1)size :
• The height increases from 7.5 x 5 x 2.5 cm in
nonpregnant states to 35 x 25 x 20 cm at term
🔸
-i.e. the volume increase 1000 time
Due to estrogen & progesterone leading to
myometrium hypertrophy & hyperplasia
2)WEIGHT:
•Increases from 50 gm in nonpregnant state to 1000
gm at term
3)SHAPE :
•pyriform in the non-pregnant state
-becomes globular at 8th week
-till 14 weeks then become pyriformtill term .
• Sensory changes from compression of nerves 4)POSITION:
• Tension headaches •with ascent from the pelvis , the uterus usually
• Carpal tunnel syndrome due to edema undergoes rotation with tilting to theright 80% of
• Numbness and tingling related to postural changes cases (dextrorotation) due to the presence of the
rectosegmoid colon on the left side.
5)CONSISTENCY:
1. Headache It is relatively common, and attributed to intracranial vasodilatation becomes progressively softer due to :
caused by oestrogen and progesterone •i - Increased vascularity
• It is most troublesome in the second trimester, but may persist throughout pregnancy. •ii - Presence of amniotic fluid
• However, headache may be due to lack of sleep, or overwork.
• An analgesic is prescribed
6)CONTRACTILITY:
uterus •from the first trimester onwards , the uterus
2. Fainting: It results from lowering of blood pressure due to vasodilatation which
occur in pregnancy
Neurologic system undergoes irregular painless contractions (Braxton
Hicks contractions) .
3. Insomnia During pregnancy some women are sleepy and depressed, others may be
-They may cause some discomfort late in pregnancy
irritable and suffer insomnia
and may account for false labour pain
4.Carpal tunnel syndrome Caused by compression of the median nerve as it passes
through its fibrous tunnel at the wrist, as a result of fluid retention and oedema in
pregnancy There is tingling, numbness and burning sensation affecting the radial side 7)CAPACITY:
of the hand. increases from 4 ml in non-pregnant state to 4000 ml
at term
LEUCORRHOEA
•The normal vaginal discharge increases during pregnancy because of excess THE LOWER UTERINE SEGMENT
oestrogen . -Formation of the lower uterine segment (L.U.S.) from the isthmus and
•However, a pathological discharge, e.g., monilial infections which is common in lower half inch of the body
pregnancy must be excluded. (B) MYOMETRIAL CHANGES - Formation of lower uterine segment After 12 weeks, the isthmus
1- Hypertrophy (estrogen effect) rather than (0.5cm) starts to expand gradually to form the lower uterine segment
hyperplasia (progesterone effect) till 14th week, then which measures 10 cm in length at term
the fetus exerts adirect stretch OBSTETRICS SIGNIFICANCE OF THE LUS
Position: • 1. Site of lower segment cesarean section (LSCS)
•As the diaphragm is elevated progressively during • 2. Site of rupture in obstetric labor.
pregnancy the apex is displaced upwardsand to the • 3. Site of implantation of placenta previa
left so that it lies in the 4th intercostal space outside
the midclavicular line UTERINE BLOOD VESSELS
1 - Uterine artery lumen: is doubled and its blood
Pulse rate :
flow increases 5 times
•The resting pulse rate increases by 8 beats / min. (8
weeks) and 16 beats / min. (full term). 2 - Myometrial and decidual arteries (spiral
•Some episodes of ectopic beats reproductive arteries) undergo fibrinoid degeneration due to 2
• Water hummer pulse . system waves of trophoblastic migration , so they become
dilated to be the uteroplacental arteries
Murmurs CHANGES IN THE HEART
• Systolic functional murmurs develop in most of •Uterine blood flow increases progressively and
women( early systolic), but mid systolic murmurs may reaches about 500 ml / minute at term
occur they are thought to be due to functional
tricuspid regurgitation 1)- It becomes hypertrophied , soft “Goodells sign” and bluish in colour
“Chadwick sign” due to oedema and increased vascularity.
