1 - Persistence of basal body temperature (BBT) elevation beyond the expected
day of menstruation (due to increased progesterone). ANATOMICALLY
2 - Spider telangiectasis & palmar erythema due to increased estrogen or The enlarged uterus displaces the diaphragm up to
cutaneous vasodilatation 4 cm
3 - Cutaneous vasodilatation (hyperaemia) leads to : This result in :
i - Masks pallor due to anaemia with or without palmar erythema . 1. The diaphragmatic mobility is reduced and
B) BREAST SIGNS:
ii - increased Glandular activities (sweat & sebaceous glands). respiration becomes mainly thoracic ( dyspnea) .
i - First month : increased size & vascularity (dilated veins)
iii - Sensation of heat and nasal congestion 2. Total lung capacity is reduced by 5%.
, mastodyniamay be present which ranges from tingling to
4 - Pigmentation due to increased estrogen or melanocyte stimulating hormone 3. The subcostal angle increases and the transverse
frank pain due to hormonal responses of the mammary
MSH or ACTH diameter of the chest expands
ducts and alveolar system
ii - Second month : increased pigmentation of the nipple & • In the face = chloasma gravidarom = mask of pregnancy abutterfly pigmentation
areola and prominence of Montgomery tubercles on the cheeks and nose . It usually disappears few months after labour . RESPIRATORY FUNCTIONS
•In abdomen: Linea Nigra= pigmentation in midline below the umbilicus
(nonpigmented nodules around the primary areola (12 - 20)
•Stria gravidarum pigmentation (Stretch Marks) in the lower abdomen , flanks ,
skin changes -The respiratory rate does not increase during
Montgomery tubercles They were thought to be enlarged pregnancy from its normal rate of 14 - 15 / minute.
sebaceous glands, but recently they are found to be the inner thighs , buttocks & breast and increase as pregnancy advances It starts bluish -Total pulmonary resistance is reduced due to
(stria rubra) , then becomes pale to become white (stria albicans) after delivery ,
lips of orifices of peripheral active lacteal ducts
which persists (primigravida has stria rubra only ,while multigravida has both S.R and Respiratory system progesterone effect
iii - Third month : secretion of colostrum like fluid (thick -A state of hyperventilation occurs during
yellowish fluid) which can be expressed from the nipple S.A) pregnancy leading to increase in tidal volume and
iv - Fourth month : a pigmented area appears around the It may be due to mechanical stretching or increased glucocorticoids which results in respiratory minute volume by 40% so the woman
primary areola called the secondary areola rupture of the subcutaneous elastic fibers in the dermis and exposure of the feels shortness of breath
vascular subcutaneous tissues .
5 - Secretions increase in sweat and sebaceous glands activity
6-Lower limbs signs THE VITAL CAPACITY
i - Edema : bilateral and pitting 1.The inspiratory capacity is increased by 10%
ii - Varicose veins 2.The expiratory reserve volume (maximum amount
of air which can be expired after normal
expiration) is reduced
3.The residual volume is reduced .
ANTERIOR PITUITARY The hyperventilation causes change in theacid-
i - Increase in size more than increase in vascularity . This renders anterior base balance.The arterial pCO2 is decrease while
pituitary liable for ischemia arterial PO2 rised these facilitate transfer of CO2
ii - Pregnancy cell (modified chromophobe) appears due to increased from fetus to mother and O2 from mother to fetus.
hCG .
iii - Prolactin level increases up to 150 ng /ml at term to ensure lactation
POSTERIOR PITUITARY KIDNEY AND KIDNEY FUNCTION TESTS
Does not hypertrophy , but increase its oxytocin secretion near term • Renal blood flow and glomerular filtration rate increases by 50 % .
-This leads to increased excretion glucosuria {the renaltubules can not
THYROID GLAND reabsorb the extra amount of filtered glucose physiological glucosuria}
There is diffuse slight enlargement of the gland • Therefore:
physiology Goiter . Due to :Increased thyroid binding globulin (TBG) , 1. There is decrease serum creatinine (due to ↑ creatinine clearance) , the same
BMR INCREASED by 20 % above normal , Increased total T3 , protein for uric acid.
bound iodine and TSH. 2.decrease blood urea
Therefore , in interpretating the results of kidney function test you should take
PARATHYROID GLAND into consideration that the highest normal values in pregnancy = the lowest
Increased in size and activity to regulated calcium metabolism normal values in non- pregnant state
Parathyroid hormone is Increased which lead to increases of calcium
uptake in the gut and reabsorption by the kidney. Endocrine system URETERS
urinary system
SUPRARENAL GLAND physiological Dilatation of the ureters and renal pelvis due to :
i - Relaxation of the ureters by the effect of progesterone & relaxin .
