Changes in a woman's body during pregnancy. organs of digestion and excretion. Changes in the female body during pregnancy

All the metamorphoses that take place in the body of the expectant mother are due to one and only reason: her body is trying to provide the newly born life with all the necessary conditions for harmonious growth and development.

When do changes begin in a woman's body during pregnancy?

Changes in the body begin to occur from the very first day after conception. A woman may not be aware of her interesting position at all, since nothing changes except the level of hCG.

Reference! HCG (Chronological Gonadotropin) is a hormone that begins to be produced by the chorionic tissue on the 6-8th day after the cell is fertilized. This is one of the most important indicators of a successful conception.

The first weeks of pregnancy pass for each woman individually: some do not feel any changes at all, others suffer from drowsiness and apathy, while others, on the contrary, become too sensitive and receptive. All this speaks of the restructuring of the hormonal background.

In the first two months a pregnant woman may experience the following changes:

• Toxicosis - is expressed by bouts of nausea and increased susceptibility to odors. Sometimes, against the background of vomiting, a woman slightly loses weight.
• Frequent urination - the general level of fluid in the body rises, the uterus begins to press on the bladder.
• Swelling of the mammary glands - the level of estrogen and progesterone increases, the breasts become larger and more sensitive. The halo around the nipples also darkens and grows. Sometimes the vascular network becomes visible.

In the third month the external parameters of the body hardly change, with the exception of a slight increase in weight (1 - 1.5 kg). Toxicosis subsides, health improves. Frequent urge to go to the toilet for little need is now due not only to the pressure of the uterus on the bladder, but also to the formation of the excretory system in the embryo. Of the inconveniences in the third month, uncontrolled changes in appetite can be noted, from hunger to complete aversion to food. Headaches become more frequent.

In the fourth month the belly begins to round, and the expectant mother should think about purchasing looser and more comfortable clothes. The gait becomes more angular (the belly moves forward and the back bends back). The uterus begins to press on the intestines, which causes digestive disorders. The swelling becomes more noticeable, especially on the face and ankles.

Fifth month for many expectant mothers it is remembered as the time when the lack of calcium in the body is felt to the full. Teeth can begin to crumble, old fillings fall out, nails break and hair chops. In some cases, muscle cramps appear. Due to the increase in body weight, veins in the legs (varicose veins) come out.

At the beginning of the sixth month the woman happily feels the first movements of the baby inside the womb. The way her hips and belly are rounded is noticeable even to those around her.

Note! During this period, many pregnant women may begin to experience so-called training contractions (Braxton Hicks contractions). They are not painful or harmful.

In the seventh month the uterus rises so high that it begins to prop up the diaphragm. The whole body is under intense stress. Many women suffer from severe back pain and an increase in natural vaginal discharge. In some cases, stretch marks appear on the body.

At eight months the uterus becomes very sensitive to all movements of the child, and the woman feels this by the tension of the muscles. Many people get “late toxicosis”. Of the inconveniences of this period, shortness of breath, swelling, sluggishness and chronic fatigue can be noted.

Ninth, final month- this is a period when a woman's body is experiencing colossal overload. Severe back pain and a large abdomen force the expectant mother to walk strongly backward. Colostrum begins to flow from the nipples.

What changes can be observed in the body during pregnancy:

To understand what changes occur in the body of a pregnant woman, it is worth breaking them down into points and considering each separately.

- body weight and metabolism

During the entire pregnancy, a woman gains weight by 8 - 18 kg. Do not be intimidated by this figure, because all the weight is dispersed according to the following principle:

• Fetus, amniotic fluid, placental membranes - from 4 to 4.5 kg.
• Uterus- the weight of the uterus increases from 50-100 grams to 1 kg.
• Blood- during the carrying of a child, about 1 liter of blood is added in the body of a pregnant woman.
• Adipose tissue and interstitial fluid - about 5 kg.

Reference! In the first half of pregnancy, the weight increases by about 4 kg, in the second - 2 times more.

The woman's metabolism is being rebuilt taking into account the fact that another small person grows and lives in the womb. The production of digestive enzymes is doubled. A woman should make such a menu for herself so that, together with food, a sufficient amount of nutrients, vitamins and microelements enter her body.

- nervous system

The first 4 months of pregnancy are accompanied by inhibition of the nervous system. In most cases, the expectant mother becomes lethargic, sleepy, and apathetic. Thus, her body creates all the conditions for the fertilized egg to be fixed, and the embryo began to develop.

After 4 months, the situation changes dramatically: abrupt mood swings appear, and the reaction to mental and physical stimuli is aggravated. In some cases, neuralgic back pain appears.

- respiratory system

In the last stages, the growing uterus displaces the diaphragm upward, however, this does not in any way affect the volume of inhaled and exhaled air. The breathing rate remains the same. Physiological changes are minimal.

- cardiovascular system, blood pressure

Unlike the respiratory system, the cardiovascular system undergoes significant changes:

• The volume of circulating blood increases: at about 32 weeks, it becomes 35% more than before pregnancy. This meets the increased requirements of the uterus and the fetus, protects against hypotension syndrome in the supine position and critical blood loss during childbirth.
• The composition of the blood changes. The number of erythrocytes slightly decreases, the level of folic acid in the plasma decreases, the concentration of hemoglobin and the value of hematocrit decrease. This increases the number of leukocytes, the erythrocyte sedimentation rate and the concentration of fibrinogen.
• Blood pressure changes. In the first half of pregnancy, blood pressure decreases, and in the second, on the contrary, it rises. It is important to ensure that pressure surges are not accompanied by a sharp deterioration in well-being.
• The venous pressure in the legs rises, and also the compression of the central nerve highways occurs. This can provoke varicose veins, severe swelling of the extremities, and in some cases even hemorrhoids.

- organs of digestion and excretion

Many expectant mothers notice changes in the work of the digestive tract with the first signs of toxicosis - increased salivation, susceptibility to odors, nausea and vomiting. Unusual food addictions or aversions to familiar foods appear. Besides the obvious:

• metabolism accelerates;
• the liver begins to work in an enhanced mode, providing dehydration of decay products;
• there is a tendency to constipation or diarrhea, due to the fact that the growing uterus presses on the intestines.

- urinary organs

The urinary system works for two, which is why the expectant mother is forced to visit the ladies' room twice as often. In addition, as it grows, the uterus puts more pressure on the bladder, which also leads to frequent urination.

Reference! During pregnancy, the tone of the muscle layers of the urinary organs is significantly reduced.

- endocrine system

The endocrine system is a kind of "conductor" of the reproductive function. The normal functioning of the hypothalamus, pituitary and ovaries ensures the development of the egg and promotes successful conception, and hormones produced by the endocrine gland are responsible for the formation of bone tissue and the brain of the embryo.

Changes in the functioning of the organism of the expectant mother are caused by the influence of the endocrine glands. The ovaries slightly increase, and one of them contains a functioning corpus luteum for up to 4 months.

Then, the placenta takes over the production of progesterone and estrogen. The number of blood vessels that expand and encircle the uterus gradually increases.

- skin, hair and nails

As much as the expectant mother wants to look perfect while carrying a child, this does not always work due to natural physiological changes.

Due to the hormonal surge, the skin on the face can become more oily and covered with small pimples, as a rule, this is a normal and reversible process.

Reference! There is a sign according to which damage to the skin on the face and deterioration of the condition of the hair are a sign of bearing a girl.

It is not only the face that is hit - the chest and abdomen can be covered with brown age spots. This is due to a change in the activity of the adrenal glands. If the skin is not elastic enough, stretch marks appear on the abdomen and hips.

As for hair and nails, their condition is strongly influenced by the level of calcium in the body. As mentioned earlier, its deficiency becomes especially noticeable in the fifth month of pregnancy. Hair can begin to fall out, split, and nails - break and exfoliate. The situation can be corrected by adding calcium-containing foods and vitamin-mineral complexes to the diet.

It is noteworthy, but the loss of hair on the head can be accompanied by hair growth in completely unexpected places: the chin, coccyx, "path" from the navel to the groin, etc.

- the immune system

For clarity, one can imagine that the body of a pregnant woman works in a mode of saving resource consumption, so that its reserves are enough to ensure the life of both the mother and the embryo growing in her womb.

Specific (acquired immunity) decreases significantly, while nonspecific, on the contrary, increases. This process can be traced by the composition of blood cells and plasma proteins.

Important! It is twice as easy for a pregnant woman to catch a disease transmitted by airborne droplets. Therefore, wear a medical mask before going outside during cold season.

How does a past pregnancy affect a woman's health?

