Blood volume……….1.5kg
• Weight of uterus……0.9kg
• Weight of breasts…..0.4kg
• Extracellular fluid……1.4kg
• Fat …………………………3.5kg
• Total………………………..12.5kg

39. CONT…..
• The pregnant women gains on the average approximatelly
2.5kg during the first 20 weeks of pregnancy.
• During the second 20 weeks, a gain of appr
• oximatelly 9kg (0.45kg per week).Many factors are
involved, including the metabolic rate of an individual, fluid
balance, and the uterine contents eg twins,
polyhydromnious
• Inadequate weight gain during the first 20 weeks could be
due to poor nutrition often in conjunction with smoking or
to condition such as severe anaemia or pyelonephritis.
• During the second 20 weeks, it may be due to fetal growth
retardation and when fetal death occurs.
• Oligohydromnious is a less common cause.

40. SKELETAL CHANGES CONT…
• The pregnant woman has a different pattern of gait. The step
lengthens as the pregnancy progresses, due to weight gain and
changes in posture. On average, a woman's foot can grow by a half
size or more during pregnancy.
• In addition, the increased body weight of pregnancy, fluid
retention, and weight gain lowers the arches of the foot, further
adding to the foot's length and width.
• The influences of increased hormones such as estrogen and relaxin
initiate the remodeling of soft tissues, cartilage and ligaments.
Certain skeletal joints such as the pubic symphysis and sacroiliac
widen or have increased laxity.
• NOTE: It is the bones and not the teeth that are the store house
for calcium, so it is no longer believed that the woman’s teeth
decay during pregnancy because calcium is being withdrawn from
them

41. Physiological changes in the
reproductive system
The body of the uterus

42. • After conception, the uterus develops to
provide a nutritive and protective
environment in which the fetus will develop
and grow.

43. Decidua
• After embedding of the blastocyst there is
thickening and increased vascularity of the
lining of the uterus, or decidua.
• Decidualisation,influenced by progesterone
and oestradiol,is most marked in the fundus
and upper body of the uterus (the usual sites
of implantation).
• The decidua is now believed to maintain
quiescence of the uterus during pregnancy.

44. • Spontaneous labour is thought to result from
the activation of the decidua with resultant
prostaglandin release following withdrawal of
placental hormones.
• The decidua and trophoblast also produce
relaxin,which appears to promote myometrial
relaxation and may have a role to play in
cervical ripening and rupture of fetal
membranes.

45. Myometrium
• In early pregnancy uterine growth is due to
hyperplasia (increase in number due to
division) and hypertrophy(increase in size) of
myometrial cells under the influence of
oestrogen.
• As gestation increases, hyperplasia is less
important and hypertrophy accounts for most
of the growth of the uterus.

46. • In the latter half of pregnancy the uterus expands
mechanically owing to distension of muscle cells
by the growing fetus and placenta.
• The dimensions of the uterus vary
considerably,however depending on the age and
parity of the woman.
• During the first few weeks of pregnancy the
uterus walls become thicker and less firm
growing from 1cm to 2.5cm by 4 months.

47. • By term the uterus has become a muscular sac
with soft, readily indentable walls of 0.5-1cm
or less in thickness, making palpation of the
fetus relatively easy.
• Hyperplasia and hypertrophy of the
myometrium cells leads to the three layers of
myometrium becoming more clearly defined.
• Muscle layers:The outer longitudinal layer of
muscle fibres is thin.

48. • It consists of a network of bundles of smooth
muscles.
• These pass longitudinaly from the front of the
isthmus anteriorly over the fundus and into
the vault of the vagina posteriorly,and extend
to the round transverse ligaments.
• The thicker middle layer comprises
interlocked spiral myometrial fibres that are
perforated in all directions by blood vessels.

49. • Each cell in this layer has a double curve so
that the interlacing of any two gives the
approximate form of a figure of eight.
• Due to this arrangement ,contraction of these
cells after delivery causes constriction of the
blood vessels.
• The inner circular layer is arranged
concentrically around the longitudinal axis of
the uterus and bundle formation is diffuse.