ECG CHANGES 2) - Soon after conception , a thick cervical secretion obstructs the cervical
• The main features of ECG may be attributed to the canal forming a mucous plug . Closing the cervical canal .
changes in the position of the heart. CERVIX 3) - The endocervical epithelium proliferates and everted forming cervical
• The axis undergoes left shift by 15 - 28 . ectopy (previously called erosion)
• The QRS complexes become of low voltage, and T Disappears spontaneously 3-6 months after delivery
wave becomes flattened. 4)- Cervical ripening mainly at the end of pregnancy due to edema and
decreased collagen caused by prostaglandins
• 1 - Cardiac output (C.O.P.) CARDIOVASCULAR SYSTEM
• Increased COP 40% is due to both increases stroke volume (main reason) & increased in the HR The vagina becomes soft , warm , moist with increased secretion and violet in
vagina colour (Chadwick's sign) due to increased vascularity
Cardiac output Distribution :
• 400 ml to the uterus
• 300 ml to the kidneys vulva •It becomes soft, violet in colour • Oedema and varicosities may develop
• 300 ml to skin
• 300 ml to GIT , breast & heart 1 - Both ovaries are enlarged due to increased vascularity and oedema
particularly the ovary which contains the corpus luteum .
2 - ARTERIAL BLOOD PRESSURE
• A.B.P. is decreased in midtrimester ( due to opening of arterio-venous shunt at the placenta) to increase again in 3rd trimester
physiological 2 - Corpus luteum continues to grow till 7 - 8 weeks , then it stops growing , It
becomes inactive and starts degeneration at 10th weeks (degeneration is
• This is due to:
• i - Decreased Peripheral resistance : (mainly affect diastolic B.P.)
changes in pregnancy completed after labour) Corpus luteum secretes •
1.Estrogen .2.Progesterone. 3.Relaxin hormone
ovaries
• ii - Supine hypotension
• iii - Decreased sensitivity of blood vessels to angiotensin II which is vasoconstrictor HAEMODYNAMIC
1 3 - Ovulation ceases during pregnancy due to pituitary inhibition by the high
CHANGES levels of oestrogen and progesterone • RelaxinIs a protein hormone.
VENA CAVA SYNDROME • Its exact role in pregnancy is unknown.
The posture of the pregnant woman affects arterial blood pressure. • It may induce softness and effacement of the cervix
• Typically, it is highest when she is sitting, lowest when lying in the lateral recumbent position and intermediate when supine.
PERIPHERAL VASODILATATION
•Peripheral Vasodilatation ↑ blood flow to the skin, particularly in the hands and feet generally giving the pregnant women a feeling of
warmth LOWER UTERINE SEGMENT UPPER UTERINE SEGMENT
•Peripheral Vasodilatation Increases the congestion of nasal mucosa leading to a common complaint of nasal obstruction and bleeding
(epistaxis)
3 - VENOUS PRESSURE
Increased venous pressure in the lower limbs Predisposes to : Oedema , varicose veins and piles Peritoneum Loosely- attached Firmly-attached
VALUES OF INCREASED BLOOD VOLUME
1 - Meets increased demands for uterus , baby .. etc
comparison 3 layers;
1)-outer longitudinal
2 - Protects against supine hypotension syndrome 2 layers; 2)-middle oblique(forms figures of 8-shaped
BLOOD VOLUME:
🔸
3 - Protects against fluid loss in labour
Increased blood volume more than the increase The total blood volume increases steadily fromearly
pregnancy to reach a maximum of 40% abovethe non-
Myometrium outer longitudinal and inner circular fibersaround the blood vessels to control
postpartum hemorrhage { living ligatures})
in red cell mass , leads to decreased blood
pregnant level by the end 32nd week of pregnancy The junction between the upper 3)-inner circular.
viscosity which leads to decrease in peripheral
resistance
uterine segment (U.U.S.) which is
PLASMA VOLUME: thick and the lower uterine segment Decidua Poorly-developed Well-developed
-Increases from 2500 ml to 3750ml by near term 45 %
(1250 in the 1st pregnancy) and 1500 ml in subsequent (L.U.S.) which is thin is called the
•DILUTIONAL ANEMIA OF PREGNANCY: pregnancies
•Lower hematocrit due to expansion of plasma blood Membranes Loosely- attached. Firmly-attached.
volume which is greater than the increase in red -The increase in plasma volume (45%) is more than the physiologic contraction ring at
blood cell mass increase in red blood cell mass (Hb mass) (25%)
resulting in haemodilution (physiologic anemia)& hyper
dynamic circulation (functional murmurs) the level of the symphysis pubis (not
•However, the minimal Hb. accepted is 10-11 gm% Passive, dilates, stretches and becomes thinner Active, contracts, retracts and becomes shorter
Activity
seen or felt) & longer during labour & thicker during labour.