If a woman carefully monitors her own condition and timely eliminates existing ailments, then only frequent, multiple births, between which her body does not have time to recover, can cause significant harm to her. But, unfortunately, not all women in labor are in good health, and therefore, even at the planning stage, it is worth considering all the possible risks and consequences:

• Excess weight: during pregnancy, many women gain excess weight, which is quite difficult to eliminate without systematic exercise and diet correction. Not all young mothers have the time and energy for this. In addition, if a woman is genetically prone to obesity, pregnancy can be a trigger for the development of obesity.
• Breast shape changes. Breasts, especially large ones, may sag somewhat. In addition, there is a risk of nipple injury during feeding.
• Stretch marks. If the skin is not elastic enough, dark streaks of stretch marks can remain on the abdomen and thighs for life.
• Anemia as a result of large blood loss during childbirth.
• Postpartum depression. It occurs in women who have difficulty accepting their new status.

But, apart from the negative aspects, it is worth noting the positive ones. For example, a past pregnancy has a positive effect on the outcome of endometriosis and reduces the risk of developing ovarian cancer.

Conclusion

A woman who carries a child under her heart cautiously listens and looks closely at all the changes in her health and appearance, especially if the first pregnancy. We hope that our article helped you sort out your feelings.

Specially for- Elena Kichak

Pregnancy is a special condition of a woman, during which constant changes occur. These changes are both external and internal.

As for external changes, their appearance, as a rule, does not raise any special questions. These are, first of all, such obvious signs as the rounding of the forms of the expectant mother, pigmentation on the skin, the release of colostrum from the breast at a later date.

But internal processes are hidden from our eyes. Therefore, noticing any physiological or mental changes in herself, the expectant mother is worried whether everything is going well with her and the baby.

Indeed, a lot of questions arise. Why does mood change quickly? Why did you start going to the toilet more often? Why did such unpleasant phenomena as heartburn, shortness of breath, swelling appear? Etc…

To begin with, emotional instability is a normal condition during pregnancy. Future mothers - they are, they will always find a reason to worry. Even if it is difficult to find such a reason. And we will talk about this today too.

In this article, you will learn that the special emotional state of pregnant women, accompanied by anxieties and fears, is the result of hormonal changes.

You will also find here information on how an already realized pregnancy affects the female body.

Changes in the female body during pregnancy:

On the part of the cardiovascular system

The volume of circulating blood is increased to provide blood flow for two organisms. This increased volume is much more difficult for the heart to pump. For this reason, the heart muscle thickens slightly. The heart rate also increases slightly.

Due to the increase in blood volume and special hormonal changes, venous outflow from the lower extremities is difficult. In this regard, varicose veins so often develop in pregnant women.

Blood pressure in the early stages, as a rule, decreases moderately. In later stages, many women have a tendency to high blood pressure. This is due to the physiological thickening of the blood and the action of hormones that prepare the female body for childbirth.

Thickening of blood and increasing vascular tone is a protective reaction of the female body, prevention of massive bleeding during childbirth. Thanks to such processes, in the female body with blood loss during childbirth, the vessels react sharply with spasm.

The blood in the damaged vessel quickly coagulates, forming a blood clot. The blood clot clogs the site of damage to the blood vessel. Thus, blood loss will be minimal.

The blood supply not only to the uterus is enhanced, but also to all organs of the small pelvis. Therefore, so often in pregnant women, the symptoms of hemorrhoids are exacerbated in the early stages.

From the respiratory system

In order to provide oxygen to mother and child, the woman's respiratory system also undergoes changes during pregnancy. The diaphragm rises due to the enlarged uterus. Due to this, the volume of the chest decreases.

The lungs become cramped in the chest, they cannot fully straighten with a deep breath. To solve these problems, the respiratory center in the brain instructs to breathe more often. As a result, breathing becomes more frequent.

The woman becomes more sensitive to the lack of oxygen. Therefore, many pregnant women cannot be in stuffy, hot rooms, public transport.

In the later stages, shortness of breath is often worried. It appears by increasing the load on the heart and lungs. By increasing the frequency and depth of breathing, the mother's body tries to compensate for the lack of oxygen. Everything is done so that your baby does not need anything.

From the digestive system

In the first trimester, as a rule, women are worried about toxicosis. The severity of its manifestations is individual. Someone notes nausea only in the morning. Someone suffers from nausea around the clock. Someone is worried about both nausea and vomiting. And many do not experience such symptoms at all.

Toxicosis occurs due to the temporary poisoning of the mother's body with the baby's metabolic products. Most often, the symptoms of toxicosis end after the first three months of pregnancy, when the placenta begins to fully function. In the future, it will be she who will be responsible for the metabolism between mother and child.

Sometimes expectant mothers develop a perversion of taste. For example, you want to eat something inedible (chalk, clay, soap). This condition most often indicates an acute shortage of some substances in the maternal body. Therefore, it is imperative to tell the attending physician about such a situation.

Heartburn is another common symptom that accompanies pregnancy. Due to a change in the position of the stomach in the abdominal cavity due to an enlarged uterus, the acidic contents of the stomach are often thrown into the esophagus. The acid irritates the walls of the esophagus, and this causes soreness in the sternum.

Alkaline drinks, such as milk, will help to cope with this problem. Why will it partly help? Because the main reason - a change in the position of the stomach of a pregnant woman - cannot be corrected.

In order to suffer less from heartburn, it is important for the expectant mother not to take a horizontal position immediately after eating and take food at least two hours before bedtime.

On the part of the skeletal system

The child is growing rapidly, he needs more and more resources for growth and development. And nature is so laid down that the baby will take everything he needs from the mother's body.

Moreover, if nutrients, vitamins and microelements are supplied in insufficient quantities, then the resources of the mother's body will be used for the development of the crumbs.

For example, with a lack of calcium, bone density (initial osteoporotic changes) in a woman's body decreases. Therefore, so often, future and successful mothers have problems with their teeth.

Due to the increase in the mass and size of the uterus, the center of gravity in expectant mothers shifts. This straightens the spinal column and deepens the lumbar lordosis (the curve of the spine facing the abdomen). Many people notice that the gait of pregnant women changes, becomes more important. It is also called "proud gait".

The connective tissue of the ligaments, cartilage, and pelvic bones is loosened. This effect is exerted by hormones secreted by the placenta (relaxin, progesterone). Thanks to their action, the mobility of the sacral joints, symphysis increases. The pelvic bones are slightly parted.

So the body of the future mom prepares for childbirth. Thanks to such changes, the baby's head passes through the birth canal more easily during childbirth.

From the endocrine system

Pregnancy is rightfully considered a serious hormonal surge in a woman's life. You will be surprised how many processes in a woman's body are regulated by hormones.

Without the proper hormonal background, pregnancy itself cannot occur. And preparation for childbirth is carried out thanks to the action of hormones. Subsequent breastfeeding after childbirth is also impossible without a certain hormonal background.

So, first things first.

During pregnancy, the pituitary gland increases its activity. This is the part of the brain responsible for the activity of all endocrine glands. He begins to work more actively.

In the pituitary gland, the production of follicle-stimulating and luteinizing hormones, which regulate the hormonal work of the gonads, is significantly reduced. In this regard, the process of maturation of new follicles in the ovary stops and ovulation does not occur.

During pregnancy, the hormone prolactin is actively produced in the pituitary gland in the same place. It is he who prepares the mammary gland for further breastfeeding.

The result of its action can be seen already in the early stages of pregnancy. The breast actively increases in size, becomes sensitive, especially in the nipple area.

With the onset of pregnancy, a new endocrine organ begins to function - the corpus luteum of the ovary. He is responsible for the production of progesterone. It is the main hormone of pregnancy, which is responsible for the implantation of the embryo, for its retention and preservation.

Closer to 14-16 weeks, the placenta takes over the function of producing progesterone.

Thyroid hormones are actively produced, which actively affect all metabolic processes of both the mother and the fetus. The thyroid gland itself increases in size during pregnancy.

The lack of her hormones can lead to a violation of the formation of the baby's brain. And their excess can provoke early termination of pregnancy.

The parathyroid glands, adrenal glands, and pancreas are also actively involved in the work.

A very important hormone, oxytocin, is produced in the hypothalamus (submucosal region of the diencephalon). From the hypothalamus, it enters the posterior lobe of the pituitary gland and from there begins its work.

The peak concentration of oxytocin reaches at a later date. It is he who is responsible for the onset of labor, contraction of the uterus during labor and stimulation of the release of milk from the mammary glands.

From the urinary system

With the onset of pregnancy, the expectant mother's load on the kidneys increases. Since the kidneys are a filtering organ, they are responsible for purifying the blood from metabolic products from both the mother and the fetus.

Due to the increasing size of the uterus and under the influence of a certain hormonal background, the walls of the ureters and bladder relax and experience constant pressure. All this leads to greater urinary retention in the urinary organs.

In turn, this is a significant risk of urinary tract infections. Therefore, pregnant women so often have to monitor urine tests.

In women expecting a baby, the urge to urinate is noticeably more frequent. All for the same reason, due to the compression of the bladder by the pregnant uterus. But the relaxed walls of the bladder can no longer fully contract, as before pregnancy. Therefore, the residual volume of urine in it after urination is greater than that of a non-pregnant woman.

