obstetric and gyneacology; Changes in pregnancy, cardiovascular changes, respiratory changes, endocrine changes, gastrointestinal changes, related organ changes in pregnancy. hormonal changes during pregnancy.

1. FOUNDATION OF MIDWIFERY
ANATOMY AND PHYSIOLOGYCAL
CHANGES DURING PREGNANCY
IN OTHER RELATED SYSTEM

2. GROUP 1
 ANASTASIA WILLIAM
 ANNIE ANAK JADAM
 ASBIH BINTI JITAL
 BIBIANA IVY @ IVY AMIN
 BOKIAH BINTI JAINAL PUDDIN
 CHAIRIN OSIIN
 DAINE CHRISTY LEBA ANAK UJAI
 DAYANA GEORGE TIMIN

3. LEARNING OBJECTIVE
 At the end of this session, student should be able to
1. Described the gross structure of related system in reproductive system.
2. Described the macroscopic and microscopic of system
3. Explained the function of related system to pregnancy
4. Explain the changes of related system during pregnancy, labour, and
puerperium
5. Explained the contribution of the reproductive system

4. INTRODUCTION
 The changes that occur in the pregnant mother’s body are
caused by a several factors.
 Many of these changes are caused by the growth of the fetus
inside the uterus.

5. CARDIOVASCULAR
( CVS )
CHANGES DURING
PREGNANCY

6. GROSS SRUCTURE CVS

7. LOCATION
 Heart enlarged by chamber dilation
and hyperthropy. Upward
displacement of the diapgram causes
the heart shifted to the left and
upwards..
Displacement diapgram and
shifted of the heart during
pregnancy

8. FUNCTION
1. Meet the increase metabolic demands of the mother and foetus
2. Promote growth and development of uteroplacenta-foetal unit.
3. Compensated for blood loss at the end of labour.

9. RELATIONSHP WITH OTHER ORGAN
 To promote blood circulation to other organ ( pulmonary and
systemic )
 Utero placenta – fetal circulation is supply oxygen and
nutrient to fetus.

10. BLOOD SUPPLY
Coronary artery is the blood supply to
heart. Its divided to left coronary artery
and right coronary artery.

11. NERVES SUPPLY
 The cardiac nerve are autonomic nerves which supply to the
heart. They are superior cardiac nerve, middle cardiac nerve
and inferior cardiac nerve.

12. SUPPORT
 Supported by thoracic cavity where the diaphgram separating
the thorax from the abdomen.

13. CHANGES CVS DURING PREGNANCY CHANGES CVS DURING
LABOUR
CHANGES CVS DURING
PUERPERIUM
Blood volume increase 30-40% at 6 – 8 week
-Cardiac output increase 30 – 50 at first
trimester.
-Blood pressure normal lowering in early
pregnancy and back to normal during term
-Heart rate modest increase
-Anemia due toincrease plasma volume
followed small increase in RBC 20 – 30%
-Varicose vein develop because of enlarged
uterus puts pressure to the inferior vena cava
and pressure to the leg veins
-Aortacaval compression in mid pregnancy
Oxygen consumption increased
-Intravascular volume increased
300 – 500 ml blood from the
contracting uterus to the
venouse system
-Cardiac output increased
during contracting due to
response of cathecolamine
secretion.
-Heart rate increased
-Blood pressure increased
Stroke volume increased
despite blood loss secondary
to increased venouse returned
Cardiac output not changes
after 2 weeks delivery
- Heart rate back to normal

14. CHANGES IN
GASTROINTESTINAL
DURING PREGNANCY

15. GROSS STRUCTURE

16. FUNCTION
 Digestive system is unique and specialized function of
turning food into the energy you need to survive and
packaging the residue for waste disposal.

