Maternal

Physiology

By: Rachmad
Reproductive Tract

Breast

Skin

Metabolic Changes

Hematological changes

Cardiovascular System
Respiratory Tract

Urinary System

Gastrointestinal Tract

Endocrine System

Musculoskeletal System

Central Nervous System

 Reproductive Tract
Uteru
s
Non Pregnant woman 70 gr with cavity
of 10 ml or less.
Early in pregnancy estrogen and
perhaps progesterone.
12 weeks the expanding products of
conception
For the first few weeks pear shape.
And almost spherical by 12weeksgestation
Cervix
1 month after conception softening and
cyanosis.
By increased vascularity and edema of the entire
cervix, together with hypertrophy and hyperplasia of
the cervical glands.
The endocervical mucosa cells produce copious
tenacious mucus immunoglobulins and
cytokines to protect the uterine contents against
infection.
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 7weeks of pregnancy and thereafter
contributes relatively little to progesterone
production.
 Fallopian Tubes

During pregnancy little hypertrophy.

Vagina and Perineum
During pregnancy vascularity and
hyperemia softening of the underlying
abundant connective tissue.
Increased vascularity prominently affects
the vagina and results in the violet color
characteristic of Chadwick sign.
 The vaginal walls undergo striking changes
in preparation for the distention that
accompanies labor and delivery.
Increased volume of cervical secretions
white discharge 3.5 to 6 lactic
acid lactobacillus acidophilus.
Breasts
Early weeks of pregnancy tenderness and
paresthesias.
Second month the breasts increase in size,
and delicate veins become visible just beneath
the skin. The nipples become considerably
larger, more deeply pigmented, and more
erectile.
Prepregnancy breast size and volume of milk
production do not correlate.
 Skin
Midpregnancy slightly depressed streaks
commonly develop in the abdominal skin and
sometimes in the skin over the breasts and
thighs striae gravidarum or stretch
marks
Risk factors weight gain during pregnancy,
younger maternal age, and family history.
The etiology of striae gravidarum is unknown,
and there are no definitive treatments.
 Hyperpigmentation a darker complexion
The midline of the anterior abdominal wall skin
(linea alba) linea nigra.
face and neck chloasma / melasma
gravidarum mask of pregnancy.
Pigmentation of the areolae and genital skin
may also be accentuated.
 These pigmentary changes usually
disappear after delivery.
levels of melanocyte-stimulating
hormone are elevated remarkably
through- out pregnancy.
Estrogen and progesterone also are
reported to have melanocyte-
stimulating effects.
 Metabolic Changes

