Progesterone causes many changes to the genitournary system. A pregnant woman may experience an increase in the size of the kidneys and ureter due to the increase blood volume and vasculature. Later in pregnancy, the woman might develop physiological hydronephrosis and hydroureter, which are normal. Progesterone causes vasodilatation and increased blood flow to the kidneys, and as a result glomeruler filtration rate (GFR) commonly increases by 50%, returning to normal around 20 weeks postpartum. The increased GFR increases the excretion of protein, albumin, and glucose. The increased GFR leads to increased urinary output, which the woman may experience as increased urinary frequency. Progesterone also causes decreased motility of the ureters, which can lead to stasis of the urine and hence an increased risk of urinary tract infection.
Pregnancy alters the vaginal microboita with a reduction in species/genus diversity. Physiological hydronephrosis may appear from six weeks.
During pregnancy the plasma volume increases by 40-50% and the red blood cell volume increases only by 20–30%. These changes occur mostly in the second trimester and prior to 32 weeks gestation. Due to dilution, the net result is a decrease in hematocrit or hemoglobin, which are measures of red blood cell concentration. Erytheopeotien, which stimulates red blood cell production, increases throughout pregnancy and reaches approximately 150 percent of their pregnancy levels at term. The slight drop in hematocrit or hemoglobin is most pronounced at the end of the second trimester and slowly improves when reaching term.
Platelet and white cell count
The effect of pregnancy on platelet count is unclear, with some studies demonstrating a mild decline in platelet count and other studies that show no effect. The white blood cell count increases with occasional appearance of myelocytes or metamyelocytes in the blood. During labor, there is a rise in leukocyte count.
Hypercoagulability
A pregnant woman will also become hypercoaguable, leading to increased risk for developing blood clots and embolisms, such as deep vein thrombosis and pulmonary embolism. Women are 4-5 times more likely to develop a clot during pregnancy and in the postpartum period than when they are not pregnant. Hypercoagulability in pregnancy likely evolved to protect women from hemorrhage at the time of miscarriage or childbirth. In third world countries, the leading cause of maternal death is still hemorrhage. In the United States 2011-2013, hemorrhage made up of 11.4% and pulmonary embolisms made up of 9.2% of all pregnancy-related deaths.
The increased risk of clots can be attributed to several things. Plasma levels of pro-coagulantion factors increased markedly in pregnancy. Both the production of prostacyclin (an inhibitor of platelet aggregation) and thromboxane (an inducer of platelet aggregation and a vasoconstrictor) are increased, but overall there is an increase in platelet reactivity which can lead to a predisposition to clots. There is also increased blood stasis due to the compression of the vena cava by the enlargening uterus. Many factors have been shown to increase the risk of clots in pregnancy, including baseline thrombophillia, cesarean section, preeclampsia, etc. Clots usually develop in the left leg or the left iliac/ femoral venous system. Recently, there have been several case reports of May-Thurner Syndrome in pregnancy, where the right common iliac artery compresses the below left common iliac vein.
Edema
Edema, or swelling, of the feet is common during pregnancy, partly because the enlarging uterus compresses veins and lymphatic drainage from the legs.
The heart adapts to the increased cardiac demand that occurs during pregnancy in many ways.
Cardiac output (Lit./Min.): 6.26
Stoke Volume (Ml.): 75
Heart Rate (Per min.): 85
Blood Pressure: Unaffected
Cardiac output increases throughout early pregnancy, and peaks in the third trimester, usually to 30-50% above baseline. Estrogen mediates this rise in cardiac output by increasing the pre-load and stroke volume, mainly via a higher overall blood volume (which increases by 40–50%). The heart rate increases, but generally not above 100 beats/ minute. Total systematic vascular resistance decreases by 20% secondary to the vasodilatory effect of progesterone. Overall, the systolic and diastolic blood pressure drops 10–15 mm Hg in the first trimester and then returns to baseline in the second half of pregnancy. All of these cardiovascular adaptations can lead to common complaints, such as palpitations, decreased exercise tolerance, and dizziness.
Uterine Compression of IVC and Pelvic Veins. Displacement of PMI by Uterus
Uterine enlargement beyond 20 weeks’ size can compress the inferior vena cava, which can markedly decrease the return of blood into the heart or preload. As a result, healthy pregnancy patients in a supine position or prolonged standing can experience symptoms of hypotension.
Pregnant women experience numerous adjustments in their endocrine system that help support the developing fetus. The fetal-placental unit secretes steroid hormones and proteins that alter the function of various maternal endocrine glands. Sometimes, the changes in certain hormone levels and their effects on their target organs can lead to gestational diabetes and gestational hypertension.