Increased in size and activityHypertrophy particularly the cortex resulting
in increased glucocorticoids (cortisone) and increased mineralocorticoids changes in ii - Pressure against the pelvic brim by the uterus particularly on the right side
due to dextroposed uterus and dilatation of the right ovarian vessels
(aldosterone)
pregnancy BLADDER AND URETHRA
PLACENTA FUNCTION
all placental hormones are secreted by the syncytium and include the 2 • Frequency of micturition in early pregnancy due to :
i - Pressure on the bladder by the enlarged uterus
following: ii - Congestion of the bladder muscosa .
•Steroid hormone: Estrogen { oestriol 90%} and progesterone Frequency of micturition in late pregnancy due to: engagement of the head
•Hypothalamic like hormones: GTRH , Corticotrophin releasing
hormone, thyrotrophin-releasing hormone, and growth hormone releasing
hormone.
•Pituitary like hormones: GINGIVITIS
Human chorionic gonadotropin(HCG) There is increased vascularity and tendency for bleeding as
Human placental lactogen(HPL) well as hypertrophy of the interdental papillae
Pregnancy specific B-glycoprotein(PS B1G) • The gums may become hyperemic and soft and may bleed
Human chorionic thyrotrophin(HCT) PTYALISM
when mildly traumatized, as with a tooth brush. • It is excessive salivation which is more common
Chorionic corticotropDhin
Melanocyte-stimulating hormone
Relaxine.
🔸
• Epulis of pregnancy may develop.
Treated by dental hygiene and cryosurgery for severe
cases
in association with oral sepsis .
• It is due to failure to swallow saliva and not due
Inhibin and activin. to increase in amount.
Leptin: play role in fetal growth and development. • Smoking is stopped and anticholinergic drugs
Production of enzymes: as histaminase, oxytocinase & insulinase. may help
Hemopoietic : it forms fetal Hb.Barrier action.Production of proteins
WEIGHT GAIN : APPETITE CHANGES
The average weight gain in pregnancy is 10 - 12 kg The increase occurs • The pregnant woman dislikes some foods and
mainly in the second and third trimester at a rate of 350 - 400 gm/ week odours while desires others
NAUSEA AND VOMITING
Out of the 11 kg weight gain 6 kg is composed of maternal tissues • Reduced sensitivity of the taste buds during
Nausea (morning sickness) and vomiting (emesis
(breast, fat, blood and uterine tissues), and 5 kg of fetal tissue , placenta pregnancy creates the desire for markedly sweet,
gravidarum) occur in early months
and amniotic fluid sour , or salt foods .(pica) Deviation may be so
extreme to the extent of eating blackboard chalk ,
WATER METABOLISM coal or mud
There is tendency to water retention secondary to sodium retention
HEART BURN
PROTEIN METABOLISM Due to reflux of acidic gastric contents to the
There is tendency for nitrogen retention (+ ve nitrogen balance) with oesophagus
increased binding globulins produced by liver for fetal and maternal The treatment includes :
tissue formation gastrointestinal system & liver INDIGESTION AND FLATULENCE (a) small frequent meals to prevent over distension
This is probably due to :
of the stomach
i - Decreased gastric acidity caused by regurgitation of (b) avoid fatty foods, chocolate, and smoking, as
CARBOHYDRATE METABOLISM Metabolic changes alkaline secretion from the intestine to the stomach .
Pregnancy is potentially diabetogenic due to Placental hormones (HPL, these relax the lower esophageal sphincter.
ii - Decreased gastric motility (progesterone effect) (c) the bed should be raised at the head (15-20
estrogen E, and progesterone )Alimentary glucosuria ( due to rapid
absorption of glucose from the GIT) may occur in early pregnancy .- cm), and an extra pillow is used.
Renal glucosuria ( due to increase loss of glucose in urine ) may occur in (d) Antacid Preparations containing aluminium
the middle of pregnancyLower fasting blood glucose ( due to transfer of hydroxide are favoured
glucose to the fetus) fasting hypoglycemia
CONSTIPATION GALL STONES
FAT METABOLISM Constipation due to : More tendency to stone formation due to atony
There is increase of plasma lipids(increased lipolysis to deliver more free i - Reduced motility of large intestine (progesterone and delayed emptying of the gall bladder.
fatty acids to the fetus) with tendency to acidosis (HPL action) effect).
ii - Increased water reabsorption from large intestine HAEMORROIDS
MINERAL METABOLISM (aldosterone effect). due :
There is increased demand for iron , calcium , phosphate and iii - Pressure on the pelvic colon by the pregnant uterus. i - Mechanical pressure on the pelvic veins.
