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Physiological changes during Pregnancy


Pregnancy is a phase in women's life where there will be progressive changes in the body which will not be related only to the genital organs but the entire system. These changes happen in the body so that the fetus develops in the proper way. There are complex changes in the hormones in the body and other progressive anatomical and physiological changes. This is due to the growing demands of the fetus that is growing in the mother's womb.

Changes in the genital organs Vulva
The vulva will become swollen and there will be increased blood supply to it. In women who have had earlier pregnancies the veins on the vulva will be prominent this is known as varicosity of the veins. Labia minora will be pigmented i.e. there will be change in the skin color .Labia minora will also become enlarged.

Vagina
There is increased supply of blood to the vagina and to the network of veins that surround the walls of the vagina .Due to this increased blood flow there is blue discoloration of the mucosa. This is also known as Jacquemiers sign. The vaginal walls are enlarged (hypertrophied) and the length of the anterior vaginal wall is increased.

Secretion in vagina The secretion from the vagina becomes copious, thin, curdy white in color which is due to marked release of cells (exfoliation) and bacteria. Lactobacillus acidophilus converts more glycogen into lactic acid and the discharge becomes acidic in nature. The ph of the discharge is (3.5-6).Due to this acidic nature of the secretion the development of pathological organisms is prevented.

Changes that take place in the Uterus (womb)
There are marked changes in all the parts of the uterus during the pregnancy. Normally the uterus weighs approximately 50gms and measures about 7.5 cms. in length when it is in the non pregnant state. At the end of nine months the uterus weighs between 900-1000 grams and measures about 35 centimeters in length.

Body of the uterus The body of the uterus increases in size and there is also enlargement of the body of the uterus.
Enlargement: the following factors affect the growth of the uterus

Changes in the muscles
a) Hypertrophy and hyperplasia (Enlargement and increase in number of tissues) under the action of the hormones oestrogen and progesterone not only there is increase in individual length of the muscle fibers of the body of uterus but also there is addition of few new muscle fibers .This is marked during the first half of the pregnancy and more pronounced during the first 12 weeks of pregnancy.
b) Stretching: there is further stretching of the muscle fibers after 20weeks of pregnancy due to the growing fetus .The wall of the uterus becomes thinner and measures about 1.5cms or less at term (i.e. end of Nine months of pregnancy).The feel of the uterus is soft and elastic whereas the non pregnant uterus is firm to feel.

The Blood supply
The uterine artery is the main source of blood supply to the non pregnant uterus .But during pregnancy the ovarian artery also carries as much as blood to the uterus as the uterine artery. This ovarian artery carries the least amount of blood in the non pregnant uterus. There is marked spiraling of the arteries which reaches it maximum limit at 20 weeks of pregnancy. They then straighten and become dilated. The veins are more dilated then the arteries as they do not have valves. Numerous lymphatic channels are opened up. These changes are more marked at the placental site. During the second half of the pregnancy there is inconsistent enlargement of the uterus which happens due to the stretching of the uterus as the changes take place in the muscle fibers of the uterus. The fundus of the uterus enlarges more then the body of the uterus.

Weight
The increase in weight is due to the increased growth of the uterine muscle fibers, the connective tissues and the vascular channels that grow during pregnancy.

Contractions (Braxton-Hicks)
The uterine contractions that take place during pregnancy are named after Braxton and Hicks who first described this phenomenon. The uterus undergoes spontaneous contractions from the early weeks of pregnancy. These contractions are spontaneous but can be elicited by rubbing the uterus. The contractions are frequent, spontaneous, spasmodic, and painless these contractions do not have an effect on dilatation of the cervix. At the end of the third trimester the contractions become more intense and produce some discomfort to the patient and they finally merge into the painful uterine contractions of labor.

Important changes in the isthmus of uterus during pregnancy Isthmus is the constricted part which measures about 0.5 cms .It is situated between the body and cervix of the uterus.It is limited above by the anatomical os and below by the histological os please refers the picture. During the first part of the pregnancy i.e. during the first trimester the isthmus becomes swollen (hypertrophied) and elongated to almost 3 times its normal length and also becomes softer. As the pregnancy advances after the 12th week there are further changes in the isthmus it unfolds downwards and gets incorporated in the uterine cavity .During the early pregnancy the circular muscle fibers act as a sphincter which helps in retaining the fetus within the uterus .Incompetence of the sphincter leads to mid trimester abortions.

Changes in the Cervix
There are changes in the elastic and connective tissues of the cervix. There is accumulation of fluid inside and in between the muscle fibers. The glands that are present in the cervix become enlarged and hypertrophied. The blood supply to the cervix is also significantly increased all these changes lead to the softening of the cervix. This helps in dilatation of the cervix during labor .This sign of softening of the cervix is known as Goodells sign which is an important diagnostic feature for pregnancy

Secretion in the cervix
The secretion is copious, tenacious in nature it is known as physiological leucorrhea. This happens due to the action of the hormone progesterone. The mucus that is formed fills up the gland and a thick mucus plug is formed which effectively seals the cervical canal.

Anatomical changes in Cervix
The length of the cervix remains unaltered but it becomes bulky. In women who have given birth earlier in them the cervical canal is slightly dilated.

Changes in the breast during pregnancy
In women who are pregnant for the first time the changes in the breast are very much evident then in women who have given birth and have lactated once. Size: due to the action of the hormones there are changes in the breast which become evident during the early weeks of pregnancy. There is increase in the size of the breast due to changes in the connective tissue stroma and the lobules. These changes happen to facilitate the secretion of milk.

Nipples and areola
The nipples become enlarged highly erectile and deeply pigmented. The sebaceous glands which are 5-15 in number become enlarged and keep the nipple and the areola moist and healthy. These glands are not visible during the non pregnant state. These are present in the areola. There is also pigmentation around the areola. These enlarged sebaceous glands are known as Montgomery's tubercles.

Secretion from Breast
During the 12th week secretion can be squeezed out from the breast which is sticky initially .By 16th week of pregnancy it becomes thick and yellow. Secretion in the breast in women who have not given birth earlier is an important sign of pregnancy.

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