Fetal-placental unit
Graph of the levels of estrogen, progesterone, beta-hcg throughout pregnancy
Levels of progesterone and estrogen rise continually throughout pregnancy, suppressing the hypothalamic axis and subsequently the menstrual cycle. The progesterone is first produced by the corpus luteum and then by the placenta in the second trimester. Women also experience increased human chroinic gonadotropin (β-hCG), which is produced by the placenta.
Pancreatic Insulin
The placenta also produces human placental lactogen (hPL), which stimulates maternal lipolysis and fatty acid metabolism. As a result, this conserves blood glucose for use by the fetus. It can also decrease maternal tissue sensitivity to insulin, resulting in gestational diabetes.
Pituitary gland
The pituitary glands grows by about one-third as a result of hyperplasia of the lactrotrophs in response to the high plasma estrogen. Prolactin, which is produced by the lactrotrophs increases progressively throughout pregnancy. Prolactin mediates a change in the structure of the breast mammary glands from ductal to lobular-alveolar and stimulates milk production.
Parathyroid
Fetal skeletal formation and then later lactation challenges the maternal body to maintain their calcium levels. The fetal skeleton requires approximately 30 grams of calcium by the end of pregnancy. The mother’s body adapts by increasingparathyroid hormone, leading to an increase in calcium uptake within the gut as well as increased calcium reabsorption by the kidneys. Maternal total serum calcium decreases due to maternal hypoalbuminemia, but the ionized calcium levels are maintained.
Adrenal goals
Total cortisol increases to three times of non-pregnant levels by the third trimester. The increased estrogen in pregnancy leads to increase corticosteroid-binding globulin production and in response the adernal glad produces more cortisol. The net effect is an increase of free cortisol. This contributes to insulin resistance of pregnancy and possibly striae.Despite the increase in cortisol, the pregnant mom does not exhibit Cushing syndrome or symptoms of high cortisol. One theory is that high progesterone levels act as an antagonist to the cortisol.
The adrenal gland also produces more aldosterone, leading to an eight-fold increase in aldosterone. Women do not show signs of hyperaldosterone, such as hypokalemia, hypernatremia, or high blood pressure.
The adrenal gland also produces more androgens, such as testosterone, but this is buffered by estrogen’s increase in sex-hormone binding globulin (SHBG). SHBG binds avidly to testosterone and to a lesser degree DHEA.
Thyroid
The thyroid enlarges and may be more easily felt during the first trimester. The increase in kidney clearance during pregnancy causes more iodide to be excreted and causes relative iodine deficiency and as a result an increase in thyroid size. Estrogen-stimulated increase in thyroid-binding globulin (TBG) leads to an increase in total thyroxine (T4), but free thyroxine (T4) and triiodothyronine (T3) remain normal.
The various changes that occur in hormone secretions during pregnancy have been reviewed. The first trimester is characterized by a rapid rise in levels of chorionic gonadotrophin in blood and urine. The function of the adrenal cortex is slightly increased at this time. In the last trimester, estrogens, progesterone (or its metabolite pregnanediol) and the adrenocortical hormones are at a high level in blood and urine. The relationship of the hormones to certain metabolic changes observed in pregnancy is discussed.
The earliest symptoms of pregnancy differ from person to person. For most, this is the month you discover you’re pregnant – and that positive pregnancy test (and a missed period) may be the only sign you have.
CHANGES YOU MAY EXPERIENCE
Nausea – the earliest signs of “morning sickness” can appear in the first month.
Breast Tenderness – your breasts or nipples may be swollen and tender to the touch.
Fatigue – you may feel tired as your body adjusts to hormonal changes.
Frequent Urination – a common side effect of the production of human chorionic gonadotropin (hCG) which causes an increased need to urinate in early pregnancy.
Food Sensitivity – just the smell of food may turn your stomach.
HOW YOUR BABY IS DEVELOPING Your baby is only .1 to .2 millimeters and at this stage is called a blastocyst. At three weeks pregnant, your child has already developed all his genetic material – and the sex is already decided.
WHAT TO EXPECT AT YOUR PRENATAL VISIT THIS MONTH
A pregnancy test to confirm the pregnancy.
You’ll complete an extensive family medical history.
The doctor usually performs an internal pelvic exam to check your uterus, vagina, and cervix.
A Pap smear, if you haven’t had one in the past year.
Routine blood tests and urine tests may be performed.
An assessment of your health, including height, weight and blood pressure.
You will be prescribed a prenatal vitamin and folic acid.
Consult with your doctor about any over-the-counter or prescription drugs you take.
Second Month
Baby goes from blastocyst to zygote, as that dividing ball of cells takes on a more human form. You may be experiencing a change, too, as your body and mind adjust to your new role as mom-to-be.
CHANGES YOU MAY EXPERIENCE
Nausea, vomiting, food sensitivity and fatigue may develop or become more severe.
If you haven’t already, you should make changes in your lifestyle so you and your baby will be healthy. You should stop smoking, drinking and using caffeine. Consult your caregiver about other changes you may need to make.