17. Changes during pregnancy Changes during labour Changes during
puerperium
Mouth
-Become highly vascularised, oedematous, have less
resistance to infection and easily irritate (
progesterone and oestrogen)
-Increase thirsty and appetite
Oesophagus
-Heartburn and burning sensation affecting 30 -70%
- lower tone of the oesophagus spintcer caused
impaired and regurgitation of gastric acids.(
progesterone and oestrogen)
Stomach
-Decreased of acid gastric secretion and motility
delayed the gastric empty
-Delayed chymes increase heartburn and nauseated
Intestine and colon
-Constipation due to reduced gastrointestinal muscle
tone and motility
-Mendelson’s syndrome
Only during LSCS
-chemical pneumonitis
cased by reflux of acid
gastric
-caused of pressure of
gravid uterus
-progesterone relaxant
smooth and cardiac
muscle
-Increase gas distension due
to relaxed of abdomen
-Haemorrhoid will be more
painful if there is presence of
haemorrhoid and will
disappear within a few
weeks.

18. BLOOD & NERVES SUPPLY
 The organs of the GIT receive arterial blood supply from three arteries:
 -Coeliac trunk for foregut
 -Superior mesenteric artery for mid gut
 -Inferior mesenteric artery for hindgut
 -The veins drain into the portal vein and from thence to the liver and ultimately inferior
vena cava.
 -The vagus nerve supplies parasympathetic innervation up to the proximal 2/3rd of the
transverse colon where it hands over to the sacral outflow. Sympathetic innervation is
derived from the greater, lesser and least splanchnic nerves (T6-T12). Sensory fibres
run with the sympathetic.

19. RESPIRATORY SYSTEM
CHANGES DURING
PREGNANCY

20. GROSS STRUCTURE

21. FUNCTION
 Deliver oxygenated blood and nutrition to the mother
and fetus.

22. CHANGES DURING
PREGNANCY, LABOUR AND
PUERPERIUM

23. ANATOMIC CHANGES
Upper airway
 Hyperemia, friability, mucosal oedema, hypersecretion of the airway
mucosa.
 Nasal obstruction, epistaxis, sneezing episodes and vocal changes may
occur, and worsen when lies down.
 Preferential mouth breathing and intolerant of nasal canula delivery of O₂.

24. CONT….
Lower airway
 Mucosal changes occur in larynx and trachea.
 Nonspecifec complaints of airway irritinat ( irritant cough or sputum
production)
 Estrogen increse tisu hydration and edema,also cause capillary
congestion and hyperplastic and hypersecretory mucous glands.

25. Subcostal
angle 68˚ −
103˚
Thoracic cage
upwards by
5 -7
circumference
Displacement of the ribcage in pregnancy and non pregnancy showing elevated diaphragm,
the increase tranverse and circumference, flaring out of ribs and the subcostal angle

26. Displacement of the ribcage,diaphragm and the heart during pregnancy

27. CHANGES DURING PREGNANCY CHANGES DURING LABOUR CHANGES DURING
PUERPERIUM
- RR ↑ in pregnancy.
- Breath more deeply event at rest.
-Anterior posterior and transverse -
diameter ↑ about 2cm resulting in a 5-7
expansion of the chest circumference.
- Progressively increase the
subscostal angle from 68ᵒ to 103ᵒ at
term.
- Changes mediated by progesterone
and relaxin which ↑ ribcage elasticity
by relaxing ligaments.
-By 8/52 gestation: Expansion of the
ribcage cause the Tidal Volume (TV)↑ by
30-40%.
-Respiratory responses are
greatly affected by stage of
labour and the respond to pain
and anxiety.
- TV ( tidal volume ) range from
350 to 2250ml and minute
ventilations from 7 to 90 L/min
Back to normal

28. Summary of changes in respiratory function

29. Blood Gases
 Aterial O₂ partial pressure (PₐO₂) is slightly ↑:
 Non pregnant (98-100mmHg)
 Pregnant (101-104mmHg)
 Hyperventilation of pregnancy cause a 15-20% ↓ in martenal arterial Carbon Dioxide
artial Pressure (PₐCO₂) = 35 - 40mmHg → 30mmHg or ↓ in late pregnancy.