RED BLOOD CELL MASS :
• Increases from 1400 ml (nonpregnant) to 1750 ml near
term by 25-30 % ( 350 ml) due to increased production
resulting from erythropoeitin or action of hCG or HPL .
• The increase is steady till full term.
1 - Decreased Hb % and RBCs % :
• Erythrocytes decrease from 4.5 million / mm3 to 3.7 million / mm3 (due
🔸
to the relative increase in plasma volume more than red cell mass) .
Hb concentrations falls from 14 gm / dl To 12 gm / dl.
2 - M.C.H.C : {The mean corpuscular hemoglobin} no change Hematological
3 - M.C.V. : {The mean corpuscular volume} decrease, ↑ or no change
(depending on the availability of Fe).
4- Fragility of R.B.Cs: ↑
5 - Reticulocytes : mild↑ BLOOD INDICES
6 - E.S.R : ↑ from 12 to 50 mm / hour
7 – Fibrinogen: ↑ from 200 - 400 mg / dl to 400 - 600 mg /
dl.
8 - White blood cells: ↑ (from 7.000 / mm3 to 10.500 / mm3 during
pregnancy and up to 16.000 / mm3 during labour
9 - Platelets: increase or decrease
10-Total plasma proteins : slightly decrease (mainly decrease
albumin) resulting in decrease osmotic pressure
• Platelets increases or decrease. (controversial).
• Fibrinogen doubled to 600 mg %
•Pregnancy is hypercoagulatable • Factor VIII tripled .
state.
•Increased risk for venous clothing
• Factor VII & factor X are doubled COAGULATION SYSTEM
• Factor XI & factor XIII slight increase
episodes • Fibrinolytic activity increase
Therefore pregnancy is a hypercoagulative state .
by fatema okoff
• The height increases from 7.5 x 5 x 2.5 cm in
nonpregnant states to 35 x 25 x 20 cm at term
🔸
-i.e. the volume increase 1000 time
Due to estrogen & progesterone leading to
myometrium hypertrophy & hyperplasia
2)WEIGHT:
•Increases from 50 gm in nonpregnant state to 1000
gm at term
3)SHAPE :
•pyriform in the non-pregnant state
-becomes globular at 8th week
-till 14 weeks then become pyriformtill term .
• Sensory changes from compression of nerves 4)POSITION:
• Tension headaches •with ascent from the pelvis , the uterus usually
• Carpal tunnel syndrome due to edema undergoes rotation with tilting to theright 80% of
• Numbness and tingling related to postural changes cases (dextrorotation) due to the presence of the
rectosegmoid colon on the left side.
5)CONSISTENCY:
1. Headache It is relatively common, and attributed to intracranial vasodilatation becomes progressively softer due to :
caused by oestrogen and progesterone •i - Increased vascularity
• It is most troublesome in the second trimester, but may persist throughout pregnancy. •ii - Presence of amniotic fluid
• However, headache may be due to lack of sleep, or overwork.
• An analgesic is prescribed
6)CONTRACTILITY:
uterus •from the first trimester onwards , the uterus
2. Fainting: It results from lowering of blood pressure due to vasodilatation which
occur in pregnancy
Neurologic system undergoes irregular painless contractions (Braxton
Hicks contractions) .
