1. CHANGES IN THE RESPIRATORY SYSTEM

2. CHANGES IN THE RESPIRATORY SYSTEM
• The shape of the chest changes and the
circumference increases in pregnancy by 6 cm.
• As the uterus enlarges the diaphragm is elevated
as much as 4 cm, and the rib cage is displaced
upwards.
• The lower ribs flare out and may not always fully
recover their original position after pregnancy .

3. • There is a progressive increase in oxygen
consumption, which is caused by the increased
metabolic needs of the mother and fetus.
• Progesterone causes an increase in the sensitivity
of the respiratory center to stimulation by carbon
dioxide.

4. • Hyperventilation (over breathing) can lead to
discomfort, dyspnea and dizziness.
• Women may complain of shortness of breath,
when their need to breathe become a conscious
one.

5. • The stress on respiratory system, imposed by
pregnancy, is very little in comparison with the
cardiovascular system.
• The changes however, can cause some discomfort
or inconvenience to the pregnant woman and
diseases of the respiratory tract may be more
serious during pregnancy.

6. CHANGES IN THE URINARY
SYSTEM

7. CHANGES IN THE URINARY
SYSTEM
• Renal blood flow increases by as much as 70-80
percent by the second trimester .
• After 30 weeks it decreases slowly although it is still
above non-pregnant levels at term.
• The kidneys enlarge and glomerular filtration
increases The increase is maintained throughout the
second trimester but decreases significantly during
the last weeks of pregnancy.

8. • Plasma levels of urea, uric acid and creati- nine
fall in pregnancy although uric acid level return
to non-pregnant level in late pregnancy
• Glucose excretion increases as a result of
increased glomerular filtration rate of glucose
Glycosuria is therefore quite common in
pregnancy and is not usually related to a high
blood glucose level.

9. • Glycosuria can be a cause, of urinary tract infection.
It should, however, be monitored to exclude diabetes
mellitus.
• The urine of pregnant women is more alkaline due to
the alkalemia of pregnancy
• In early pregnancy, increased production of urine
causes frequency of micturition.
• In later pregnancy, frequency is caused by pressure
of the growing uterus on the bladder.

10. • The ureters become relaxed, and are dilated,
elongated and curved above the brim of the
pelvis due to the influence of progesterone.
• Towards the end of pregnancy, as the head
engages, the entire bladder may be displaced
upwards.

11. CHANGES IN THE
GASTROINTESTINAL SYSTEM

12. CHANGES IN THE
GASTROINTESTINAL SYSTEM
• In the mouth, the gums become edematous, soft and
spongy which can bleed when mildly traumatized as
with a toothbrush.
• Increased salivation (ptyalism) is a common
complaint in pregnancy. This problem seems to be
associated with nausea, which prevents women from
swallowing their saliva.

13. • Around 4-8 weeks, most women (about 70%) start
complaining of nausea and vomiting, which may
continue until about 14-16 weeks.
• Relaxation of the smooth muscles of the -stomach,
and hypomotility may also contribute to this
problem. It can be quite distressing and sometimes
causing weight loss in early pregnancy. It
occasionally causes nutritional or electrolyte
imbalance.

14. • In earlier period of pregnancy, a change in the
sense of taste can occur.
• It can be metallic taste in the mouth, distaste for
something usually enjoyed or craving for a food
usually not eaten.
• Craving for bizarre substances such as coal, wall
plaster, mothball, mud, etc. may be seen
occasionally This is termed as pica.

15. • The enlarging uterus misplaces the stomach
and intestines.
• Raised intra-gastric pressure without
accompanying increase in tone of the cardiac
sphincter, causes reflux of acid mouth fuls
with epigastric pain.
• The resulting symptoms of heartburn is quite
common in pregnancy,

16. • The tendency to constipation is more in
pregnancy, as the passage of food through the
intestines is so much slower that there is
increased absorption of water from the colon.
• Oral iron may also contribute to the problem .
Constipation may worsen hemorrhoids, which
are caused by the increased pressure in the
veins below the level of the enlarged uterus.

17. • Serum albumin levels fall progressively
throughout pregnancy and at term are 30
percent lower than the non-pregnant level
• Serum alkaline phosphatase levels rise
progressively .
• Serum cholesterol levels are raised two-fold by
the end of pregnancy.

