Maternal anatomy and physiology

1. Maternal Anatomy andMaternal Anatomy and
PhysiologyPhysiology
http://crisbertcualteros.page.tlhttp://crisbertcualteros.page.tl

2. Definition of Terms
1. Perinatal period - period after birth of an
infant weighing 500 g or more and ending at
28 completed days after birth
2. Birth Rate – number of live births per 1000
population
3. Fertility Rate – number of live births per 1000
females aged 15 to 44 yrs.

3. 4. Live Birth – birth whenever the newborn at or
sometime after birth breaths spontaneously or shows
any other signs of life
5. Stillbirth or Fetal Death – absence of signs of life at
or after birth
6. Neonatal Death –
- early – death of the liveborn during the first 7 days
after birth
- late – death after 7 days but before 29 days

4. 7. Stillbirth Rate – number of stillborn
neonates per 1000 neonates born,
including livebirths and stillbirths
8. Neonatal Mortality Rate – number of
neonatal deaths per 1000 live births

5. 9. Perinatal Mortality Rate – number of stillbirths
plus neonatal deaths per 1000 total births
10. Infant death – all deaths of liveborn infants
from birth through 12 months of age
11. Infant Mortality Rate – number of infant
deaths per 1000 live births

6. 12.Low-birthweight – newborn whose
weight is less than 2500 gms
13.Very-Low-Birthweight – newborn
whose weight is less than 1500 gms
14.Term Neonate- a neonate born anytime
after 37 completed weeks

7. 15. Preterm Neonate – neonate born before 37
completed weeks
16. Postterm Neonate – neonate born anytime
after completion of the 42nd
week
17. Abortus – fetus or embryo removed or
expelled from the uterus during the first half of
gestation (20 wks or less and weighing less
than 500 gms.)

8. 18.Direct Maternal Death – death of the
mother resulting from obstetrical
complications of pregnancy, labor, or the
puerperium, and from interventions,
omissions, or incorrect treatment
Ex. Exsanguination after uterine rupture

9. 19. Indirect Maternal Death – maternal death not
directly due to an obstetrical cause, but
resulting from previously existing disease or a
disease that developed during pregnancy,
labor, or the puerperium, but which was
aggravated by maternal physiological
adaptation to pregnancy
Ex. Complications of Mitral Valve Prolapse

10. 20.Nonmaternal Death – death of the
mother resulting from accidental or
incidental causes not related to
pregnancy
Ex. Vehicular accident

11. Maternal AnatomyMaternal Anatomy

12. External Generative Organs

14. Mons pubisMons pubis
- Fat filled cushion that
lies over the
symphysis pubis
- After puberty, covered
by curly hair called
the escutcheon
- Women– triangular
- Men – not well
circumscribed

15. Labia MajoraLabia Majora
- Homologous with the
male scrotum
- Round ligament
terminates at the upper
border
- Merge posteriorly to form
the posterior commissure
- Puberty covered with hair
- Richly supplied with
sebaceous glands and
plexus of veins

16. Labia MinoraLabia Minora
- Supplied with a
variety of nerve
endings and are very
sensitive
- Merge anteriorly into
2 lamellae:
- lower- frenulum
- upper – prepuce
- Posteriorly fuse to
form fourchette

17. ClitorisClitoris
- Principal female
erogenous organ
- Homologue of the
penis
- Composed of glans,
corpus, and 2 crura
- Vessels are
connected with the
vestibular bulbs

18. VestibuleVestibule
- Almond shaped area
enclosed by labia
minora laterally and
extends from the
clitoris to fourchette
- Peforated by 6
openings

19. VestibuleVestibule
Vestibular Bulbs
- Correspond to the anlage
of the corpus spongiosum
of the penis
- Almond-shaped
aggregations of veins that
lie beneath the mucous
membrane on either side
of the vestiblue

20. PerineumPerineum
- Support:
- pelvic diaphragm
consists of levator ani M
and coccygeus M
posteriorly
- urogenital diaphragm
made up of deep
transverse perineal M,
constrictor of urethra, int.
& ext. fascial coverings

21. Internal Generative OrgansInternal Generative Organs

23. UterusUterus
- Posterior wall covered by
serosa
- Forms the Pouch of
Douglas
- Upper ant. Wall covered
by seosa, lower united
with post. Wall of bladder
by loose connective
tissue
- Resembles a flattened
pear

