Anatomical and Physiological

Change of Pregnant and

Postpartum Women
 PREGNANT WOMEN
1. Reproductive Organs
Cervix
Uterus
Cervix undergoes
Uterine enlargement softening and thinning
due to muscle cell Endocervical mucosal cells
hypertrophy, fibrous tissue produce large amounts of
accumulation, and mucus immediately after
increased elastic tissue conception
Develop into thin-
walled muscular organ
 Ovarium Vagina and Perineum
Ovulation stops and new Increased vascularization of the
follicular maturation is vagina and perineum
delayed On the vaginal wall an increase in
Uterine tube mucosal thickness, connective
The tubal mucosal epithelium tissue becomes loose, and smooth
becomes flat muscle cell hypertrophy
Acidic atmosphere (pH 3.5 - 6) due
to increased production of lactic
acid from glycogen in vaginal
epithelium by Lactobacillus
acidophilus
2. Skin 3. Breast
Striae gravidarum Paresthesias occur in the
MSH increase breast
hyperpigmentation Enlarged breasts and visible
Palmar erythema in most vascularisation of the vein
white women smoothly
Lactiferous duct cell
hypertrophy and an increase
in the number of acinus cells
4. Haematological Changes
Increase blood volume
Increase need of iron
Decrease in platelet levels as
a hemodilution effect
5. Cardiovascular System
Increase in cardiac output
Decrease in systemic
resistance
6. Respiration System
The diaphragm is raised about
4cm increased tidal
volume and inspiration
capacity and decreased
residual volume and
functional residual capacity
Decrease in total lung
resistance (progesterone
effect) airway conduction
increases
7. Urinary Tract 8. GI Tract
Increased GFR and renal Stomach and intestine
plasma flow shifted due to
The right ureteral dilatation enlargement of the
occurs uterus
VU is depressed by the Pyrosis, hemorrhoid
uterus so that pregnant Decrease in vesica felea
women often urinate contractility
9. Musculoskeletal 10. Endocrine System
System Increased levels of
There is a progressive androstenedione,
lordosis testosterone,
Increase mobility of the dioxicorticosterone,
sacroilliac joints, aldosterone and cortisol,
sacrococccigeus, and whereas DHEA levels
pubis decreased
11. Eyes
Decreased corneal sensitivity
12. CNS
There is a decrease in
memory of pregnant women
in the 3rd trimester, but will
recover after delivery (Keenan
1998)
Pregnant women are difficult
to sleep since 12 weeks of
pregnancy until 2 months
after childbirth
13. Metabolic Changes
Weight gain of about 10 to 12
kg
Water metabolism:
water retention occurs along
with increased aldosterone
there is often edema of the
inferior extremity due to
increased venous pressure
under the uterus and partial
blockage in VC due to enlarged
uterus
 Protein metabolism Fat metabolism
Mother's blood is rich in Hyperlipidaemia and
protein elevated HDL, LDL, and VLDL
Carbohydrate metabolisme levels
Fasting hypoglycemia,
postmeal hyperglycaemia,
and mild hyperinsulinemia
 Postpartum Women
1. Vagina and Ostium
Vagina
Forming smooth walled
channels whose size will be
reduced but not the same
as before pregnancy
Ruggae reappears 3 weeks
after delivery
Hymen remaining small
pieces of tissue left
2. Uterus
Uterine involution
proceeds immediately
after placental expulsion
Uterine diameter is
reduced approximately as
before pregnancy
Ostium externa vaginalis
can not return as it was
before pregnancy
3. Urinary Tract 4. Abdominal Wall and
ureter returns to its pre- Perineum
pregnancy state The latum ligament and the
VU has increased rotundum ligament take a
capacity and is relatively long time to recover from
less sensitive to stretching
increased intravesical Abdominal wall may return
pressure to pre pregnancy, except
striae
5. Weight loss is
approaching the condition
before pregnancy 6
months after delivery, but
is over 1.4 kg
6. Haematological Changes
The blood volume returns
to its pre-pregnancy state 1
week after delivery
The rate of blood
sedimentation and plasma
fibrinogen increased for 1
week after delivery