3. Insomnia During pregnancy some women are sleepy and depressed, others may be
-They may cause some discomfort late in pregnancy
irritable and suffer insomnia
and may account for false labour pain
4.Carpal tunnel syndrome Caused by compression of the median nerve as it passes
through its fibrous tunnel at the wrist, as a result of fluid retention and oedema in
pregnancy There is tingling, numbness and burning sensation affecting the radial side 7)CAPACITY:
of the hand. increases from 4 ml in non-pregnant state to 4000 ml
at term
LEUCORRHOEA
•The normal vaginal discharge increases during pregnancy because of excess THE LOWER UTERINE SEGMENT
oestrogen . -Formation of the lower uterine segment (L.U.S.) from the isthmus and
•However, a pathological discharge, e.g., monilial infections which is common in lower half inch of the body
pregnancy must be excluded. (B) MYOMETRIAL CHANGES - Formation of lower uterine segment After 12 weeks, the isthmus
1- Hypertrophy (estrogen effect) rather than (0.5cm) starts to expand gradually to form the lower uterine segment
hyperplasia (progesterone effect) till 14th week, then which measures 10 cm in length at term
the fetus exerts adirect stretch OBSTETRICS SIGNIFICANCE OF THE LUS
Position: • 1. Site of lower segment cesarean section (LSCS)
•As the diaphragm is elevated progressively during • 2. Site of rupture in obstetric labor.
pregnancy the apex is displaced upwardsand to the • 3. Site of implantation of placenta previa
left so that it lies in the 4th intercostal space outside
the midclavicular line UTERINE BLOOD VESSELS
1 - Uterine artery lumen: is doubled and its blood
Pulse rate :
flow increases 5 times
•The resting pulse rate increases by 8 beats / min. (8
weeks) and 16 beats / min. (full term). 2 - Myometrial and decidual arteries (spiral
•Some episodes of ectopic beats reproductive arteries) undergo fibrinoid degeneration due to 2
• Water hummer pulse . system waves of trophoblastic migration , so they become
dilated to be the uteroplacental arteries
Murmurs CHANGES IN THE HEART
• Systolic functional murmurs develop in most of •Uterine blood flow increases progressively and
women( early systolic), but mid systolic murmurs may reaches about 500 ml / minute at term
occur they are thought to be due to functional
tricuspid regurgitation 1)- It becomes hypertrophied , soft “Goodells sign” and bluish in colour
“Chadwick sign” due to oedema and increased vascularity.
ECG CHANGES 2) - Soon after conception , a thick cervical secretion obstructs the cervical
• The main features of ECG may be attributed to the canal forming a mucous plug . Closing the cervical canal .
changes in the position of the heart. CERVIX 3) - The endocervical epithelium proliferates and everted forming cervical
• The axis undergoes left shift by 15 - 28 . ectopy (previously called erosion)
• The QRS complexes become of low voltage, and T Disappears spontaneously 3-6 months after delivery
wave becomes flattened. 4)- Cervical ripening mainly at the end of pregnancy due to edema and
decreased collagen caused by prostaglandins
• 1 - Cardiac output (C.O.P.) CARDIOVASCULAR SYSTEM
• Increased COP 40% is due to both increases stroke volume (main reason) & increased in the HR The vagina becomes soft , warm , moist with increased secretion and violet in
vagina colour (Chadwick's sign) due to increased vascularity
Cardiac output Distribution :
• 400 ml to the uterus
• 300 ml to the kidneys vulva •It becomes soft, violet in colour • Oedema and varicosities may develop
• 300 ml to skin
• 300 ml to GIT , breast & heart 1 - Both ovaries are enlarged due to increased vascularity and oedema
particularly the ovary which contains the corpus luteum .
2 - ARTERIAL BLOOD PRESSURE
• A.B.P. is decreased in midtrimester ( due to opening of arterio-venous shunt at the placenta) to increase again in 3rd trimester
physiological 2 - Corpus luteum continues to grow till 7 - 8 weeks , then it stops growing , It
becomes inactive and starts degeneration at 10th weeks (degeneration is
• This is due to:
• i - Decreased Peripheral resistance : (mainly affect diastolic B.P.)
changes in pregnancy completed after labour) Corpus luteum secretes •
1.Estrogen .2.Progesterone. 3.Relaxin hormone
ovaries
• ii - Supine hypotension
• iii - Decreased sensitivity of blood vessels to angiotensin II which is vasoconstrictor HAEMODYNAMIC
1 3 - Ovulation ceases during pregnancy due to pituitary inhibition by the high
CHANGES levels of oestrogen and progesterone • RelaxinIs a protein hormone.
VENA CAVA SYNDROME • Its exact role in pregnancy is unknown.
The posture of the pregnant woman affects arterial blood pressure. • It may induce softness and effacement of the cervix
• Typically, it is highest when she is sitting, lowest when lying in the lateral recumbent position and intermediate when supine.