30. ENDOCRINE SYSTEM CHANGES
DURING PREGNANCY

31. The Endocrine
system
-the collection of glands of an organism that secrete
hormones directly into the circulatory system to be carried
towards a distant target organ.
- The major endocrine glands in female include the pineal
gland, pituitary gland, pancreas, ovaries, thyroid gland,
parathyroid gland, hypothalamus, and adrenal glands
Figure 1: The endocrine system in non pregnant female

32. What changes in the Endocrine
system during pregnancy?
 The major changes in endocrine system during
pregnancy is the placenta where it acting as a
temporary endocrine gland called Endocrine
placenta.
 synthesizes a huge and diverse number of
hormones and cytokines that have major influences
on ovarian, uterine, mammary and fetal physiology
placenta
Foetus
Figure 2: The placenta as temporary endocrine gland

33. Placental hormones
Hormones Changes Roles
1. hCG (human
chorionic
gonadotrophin)
Peaks:
8-10 weeks and
then declines by
week 20th
remains stable
until labour
1. produced by the placental syncytiotrophoblast and
cytootrophoblast cells following implantation
2. stimulates the production of oestrogen and progesterone
within the ovary
2. diminishes once the placenta is mature enough to take
over oestrogen and progesterone production.
- rescue the corpus
luteum from involution
so that it can continue
to produce
progesterone to
maintain the decidua
Table 1: hCG hormones and its contribution

34. Placental hormones
hormones changes Role
2. Progesterone
Peaks :
increases around
8-10 weeks
- produced by the
corpus luteum during
the first 9 weeks of
pregnancy before shift
to placenta
# decreases or disruption of the
progesterone production
promotes the cervical re-modelling
and initiates labour
(Mesiano at el 2011)
1. promotes decidualization
2. prevent menstruation and rejection of the
trophoblast
3. inhibits smooth muscles contractility
4. maintains myometrial quiescent
5. prevent onset of uterine contraction (Feldt-
Rasmussen and Mathiessen 2011)
Table 2: Progesterone hormones and its contribution

35. Placental hormones
hormones Changes Roles
3. Oestrogen -- Primarily produced by the
corpus luteum and follicles
- 3-8 times higher during
pregnancy , it is within 6-7
weeks
Where the secretion had taken
over by the placenta.
- increases uterine blood flow
– facilitates the placental oxygenation and nutrition to
fetus
– prepares the breast for lactation
– simulates the production of hormone-binding globulin
in liver ( Myatt and Powell 2010)
- During last trimester, increasing the excitability of the
myometrium and prostaglandins synsthesis.
Table 3: Oestrogen hormones and its contribution

36. Placental hormones
hormones changes Role
4. Human
placental
Lactogen (hPL)
--Produced by the
syncytiotrophoblast
- increases up to 30
folds throughout
pregnancy
1. regulated the maternal carbohydrate, lipid, protein
metabolism and fetal growth.
2. promote the growth of the breast tissues in
preparation for lactation (Braun at el 2013)
3. It can also decrease maternal tissue sensitivity to
insulin, resulting in gestational diabetes
Table 4: hPL hormones and its contribution

37. Placental hormones
hormones Changes Roles
5. Relaxin -produced by corpus luteum in
both pregnant and non pregnant
female
-levels rise during 1st trimester
and additional relaxin is
produced by the decidua.
- peak is reached during the 14
weeks and at delivery
1. increased cardiac output
2. increased renal blood flow
3. and increased arterial compliance.
4. It also relaxes other pelvic ligaments. It is believed to
soften the pubic symphysis.
Table 5 : Relaxin hormones and it contribution

38. Figure 3 : schematic level of progesterone, oestrogen and HCG
throughout the pregnancy

39. Other Endocrine changes
THE PITUITARY GLAND
The pituitary gland are increasing in size 2- 3 folds from it normal size during pregnancy
Figure 4: The pituitary gland is a pea-sized structure located at the base of the brain, just below the hypothalamus and attached to
it by nerve fibers

40. Pituitary Glands hormones
Anterior Pituitary
- Prolactin Hormone
Changes:
- hypertrophy and hyperplasia of the lactotrophs ( prolactin secreting cells) by the anterior lobe of the
pituitary gland under the influence of oestrogen hormone as a result prolactin level increases
- by term, the levels are about 10 times in preparation of milk production
Roles:
1. prepares the mother’s breasts for lactation and also aids in the final stages of lung maturation for the
baby
2. infant sucking at the breast can cause the prolactin secrection released
Table 6 : prolactin hormones and it contribution