magnesium& iodides iv - Sedentary life during pregnancy ii - Laxity of the walls of the veins by progesterone
iii - Constipation
APPENDIX:
by fatema okoff Is displaced upwards and laterally (pain and tenderness due
to appendicitis is higher than in nonpregnant state)
day of menstruation (due to increased progesterone). ANATOMICALLY
2 - Spider telangiectasis & palmar erythema due to increased estrogen or The enlarged uterus displaces the diaphragm up to
cutaneous vasodilatation 4 cm
3 - Cutaneous vasodilatation (hyperaemia) leads to : This result in :
i - Masks pallor due to anaemia with or without palmar erythema . 1. The diaphragmatic mobility is reduced and
B) BREAST SIGNS:
ii - increased Glandular activities (sweat & sebaceous glands). respiration becomes mainly thoracic ( dyspnea) .
i - First month : increased size & vascularity (dilated veins)
iii - Sensation of heat and nasal congestion 2. Total lung capacity is reduced by 5%.
, mastodyniamay be present which ranges from tingling to
4 - Pigmentation due to increased estrogen or melanocyte stimulating hormone 3. The subcostal angle increases and the transverse
frank pain due to hormonal responses of the mammary
MSH or ACTH diameter of the chest expands
ducts and alveolar system
ii - Second month : increased pigmentation of the nipple & • In the face = chloasma gravidarom = mask of pregnancy abutterfly pigmentation
areola and prominence of Montgomery tubercles on the cheeks and nose . It usually disappears few months after labour . RESPIRATORY FUNCTIONS
•In abdomen: Linea Nigra= pigmentation in midline below the umbilicus
(nonpigmented nodules around the primary areola (12 - 20)
•Stria gravidarum pigmentation (Stretch Marks) in the lower abdomen , flanks ,
skin changes -The respiratory rate does not increase during
Montgomery tubercles They were thought to be enlarged pregnancy from its normal rate of 14 - 15 / minute.
sebaceous glands, but recently they are found to be the inner thighs , buttocks & breast and increase as pregnancy advances It starts bluish -Total pulmonary resistance is reduced due to
(stria rubra) , then becomes pale to become white (stria albicans) after delivery ,
lips of orifices of peripheral active lacteal ducts
which persists (primigravida has stria rubra only ,while multigravida has both S.R and Respiratory system progesterone effect
iii - Third month : secretion of colostrum like fluid (thick -A state of hyperventilation occurs during
yellowish fluid) which can be expressed from the nipple S.A) pregnancy leading to increase in tidal volume and
iv - Fourth month : a pigmented area appears around the It may be due to mechanical stretching or increased glucocorticoids which results in respiratory minute volume by 40% so the woman
primary areola called the secondary areola rupture of the subcutaneous elastic fibers in the dermis and exposure of the feels shortness of breath
vascular subcutaneous tissues .
5 - Secretions increase in sweat and sebaceous glands activity
6-Lower limbs signs THE VITAL CAPACITY
i - Edema : bilateral and pitting 1.The inspiratory capacity is increased by 10%
ii - Varicose veins 2.The expiratory reserve volume (maximum amount
of air which can be expired after normal
expiration) is reduced
3.The residual volume is reduced .
ANTERIOR PITUITARY The hyperventilation causes change in theacid-
i - Increase in size more than increase in vascularity . This renders anterior base balance.The arterial pCO2 is decrease while
pituitary liable for ischemia arterial PO2 rised these facilitate transfer of CO2
ii - Pregnancy cell (modified chromophobe) appears due to increased from fetus to mother and O2 from mother to fetus.
hCG .
iii - Prolactin level increases up to 150 ng /ml at term to ensure lactation
POSTERIOR PITUITARY KIDNEY AND KIDNEY FUNCTION TESTS
Does not hypertrophy , but increase its oxytocin secretion near term • Renal blood flow and glomerular filtration rate increases by 50 % .
-This leads to increased excretion glucosuria {the renaltubules can not
THYROID GLAND reabsorb the extra amount of filtered glucose physiological glucosuria}
There is diffuse slight enlargement of the gland • Therefore:
physiology Goiter . Due to :Increased thyroid binding globulin (TBG) , 1. There is decrease serum creatinine (due to ↑ creatinine clearance) , the same
BMR INCREASED by 20 % above normal , Increased total T3 , protein for uric acid.
bound iodine and TSH. 2.decrease blood urea
Therefore , in interpretating the results of kidney function test you should take
PARATHYROID GLAND into consideration that the highest normal values in pregnancy = the lowest
Increased in size and activity to regulated calcium metabolism normal values in non- pregnant state
Parathyroid hormone is Increased which lead to increases of calcium
uptake in the gut and reabsorption by the kidney. Endocrine system URETERS
urinary system
SUPRARENAL GLAND physiological Dilatation of the ureters and renal pelvis due to :
i - Relaxation of the ureters by the effect of progesterone & relaxin .