24. UterusUterus
- 2 parts;
- upper triangular-
corpus or body
- lower cylindrical-
cervix
- isthmus- portion
between internal os
and endometrial
cavity

25. UterusUterus
1. Cornua- portion were
oviduct emerges
2. Fundus – convex upper
segment above cornua
3. Round ligament – insert
below the tubes
4. Broad ligament – fold of
peritoneum extending to
pekvic side walls
5. Uterosacral ligament –
posterior to the uterus

26. UterusUterus
Cervix
- Internal os- level at which
peritoneum reflects upos
the bladder
- Portio vaginalis- lower
vaginal portion
- Nabothian cysts-
occluded cervical glands

27. UterusUterus
Endometrium
- Epithelium made up
of single layer high
columnar ciliated cells
- Invaginations form the
tubular uterine glands

28. UterusUterus
Blood Supply
- Internal iliac A 
uterine A & ovarian
A(aorta) arcuate A
 radial A coiled or
spiral A
(endometrium)
- supply midportion &
superficial third of the
endometrium

29. UterusUterus
Blood Supply
- Lateral to cervix,
uterine A crosses
over the ureter
- of significance
during hysterectomy

30. UterusUterus
Myometrium
- Makes up the major
portion of the uterus
- Smooth M
- Thicker in the inner
layers

31. UterusUterus
Ligaments
1. Broad ligament- wing-
like structure
- mesosalpinx- inner 2/3
where fallopian tubes
are attached
- infundibulopelvic
ligamentor suspensory
ligament of the ovary-
ovarian vessels traverse

32. UterusUterus
2. Cardinal Ligament –
transverse cervical
ligament,
Mackenrodt ligament
- thick
base of the broad
ligament united with
the supravaginal
portion of the cervix

33. UterusUterus
3. Round Ligament
- terminates in the
upper portion of the
labia majora
- corresponds with
the gubernaculum
testis

34. UterusUterus
4. Uterosacral Ligament
- from the
supravaginal portion
of the uterus and
attaches to the fascia
over the sacrum
- form the lateral
boundaries of the
Pouch of Douglas

35. OviductsOviducts
- Fallopian tubes
- 4 portions:
1. Interstitial-within the
muscular wall of uterus
2. Isthmus- narrow portion
3. Ampulla- wide lateral
portion
4. Infundibulum- fimbriated
end, funnel-shaped
opening

36. OviductOviduct
- Lined by a single
layer of columnar
cells some ciliated,
others secretory
- Musculature- inner
circular , outer
longitudinal
- Major innervation is
sympathetic

37. OvariesOvaries
- Size in the childbearing
years:
- length: 2.5-5 cm.
- width: 1.5-3 cm.
- thickness: 0.6-1.5 cm.
- Ovarian fossa of waldeyer-
slight depression on the
lateral wall of pelvis for
ovaries

38. OvariesOvaries
- Attached to broad
ligament by
mesovarium
- Utero-ovarian ligament-
just below interstitium
to ovary
- Infundibulopelvic or
suspensory ligament of
the ovary- to the pelvic
wall; through it course
the vessels and nerves

39. OvariesOvaries
- 2 portions:
1. Cortex- outer layer
- connective tissue cells
where primodial and
graafian follicles are
scattered
- outer portion- tunica
albuginea lined by a
single layer of cuboidal
epithelium, germinal
epithelium of Waldeyer

40. OvariesOvaries
2. Medulla – central
portion
- composed of loose
connective tissue
continuous with the
mesovarium
- with arteries and
veins, with small
amount of M fibers

41. The Bony PelvisThe Bony Pelvis

42. The Bony PelvisThe Bony Pelvis
- Composed of the sacrum,
coccyx, and 2 innominate
bones
- Innominate bone formed
by the fusion of the ilium,
ischium, and pubis
- Joined to the sacrum by
sacroiliac synchondrosis
and to one another at the
symphysis pubis

43. Pelvic anatomyPelvic anatomy
- False pelvis lies above
the linea terminalis
- True pelvis below this
boundary
- important in childbearing
- ishial spines- its
distance represents the
shortest pelvic diameter
- landmark for
assessing level of
presenting part

44. Planes and Diameters of the PelvisPlanes and Diameters of the Pelvis
Four Imaginary Planes:
1. Plane of the Pelvic inlet – superior strait
2. Plane of the Pelvic Outlet – inferior strait
3. Plane of the Midpelvis – least pelvic
dimensions
4. Plane of the Greatest Pelvic Dimension –
no obstetrical significance