Due to an increase in the volume of circulating blood, fluid retention and an increase in the concentration of sodium ions in the body under the influence of hormonal levels, physiological edema appears.

In addition, the following factors can provoke the appearance of edema: an excess of table salt in the food of the expectant mother (table salt is NaCl, that is, Na + ions), physical activity, heat.

Edema can be physiological (a manifestation of the norm) or pathological. The difference between physiological edema and pathological edema is that with the exclusion of provoking factors, physiological edema disappears.

For better kidney function, doctors advise women to rest on their left side. This facilitates the flow of urine through the ureters into the bladder, thereby making it easier for the kidneys to function.

From the immune system

With the onset of pregnancy, women undergo a restructuring of the immune system. Such a restructuring is necessary to ensure the preservation of pregnancy and the normal development of the baby.

The fetus has genetic material from the child's father, which is initially recognized by the mother's immune system as foreign and potentially harmful. Temporary changes immediately after the onset of pregnancy allow the mother's body not to trigger the immune processes of embryo rejection.

The restructuring of the immune system in the direction of "dulling vigilance" does not act selectively. Immunity is declining across the board. This can provoke an exacerbation of any chronic diseases of the expectant mother.

Against the background of a decrease in the body's immune defense, pathogens “crawl out of shelters” and activate, which previously “quietly sat in ambush” in the form of a chronic infection or carriage.

During pregnancy, diseases of the urinary system and respiratory tract can worsen. Allergic reactions are often observed, even to previously consumed foods.

The skin changes that occur during pregnancy are noticed by almost all expectant mothers. The severity of these changes varies significantly from woman to woman. Throughout pregnancy, the skin condition of even the same woman can change.

The general patterns are as follows. In the first trimester, the skin can be dry and sensitive due to the predominance of progesterone in the blood. In the second trimester, due to improved blood flow, complexion may improve and a healthy glow may appear. Naturally, if the expectant mother does not suffer from anemia.

The sebaceous and sweat glands in pregnant women also work differently. As a rule, their work is intensified. A woman may notice increased sweating and the appearance of an oily sheen on the skin.

The darker representatives of the fair half of humanity may have age spots on the skin. Freckles also become more pronounced or more of them.

Normally, areas of hyperpigmentation appear on the body of a pregnant woman. This is a kind of dark strip along the midline of the abdomen and darkening in the areola. The skin around the woman's genitals also darkens.

Stretch marks often appear on the body. This process is associated with overstretching of the skin and a rupture in a thin layer of the skin - the dermis. Stretch marks are brown at first. But gradually they turn white and resemble scars. The appearance of stretch marks directly depends on the elasticity of the woman's skin, which is genetically determined.

Hair and nails grow faster during pregnancy. At this time, the growth period (life period) of the hair is lengthened. This is due to the action of estrogens, the concentration of which increases. Therefore, women can often notice an increase in hair density during pregnancy.

After giving birth, women often complain of profuse hair loss. This is due to the normalization of estrogen levels after childbirth. Accordingly, hair growth and hair longevity return to their original levels.

If your hair and nails become dull, brittle, then most likely you are deficient in any trace elements and vitamins. Do not forget to inform your doctor about such changes. These may be the first manifestations of deficiency conditions during pregnancy (eg, anemia).

Changes in the emotional sphere of a pregnant woman

With the onset of pregnancy, both the woman herself and her loved ones may notice changes in the emotional sphere. The psycho-emotional system becomes more labile.

Hormonal changes, a sense of double responsibility, anxiety for the well-being of the ongoing pregnancy, and a restructuring of habitual lifestyles, and a reassessment of priorities lead to this state.

At the very beginning of pregnancy, powerful hormonal changes occur. In the beginning, female hormones predominate - estrogens. Then estrogens give up their dominant role to the hormone that preserves pregnancy - progesterone.

By the second trimester, a relatively even hormonal background is established. By the end of pregnancy, the usual anxiety about the upcoming birth joins the changes in the hormonal background.

I can say that myths are too widespread among the people that all pregnant women are very capricious. This often pushes expectant mothers to artificially invent special desires and puzzle their close relatives.

In fact, pregnant women want care and attention, a sense of security. During this crucial period, there should be such a person next to the expectant mother who can support, calm down, dispel anxiety and doubts. After all, she needs positive emotions so much.

In the joyful moments of our life, special hormones are produced - endorphins. They have a positive effect on the metabolism and development of the baby. Therefore, the more the mother is happy, the better the baby develops in her womb.

How does a postponed pregnancy affect a woman's health?

Many studies by scientists have shown that a history of pregnancy significantly reduces the risk of ovarian cancer. According to current evidence, breastfeeding provides additional protection not only against ovarian cancer, but also against breast cancer.

One of the hypothetical explanations for this phenomenon is a change in the hormonal background in a pregnant woman, a temporary rest of the ovaries and the absence of ovulation.

It is known that at the site of the release of the egg from the mature follicle in the ovary, a microtrauma is formed. After each tear heals, a small whitish scar forms.

According to some researchers, disturbances in the healing processes of these microtraumas can lead to malignant degeneration of ovarian cells. Therefore, women who ovulate less often suffer from ovarian cancer.

Changes in the body due to pregnancy should not be feared. After all, after childbirth, all processes are quickly normalized. And let the figure, shape, sleep and wakefulness regime change. If desired, you can cope with a change in figure.

Motherhood is a woman's main mission. A woman, having realized herself as a mother, acquires a new meaning in life. Trust me, it's worth it. Health to you and your children!

Some women are able to feel their pregnancy almost immediately after fertilization, but for most it takes several weeks. Early pregnancy is almost always accompanied by signs such as the absence of menstruation, drowsiness and fatigue, frequent urination, nausea, the appearance of other taste preferences, changes in the mammary glands: the appearance of a feeling of heaviness in them, darkening of the nipples, and their increased sensitivity.

The first month is the most important in the entire pregnancy. Under unfavorable conditions for the development of the egg, pregnancy is usually terminated at this time. If the pregnancy is not interrupted, then in the future, in the absence of a negative impact, it will develop normally.

In the first month, a woman needs to be especially careful about her health.
A good rest is necessary, since fatigue at this stage is felt especially strongly. It is important to ensure that your diet is balanced, rich in vitamins, proteins and carbohydrates. Drink plenty of fluids. Many people think that puffiness during pregnancy occurs from excess fluid, but in reality this is not the case: puffiness is a consequence of its lack. You need to try to protect yourself from all the troubles, create a calm microclimate at home and, if possible, avoid stress at work.

Hormonal changes at 1 month of pregnancy:

Many physiological changes in the body during pregnancy are caused by the influence of hormones. The corpus luteum in the ovary (human chorionic gonadotropin) is responsible for the production of hormones in the first three months of pregnancy.
By the time of 16 weeks, the organ that will take over the function of producing estrogen and progesterone, the placenta, will mature. In addition to estrogen and progesterone, other hormones are produced in large quantities that affect growth, mineral balance, metabolism and cause many physiological changes in the mother's body during pregnancy. And yet, it is these two hormones that do the bulk of the work.

The task of hormonal changes in the first 16 weeks of pregnancy is to rebuild a woman's body to carry a baby. While this active restructuring is underway, the expectant mother needs to tune in to a calm perception of this period.

What functions are the two main hormones responsible for in the body of the expectant mother?

Estrogen helps to thicken the uterine lining, increase the size of the muscles of the uterus and improve its blood supply, the growth of reproductive tissues, and also stimulates the supply of blood to the mammary gland.
There is a high degree of probability that high estrogen levels are also responsible for skin pigmentation, water retention in the body and the "deposition" of subcutaneous fat.

Progesterone prevents smooth muscle contraction, softens the uterus, and prevents it from contracting excessively. This hormone relaxes the walls of the stomach and intestines, thus allowing them to absorb more nutrients. In addition, progesterone softens the walls of blood vessels, maintaining normal blood pressure in a woman's body. And progesterone also plays an important role during childbirth, which softens the ligaments, cartilage and cervix, making these tissues more elastic, allowing them to stretch during the birth of the baby. In the first 16 weeks, the mother's body, including the ovaries, is fully responsible for maintaining pregnancy and producing hormones. Many unpleasant sensations are associated with this, which most often pass by the fourth month of pregnancy.

Physiological changes:

During the entire period of pregnancy, all functions of the body of the expectant mother undergo changes, adapting to their new tasks and the needs of the unborn child growing inside.

Treat all pregnancy-related phenomena as natural and completely normal. Take them calmly. After all, pregnancy is just a special state of health of your body in new conditions. This condition is not at all equivalent to an illness, although to one degree or another you will be inclined to experience various ailments throughout the entire waiting period. What are the first symptoms of changes that a woman can worry about in the initial period of pregnancy?