41. Pituitary Glands hormones
Posterior pituitary
- Oxytocin hormone
Changes:
- Low throughout pregnancy but increase in labour (Feldt-Rasmussen and Mathiessen 2011)
Roles:
1. act on the myometrium to increase the length, strength and frequency of contraction during
labour
2. keeping the uterine contractions going continues after the baby is born and begin to shrink the
uterus back to its original size
3. the high levels of oxytocin in both mother and baby at this time promote affection, attachment
and a desire in the mother to protect and guard the baby
4. promotes the let-down reflex, too, which enables the breasts to produce milk
Table 7 : oxytocin hormones and it contribution

42. Other Endocrine changes
Thyroid Gland
Changes in size:
moderately enlarged during pregnancy
due to hormone-induced glandular
hyperplasia and increased vascularity.
Fetal thyroxine
wholly obtained from maternal sources
in early pregnancy since the fetal
thyroid gland only becomes functional
in the 2nd trimester of gestation.
Figure 5: showing situated on the anterior side of the neck, lying
against and around the larynx and trachea, reaching posteriorly
the oesophagus and carotid sheath

43. Thyroid Gland Hormones
hormones changes Roles
(TBG) Thyroxine binding
globulin
- rise almost 2-3 folds because
estrogen increases TBG
production
1. required for metabolic changes as well as
transfer the thyroxine to fetal brain cells
for normal brain development
2. Maintaining it supply for both mother and
fetal requirement
thyroxine (T4) and
triiodothyronine (T3)
- levels rise from about 6–12
weeks and plateauing at
approximately 20 weeks of
gestation
Parathyroid hormone Parathyroid gland Increase in
size slightly
1. To meet up the increases of the
requirement for the calcium needed in
fetal growth

44. Thyroid Hormones
Figure 6: Changes in thyroid
function indices throughout
gestation. The shaded area
represents the normal range of the
TBG, total T4, TSH, free T4 and hCG.
Level concentration
Weeks of gestation

45. Adrenal gland
•the outer cortex is under the control of ACTH from the
anterior pituitary. It secretes steroid hormones
(corticosteroids).
•the inner medulla is controlled by the sympathetic
nervous system. It secretes adrenaline.
Figure 6: The adrenal glands are located bilaterally in the
retroperitoneum superior and slightly medial to the kidneys

46. Changes during Pregnancy
 Size:
does not cause much change in the size of the adrenal glands
Hormone Changes Roles
Cortisol or
glucocorticoid
Marked increase 1. particularly helpful in times of long and short term stress.
2. have anti-insulin, anti-inflammatory, and anti-allergic
actions
3. needed to make the precursors of adrenaline, which the
inner medulla will produce and secrete
Aldosterone increased amounts
by the adrenal
glands as early as 15
weeks of pregnancy
1. regulates absorption of sodium from the distal tubules of
the kidney

47. CONCLUSION
 This system plays an important role in growth and development of the
foetus in pregnancy. It is important for the midwives trained staff to know
the changes during pregnancy and to deliver good care and reduces
complication.

48. Reference
Jayne Marshall, Maureen Raynor ( 2014 ) Myles Textbook for Midwives sixteen edition, Churcill Livingstone
Jane Coad, Melvyn Dunstall ( 2007 ) Anatomy and Physiology for Midwives second edition, Churcill Livingstone
Janet Medforth et.al ( 2010 ) Oxford Handbook of Midwives South Asian Eition, oxford
Quick Doctor, physiological changes of pregnancy. Retrieved from www.doctor.com/docs/476537/physiologic_changes_of_pregnancy.
Elizabeth Eden ,MD understanding pregnancy symptoms. Retrieved from
http:www.pregnancy_and_parenting/pregnancy/issue/understanding_pregnancy_symptoms.
Mother & child glossary ( 2002 ) Health on The Net Foundation. Retrieved from www.hon.ch/Dossier/motherchild/preg_changes/circulation.html
Mother& child glossary ( 2002 ) Health on The Net foundation. Retrieved from www.hon.ch/Dossier/motherchild/preg_changes/lungs.html.
Alexandra house, Oldham terrace ( 2013 ) The UK’s for parents. Hormone in pregnancy. Retrived at http://www.nct.org.uk/birth/hormones-labour.