45. Pelvic InletPelvic Inlet
Pelvic Inlet
- 50% of women
with a gynecoid
pelvic inlet
- 4 diameters:

46. Pelvic InletPelvic Inlet
1. Anteroposterior diameter:
- shortest distance between the promontory
and the symphysis pubis
- obstetrical conjugate
- normally measures 10 cm. or more
- clinical measurement of the obstetrical
conjugate s done by subtracting 1.5-2 cm.
from the diagonal conjugate

48. Pelvic InletPelvic Inlet
2. Transverse diameter
- at right angles to the obstetrical conjugate
- greatest distance between the linea
terminalis on either side :13.5 cm.
3. 2 Oblique diameters
- from the sacroiliac synchondrosis to the
ileopectineal eminence: 13 cm.

49. MidpelvisMidpelvis
- Measured at the level
of the ischial spine
- Interspinous diameter
: 10 cm. or more,
smallest diameter of
the pelvis

50. Pelvic OutletPelvic Outlet
- Three diameters:
- anteroposterior
- transverse: between
the ischial tuberosities
: 11cm.
- posterior sagittal

51. Pelvic ShapesPelvic Shapes

52. Pelvic ShapesPelvic Shapes
1. Android : anterior
portion is narrow and
triangular
2. Platypelloid : flattened
gynecoid pelvis
- short anteroposterior,
wide transverse

53. Pelvic ShapesPelvic Shapes
3. Gynecoid
- found in 50% of
women
- most suitable for
delivery of the fetus
4. Anthropoid
- anteroposterior
diameter is greater than
the transverse
- found in 1/3 of women

54. Menstrual CycleMenstrual Cycle
PhysiologyPhysiology

55. Normal Menstrual CycleNormal Menstrual Cycle
Two Segments:
1. Ovarian Cycle
a. follicular phase
b. luteal phase
2. Uterine Cycle
a. proliferative phase
b. secretory phase

56. Normal Menstrual CycleNormal Menstrual Cycle
lasts from 21 – 35 days
 duration of 2 – 6 days of flow
 average blood loss of 20 – 60 ml
 changes in weight gain – 1 – 3 lbs.
- due to fluid retention

57. Definition of Menstrual Cycle IrregularitiesDefinition of Menstrual Cycle Irregularities
1. Oligomenorrhea – infrequent, irregularly
timed episodes of bleeding usually
occurring at intervals of more than 35 days
2. Polymenorrhea – Frequent but regularly
timed episodes of bleeding usually
occurring at intervals of 21 days or less
3. Menorrhagia – Regularly timed episodes of
bleeding that are excessive in amount (>80
ml) and duration of flow (> 5 days)

58. 4.4. Metrorrhagia – irregularly timed bleeding
5. Menometrorrhagia – excessive prolonged
bleeding that occurs at irregularly timed,
frequent intervals
6. Hypomenorrhea – regularly timed bleeding
that is decreased in amount
7. Intermenstrual Bleeding – (usually not of
excessive amount) that occurs between
bleeding otherwise normal menstrual cycle

60. Endometrial CycleEndometrial Cycle
Main Stages of the Endometrial Cycle:
1. Early Proliferative Phase
- 2/3 shed off during menstruation
- reepithilialization starts even before
menstraution ceases
- 5th
day epithelial surface is restored,
revascularization of endometrium
- endometrial thickness - < 2mm

61. -- glands narrow, tubular structures follow almost a
straight parallel course
- glandular epithelium – low columnar, nuclei round,
more vesicular, larger
- stroma:
- deep layer – packed densely, nuclei
deep staining, small
- superficial layer – packed loosely, nuclei
round, more vesicular larger
- mitotic figures – present by fifth day until 2 – 3
days
after ovulation
- blood vessels numerous but no extravasated blood
or
lymphatic infiltrarion

62. 2. Late Proliferative Phase
- endometrium thicker due to glandular
hyperplasia and increased steomal ground
substance
- stroma:
- superficial layer – loose stroma with glands
widely separated
- deep layer – dense stroma with glands
crowded and tortuous
- glandular epithelium – taller and
pseudostratified

64. Proliferative PhaseProliferative Phase
• Day by day dating is not possible
• Vary in length from 7-21 days

66. 3. Early Secretory Phase
- 3 zones become well-defined:
a. basal zone – adjacent to myometrium,
undergoes little changes
b. compact zone – beneath endometrial
surface, glands are straight and narrower with
secretions
c. spongy zone – in between both layers,
glands are tortuous, serrated, little stroma
- stroma edematous