Already in the first month of pregnancy, many women experience nausea and vomiting. Most commonly referred to as "morning sickness", although it can occur at any time of the day. In addition to nausea, some women develop other signs of the hormonal storm that is currently occurring in the body, such as heartburn, indigestion, constipation and bloating. The only reason for the troubles of the first period of pregnancy is the production of an increased amount of progesterone and estrogen. To reduce these discomfort, try changing your diet. Eat more vegetables and fruits, whole grain breads, nuts, drink plenty of liquids: herbal drinks, juices, water, limit your intake of coffee, strong black tea and foods that are too fatty.

In the first months of pregnancy, many women have an increased urinary frequency. This phenomenon is explained by two factors: firstly, the enlarging uterus begins to press on the bladder, and secondly, the volume of fluid in the body increases. Try to empty your bladder completely every time you use the toilet. When urinating, bend forward to release the bladder completely. At night, three hours before bedtime, try not to drink any liquid so that your sleep is restful. If you experience dry mouth and thirst, rinse your mouth with cool water.

Under the influence of higher levels of estrogen, progesterone, and other hormones, you may notice noticeable changes in your breasts. The area around the nipples (areola) enlarges and darkens. The breast increases in size, becomes more sensitive, the vascular network protrudes on it, and a tingling sensation may appear in the nipple area. Small bumps on the areola, called Montgomery glands, become more visible, grow in size, and release more lubricant. This is how the breast prepares to supply the baby with milk. By the time of delivery, the breasts will become heavier by almost a kilogram.

Causes of bleeding in the 1st (first) month of pregnancy:

During this period, some women experience bleeding, due to which many become very worried and worried about maintaining the pregnancy. The causes of bleeding can be different, and if they occur, you should immediately consult a doctor.

Perhaps these bleeding is not so dangerous for your health, but only a doctor can determine this:
1. Imaginary menstruation.
2. Lack of pregnancy hormone (progesterone). If the body does not produce enough progesterone, the lining of the uterus is rejected and bleeds. This is most often seen in women with irregular cycles or after cured infertility. Lack of progesterone is dangerous due to miscarriage, spontaneous miscarriage.

3. Damage to the uterine pharynx. During sexual intercourse, sports activities, the uterine pharynx, which is intensively supplied with blood, can be injured if a woman has erosion. Again, it is important to consult your consulting physician.

4. Decreased immunity. In the first months of pregnancy, most women naturally decrease their immunity - this process is provided by nature. It is necessary so that both organisms - the fetus and the mother - can accept each other and the rejection of the fetus as a foreign body does not occur. The only danger is that, due to a decrease in protective functions, a woman's body becomes vulnerable to other diseases, the most common of which are colds and diseases of the genital tract.

5. Tubal (ectopic) pregnancy. With an ectopic pregnancy, bleeding usually begins at 7-8 weeks, when the fertilized egg, stuck in the fallopian tube due to adhesions, scars in the oviduct, prolonged use of intrauterine devices or untreated inflammation of the ovaries, increases in size and can rupture the oviduct. Pain in the lower abdomen resembles labor pains. In this case, the woman needs urgent hospitalization.

6. Miscarriage (spontaneous abortion). A miscarriage is usually preceded by severe pulling pains, similar to pain during menstruation. A miscarriage at such an early stage is most often due to genetic disorders, a lack of pregnancy hormone or abnormalities in the structure of the uterus. At the first symptoms of a miscarriage, you should contact your doctor as soon as possible and call an ambulance.

Psychological changes:

The beginning of pregnancy is a period of emotional swings, ups and downs in a woman's mood and well-being. Sometimes mood swings are powerful and even difficult to understand. Reflections on motherhood can now please, then suddenly upset. This is especially true of those cases when the news of pregnancy was unexpected for a woman and not included in life plans.

During this period, expectant mothers may feel unusually tired and have a desire to sleep a lot. They hardly get out of bed in the morning, in the afternoon they strive to "kiss" the pillow, and in the evening, barely reaching home, they immediately fall asleep. Indeed, expectant mothers need more sleep due to increased energy consumption, accompanied by a change in metabolic rate. This is how the body adapts, adapting to its new state.

Sometimes a woman develops depression - just don't confuse normal mood swings with depression. The most common symptoms are poor health, sleep disturbances, lack of appetite or, conversely, a constant desire to eat, apathy, sudden mood swings, a feeling of emptiness.

Sometimes a woman becomes extremely sensitive and sentimental. She can be moved to tears by the plot of a cartoon or a book. Now it seems that no one loves her, then she does not want anything at all. Tearfulness, feelings of lethargy and despondency can be combined with a temporary decrease in intellectual abilities.

The hormonal changes in the body are responsible for such a powerful change in the psychological state. As a result, the state of mind of the expectant mother in the first months of pregnancy approaches that of a child. In this state, a woman perceives her surroundings in a childlike way, feeling like a child. And this has its advantages - such a sense of self will help her when communicating with her own baby.

The emotional well-being of the expectant mother can be influenced by social or domestic disorder, including much depends on the partner's reaction to the news of pregnancy. If you do show signs of depression, try to help yourself and take the necessary steps to do so. First of all, try to understand what is happening to you ”and determine the reason for your well-being. Think about how you can fix it.

Tell your husband and loved ones whom you completely trust about everything that bothers you.
Follow your desires. Sleep more, rest if you feel like it.
Do not stop leading an active lifestyle that will distract you from sad thoughts: go for a walk; have relaxing activities: take a bath, exercise, go to concerts.
Find or think of a new hobby.

Sometimes you just need to let go of all the depressive feelings so that they go away by themselves. Some women know how to manage their emotions and warn their loved ones about it. Others are unable to calmly perceive the emotional storm that occurs during this period. But, as you know, any storm ends - you just need to be able to wait it out. After all, it is no secret that very, very many women are susceptible to this in the first months of pregnancy - this is how adaptation to a new state takes place - spontaneously and sometimes unconsciously there is an understanding of a global change in life.

Remember one more thing. We are all subject to various influences, including the so-called fashion trends. It's not just about clothing, cosmetics, or lifestyle choices. Under the influence of fashion, a person's worldview and worldview are changing. This manifests itself in the craze for astrology, feng shui, positive thinking, esotericism. Many glossy media claim the fashion for absolute positive and optimism at all costs. This almost imposed point of view is reflected in the approach to pregnancy. In many magazines and books, you can find the statement of one postulate: you are pregnant, the happiest period in your life has come. This is indeed the case. But at the same time it is only part of the truth, reflecting only our desire for the ideal ...

Pregnancy is a part of life in which there is a place for grief and joy, sad and happy experiences. And the wisdom of a woman during this period is to readily accept life now as it is, without falling into panic and extremes. Therefore, you need to be prepared not only for joyful experiences, but also for such prosaic phenomena as morning sickness, constipation, insomnia or other troubles. Then you can accept with a feeling of happiness all the pleasant surprises that only pregnancy gives: the first movements of your baby and his "responses" to the sound of your voice or the first portrait on an ultrasound scan, which you will proudly hang on the wall at home.

The most common reasons for concern are:

You understand that now your health, physical condition and mood will be reflected in the future baby. Therefore, you need to take more care of yourself and treat yourself almost like a child. Let your loved ones also take care of you more reverently. Many of your responsibilities now need to be shifted onto their shoulders. Start gradually introducing your household to activities such as washing, cleaning, preparing meals, or going to the store.

Already in the first month of pregnancy, fatigue begins to affect, which can be caused by various reasons: a lack of iron, protein, calories, poor lighting, polluted air or a sedentary lifestyle. All these unfavorable factors can be eliminated on your own by adhering to proper nutrition, exercising. In particular, pay attention to your passive rest - now you need to allow yourself to sleep one to two hours longer than usual. But remember that sleep is different from sleep - you need to satisfy your need for extra hours for sleep so that sleep brings vigor, restores strength and gives clarity of mind. If your fatigue comes to fainting, see your doctor immediately.

Not all processes occurring in the body should be immediately attributed to ailments and taken to be treated in all available ways. Be critical of the advice of friends and acquaintances; medications not recommended by a doctor should not be taken. Medicines that are safe for your body can cause irreparable harm to your unborn baby. Experts say that medications such as aspirin, tranquilizers, diet and anxiety pills, nasal drops, in some cases, cause complications of pregnancy and fetal malformations.

Nausea that occurs in the morning or during the day is quite common in the first trimester. A woman may be much more concerned about late toxicosis of pregnant women (gestosis), which appears after 20 weeks of pregnancy. It is a fairly common complication of pregnancy and, in severe forms, can lead to seizures (eclampsia). Late toxicosis is classified as a hypertensive disease, since its leading symptom is an increase in blood pressure.

With toxicosis, sodium metabolism is disturbed, while excess water is not excreted through the kidneys and urinary tract, but accumulates in the tissues and leads to edema. To return the blood to normal, the adrenal gland secretes vasoconstrictor hormones, which leads to high blood pressure.

