changes in pregnancy

Cause of most physiological changes in pregnancy

Hormonal changes (estrogen, progesterone) and increased blood volume

CUTANEOUS CHANGES IN PREGNANCY – GENERAL

Caused mainly by increased estrogen, progesterone, and MSH

Linea nigra – definition

Pigmented line extending from symphysis pubis to umbilicus

Chloasma gravidarum

Pigmentation over cheeks and forehead (“mask of pregnancy”)

Cause of hyperpigmentation in pregnancy

Increased melanocyte-stimulating hormone

Are cutaneous pigmentary changes reversible?

Yes, usually regress after delivery

Striae gravidarum – cause

Rupture of elastic fibers due to stretching and cortisol

Sites of striae gravidarum

Abdomen, breasts, thighs, buttocks

Palmar erythema – cause

Estrogen-induced vasodilatation

Spider angioma – cause

Increased estrogen

Hair changes in pregnancy

Increased anagen phase → thick hair

Postpartum hair fall – cause

Shift to telogen phase

Nail changes in pregnancy

Increased growth, brittleness

REPRODUCTIVE ORGAN CHANGES – UTERUS

Uterine weight increase from ~70 g to ~1000 g

Uterine enlargement mechanism

Hyperplasia + hypertrophy of myometrium

Uterine muscle arrangement

Upper segment contracts, lower segment stretches

Braxton Hicks contractions

Painless irregular uterine contractions after mid-pregnancy

Decidual reaction

Progesterone-induced endometrial change

REPRODUCTIVE ORGAN CHANGES – CERVIX

Goodell’s sign – cervical softening

Chadwick sign

Bluish discoloration of cervix and vagina

Mucus plug formation (operculum)

Seals cervical canal preventing infection

Cervical glands in pregnancy

Hypertrophy with mucus secretion

REPRODUCTIVE ORGAN CHANGES – VAGINA

Increased vascularity and congestion

Vaginal pH change in pregnancy

Becomes acidic

Cause of acidic vaginal pH

Increased glycogen → lactobacilli → lactic acid

Leukorrhea of pregnancy

Physiological increase in vaginal discharge

REPRODUCTIVE ORGAN CHANGES – OVARIES

Ovulation suppressed due to high estrogen and progesterone

Corpus luteum function

Maintains pregnancy till placenta takes over

HEMATOLOGICAL CHANGES – GENERAL

Physiological hypervolemia of pregnancy

Plasma volume increase

40–50%

RBC mass increase

20–30%

Physiological anemia of pregnancy

Due to hemodilution

Hemoglobin level change

Slight decrease

WBC count in pregnancy

Physiological leukocytosis

Platelet count in pregnancy

Slight decrease (gestational thrombocytopenia)

Coagulation state of pregnancy

Hypercoagulable state

Reason for hypercoagulability

Increased fibrinogen and clotting factors

Fibrinogen level in pregnancy

Increased

ESR in pregnancy

Increased

Purpose of hypercoagulable state

Prevents postpartum hemorrhage

Risk associated with hypercoagulable state

Thromboembolism