67. 4. Mid to Late Secretory Phase
- extremely vascular, succulent, rich in
glycogen
- suited for implantation and growth of
blastocyst
- decidualization – stromal cells around blood
vessels undergo hypertrophic changes
- intimate relationship of arteries and
aterioles
- formation of pericellular basement membrane
around stromal cells

68. 5. Premenstrual Phase
- 2 – 5 days prior to menstruation
- regression of the corpus luteum
- decrease progesterone and estrogen
- changes:
a. regression in endometrial growth
- decrease thickness, glands collapse
- spiral arterioles more coiled  inc.
resistance to
arterial blood flow  hypoxia
b. infiltration of stroma by polymorphonuclears
and mononuclear leukocytes
- pseudoinflammatory appearance

69. 6. Menstrual Phase
- arterial and venous bleeding, more
arterial
- leakage from vessels and hematoma
formation
* Secretory Phase of constant duration
- 12 - 14 days

70. Accurate Dating by HistologicAccurate Dating by Histologic
CriteriaCriteria
• 14 – 16 : (assuming ovulation occurs at day 14)
subnuclear glycogen with vacuoles in
glandular epithelium
• 17 -18 : vacuoles displace nuclei toward middle of
cells, mitosis rare
• 18 : mitosis cease
• 20 : near maximum secretion into lumen, few
vacuoles left

73. • 20 – 21 : interstitial edema, abundant ground
substance
• 23 – 24 : predecidualization
- increase cytoplasm of stromal cells
around arterioles then
throughout stroma
• 24 – 28 : marked decrease in
endometrial thickness
- extravasation of blood
- disintegration of stromal cells

74. Ovarian CycleOvarian Cycle
• At birth 1-2 million oocytes remain in the ovary
• At puberty, 300,000 only available for ovulation
• Only 400 – 500 will ultimately be released
• Oocytes persist at diplotene resting stage of
meiosis until ovulation
• Mitotic stasis- due to oocyte maturation inhibitor
(OMI) from granulosa cells
• Midcycle LH surge disrupts the gap junction
allowing meiosis to resume

75. Follicular PhaseFollicular Phase
1. Primordial follicles
- initial recruitment and
growth gonadotropin
independent
- FSH resumes control of
follicular differentiation
- changes: oocyte growth
expansion of a single
layer of follicular
granulosa cells to a
multilayer of cuboidal
cells

76. 2. Preantral Follicle
- breakdown of corpus
luteum, follicular growth
stimulated by FSH
- formation of zona
pellucida – glycogen- rich
- mitotic proliferation of
granulosa cells
- theca cells proliferate
- production of estrogen –
released to systemic
circulation
- dominant follicle
determined

77. 3. Preovulatory follicle
- fluid-filled antrum –
plasma with granulosa
cell secretions
- oocyte connected to
follicle by a stalk of
specialized granulosa
cells (cumulus
oophorus)
- high levels of estrogen
> 48 hrs. enhaces LH
release  LH surge 
luteinization of
granulosa cells 
progesterone
production  ovulation

78. Granulosa cell-derived peptides:
1. Inhibin – inhibits FSH release
a. Inhibin A – mainly active in luteal
phase
b. Inhibin B – secreted in follicular phase
- stimulated by FSH
2. Activin – stimulates release of FSH from
pituitary gland and potentiates its action
in the ovary

79. 4. Ovulation
- midcycle LH surge responsible for
increase in prostaglandins and
proteolytic enzymes in follicular wall
- weakens wall and allow perforation

80. Luteal PhaseLuteal Phase
Corpus LuteumCorpus Luteum
-- remaining follicular shell
- primary regulator of luteal phase
- produce progesterone which support
endrometrium
- if pregnancy does not occur-
regression
- estradiol and progesterone provide
negative feedback  decrease FSH and
LH

81. Corpus LuteumCorpus Luteum
-- function depends on continued LH
production
- in absence of stimulation – regress in 12
– 16 days  corpora albicans
- pregnancy : hCG mimics LH action
stimulates corpus luteum to
continually produce progesterone
- luteal-placental shift – 5 wks. AOG

84. Decidua of the EndometriumDecidua of the Endometrium
- Decidua – highly
specialized
endomerium of
pregnancy
- Trophoblast invasion
occurs