Early toxicosis (nausea) occurs in 75% of pregnant women. Usually after three months, nausea goes away, but sometimes, especially in women with multiple pregnancies, it can be observed throughout the pregnancy.

Some of the causes of nausea include:

sharp hormonal changes;
violation of the body's adaptation to new conditions;
a change in the acidity of the stomach;
stretching of the muscles of the uterus;
some weakening of the muscles of the esophagus;
physical and mental fatigue.

Most often, women are susceptible to early toxicosis:

having diseases of the gastrointestinal tract (colitis, chronic gastritis, pancreatitis, cholecystitis, stomach ulcer, duodenal ulcer);
suffering from hypertension;
with diseases of the endocrine system (diabetes mellitus);
with neuropsychiatric disorders;
and also prone to frequent overwork.

The onset of toxicosis is also influenced by the general emotional state, your attitude towards pregnancy and the attitude of others to it. Early toxicosis is accompanied by nausea, vomiting, sometimes salivation, swelling, mild physiological jaundice. There are three degrees of severity of early toxicosis. With a mild form, the general condition is satisfactory, vomiting occurs 3-4 times a day. In this case, it is enough to follow the diet, regimen and use vitamin therapy.

With toxicosis of moderate severity, vomiting increases up to 10-12 times, there is a loss of appetite, weight loss, general weakness, and dehydration of the body occurs. You should seek the help of a doctor who will check your blood pressure and give a referral for a urinalysis, after which a more complete examination may be required to identify chronic diseases.
As practice shows, women find it difficult to withstand vomiting more than 4 times a day. If symptoms increase, it is best to stay temporarily in a hospital where the psychological peace necessary for successful treatment will be provided.

The most severe form of toxicosis poses a threat to the life of the child, and often to the life of the mother. The disease is accompanied by indomitable vomiting, sudden and severe headaches, blurred vision, flickering in the eyes. Treatment of this form of toxicosis always takes place in a hospital, sometimes it is necessary to terminate the pregnancy. And do not rush to use medications without the recommendation of doctors. And remember that early toxicosis is treated quite successfully!

How to relieve nausea, toxicosis during pregnancy:

Diet.
Eat a varied diet rich in protein and carbohydrates.
Eat small meals often.
Drink plenty of fluids: vegetable and berry juices, soups, broths. Eat fresh vegetables and fruits that contain plenty of liquid, especially salads, melons, citrus fruits.
Add vitamins to your diet. For example, taking vitamin B before bed can help treat nausea.
Do not eat food that smells or looks unpleasant. The body itself will tell you what it needs.
Do not provoke nausea by driving yourself to a hungry state. An empty stomach often causes nausea. Eat as soon as you feel hungry.
Keep crackers, crackers, and a handful of raisins or nuts close to your bed at all times. In the morning, before getting out of bed, nibble on a crouton, drink juice or a glass of water, and only then slowly and calmly get up.

Daily regime.
Do not overwork; allow yourself to sleep a little longer.
Walk in the fresh air as often as possible. This is also useful for your husband - spending time together will bring you closer together.
Reduce stress levels and avoid them as much as possible.

In general, the calmer your lifestyle, the less you will be bothered by the symptoms of toxicosis. Natural therapies can help manage nausea, some of the most readily available are herbal medicine, aromatherapy, and homeopathy. If you are doing yoga, consult a trainer - he will suggest theasans and breathing techniques with which you can ease your condition. You can turn to color therapy, acupuncture or shiatsu if you are familiar with these techniques and are familiar with qualified specialists who know the peculiarities of using their methods for pregnant women.

Medical examination and tests in the 1st (first) month of pregnancy:

A mother-to-be often meets with the fact that she does not know which institution is best to contact for pregnancy management; in addition, it is often deprived of the necessary support of older and more experienced women, relatives; Finally, information about new medical technologies is very contradictory and does not add confidence in their actions. As a result, the woman comes to a certain state of confusion.

Nevertheless, it is better to make the first visit to a doctor at your place of residence, if you do not have a “personal” gynecologist. The first contact with your doctor will show you whether you want to continue the communication. One way or another, ordinary antenatal clinics are guaranteed to provide a complete initial examination of pregnant women. Compulsory medical examinations can be perceived in different ways. Some women are suspicious of a large number of tests and examinations, while others, due to their high anxiety, are ready to be tested at least every week.

In order for a woman to be admitted to any maternity hospital without problems, regardless of place of residence, she needs to have a birth certificate. The expectant mother receives this certificate in the antenatal clinic, having visited the doctor at least 12 times. If a woman does not have data on the necessary tests, she will be sent to give birth to the infectious diseases department of the maternity hospital.

Medical examinations are designed, first of all, to preserve the woman's confidence in her health and the condition of the unborn baby. And regular meetings with a doctor, as experience shows, significantly reduce the anxiety of expectant mothers.

You are free to choose the safest tests and even refuse those examinations that seem unnecessary or, for some reason, dangerous. Pregnancy is a special state of health, and medical intervention in the process of carrying a child should take place in exceptional cases when the expectant mother or child has serious symptoms of a particular disease. This is especially true for those mothers who are going to give birth for the first time. It is known that during the second pregnancy, women become more independent, they know how these nine months of waiting pass, they understand what they really need and what they can refuse.

Currently, there are many technical means for prenatal (prenatal) diagnosis. With their help, the presence of pregnancy in a woman is determined. With the help of ultrasound, the development of the fetus is monitored. A blood test allows you to check whether the placenta is working correctly and whether the unborn child is provided with sufficient nutrients and oxygen. Based on the analysis of amniotic fluid and the analysis of the chorion, the presence of congenital diseases is determined.

The most popular of all types of examination is, perhaps, an ultrasound scan. Today, ultrasound examination is considered the safest method of observing a child during the prenatal period, although there are sometimes mixed opinions on this issue. The scope of ultrasound is constantly expanding, but it is mainly used in order to see the uterine cavity, fetus, amniotic fluid, placenta and identify possible violations.

An ultrasound scan is performed in two ways: through the abdominal wall or the vagina. In early pregnancy, up to about 12-15 weeks, the woman needs to have a full bladder to get a clear image on the screen. Therefore, it is recommended to drink a liter of liquid before the procedure. There is no need to fill the bladder during subsequent ultrasound examinations.

In the first weeks of pregnancy, using ultrasound, you can confirm the presence of pregnancy and determine its duration, as well as diagnose an ectopic pregnancy.

After confirming pregnancy for the first four weeks, doctors will recommend a complete medical examination:
Examination of the external genital organs: vagina, cervix, pelvic organs, determination of the size of the pelvis.
Measurement of blood pressure.
Measurement of height and weight. This information is necessary to determine how much your weight corresponds to height and age and whether it needs correction depending on the peculiarities of the constitution.
Examination of internal organs: heart, kidneys, lungs, abdominal cavity, chest.
Dentist examination. A woman's body is now undergoing changes that can accelerate the decay of unbaked teeth. The dentist will advise on how to care for your teeth during this period.

The doctor will also need information regarding the following:
chronic illnesses, past illnesses and operations;
chronic and genetic diseases in the family (if any, the doctor will give a referral to identify possible genetic diseases);
the time of the onset of the first menstruation, their duration and regularity;
previous pregnancies, if any, how they proceeded and how they ended: childbirth, abortion, miscarriage;
age, profession and similar information about your partner;
eating habits, exercise;
do you have bad habits (smoking and drinking alcohol);
if you or your partner have allergies, tell us about the substances and medicines that cause allergic reactions.

All these examinations, or some of them, are especially necessary for those expectant mothers whose pregnancy was a surprise, because in this case they did not undergo a preliminary examination by all specialists. There is a list of tests that are required for all pregnant women; if they are absent, a woman will not be able to be admitted to the department of a maternity hospital for healthy women.

Therefore, do the following analyzes:

general and clinical urine analysis, for the content of sugar, protein, bacteria;
blood test for resistance to rubella, determination of blood group, Rh factor and detection of anemia;
genetic tests (according to the individual doctor's indications);
general analysis of a smear from the vagina;
tests for hepatitis, as well as for genital diseases:

In connection with the development of the fetus, there are great changes in the functions of all the most important organs and systems of the pregnant woman. These changes are of an adaptive nature and are aimed at creating optimal conditions for the growth and development of the fetus.

1. Nervous system:

a) the appearance in the central nervous system of a local focus of increased excitability - a gestational dominant or a dominant of pregnancy (in the 60s. Yakovlev);

b) the excitability of the cerebral cortex is reduced until 3-4 months of pregnancy, and then gradually increases;

c) the excitability of the underlying parts of the central nervous system and the reflex apparatus of the uterus is reduced, which ensures relaxation of the uterus and the normal course of pregnancy;

d) increased excitability of the spinal cord and nerve elements of the uterus before childbirth, which creates favorable conditions for the onset of labor;

e) a change in the tone of the autonomic nervous system (which is manifested by drowsiness, irritability, dizziness, etc., especially in the early stages of pregnancy).

