Physiology of Pregnancy
Introduction
• The physiology of pregnancy involves
significant changes in a woman's body to
support the growth and development of a
fetus.
1. Hormonal Changes:
• Increased levels of Progesterone prepare the
uterus for pregnancy and maintain it
throughout.
• Human chorionic gonadotropin (hCG) , by
placenta is responsible for early pregnancy
symptoms like nausea and breast tenderness.
2. Uterine Changes:
• The uterus
undergoes
dramatic growth
to accommodate
the growing fetus.
3. Cardiovascular Changes:
• Blood volume increases by 40-50% to meet
the demands of the growing fetus and placenta.
• Heart rate increases, and blood pressure may
slightly decrease.
4. Respiratory Changes:
• The diaphragm rises, and the rib cage expands
to accommodate the growing uterus, leading to
increased oxygen consumption.
5. Gastrointestinal Changes:
• Nausea and vomiting (morning sickness)
are common in early pregnancy due to
hormonal changes.
• Constipation may occur due to decreased
gastrointestinal motility.
6. Musculoskeletal Changes:
• The ligaments and joints relaxin preparation
for childbirth.
• The center of gravity shifts forward, affecting
posture and balance.
• 7. Breast Changes:
• Breasts enlarge and become firmer in
preparation for lactation.
• 8. Urinary Changes:
• Increased urine production due to
increased blood flow to the kidneys.
• Frequent urination, especially in the later
stages of pregnancy.
9. Skin Changes:
• Increased pigmentation, especially around
the nipples, areolas, and linea alba.
• Stretch marks may develop on the
abdomen, thighs, and breasts.
10. Emotional Changes:
• Mood swings, anxiety, and emotional
sensitivity are common due to hormonal
fluctuations.
• Remember, every pregnancy is unique, and
individual experiences may vary.
Developing placenta
Organization
of the mature
placenta and
intervillus
space.
Figure 82-5
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
Placental conductivity
Figure 82-7; Guyton & Hall
Functions of hCG --
1. Maintains corpus luteum beyond normal lifespan
2. Stimulates progesterone and estrogen by corpus luteum
3. Stimulates testosterone production in male fetus
4. hCG receptors in endometrium and myometrium --
can inhibit contractions produced by oxytocin
5. Immunosuppressant
Maternal response to pregnancy
Blood flow to placenta requires increased
cardiac output (40% higher) until last 8 wks
Blood volume increases by 30% - due to
aldosterone and estrogen -- cause active Na
and H2O retention (also dec. ANP)
Increased thyroxine due to hCG and thyrotropin
(made by placenta)
Maternal response to pregnancy
• Kidney function increases: GFR by 40%,
RPF by 75%
• Incr. Na and H2O reabsorption by tubule –
Estradiol
• Insulin secretion increases after 3rd month of
pregnancy
• Maternal response to insulin decreased/no
change to glucagon
Increased aldosterone, renin, angiotensinogen
due to estradiol – refractory to increased Ang II
-- may be stimulated by reduction in effective
circulating blood volume caused by large
placental blood pool
BP increases slightly:
86 (11-12 wks); 90 (36-38 wks)
but decreases close to term
TPR decreased
Maternal response to pregnancy
Increased Ca reabsorption, increased 25-OH-vit
D, 1,25-(OH)2-vit D
Increased alveolar ventilation -- due to
progesterone
Increased tidal volume (40%) -- causes dec in
maternal plasma CO2 -- slight alkalosis
Somato-mammotropin
1. Secreted by placenta about 5 wks gestation
2. Important in breast development for lactation
3. Promote growth (chemical structure is similar to GH)
4. Decreases glucose usage in mother; more glucose for fetus
5. Promotes release of fatty acids from fat stores of mother
Relaxin
1. Relaxation of symphysis pubis
2. May play a role in increased GFR/renal blood flow
Amniotic fluid
-- fluid in which fetus floats in uterus
-- 500-1000 mL
Functions:
1. Mechanical buffer -- protects fetus
2. Mechanism by which fetus excretes waste -- turns
over daily, renal excretions (75%), pulmonary
secretion
Morning sickness
Occurrence -- 70% of pregnancies
Onset 4-8 wks gestation; improvement before
14-16 wks
Mechanisms:
Relaxation of smooth muscle of stomach
Increase hCG -- serum levels
Higher frequency of female fetus -- 56%
Supine hypotension syndrome in pregnancy
Supine position
IVC occlusion
Dec atrial filling pressure
Dec cardiac output5% of women
95% of women
Inc vascular resistance ? Parasympathetic response
Normalize BP Hypotension
Pre-eclampsia
• Idiopathic multisystem disorder
• Incidence:
– Affects 7-13% of pregnancies
– Leading cause of maternal and perinatal mortality
• Characterized by maternal hypertension, proteinuria,
and generalized edema that occurs
after 20 wks gestation
• Disease of the placenta
– Failure of trophoblast invasion of spiral arteries
– Intrauterine growth restriction (IUGR) of the fetus
Phases of parturition
Phase 0: From conception to beginning of labor;
quiescent uterus
Phase 1: From time of uterine activation to
delivery of fetus
Phase 2: From time of delivery of fetus to
delivery of placenta
Phase 3: Postpartum; involution of uterus
Phases of parturition
Phase 0: quiescent uterus: associated with dec
cAMP, cGMP, MLCK activity due to progesterone,
relaxin, prostacyclin, NO
Phase 1: activation of uterus
• Upregulation of contraction-associated proteins --
connexin-43
• Increase gap junctions
• 50X increase myometrial oxytocin receptor
• Dilation and effacement of cervix,
• Cervical softening due to rearrangement of collagen
fibers,
Phases of parturition
Phase 2:
delivery of fetus and placenta
activated uterus stimulated by platelet
activating factor, endothelin (via ETA
Receptor),Ang II (via AT1 R)
Phase 3: oxytocin most important in
postpartum
bleeding and involution of the uterus
Mechanisms starting “labor”
“Fetal genotype controls length of gestation”
3 theories:
1. Removal of progesterone; change in
estrogen: progesterone ratio
2. Increase in uterotonins: oxytocin
3. PGF 2 and PGE2
“Positive feedback” theory of parturition
Braxton-Hicks contractions -- irritability of uterine
muscle ,weak, slow contractions ,begins about
1 month before labor.
True labor has circadian rhythym,
peaks between 12 midnite and 5 am.
“labor pains” -- due to ischemia of uterine muscle in
early stage, then stretch of cervix, perineum, vagina
Lactation
Breast development: begins at puberty due to
estrogen stimulation
Increases during pregnancy, due to estrogen and
progesterone.
Prolactin: promotes milk secretion
secreted by anterior pituitary, starting from
5th wk of pregnancy until birth.
1st milk = colostrum -- same proteins and lactose
as milk, but no fat
Prolactin surges -
• Each time mother nurses baby due to nerve impulses
from nipples to hypothalamus
• When not nursing, hypothalamus produces prolactin
inhibitory hormone
• Lactation inhibits FSH, LH and thus lactation interferes
with reproductive function