85. Decidual StructureDecidual Structure
Three portions:
Decidua basalis- directly beneath blastocyst
implantation
Decidua Capsularis – overlies the enlarging
blastocyst separating it from the rest of the
uterine cavity
- in contact internally with the avascular
extraembryonic fetal membrane, chorion
laeve
3. Decidua Parietalis/Decidua Vera – lines the
remainder of the uterus

86. Placental CirculationPlacental Circulation
Maternal blood->basal
plate >maternal arterial
pressure > chorionic
plate > bath external
microvillous surface of
chorionic villi > venous
orifices > uterine V
= spiral A perpendicular to
; veins parallel to
uterine wall

87. AmnionAmnion
- Innermost fetal membrane contiguous with the
amniotic fluid
- Avascular structure
- Provides almost all of the tensile strength of fetal
membranes
- Its integrity is important to successful fetal
outcome
- Metabolic function: involved in solute and water
transport to maintain amniotic fluid homeostasis

88. Umbilical cordUmbilical cord
- Funis
- Has two arteries and
one vein
- A component of fetal
membranes
- Wharton jelly-
extracellular matrix of
specialized
connective tissue

89. Fetal CirculationFetal Circulation

90. Maternal PhysiologyMaternal Physiology

91. Reproductive Tract

92. UterusUterus
- During pregnancy, it is transformed into a thin-
walled organ sufficient to accommodate the
fetus, placenta, and amniotic fluid
- Non-pregnant Pregnant
Volume: 10 ml cavity 5- 20 L
Weight: 70 g 1100 g
- Uterine enlargement involves stretching and
marked hypertrophy of muscle cells
- stimulated by estrogen and some
progesterone influence

93. UterusUterus
- Arrangement of Muscle cells:
1. Outer hoodlike layer- arches over the fundus
and extends into the ligaments
2. Middle layer – dense network of M fibers
perforated in all direction by blood vessels
3. Internal layer – sphincter-like fibers around
the orifice of the fallopian tubes and the
internal os of the cervix

94. UterusUterus
- Braxton Hicks contraction – painless
uterine contraction in a normal pregnancy
- Uteroplacental Blood Flow- delivers most
substances essential for growth and
metabolism

95. CervixCervix
- During pregnancy, the cervix undergoes
softening and cyanosis due to increased
vascularity and edema
- Mucus plug – copious amount of mucus
produced to obstruct the cervical canal
- Bloody show- expulsion of the mucus plug
- cervical mucus beading in pregnancy due to
progesterone
- Ferning- amniotic fluid leakage

96. OvariesOvaries
- Ovulation ceases and maturation of new
follicles is suspended in pregnancy
- Corpus luteum- maximally functions in
progesterone production in the 1st
6-7 wks.
of pregnancy
- Luteoma of pregnancy – solid ovarian
tumors produced due to exaggerated
luteinization reaction

97. OvariesOvaries
- Theca-lutein Cysts – benign ovarian
lesions resulting from exaggerated
physiological follicle stimulation
- associated with markedly elevated serum
hCG levels

98. Fallopian TubesFallopian Tubes
- Musculature undergoes hypertrophy
- Epithelium of tubal mucosa becomes
flattened

99. Vagina and PerineumVagina and Perineum
-- Chadwick sign- violet discoloration due to
increased vascularity
- Changes in preparation for distention:
1. increase thickness of mucosa
2. Loosening of connective tissue
3. Hypertrophy of smooth M cells

100. SkinSkin

101. Abdominal wallAbdominal wall
- Striae gravidarum- “stretch marks”
- reddish, slightly depressed
streaks
- Diastasis recti- rectus M separated at
midline

102. PigmentationPigmentation
- Linea nigra –– markedly pigmented midline
of linea alba
- Chloasma/melasma gravidarum – irregular
brownish patches on the face and neck

103. Vascular ChangesVascular Changes
- Vascular spiders – minute red elevations
on the skin, face, neck upper chest and
arms
- Palmar erythema- no clinical significance
and disappear shortly after pregnancy

104. BreastBreast

105. BreastsBreasts
- Early weeks – breast tingling and
tenderness
- Second month- increase in size, veins
become visible, nipple become larger,
darker and more erectile
- Colostrum – thick yellowish fluid
- Glands of Montgomery – small elevations
on the broader and darker areols

106. Metabolic ChangesMetabolic Changes

107. Weight gainWeight gain
- Attributed to the uterus and its contents,
breasts, increase in blood volume and
extracellular fluid
- Average wt. gain: 12.5 kg. or 27.5 lbs.