2. Sss:

1) hypervolemia develops, which is one of the main mechanisms that maintain optimal conditions for microcirculation in the vital organs of the mother and in the placenta;

2) an increase in the work of the left ventricle;

3) decrease in blood pressure by 5-15 mm. rt. Art. in the second trimester of pregnancy due to a decrease in the total peripheral vascular resistance and a decrease in blood viscosity;

4) an increase in BCC already starting in the first trimester and reaching a maximum by 29-36 weeks,

5) an increase in regional blood flow in the uterus;

6) increasing the permeability of the capillary wall for water, salts, albumin.

3. Respiratory system:

1) increased pulmonary ventilation, which leads to hypocapnia and promotes the elimination of excess carbon dioxide from the fetus,

2) some expansion of the chest, which prevents the reduction of the respiratory surface of the lungs due to the pushing of the diaphragm upward by the pregnant uterus. ... 3) the minute respiratory volume (MRV) increases from 8.4 l / min (in the 1st trimester) to 11.1 l / min (the end of the 3rd trimester). 4. Organs of digestion,

1) a decrease in the acidity of gastric juice;

2) congestion, due to a decrease in the motility of the large intestine, constipation due to compression of its pregnant uterus,

3) in the liver, the amount of glycogen decreases, the intensity of fat metabolism changes (increased lipemia, high cholesterol content, increased fat deposition in hepatocytes), the breakdown of protein increases (to provide the fetus with the necessary amount of amino acids), the synthesis of fibrinogen increases (this leads to hypercoagulation, increases inactivation of estrogens and other steroid hormones produced by the placenta, in other words, the load on the liver increases during pregnancy.

5. Organs of urinary excretion:

1) a decrease in the tone of the urinary tract, an increase in the capacity of the bladder,

2) an increase in the activity of renin and the release of aldosterone, which contributes to the retention of chlorides necessary for the fetus; ... 3) glomerular filtration increases in the 1st trimester, and then gradually decreases; ... 4) renal blood flow increases by 30-40%. 6. Organs of hematopoiesis:

1) the number of hemoglobin, erythrocytes, leukocytes will increase,

2) the volume of blood plasma increases (more than erythrocytes, which creates a state of hyperplasmia),. 3) increased ESR, . 7.Endocrine system:

1) progesterone (has a protective effect on the fertilized egg, causes hypertrophy and hyperplasia of the muscular wrlocon of the uterus) up to 3 months of pregnancy is produced mainly in the corpus luteum of the ovary, and then in the placenta. The placenta also produces chorionic gonadotropin (affects the development of the fetal adrenal glands and the exchange of steroids in the placenta), placental lacgogen (enhances glyconeogenesis processes, reduces the body's glucose tolerance), estrogens (promotes the accumulation of actin and myosin in the muscles of the uterus, dilates blood vessels and starting from the 20th week of pregnancy, their daily excretion is linearly dependent on the gestational age, that is, the longer the gestational age, the greater the daily excretion of estradiol). The posterior lobe of the pituitary gland produces oxytocin and vasopressin.

Changes in a woman's body during pregnancy are of an adaptive nature and are aimed at creating optimal conditions for the growth and development of the fetus. Consider what are these changes in various organs and systems.

NERVOUS SYSTEM

The concept of the dominant of pregnancy (gestational dominant) was put forward: a corresponding focus of excitation arises in the central nervous system after fertilization of the egg and its implantation into the mucous membrane of the uterus; in this case, a constant source of afferent impulses is formed from the interoreceptors of the uterus.

In the first months of pregnancy, a decrease in the excitability of the cerebral cortex is observed, which leads to an increase in the reflex activity of the subcortical centers, as well as the spinal cord. Subsequently, the excitability of the cerebral cortex increases and remains elevated until the end of pregnancy. By the time of childbirth, the excitability of the cerebral cortex decreases sharply, accompanied by an increase in the excitability of the spinal cord, which leads to an increase in spinal reflexes, an increase in neuroreflex and muscle excitability of the uterus, which is necessary for the onset of labor.

The tone of the autonomic nervous system changes, and therefore, pregnant women often experience drowsiness, tearfulness, increased irritability, sometimes dizziness and other disorders. These disorders are usually inherent in the early period of pregnancy and then gradually disappear.

ENDOCRINE GLANDS. ENDOCRINE CHANGES

Understanding the complex endocrine changes during pregnancy remains sketchy and incomplete. Many of the peptide and steroid hormones that are produced by the endocrine glands outside of pregnancy can be synthesized by the tissues found in the uterus during pregnancy.

With the onset of pregnancy, the ovaries increase slightly, ovulation in them stops; in one of the ovaries, the corpus luteum functions. The hormones secreted by it (progesterone; to a lesser extent - estrogens; relaxin) contribute to the creation of conditions for the development of pregnancy. The corpus luteum undergoes reverse development after 3-4 months of pregnancy in connection with the formation of the hormonal function of the placenta; further, the function of the corpus luteum is insignificant. In vivo surgical removal of the corpus luteum before 7 weeks of pregnancy leads to a rapid decrease in progesterone levels and miscarriage; if removed later, pregnancy may persist. The corpus luteum also produces the polypeptide hormone relaxin, which inhibits the activity of the myometrium; after the termination of the function of the corpus luteum, relaxin is synthesized in the placenta.

Placenta is the organ that unites the functional systems of the mother and the fetus. It performs the following main functions.

The respiratory function provides transport from the mother to the fetus of oxygen and the release of carbon dioxide in the opposite direction. The exchange of gases takes place according to the laws of simple diffusion. The placenta contains enzymes involved in oxidation-reduction processes, the breakdown and synthesis of proteins, fats and carbohydrates necessary for the development of the fetus.

Possessing limited permeability, the placenta is able to protect the fetus from a number of damaging factors that have entered the mother's body (toxic products, microorganisms, medicinal substances, etc.), but not all, and many of them have a direct effect on the embryo and fetus.

The excretory function of the placenta is to remove metabolic products from the fetus.

The placenta is a powerful endocrine gland, in which the processes of synthesis, secretion and transformation of a number of hormones (Fig. 20), both steroid (gestagens and estrogens) and protein (CG, PL), are intensively occurring.

Hormones produced in the uterus during pregnancy.

Pregnancy-specific hormones.

Hypothalamic hormones.

Corticoliberin. Pituitary hormones.

Prolactin.

Growth hormone.

Other peptide hormones.

Insulin-like growth factor I and II.

Parathyroid-like peptide.

Angiotensin II.

Steroid hormones (estrogens, progesterone).

1,25-dihydroxycholecalciferol.

There is a functional relationship between the placenta and the fetus, which is considered as a single endocrine system - the "fetoplacental system", which has, to a certain extent, some autonomy. The fetus, placenta and mother are involved in steroidogenesis.

rin organism, which complement each other in such a way that the fetoplacental system is able to maintain the synthesis of all biologically active steroid hormones.

The main hormone of the fetoplacental system is estriol, called a pregnancy protector. It accounts for 85% of all estrogen during pregnancy. Its main role is the regulation of the uteroplacental circulation, i.e. supplying the fetus with all vital substances necessary for normal growth and development.

Synthesis and metabolism of estrogen

Estriol is synthesized in the placenta from dehydroepiandrosterone sulfate, which is formed in the adrenal cortex of the fetus and, to a lesser extent, in the adrenal cortex of the pregnant woman. 90% of estriol in the blood of a pregnant woman is of fetal origin and only 10% is of maternal origin. Part of estriol is in a free state in the blood of the pregnant woman and the fetus, performing its protective function, part enters the liver of the pregnant woman, where, combining with glucuronic acid, it is inactivated. Inactivated estriol is excreted in the urine of a pregnant woman. With a complicated course of pregnancy, the secretion of estriol in the urine may decrease, which was previously used as a diagnosis

a logical sign of fetal developmental disorders (with the advent of more specific biophysical methods, this is not necessary).

In a much smaller amount than estriol, other estrogens are formed in the fetoplacental system - estrone and estradiol. They have a diverse effect on the body of a pregnant woman: they regulate water-electrolyte metabolism, cause sodium retention, an increase in circulating blood volume (BCC), vasodilation and an increase in the formation of steroid-binding plasma proteins. Estrogens cause the growth of the pregnant uterus, cervix, vagina, promote the growth of mammary glands, change the sensitivity of the uterus to progesterone, which plays an important role in the development of labor.

Rice. twenty. The content of hormones in the blood at different times of pregnancy

The mechanism of interaction between the mother's body, the placenta and the fetus is described as the "theory of the placental clock". Starting from the middle of pregnancy, trophoblast is able to synthesize corticoliberin, which stimulates the fetal pituitary gland to increase the level of ACTH, thereby increasing the synthesis of dehydroepiandrosterone, the main precursor of placental estrogens, by the adrenal glands of the fetus. A high level of estrogen by the end of pregnancy stimulates the formation of gap junctions between the cells of the myometrium, contributing to arousal and labor. Synthesis of corticol-

berina regulates estrogen content according to the principle of positive feedback.