PERIPHERAL VASODILATATION
•Peripheral Vasodilatation ↑ blood flow to the skin, particularly in the hands and feet generally giving the pregnant women a feeling of
warmth LOWER UTERINE SEGMENT UPPER UTERINE SEGMENT
•Peripheral Vasodilatation Increases the congestion of nasal mucosa leading to a common complaint of nasal obstruction and bleeding
(epistaxis)
3 - VENOUS PRESSURE
Increased venous pressure in the lower limbs Predisposes to : Oedema , varicose veins and piles Peritoneum Loosely- attached Firmly-attached
VALUES OF INCREASED BLOOD VOLUME
1 - Meets increased demands for uterus , baby .. etc
comparison 3 layers;
1)-outer longitudinal
2 - Protects against supine hypotension syndrome 2 layers; 2)-middle oblique(forms figures of 8-shaped
BLOOD VOLUME:
🔸
3 - Protects against fluid loss in labour
Increased blood volume more than the increase The total blood volume increases steadily fromearly
pregnancy to reach a maximum of 40% abovethe non-
Myometrium outer longitudinal and inner circular fibersaround the blood vessels to control
postpartum hemorrhage { living ligatures})
in red cell mass , leads to decreased blood
pregnant level by the end 32nd week of pregnancy The junction between the upper 3)-inner circular.
viscosity which leads to decrease in peripheral
resistance
uterine segment (U.U.S.) which is
PLASMA VOLUME: thick and the lower uterine segment Decidua Poorly-developed Well-developed
-Increases from 2500 ml to 3750ml by near term 45 %
(1250 in the 1st pregnancy) and 1500 ml in subsequent (L.U.S.) which is thin is called the
•DILUTIONAL ANEMIA OF PREGNANCY: pregnancies
•Lower hematocrit due to expansion of plasma blood Membranes Loosely- attached. Firmly-attached.
volume which is greater than the increase in red -The increase in plasma volume (45%) is more than the physiologic contraction ring at
blood cell mass increase in red blood cell mass (Hb mass) (25%)
resulting in haemodilution (physiologic anemia)& hyper
dynamic circulation (functional murmurs) the level of the symphysis pubis (not
•However, the minimal Hb. accepted is 10-11 gm% Passive, dilates, stretches and becomes thinner Active, contracts, retracts and becomes shorter
Activity
seen or felt) & longer during labour & thicker during labour.
RED BLOOD CELL MASS :
• Increases from 1400 ml (nonpregnant) to 1750 ml near
term by 25-30 % ( 350 ml) due to increased production
resulting from erythropoeitin or action of hCG or HPL .
• The increase is steady till full term.
1 - Decreased Hb % and RBCs % :
• Erythrocytes decrease from 4.5 million / mm3 to 3.7 million / mm3 (due
🔸
to the relative increase in plasma volume more than red cell mass) .
Hb concentrations falls from 14 gm / dl To 12 gm / dl.
2 - M.C.H.C : {The mean corpuscular hemoglobin} no change Hematological
3 - M.C.V. : {The mean corpuscular volume} decrease, ↑ or no change
(depending on the availability of Fe).
4- Fragility of R.B.Cs: ↑
5 - Reticulocytes : mild↑ BLOOD INDICES
6 - E.S.R : ↑ from 12 to 50 mm / hour
7 – Fibrinogen: ↑ from 200 - 400 mg / dl to 400 - 600 mg /
dl.
8 - White blood cells: ↑ (from 7.000 / mm3 to 10.500 / mm3 during
pregnancy and up to 16.000 / mm3 during labour
9 - Platelets: increase or decrease
10-Total plasma proteins : slightly decrease (mainly decrease
albumin) resulting in decrease osmotic pressure
• Platelets increases or decrease. (controversial).
• Fibrinogen doubled to 600 mg %
•Pregnancy is hypercoagulatable • Factor VIII tripled .
state.
•Increased risk for venous clothing
• Factor VII & factor X are doubled COAGULATION SYSTEM
• Factor XI & factor XIII slight increase
episodes • Fibrinolytic activity increase
Therefore pregnancy is a hypercoagulative state .
by fatema okoff