Increased in size and activityHypertrophy particularly the cortex resulting
in increased glucocorticoids (cortisone) and increased mineralocorticoids changes in ii - Pressure against the pelvic brim by the uterus particularly on the right side
due to dextroposed uterus and dilatation of the right ovarian vessels
(aldosterone)
pregnancy BLADDER AND URETHRA
PLACENTA FUNCTION
all placental hormones are secreted by the syncytium and include the 2 • Frequency of micturition in early pregnancy due to :
i - Pressure on the bladder by the enlarged uterus
following: ii - Congestion of the bladder muscosa .
•Steroid hormone: Estrogen { oestriol 90%} and progesterone Frequency of micturition in late pregnancy due to: engagement of the head
•Hypothalamic like hormones: GTRH , Corticotrophin releasing
hormone, thyrotrophin-releasing hormone, and growth hormone releasing
hormone.
•Pituitary like hormones: GINGIVITIS
Human chorionic gonadotropin(HCG) There is increased vascularity and tendency for bleeding as
Human placental lactogen(HPL) well as hypertrophy of the interdental papillae
Pregnancy specific B-glycoprotein(PS B1G) • The gums may become hyperemic and soft and may bleed
Human chorionic thyrotrophin(HCT) PTYALISM
when mildly traumatized, as with a tooth brush. • It is excessive salivation which is more common
Chorionic corticotropDhin
Melanocyte-stimulating hormone
Relaxine.
🔸
• Epulis of pregnancy may develop.
Treated by dental hygiene and cryosurgery for severe
cases
in association with oral sepsis .
• It is due to failure to swallow saliva and not due
Inhibin and activin. to increase in amount.
Leptin: play role in fetal growth and development. • Smoking is stopped and anticholinergic drugs
Production of enzymes: as histaminase, oxytocinase & insulinase. may help
Hemopoietic : it forms fetal Hb.Barrier action.Production of proteins
WEIGHT GAIN : APPETITE CHANGES
The average weight gain in pregnancy is 10 - 12 kg The increase occurs • The pregnant woman dislikes some foods and
mainly in the second and third trimester at a rate of 350 - 400 gm/ week odours while desires others
NAUSEA AND VOMITING
Out of the 11 kg weight gain 6 kg is composed of maternal tissues • Reduced sensitivity of the taste buds during
Nausea (morning sickness) and vomiting (emesis
(breast, fat, blood and uterine tissues), and 5 kg of fetal tissue , placenta pregnancy creates the desire for markedly sweet,
gravidarum) occur in early months
and amniotic fluid sour , or salt foods .(pica) Deviation may be so
extreme to the extent of eating blackboard chalk ,
WATER METABOLISM coal or mud
There is tendency to water retention secondary to sodium retention
HEART BURN
PROTEIN METABOLISM Due to reflux of acidic gastric contents to the
There is tendency for nitrogen retention (+ ve nitrogen balance) with oesophagus
increased binding globulins produced by liver for fetal and maternal The treatment includes :
tissue formation gastrointestinal system & liver INDIGESTION AND FLATULENCE (a) small frequent meals to prevent over distension
This is probably due to :
of the stomach
i - Decreased gastric acidity caused by regurgitation of (b) avoid fatty foods, chocolate, and smoking, as
CARBOHYDRATE METABOLISM Metabolic changes alkaline secretion from the intestine to the stomach .
Pregnancy is potentially diabetogenic due to Placental hormones (HPL, these relax the lower esophageal sphincter.
ii - Decreased gastric motility (progesterone effect) (c) the bed should be raised at the head (15-20
estrogen E, and progesterone )Alimentary glucosuria ( due to rapid
absorption of glucose from the GIT) may occur in early pregnancy .- cm), and an extra pillow is used.
Renal glucosuria ( due to increase loss of glucose in urine ) may occur in (d) Antacid Preparations containing aluminium
the middle of pregnancyLower fasting blood glucose ( due to transfer of hydroxide are favoured
glucose to the fetus) fasting hypoglycemia
CONSTIPATION GALL STONES
FAT METABOLISM Constipation due to : More tendency to stone formation due to atony
There is increase of plasma lipids(increased lipolysis to deliver more free i - Reduced motility of large intestine (progesterone and delayed emptying of the gall bladder.
fatty acids to the fetus) with tendency to acidosis (HPL action) effect).
ii - Increased water reabsorption from large intestine HAEMORROIDS
MINERAL METABOLISM (aldosterone effect). due :
There is increased demand for iron , calcium , phosphate and iii - Pressure on the pelvic colon by the pregnant uterus. i - Mechanical pressure on the pelvic veins.
magnesium& iodides iv - Sedentary life during pregnancy ii - Laxity of the walls of the veins by progesterone
iii - Constipation
APPENDIX:
by fatema okoff Is displaced upwards and laterally (pain and tenderness due
to appendicitis is higher than in nonpregnant state)