This mechanism by which the placenta regulates its own metabolism, influencing the fetus, which in turn, acting on the function of the uterus, possibly triggers labor, is called the placental clock. We sometimes break this delicate mechanism by untimely induction of labor.

Hormonal changes during pregnancy are reflected in table. 3.

Table 3

Hormonal changes during pregnancy

The second important steroid hormone for pregnancy is progesterone. The concentration of progesterone in the blood increases significantly with the progression of pregnancy. The hormonal function of the corpus luteum, which synthesizes progesterone in the first trimester of pregnancy, gradually passes to the placenta, from 10 weeks the maximum amount of progesterone is produced by trophoblast. The fetus receives 50% of progesterone, where it is metabolized and used for the synthesis of corticosteroids in the adrenal glands of the fetus. The rest passes through a series of transformations into estriol. Progesterone causes changes in the mother's body, contributing to the emergence and development of pregnancy

ness. Under its influence, secretory processes occur, which are necessary for the implantation and development of the ovum. Progesterone also promotes the growth of the genitals of the pregnant woman, the growth and preparation of the mammary glands for lactation, is the main hormone that reduces the contractility of the myometrium, reduces the tone of the intestines and ureters, has an inhibitory effect on the central nervous system, causing drowsiness, fatigue, impaired concentration, and in addition, it helps to increase the amount of adipose tissue due to hypertrophy of fat cells (adipocytes). The metabolite of progesterone, pregnandiol, is excreted in the urine.

The main protein hormones of pregnancy are chorionic gonadotropin (CG) and placental lactogen (PL). HCG is a glycoprotein produced by the chorion even before the formation of the placenta. In terms of its biological properties, it is similar to the LH of the pituitary gland, contributes to the preservation of the function of the corpus luteum of the ovary, affects the development of the adrenal glands and fetal gonads, and affects the exchange of steroids in the placenta. CG is detected in urine already on the 9th day after fertilization, reaches a peak concentration by 10-11 weeks of pregnancy (about 100,000 units), and then its level remains constantly low (10,000-20,000 units). Currently, the definition of hCG is used to diagnose early pregnancy and its disorders, as well as to diagnose trophoblast diseases.

PL is a polypeptide hormone, in its chemical and immunological properties close to the growth hormone of the anterior pituitary gland and prolactin. It is synthesized in the trophoblast syncytium. 90% of the hormone enters the blood of the pregnant woman, and 10% - into the blood of the fetus and amniotic fluid. PL can be detected in blood from 5 weeks of gestation. Long-term low levels of prolactin or a sharp drop in the level of the hormone indicate a violation of the condition of the fetus up to its antenatal death.

PL affects metabolic processes, which are aimed at ensuring the growth and development of the fetus. PL gives an anabolic effect, retains nitrogen, potassium, phosphorus, calcium in the body; has a diabetogenic effect. Due to its anti-insulin action, PL leads to an increase in glyconeogenesis in the liver, a decrease in the body's tolerance to glucose, and an increase in lipolysis.

The placenta produces a number of other protein-peptide hormones, such as melanocyte-stimulating hormone, relaxin, vasopressin,

oxytocin. Similar to insulin and insulin-like growth factor, relaxin is secreted by the corpus luteum of pregnancy, the placenta and deciidua parietalis. In the first trimester, it stimulates the synthesis of hCG. In addition, relaxin performs the following functions: relaxation of the uterus, shortening and softening of the cervix, regulation of uteroplacental blood flow, softening of the pelvic joints.

Methods for studying specific proteins of pregnancy have found clinical application, because they are produced directly in the placental trophoblast and reflect the functional state of the fetoplacental system. Embryospecific protein is α -fetoprotein (AFP), which is synthesized mainly by embryonic cells and in the yolk sac. In embryos, AFP synthesis begins simultaneously with embryonic hematopoiesis, and its concentration in the blood plasma increases from 6-7 weeks of gestation, reaching a peak at 14 weeks. In clinical practice, the determination of AFP is carried out for prenatal diagnosis of anomalies in the development of the nervous system and gastrointestinal tract in the fetus.

The placenta performs important functions of the immunological protection of the fetus. One of the components of this system is a layer of fibrinoid located on the surface of the villi and preventing direct contact between the tissues of the fetus and the mother. Immunosuppressive action is possessed by some substances located on the surface of the placenta in high concentrations (hCG, progesterone, steroid hormones), as well as some proteins of the fetus and placenta (AFP, trophoblastic R 1-glycoprotein, etc.).

The placenta plays an important role in the transport of immunoglobulins. Of the immunoglobulins of five classes, only IgG is capable of transplacental transition. The transfer of immunoglobulins in the motherfetus system begins only after 12 weeks of pregnancy and has an important biological significance.

Pituitary. The anterior lobe of the pituitary gland during pregnancy increases in size by 2-3 times due to the multiplication and hypertrophy of cells that produce hormones:

Prolactin, which helps prepare the mammary glands for lactation, by the end of pregnancy, its concentration increases 10 times or more, it is also synthesized by the placenta and is found in the amniotic fluid (the function of prolactin in the amniotic fluid is not yet precisely known, it has been shown that it promotes the maturation of fetal lungs);

Thyroid stimulating hormone (TSH), leading to an increase in thyroxine production and an increase in the activity of the thyroid gland, which is necessary for the proper development of the fetus;

Adrenocorticotropic hormone (ACTH) promotes an increase in the hormonal activity of the adrenal glands;

Growth hormone (GH), which affects the growth of the uterus and other organs of the reproductive system, and is also capable of causing transient acromegaloid features (enlargement of the limbs, lower jaw, eyebrows) in some pregnant women, disappearing after childbirth.

The formation and release of gonadotropic hormones of the pituitary gland (luteinizing and follicle-stimulating) sharply decreases, which causes a decrease in hormone production in the ovaries and cessation of the growth and development of follicles.

During pregnancy, the formation of oxytocin and vasopressin by the supraoptic and paraventricular nuclei of the hypothalamus is enhanced. Oxytocin has a specific tonomotor effect on the myometrium. The accumulation and effect of oxytocin are in direct proportion to the accumulation of estrogen and serotonin in the placenta, which block oxytocinase, an enzyme that inactivates oxytocin in the blood of a pregnant woman.

Adrenal glands during pregnancy, they undergo significant changes. Education is strengthening:

Glucocorticoids that regulate carbohydrate and protein metabolism;

Mineralocorticoids, regulating mineral metabolism;

Estrogens, progesterone and androgens in the adrenal cortex. An increase in the concentration of corticosteroids during pregnancy is not

causes pronounced clinical manifestations of hypercortisolism, which is explained by a simultaneous increase in the concentration in the plasma of binding globulin - transcortin.

The increased function of the mother's adrenal cortex contributes to the delivery to the growing fetus of the necessary amounts of nutrients, salts and hormones that the embryo itself is not yet able to produce.

An increase in blood cholesterol and other lipids is associated with the activity of the adrenal glands.

During pregnancy, insulin secretion increases, which is determined by the physiological needs of the body, as well as the influence of placental lactogen.

Thyroid during pregnancy, it increases in 35-40% of women due to hyperemia, an increase in the number of follicles and the content of colloid in them. HCG has an effect on the thyroid gland similar to that of TSH. In the first months of pregnancy, there is often a slight increase in the function of the thyroid gland (Fig. 21), an increase in the content of iodine associated with protein in the blood, but there are no hyperthyroidism phenomena. In the second half of pregnancy, there are no signs of increased thyroid function.

In the parathyroid glands, there is often a tendency to hypofunction. In such cases, calcium metabolism disorders are possible, leading to spastic phenomena (cramps in the calf muscles, etc.).

Rice. 21. Changes in thyroid function during pregnancy

THE IMMUNE SYSTEM

In normal pregnancy, the maternal immune system (Table 4) does not reject the fetoplacental complex, although it has paternal alloantigens, which are immunologically different from maternal antigens. The existence of an allogeneic fetus is ensured by the development of metabolic immunosuppression in the body of a pregnant woman, suppression of cellular and, to a lesser extent, humoral immunity is noted. During pregnancy, a unique new

balance between the specific and nonspecific immunity of the mother, in which the central cell of the immunological adaptation of the mother becomes not a lymphocyte, but a monocyte. It is the factors of natural immunity that direct the specific immune response along the Th1 (cellular, inflammatory) or Th2 (humoral, immune) pathways.

From the early stages of pregnancy, there is an increase in the number of monocytes and granulocytes in the mother's blood, and the absorption activity of macrophages increases. These monocytes secrete a large number of cytokines, including interleukins - IL-12. The concentration of complement proteins in the blood serum also increases.