108. Water MetabolismWater Metabolism
- Increased water retentionIncreased water retention
- At term, water content of fetus, placenta, and
amniotic fluid : 3.5 l
- Increased blood volume and size of uterus and
breasts : 3.0 l
- The total amount 6.5 ml

109. Protein MetabolismProtein Metabolism
- At term, fetus and placenta weigh 4 kg.
with 500 g of protein
- Nitrogen balance increases with gestation

110. Carbohydrate MetabolismCarbohydrate Metabolism
- Mild fasting hypoglycemia, postprandial
hyperglycemia, hyperinsulinemia
- Increased basal level of plasma insulin

111. Fat MetabolismFat Metabolism
-- Concentration of lipids, lipoprotein,
apolipoproteis in plasma increase
- LDL increases may be attributed to
estrogen
- Fat usually deposited in the central rather
than peripheral sites

112. Electrolyte and Mineral MetabolismElectrolyte and Mineral Metabolism
- 1000 meq of Na and 300 meq of K are
retained in pregnancy
- Total Ca and Magnesium levels decrease

113. Hematological changesHematological changes

114. Blood VolumeBlood Volume
- Increases to 40-45% above non-pregnant
levels
- Functions of prenancy-induced hypervolemia:
1. Meet demans of enlarged uterus
2. Protect mother and fetus against deliterious
effects of impaired venous effects in the supine
and erect position
3. Safeguard the mother against the adverse
effects of blood loss associated with parturition

115. Iron MetabolismIron Metabolism
- Total iron requirement: 1000 mg
- Amount of iron absorbed from the diet and
that mobilized from stores is insufficient to
meet maternal demands
- Supplemental iron is necessary
- Blood loss: Normal delivery: 500 ml
- cesarean delivery: 1000 ml

116. Cardiovascular SystemCardiovascular System

117. HeartHeart
- Resting pulse rate increases by 10
beats/min.
- Cardiac sounds: exaggerated splitting of
the 1st heart sound, increased loudness of
both sounds
- Systolic murmur noted in 90% of pregnant
women

118. HeartHeart
- Cardiac Output: increased in early
pregnancy
- much greater in the 2nd
stage of
labor
- Increase is lost immediately after delivery

119. Circulation and Blood PressureCirculation and Blood Pressure
- Arterial BP decreases to a nadir at
midpregnancy and rises thereafter
- In late pregnancy, blood flow at the lower
extremities is retarded due to occlusion of
the pelvic veins and inferior vena cava
- Supine hypotensive syndrome- due to
compression of venous system from
enlarging uterus

120. Respiratory TractRespiratory Tract

121. Pulmonary FunctionPulmonary Function
- Respiratory rate is not changed
- Increased functions:
- tidal volume
- minute ventilatory volume
- minute oxygen uptake
- Decreased functions:
- functional residual capacity
- residual volume

122. Acid-Base EquilibriumAcid-Base Equilibrium
- Increased tidal volume lowers blood PCO2
- Induced by progesterone mainly
- Respiratory alkalosis stimulated the
increased affinity of maternal hemoglobin
for oxygen (Bohr effect)

123. Uirnary SystemUirnary System

124. KidneyKidney
Renal Changes:
1. Kidney size increases
2. Glomerular filtration rate and renal
plasma flow increases early
3. Dilatation of pelves, calyces, ureter
4. Renal bicarbonate threshold decreases
5. Osmoregulation is altered

125. UretersUreters
- More ureteral dilatation on the R due to:
- cushioning on the L by sigmoid
- dextrorotaiton of he uterus
- Progesterone may contribute to ureteral
dilatation

126. BladderBladder
- Some women develop stress urinary
incontinence
- Few anatomic changes noted- deepening
and widening of trigone

127. Gastrointestinal TractGastrointestinal Tract

128. - Stomach and intestines are displaced by
the enlarging uterus
- Pyrosis (heartburn)- common during
pregnancy, caused by reflux of acidic
secretions
- Epulis - hyperemic and softened gums
- Hemorrhoids – due to constipation and
elevated pressure in veins

129. Liver
- Concentration of serum albumin
decreases
- Leucine aminopeptidase activity is
elevated – has oxytocinase activity
Gallbladder
- Decreased contractility due to
progesterone

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