You may experience moodiness as hormone levels adjust.
Sexual desire may wan as fatigue and nausea increase.
HOW YOUR BABY IS DEVELOPING Your baby is now a little under an inch long but has developed into a tiny human being. The heart is beating, the brain is developing and she has developed all her limbs as well as hands and feet. The eyes have not fully developed.
WHAT TO EXPECT AT YOUR PRENATAL VISIT THIS MONTH
If this is your first visit, you will receive an internal pelvic exam and Pap smear.
Weight gain and blood pressure will be measured and monitored.
Urine will be tested for possible infection.
Blood may be drawn to test for anemia and HIV. Genetic testing may also be given if appropriate.
Third Month
You’re reaching the end of your first trimester, and your body is adjusting to the shifting hormone levels. By the end of the third month, your baby is fully developed.
CHANGES YOU MAY EXPERIENCE
Nausea may decrease as your body adjusts to hormone levels.
Your middle may widen, as the uterus grows to the size of a grapefruit.
As you feel better, develop an exercise plan to increase strength and flexibility, which will help during labor.
Moodiness and food aversions may continue but usually subside by the end of the trimester.
You may experience your first food cravings as appetite returns.
HOW YOUR BABY IS DEVELOPING Your baby is now officially a fetus and is between two and four inches long. By the end of the first trimester, all organs are present, and even fingernails are developing. Your baby is also moving her arms and legs, though you won’t feel it yet. The rate of miscarriage drops at this point.
WHAT TO EXPECT AT YOUR PRENATAL VISIT THIS MONTH
You will be able to hear your baby’s heartbeat.
Chorionic villus sampling (CVS), which can detect Tay-Sachs, sickle cell anemia, Down syndrome, and other genetic defects, is usually scheduled between ten and twelve weeks if desired.
Weight, blood pressure and other monitoring will continue.
Fourth Month
Hormones settle, morning sickness fades, and you start to feel normal again. You also start showing – and feeling like a true mom-to-be. Welcome to the joys of the second trimester!
CHANGES YOU MAY EXPERIENCE
By the end of this month, you may feel “quickening” – the first flutters of baby movement often described as “butterflies” or “bubbles.”
You may find yourself feeling better. Nausea usually subsides and energy increases.
Hormones stabilize, and you feel less moody. Your sex drive may also return. Enjoy this time!
You may develop heartburn as your uterus rises in the abdomen.
Outward signs of pregnancy may begin to appear.
Most moms-to-be start shopping for their pregnancy wardrobe at this point.
Now is a good time to sign up for prenatal classes.
HOW YOUR BABY IS DEVELOPING Your baby is five to six inches long and weighs up to four ounces. Baby’s face and heart are fully formed at this point, though the lungs are still developing. Baby’s eyes will open during this month and he or she will begin feeling the urge to suck.
WHAT TO EXPECT AT YOUR PRENATAL VISIT THIS MONTH
Much like last month’s visit, monitoring of fetal heartbeat and size, as well as your own weight and blood pressure, will continue.
As it is every month, your urine will be tested for sugar and protein.
An ultrasound is usually performed to check for fetal age.
The alpha-fetoprotein (AFP) test for neural defects is given in week 16.
Amniocentesis test for abnormal chromosomes may be offered.
Fifth Month
You’re glowing – and showing! You’re halfway through your pregnancy, and your baby is thriving.
CHANGES YOU MAY EXPERIENCE
Most women gain between 5 to 15 pounds by this time.
Your uterus is now the size of a cantaloupe.
Appetite often increases.
Fatigue may return, as you’re carrying extra weight and your heart is pumping more blood.
Some women experience bloating, constipation or other uncomfortable symptoms. Talk to your doctor if you have any concerns.
Some women experience forgetfulness, sometimes called “pregnancy brain.”
Your belly button may pop out.
HOW YOUR BABY IS DEVELOPING Your baby is now about 10 ounces and six to nine inches long. Baby is covered with a fine protective hair. This month he or she will develop fingerprints and permanent teeth buds behind fully formed baby teeth. Little girls’ ovaries also develop at this time, and sex may be determined through ultrasound.
WHAT TO EXPECT AT YOUR PRENATAL VISIT THIS MONTH
Monitoring of baby’s growth and heartbeat continues.
Your weight, urine and blood pressure will also be checked.
At this point, an ultrasound may reveal the baby’s sex. This “second scan” may also show any anomaly.
Sixth Month
As the second trimester comes to an end, your baby is making his presence known – and your maternal instincts may be emerging as well. Start the countdown – labor day is just months away.
CHANGES YOU MAY EXPERIENCE
Your uterus is now the size of a basketball resting above your belly button. The skin on the stomach may feel itchy as it stretches around your growing womb.
