27. Maternal Adaptations In Pregnancy : Obstetrics and Gynaecology Lecture

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Maternal Adaptations In Pregnancy -
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During pregnancy, a woman's body undergoes a series of remarkable physiological changes to support the developing fetus and prepare for childbirth. These adaptations affect nearly every organ system and are essential for maintaining a healthy pregnancy, ensuring proper fetal development, and preparing the body for labor and delivery.

Cardiovascular System
Increased Blood Volume: Maternal blood volume increases by 30-50% to meet the oxygen and nutrient demands of the growing fetus. This also helps compensate for blood loss during delivery.
Cardiac Output: There is a significant increase in cardiac output (up to 40%) due to elevated heart rate and stroke volume, ensuring adequate circulation to the placenta.
Blood Pressure: Despite the increase in blood volume, systemic vascular resistance decreases, leading to a slight drop in blood pressure during the second trimester.

Respiratory System
Increased Oxygen Consumption: Oxygen demand rises by 20-30% to supply the growing fetus and maternal tissues. The respiratory rate may slightly increase, and tidal volume (the amount of air inhaled and exhaled) increases significantly.
Diaphragm Elevation: As the uterus enlarges, the diaphragm is pushed upward, reducing lung capacity. However, the body compensates by increasing the depth of respiration.

Renal System
Increased Glomerular Filtration Rate (GFR): The kidneys filter more blood, leading to increased urine production. This is a response to the higher blood volume and the need to excrete fetal waste products.
Water and Sodium Retention: To support the increased blood volume, the kidneys retain more water and sodium, which can lead to mild edema in the lower extremities.

Endocrine System
Hormonal Changes: Pregnancy hormones, particularly progesterone and estrogen, rise dramatically. Progesterone helps maintain the uterine lining and prevents contractions, while estrogen supports fetal development and stimulates uterine growth.
Thyroid Function: The thyroid gland becomes more active, increasing the production of thyroid hormones to support metabolic demands.
Insulin Resistance: As pregnancy progresses, the body becomes more resistant to insulin, ensuring that more glucose is available for the fetus. This can lead to gestational diabetes in some women.

Musculoskeletal System
Ligamentous Relaxation: Relaxin, a hormone produced during pregnancy, causes the ligaments and joints, especially in the pelvis, to become more flexible. This adaptation prepares the body for childbirth but may also lead to back pain and joint instability.
Postural Changes: The growing abdomen shifts the center of gravity, leading to lordosis (increased curvature of the lower back) and alterations in posture to maintain balance.

Gastrointestinal System -
Nausea and Vomiting: Commonly known as morning sickness, these symptoms are due to elevated hCG levels and typically subside by the second trimester.
Reduced Gastrointestinal Motility: Progesterone relaxes smooth muscle, slowing down digestion and leading to symptoms like heartburn and constipation.
Increased Nutrient Absorption: The intestines become more efficient at absorbing nutrients, ensuring adequate nutrition for both mother and fetus.

Hematologic System -
Increased Red Blood Cell Production: To meet the oxygen demands of pregnancy, erythropoiesis increases, leading to a higher red blood cell count. However, the increase in plasma volume often outpaces red cell production, resulting in physiologic anemia.
Hypercoagulable State: Pregnancy induces a state of increased clotting potential to protect against excessive bleeding during delivery, but this also raises the risk of thromboembolic events.

Skin Changes -
Hyperpigmentation: Hormonal changes can lead to darkening of the skin, particularly in areas like the areola, linea nigra (a dark line running down the abdomen), and face (chloasma or "mask of pregnancy").
Striae Gravidarum: Commonly known as stretch marks, these occur due to the rapid stretching of the skin as the abdomen grows 🍼🌸.

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