50. • It forms sphincters around the openings of the
uterine tubes and around the internal cervical os.
• The myometrium is both contractile(can lengthen
and shorten) and elastic(can enlarge and
stretch)to accommodate the growing fetus and
allow involution following the birth.
• Thin sheets of connective tissues composed of
collagen,elastic fibres,fibroblasts and mast cells
separate the interconnecting bundles.

51. • The collagenous connective tissue supports the
muscle fibres and provides a transmission
network for the tension developed by
contraction of the smooth muscles elements.
• Around the bundles of smooth muscles cells are
blood and lymphatic vessels and nerve cells.
• The myometrial smooth muscle cells increase in
pregnancy up to 15-20 times their non pregnancy
length or from 0.05-0.6mm.

52. • The contractile ability of the myometrium is
dependent on the interaction between two
contractile proteins,actin and myosin.
• The interaction of actin and myosin brings about
contraction,whereas their separation brings
about relaxation under the influence of
intracellular free calcium.
• The coordination of synchronous contractions
across the whole organ is due to the presense of
the gap junctions that connect myometrial cells
and provide connections for electrical activity.

53. • Formation of gap junctions is promoted by
oestrogens and prostaglandins.
• Uterine activity can be measured as early as 7
wks gestation.
• Contractions facilitates uterine blood flow
through the intervillous spaces of the
placenta,promoting oxygen delivery to the
fetus.

54. • By the third trimester the contractions may
become more rhythmic and noticeable,and
may reach a pressure of 20-40mmHg occurin
every 10-20mins but usually cease with
walking and exercise.
• Braxiton Hicks contractions are usually
painless but may cause some discomfort when
their intensity exceeds 15mmHg,accounting
for the so called false-labour.

55. • Typically, in the last few wks of pregnancy
prelabour occurs,in which further increase in
myometrial contractions cause the muscle fibres
of the fundus to be drawn up.
• The actively contracting upper uterine segment
becomes thicker and shorter in length.
• The prelabour contractions allow the pacemaker
activity of the fundus to promote the
coordinated,fundal-dominant contractions
necessary for labour.

56. The perimetrium
• The perimetrium is a thin layer of peritoneum
that protects the uterus.
• It provides a relatively inelastic base upon
which the myometrium develops tension to
increase intrauterine pressure’
• It does not totally cover the uterus,being
deflected over the bladder anteriorly to form
the uterovesical pouch,and over the rectum
posteriorily to form the pouch of Douglas.

57. • The anterior and posterior folds open out so that
they are no longer in opposition and can
therefore accommodate the greatly enlarged
uterine and ovarian arteries and veins.
• The round ligaments(contained within the
hanging folds of perimetrium)provide some
anterior support for the enlarging uterus and
undergo considerable hypertrophy and stretching
during pregnancy,which may cause discomfort or
strain.

58. Blood supply
• As a result of increased cardiac output,the
uterine blood flow progressively increasses
almost tenfolds,from approximately 50ml/min at
10wks gestation and reaching a maximum of
450-700ml/min at term.
• 80% perfuses the placenta and 20% perfuses the
myometrium.
• The uterine arteries course along the lateral walls
of the uterus giving off 9-14 branches,each of
which penetrates the outer third of the
myometrium.

59. • As the uterus grows and stretches however
the uterine spiral arteries become greatly
increased in diameter and uncoiled to provide
the necessary extra length and to
accommodate the increased uteroplacental
blood flow.

60. 12 week of pregnancy
th
• By 12wks the uterus is about the size of a
grapefruit.
• It is no longer anteverted and anteflexed and has
risen out of the pelvis and become upright.
• The fundus may be palpated abdominally above
the symphysis pubis.
• The uterus usually inclines and rotates to the
right so that the left margin of the uterus faces
anteriorly.

61. 16 week of pregnancy
th
• By 16th week the fetus has grown enough to
put pressure on the isthmus,causing it to
unfold so that the uterus becomes more
spherical in shape.
• The isthmus and cervix develop into the lower
uterine segment,which is thinner and contains
less muscle and blood vessels than the corpus
and is the site of incision for the majority of
caeserian sections.