18. CHANGES IN METABOLISM
• There is increased food intake during pregnancy.
This, along with the gastrointestinal changes, lead to
characteristic alteration in the metabolism of
carbohydrate, protein and fat.
• These changes, which are brought about by human
placental lactogen, ensure that glucose is readily
available for body and brain growth in the
developing fetus, and protects against nutritional
deficiencies

19. • Fasting plasma glucose concentration falls during
the first trimester, rises between 16 and 32 weeks,
then falls again towards term.
• Insulin secretion correspondingly rises in the
second trimester and then falls to non- pregnant
levels towards term.
• As human placental lactogen levels rise with
advancing pregnancy, insulin resistance increases
leading the diabetogenic effect of pregnancy.

20. • A continuous supply of glucose must be available
to transfer to the fetus. Pregnant women should
not fast or skip meals for the following reasons:
• Maternal blood glucose levels are critically
important for the fetal well-being.
• Fasting in pregnancy produces a more intense
ketosis, known as 'accelerated starvation', that may
be dangerous to fetal health.

21. • Plasma albumin concentration is reduced due
to increased plasma volume.
• Plasma calcium concentrations fall as a result
of both fetal needs and the normal hemo-
dilation of pregnancy.

22. MATERNAL WEIGHT CHANGES

23. MATERNAL WEIGHT CHANGES
A continuing weight increase in pregnancy is
considered to be a favorable indicator for
maternal adaptation and fetal growth. Analysis
of studies on weight gain in pregnancy
suggests the following as the expected increase
in primi- gravida

24. 4.0 kg in first 20 weeks
8.5 kg in second 20 weeks (0.4 kg per week in
the last trimester)
 12.5 kg approximate total.
The average weight gain in multigravida is
approximately 1 kg less than in the primi-
gravida.

25. There is a wide range of normality in weight gain
and many factors influence it which include
maternal edema,
maternal metabolic rate,
dietary intake,
vomiting or diarrhea,
amount of amniotic fluid
 size of the fetus.

26. • Maternal age, pre-pregnancy body size, parity
and diseases like diabetes and hypertension
also seem to influence the pattern of weight
gain

28. SKELETAL CHANGES

29. SKELETAL CHANGES
• Relaxation of pelvic ligaments and muscles
occurs because of the influence of estrogen and
relaxin.
• This reaches the maximum during the last weeks
of pregnancy allowing the pelvis to increase its
capacity in readiness to accommodate the fetal
presenting part at the end of pregnancy and in
labor.

30. • The ligaments of the symphysis pubis and the
sacroiliac joints loosen.
• The symphysis pubis widens by about 4 mm
by 32 weeks gestation and the sacrococcygeal
joint loosens, allowing the coccyx to be
displaced backwards.

31. • Posture of the pregnant woman alters to
compensate for the enlarging uterus anteriorly.
• The woman leans backwards exaggerating the
normal lumbar curve and causing a progressive
lordosis.
• The teeth are prone to decay during pregnancy,
perhaps due to calcium deficiency resulting from
increased demand for it by the growing fetus.

32. SKIN CHANGES

33. SKIN CHANGES
• Increased activity of the melanin-stimulating
hormone from the pituitary causes varying degrees of
pigmentation in pregnant women from the end of
second month until term.
• The depth of pigmentation varies according to skin
color and race.
• The areas most commonly affected are the areolae of
breasts, the abdominal midline, the perineum and the
axillae.

34. • On the breasts, darkening of the nipple, primary
areola (areola around the nipple), and secondary
areola (mottling of the skin around and beyond the
primary areola) are seen.
• The irregular brownish discolorations of the
forehead, nose, cheeks and neck known as the 'mask
of pregnancy' or chloasma usually develops in the
second half of pregnancy in about 50-70 percent of
women. Chloasma is most noticeable in dark-haired,
brown-eyed women.

35. 'mask of pregnancy' or chloasma

36. • In most pregnant women, a narrow of dark skin
pigmentation appears in the midline of the
abdomen from the symphysis to the umbilicus
called as linea nigra.

37. • A rise in body temperature of 0.5 degree C with an
increased blood supply causing vaso- dilatation
makes women feel hotter and sweaty.
• Many women develop angiomas during pregnancy,
which are red elevations on the skin of the face,
neck, arms and chest.
• Palmar erythema, which is reddening of the palms,
is another frequent occurrence. Both are likely to be
due to high levels of estrogen and disappear after
delivery.