WHO 77,000 kcal or 85kcal/day,

285 kcal/day, and 475kcal/day during
the first, second, and third trimester.
Increase weight during pregnancy
the uterus and its contents, the breasts,
and increases in blood volume and
extravascular extracellular fluid.
 Hytten reported that the average
weight gain during pregnancy is
approximately 12.5 kg or 27.5 lb .
Increased water retention
physiological
By a fall in plasma osmolality of
approximately 10 mOsm/kg induced by
a resetting of osmotic thresholds for
thirst and vasopressin secretion
 At term, the water content of the fetus,
placenta, and amnionic fluid
approximates 3.5 L.
Another 3.0 L accumulates from
increases in maternal blood volume and
in the size of the uterus and breasts.
the average woman accrues during
normal pregnancy is approximately 6.5
L.
 pitting edema of the ankles and legs is
seen in most pregnant women,
especially at the end of the day.
This fluid accumulation, which may
amount to a liter or so, is caused by
increased venous pressure below the
level of the uterus as a consequence of
partial vena cava occlusion.
 The products of conception, the uterus, and
maternal blood are relatively rich in protein
rather than fat or carbohydrate.
At term, the fetus and placenta together 4
kg and contain approximately 500 g of protein
or about half of the total pregnancy increase.
 The remaining 500 g is added to the uterus as
contractile protein, to the breasts primarily in
the glands, and to maternal blood as
hemoglobin and plasma proteins.
 Normal pregnancy is characterized by
mild fasting hypoglycemia, postprandial
hyperglycemia, and hyperinsulinemia.
Response is consistent with a pregnancy
induced state of peripheral insulin
resistance.
The mechanism(s) responsible for
insulin resistance is not completely
understood.
 The concentrations of lipids, lipoproteins, and
apolipoproteins in plasma increase.
Enhanced lipolytic activity, and decreased
lipoprotein lipase activity.
During the third trimester, average total serum
cholesterol, LDL- C, HDL-C, and triglyceride
levels are approximately 267 30 mg/dL, 136
33 mg/dL, 81 17 mg/dL, and 245 73 mg/ dL.
 During normal pregnancy, nearly 1000
mEq of sodium and 300mEq of
potassium
tubular resorption.
Total serum calcium levels lowered
plasma albumin concentrations and, in
turn, a consequent decrease in the
amount of circulating protein- bound
nonionized calcium.
Hematological changes
Hypervolemia 40 to 45 % after
32 to 34 weeks.
The metabolic demands of the enlarged
uterus and its greatly hypertrophied
vascular system.
Provides abundant nutrients and
elements to support the rapidly growing
placenta and fetus.
 Protects the mother, and in turn the
fetus, against the deleterious effects of
impaired venous return in the supine
and erect positions.
Safeguards the mother against the
adverse effects of parturition-associated
blood loss.
 Because of great plasma augmentation,
hemoglobin and hematocrit decrease.
Hemoglobin 12.5 g/dL
HB 11.0 g/dL abnormal iron
deficiency rather than hypervolemia.
Leukosit 25,000/L or more.
Average 14,000 to 16,000/L unknown
 Platelet 213,000/L.
Decreased platelet concentrations are
partially due to hemodilutional effects.
 Cardiovascular System

Changes in cardiac function the first

8 weeks of pregnancy.
Cardiac output is increased the fifth
week and reflects a reduced systemic
vascular resistance and an increased
heart rate.
 The heart left and upward and is
rotated on its long axis.
Supine compression of the great vessels
by the uterus causes significant arterial
hypotension supine hypotensive
syndrome
Uterine arterial is significantly lower
than that in the brachial artery.
 Respiratory Tract
The diaphragm rises about 4 cm during
pregnancy.
This physiological dyspnea, which
should not interfere with normal
physical activity, increased tidal
volume that lowers the blood Pco2.
 Urinary System

Kidney size increases approximately 1.5

cm.
GFR and renal plasma flow increase
early in pregnancy increases 25 %
(second week after conception) and 50
% (the second trimester).
 Serum creatinine decrease 0.7 to
0.5 mg/dL.
Values of 0.9 mg/dL underlying renal
disease evaluation.
Gastrointestinal Tract
As pregnancy progresses the stomach
and intestines are displaced by the
enlarging uterus.
The appendix displaced upward and
somewhat laterally as the uterus
enlarges, at times, it may reach the
right flank.
 Hemorrhoids common constipation
and elevated pressure in veins below
the level of the enlarged uterus.
 Endocrine System
Pituitary enlargement is primarily caused by
estrogen-stimulated hypertrophy and
hyperplasia of the lactotrophs
 the thyroid gland to increase production
of thyroid hormones by 40 to 100
percent to meet maternal and fetal
needs
caused by glandular hyperplasia and
increased vascularity.
Musculoskeletal System
Lordosis normal .
Compensating for the anterior position
of the enlarging uterus shifts the
center of gravity back over the lower
extremities.
Central Nervous System

Reportedproblems with attention,

concentration, and memory .
 Intraocular pressure decreases during
pregnancy
Corneal sensitivity is decreased
Increase in corneal thickness
 Beginning as early as approximately 12
weeks gestation and extending through
the first 2 months postpartum, women
have difficulty with going to sleep,
frequent awakenings, fewer hours of
night sleep, and reduced sleep
efficiency