62. 20 week of pregnancy
th
• At 20 weeks the fundus of the uterus can be
palpated at the level of the umbilicus.
• From this stage of gestation until term the uterus
becomes more cylindrical or ovoid in shape and
has a thicker,more rounded,dome-shaped
fundus.
• As the uterus continues to rise in the
abdomen,the uterine tubes become
progressively more vertical,which causes
increasing tension on the broad and round
ligaments.

63. 30 week of pregnancy
th
• The lower uterine segment is still not
complete but can be defined as the portion
lying between the line of attachment of the
uterovesical pouch of peritoneum superiorly
and the internal os inferiorly.
• At 30 weeks the fundus may be palpated
mdway between the umbilicus and the
xiphisternum.

64. • Assessment of fetal size by abdominal palpation
has been reported to be inaccurate as there is
considerable variability in the site of the
umbilicus.
• Consequently symphysis-fundal height
measurements have become common practice.
• However,a recent trial compairing the two
methods found no differences in any of the
outcomes measured and concluded that there is
insufficient evidence to evaluate the use of
symphysis-fundal height measurement during
anc

65. 38 week of pregnancy
th
• The uterus now reaches the level of the
xiphisternum.
• The uterine tubes appear to be inserted slightly
above the middle of the uterus.
• As the upper segment muscle contractions
increase in frequency and strength the lower
uterine segment develops more rapidly and is
stretched radially which along with cervical
effacement and softening of the tissues of the
pelvic floor,permits the fetal presentations.

66. • This leads to reduction in fundal height known
as lightening releaving pressure on the upper
part of the abdomen but increasing pressure
in the pelvis,which may lead to
constipation,urinary frequency and
sometimes increased vaginal discharge.
• This also encourages further descent of the
fetus into the pelvis.

67. SKIN CHANGES DURING
PREGNANCY

68. SKIN CHANGES DURING PREGNANCY
• Skin changes will occurs from the third month
of pregnancy until full term.
• The changes which occurs are such as sudden
new glow on the face or pinkish,reddish
streaks on stomach,but not all every pregnant
women will experience skin changes.The skin
changes that are common during pregnancy
are

69. The skin changes that are common
during pregnancy are:
• Stretch marks,These are one of the most talked
about skin changes that can occur during
pregnancy. Almost 90% of pregnant women will
experience stretch marks. Stretch marks appear
as pinkish or reddish streaks running down your
abdomen and/or breasts.
• Exercising and applying lotions that contain
vitamin E and alpha hydroxy acids have been said
to help in the prevention of stretch marks.

70. Skin changes cont,
• Mask of pregnancy ,This also referred to as melasma and
chlosma. Melasma causes dark splotchy spots to appear on
your face. These spots most commonly appear on your
forehead and cheeks and are a result of increased
pigmentation.
• When you become pregnant your body produces more
hormones, which causes an increase in your pigmentation.
Nearly 50% of pregnant women show some signs of the
"mask of pregnancy".
• This is minimised or prevented by avoiding sun exposure.

71. Skin changes cont,
Acne If you have a problem with acne already,
your acne may become more irritated during
pregnancy. The extra hormones in your body
cause your oil glands to secrete more oil,
which can cause breakouts.
• This is reduced through keeping strict
cleansing routine. It is a good idea to use
fragrance free soap to avoid nausea. Cleanse
your face every night and every morning.

72. Skin changes cont,
• Linea nigra is the dark line that runs from your
navel to your pubic bone. This is a line that may
have always been there, but you may have never
noticed it before because it was a light color.
• During pregnancy this line darkens and is
possibly caused by the imbalance in hormones. It
usually appears around the fourth or fifth month
of pregnancy.
• After pregnancy this line will fade.

73. Skin changes cont,
• Skin tags,These are very small, loose growths
of skin that usually appear under your arms or
breasts.
• After pregnancy the skin tags may disappear.

74. •END