Complaints of mid-pregnancy, including bleeding gums, constipation, heartburn and leg cramps, may intensify at this time.
You’ll gain about a pound a week at this time. The increased weight may result in varicose veins or hemorrhoids. Talk to your doctor if you notice protruding veins in any area.
You may become tired more easily – no wonder! Listen to your body and rest as necessary.
HOW YOUR BABY IS DEVELOPING Your baby is about 10 inches long and weighs over a pound. You’ll be aware of baby’s movements as he or she stretches and hiccups. Baby’s eyes now open and close, vocal cords are functioning, and “finishing touches” like eyebrows have formed.
WHAT TO EXPECT AT YOUR PRENATAL VISIT THIS MONTH
Monitoring will continue. Pregnancy-induced blood pressure problems (hypertension) often start at this time, so make your caregiver aware of problems with swollen ankles, headaches or nosebleeds.
Most women are tested for gestational diabetes at this time.
Seventh Month
The fetus at seven months is becoming more baby-like. Time to start thinking about maternity leaves and birth plans, as you enter the third trimester!
CHANGES YOU MAY EXPERIENCE
Your feet or hands may start cramping.
You may experience more movement of your baby.
Your joints may feel looser due to softening in preparation for birth.
Many women experience Braxton Hicks contractions (non-productive contractions) starting in the seventh month.
HOW YOUR BABY IS DEVELOPING Your baby is starting to develop fat under his or her skin. Baby’s now almost 12 inches long and weighs between two and four pounds. Your child can now see, hear and taste, and the brain and nervous system are growing rapidly.
WHAT TO EXPECT AT YOUR PRENATAL VISIT THIS MONTH
Monitoring of your weight, blood pressure and urine, as well as the baby’s growth and position, will continue.
Women who are Rh-negative may receive a shot of Rhogam at this time to prevent complications later.
Stretch marks may appear as the skin continues to stretch.
You may start seeing your caregiver more frequently at this point. Most start out with checkups every other week once you’re seven months pregnant.
Now is the time to talk to your caregiver about your birth vision. Discuss your feelings about pain management, fetal monitoring, episiotomies and breastfeeding at this time. Just remember these plans are just a blueprint, which can be adjusted as necessary during labor and delivery to protect the well being of mom and baby.
Eighth Month
Babies grow rapidly when you’re eight months pregnant – and you may be tiring of pregnancy and anxious for baby’s arrival. Enjoy setting up a nursery as the countdown begins!
CHANGES YOU MAY EXPERIENCE
You’ll continue to gain about a pound a week.
You may feel discomfort as the baby pushes on the rib cage or organs.
Pelvic pressure may increase as the baby drops into this area.
Indigestion and heartburn may become more intense.
Skin continues stretching and stretch marks may appear.
Braxton Hicks contractions become more regular.
HOW YOUR BABY IS DEVELOPING Your baby’s brainwaves resemble those of a newborn by this time. He may be a foot (12 inches) or longer and weigh about five pounds. The lungs and brain are continuing to develop and other body systems are refining to be ready for living outside of you. Movements may slow as the baby fills more of the uterus and has less room to stretch. By the end of the month, most babies are head down and descending into the pelvic area.
WHAT TO EXPECT AT YOUR PRENATAL VISIT THIS MONTH
Monitoring of your weight, urine, blood pressure and swelling will continue.
Baby’s growth, heartbeat, size, and position will be checked.
Some caregivers order a second ultrasound at this time to verify the baby’s size and position.
Caregiver visits usually increase from bi-weekly to weekly starting at the 36th week.
Ninth Month
The countdown to baby’s birthday begins. You may be tired one minute and energetic the next, as you anxiously wait for baby’s arrival.
CHANGES YOU MAY EXPERIENCE
You may breathe a little easier as baby settles into the pelvis, giving you more room in the abdominal area. This is known as lightening.
Sleep will become more difficult due to your size and any anxiety you may feel about the upcoming birth.
Some women experience a “nesting instinct” and feel compelled to ready the home for the baby’s arrival.
Your weight gain will be as high as it will go – up to 35 pounds is average. Some women start losing a pound or two as labor approaches.
HOW YOUR BABY IS DEVELOPING Baby’s lungs are maturing, and he or she is shedding the layer of hair that protected him or her in the uterus. Your baby’s brain is growing tremendously this last month. Baby measures about 18 to 21 inches long and weighs about six to eight pounds.
WHAT TO EXPECT AT YOUR PRENATAL VISIT THIS MONTH
All monitoring will continue. You will also receive an internal examination to determine if the cervix has ripened or started to dilate.
Your caregiver may swab your vagina and rectum to test for group b streptococcus infection (group b strep).
You will visit your caregiver weekly for monitoring at this point. Visits may increase if you pass your due date.
Pregnancy world 