Table 4

The immune system during pregnancy

There is a hypothesis that the activation of innate immunity in pregnant women occurs due to the entry into the bloodstream of a number of soluble placental products (Table 5), which have a suppressive effect on lymphocytes and an activating effect on monocytes.

Table 5

Influence of placental factors on the activity of cells of the immune system

During normal pregnancy, the mechanisms of systemic immunosuppression are activated. The negative side of immunosuppression in pregnant women is an increased susceptibility to infectious diseases.

METABOLISM

Metabolism during pregnancy is characterized by the following.

1. The amount of enzymes (phosphatases, histaminases, cholinesterase) increases and the activity of enzyme systems increases.

2. Protein metabolism: the content of proteins in blood serum is slightly reduced due to amino acids and albumin; specific proteins of pregnancy appear in the blood.

3. Carbohydrate metabolism: there is an accumulation of glycogen in the cells of the liver, muscle tissue, uterus and placenta. The carbohydrates are transferred to the fruit mainly in the form of glucose, which it needs as a high-energy material and as a substance that provides the processes of anaerobic glycolysis. An increase in the level of cortisol, growth hormone and PL in the blood causes a compensatory increase in the insulin content. Pregnancy is a diabetogenic factor, with a hidden inferiority of the insular apparatus of the pancreas or a hereditary predisposition to diabetes mellitus, glucose tolerance decreases.

4. Lipid metabolism (Fig. 22): the amount of free fatty acids, cholesterol, triglycerides, lipoproteins, mainly atherogenic (low and very low density lipoproteins), increases in the blood. Fats are transferred to the fruit in the form of glycerin and fatty acids. In the fetus, these compounds are consumed in the construction of tissues;

the role of fatty substances as an energetic material is great. Lipid accumulation also occurs in the adrenal glands, placenta and mammary glands.

Rice. 22. Lipid metabolism during pregnancy

5. Mineral and water exchange:

The assimilation of phosphorus, calcium salts, necessary for the development of the nervous system and the skeleton of the fetus, as well as for the synthesis of proteins in the body of a pregnant woman, is enhanced;

The consumption of iron increases (a pregnant woman should receive 4-5 mg of iron per day) and other inorganic substances: potassium, sodium, magnesium, chlorine, cobalt, copper, etc.;

In pregnant women, the release of sodium chloride from the body slows down, which leads to water retention in the body, which is necessary for the physiological hydration of the tissues and joints of the pelvic bones; in the regulation of water metabolism during pregnancy, estrogens, progesterone, natriuretic factor play an important role (contributes to an increase in renal blood flow, glomerular filtration rate, as well as a decrease in renin secretion), adrenal cortex hormones (mineralocorticoids), in particular aldosterone, deoxycorticosterone;

The need for vitamins increases due to the need to supply the fetus with them and maintain an intensive metabolism; hypovitaminosis during pregnancy causes many forms of pathology in both the mother and the fetus.

Body weight (Table 6) increases over the entire period of pregnancy by 12-14%, ie. an average of 12 kg. Normally, weight gain in the second half of pregnancy should not exceed 300-350 g per week. The increase in body weight is due to:

Conception products (fetus, placenta and amniotic fluid);

Maternal factors (uterus, mammary glands, increased BCC, increased body fat, fluid retention).

In the first 20 weeks of pregnancy, the contribution of the fetus to the weight gain is insignificant, but in the second half, the fetal weight grows faster. The mass of the placenta increases in accordance with the growth of the fetus, which is reflected in the graph (Fig. 23). The volume of amniotic fluid rapidly increases from 10 weeks of gestation, amounting to 300 ml at 20 weeks, 600 ml at 30 weeks, reaching a peak of 1000 ml by 35 weeks. After that, the amount of amniotic fluid decreases slightly.

Rice. 23. Dynamics of the weight of the fetus and placenta

Table 6

Distribution of weight gain during pregnancy

The mass of the uterus during pregnancy increases from 50 to 1000 g, and the mammary glands also increase due to the growth of glandular elements, fat deposition and fluid retention. BCC increases, as well as the amount of body fat. During normal pregnancy, the total amount of fluid increases by 6-8 liters, of which 2-4 liters are extracellular. Most of the fluid is retained for up to 30 weeks, however, even in women without clinically pronounced edema, 2-3 liters of extracellular fluid are retained in the last 10 weeks of pregnancy.

THE CARDIOVASCULAR SYSTEM

During pregnancy, significant changes occur in the cardiovascular system, which create the possibility of fetal development and functionally provide the process of childbirth.

The increase in stress on the cardiovascular system of a pregnant woman's body depends on the following factors.

Mechanical factors - high standing of the diaphragm, restriction of respiratory movements, transverse position of the heart axis, change in the shape of the chest, increased intra-abdominal pressure, general weight gain;

Hemodynamic factors - an increase in the capacity of the vascular system, the emergence of the uteroplacental circle of blood circulation, an increase in the BCC, pulse rate and cardiac output, changes in arterial and venous pressure.

Rice. 24. Change in BCC during pregnancy

During pregnancy, the BCC increases (Fig. 24), which causes physiological hypervolemia of pregnant women, aimed at maintaining optimal conditions for microcirculation in the placenta and other vital organs of the mother during pregnancy and childbirth. The protective effect of hypervolemia allows some pregnant women to lose 20-25% of their blood volume without developing severe hypotension.

The volume of blood plasma begins to increase from the 10th week of pregnancy and progressively increases until the 34th week, after which the intensity of the increase decreases. In general, the volume of circulating plasma (VCP) during pregnancy increases by 35-50%, and in multiparous women, VCP exceeds that in primiparas by about 10%. With twin pregnancy, the increase in VCP is even more significant. Increased plasma volume (total body water)

due to endocrine changes in a pregnant woman, an increase in the secretion of aldosterone and the activity of the renin-angiotensin system, the secretion of placental hormones, leading to sodium and water retention. An increase in albumin synthesis also leads to an increase in VCP.

During pregnancy, an increase in the volume of circulating erythrocytes by 11-40% occurs, but the intensity of the increase in erythrocytes is less pronounced compared to that of the plasma volume. This causes the occurrence of physiological hemodilution of pregnant women and is characterized by a decrease in hematocrit to 0.32-0.36 and hemoglobin concentration to 110-120 g / l.

During pregnancy, the capacity of the vascular system increases. With a normal pregnancy, there is a decrease in the total peripheral blood resistance, which is caused by physiological hemodilution, a decrease in blood viscosity and the vasodilating effect of estrogens and progesterone. With a normal pregnancy in the first and second trimesters, there is a tendency to a decrease in diastolic blood pressure and, to a lesser extent, systolic (Fig. 25), resulting in an increase in pulse pressure. In the third trimester, blood pressure in pregnant women returns to normal. If the blood pressure in a pregnant woman is higher than it was in the period preceding pregnancy, then this indicates either complications (gestosis) or the body's response to stress.

Rice. 25. Dynamics of systolic and diastolic blood pressure during pregnancy

The individual level of blood pressure is determined by the interaction of the following main factors: a decrease in the total peripheral vascular resistance and blood viscosity, which contributes to a decrease in blood pressure, and an increase in blood volume and cardiac output, which contributes to an increase in blood pressure. With inadequate compensatory mechanisms, for example arteriolospasm and hypovolemia, an increase in blood pressure is observed. For a correct judgment about the level and dynamics of blood pressure, it is necessary to know the initial value of blood pressure before pregnancy (for example, for pregnant women with an initial blood pressure of 90/60, a pressure of 120/80 means undoubted hypertension). An increase in systolic pressure by 30% relative to the baseline should be regarded as a pathological symptom. With a normal pregnancy, the diastolic pressure should be no more than 75-80 mm Hg, and the pulse pressure should not be less than 40 mm Hg.

Rice. 26. Dynamics of venous pressure in the ulnar and femoral veins during pregnancy and the postpartum period

Venous pressure (Fig. 26) in the lower extremities increases from the 5-6th month of pregnancy (it is especially high in the position of the pregnant woman on her back) and by the end of it exceeds the venous pressure in the upper extremities by two times. This is due to the compression of the inferior vena cava by the pregnant uterus, which relatively often causes swelling of the legs and varicose veins of the legs and external genitalia.

The most significant hemodynamic shift is considered to be an increase in cardiac output (Fig. 27) in the early stages of pregnancy: at 4-8 weeks it can exceed its average value in healthy non-pregnant women by 15%, the maximum increase is up to 40%.

Rice. 27. Changes in cardiac output during pregnancy

In the first half of pregnancy, the increase in cardiac output is mainly due to an increase in the stroke volume of the heart by 30%. Later, there is a slight increase in the heart rate (HR), which reaches a maximum in the third trimester of pregnancy, when the heart rate is higher than that of a non-pregnant woman by 15-20 beats per minute (i.e., by 15%). With multiple pregnancies, the increase in heart rate reaches 20-30 beats per minute. It is believed that tachycardia is caused by a number of factors, including increased secretion of progesterone, starting in the first trimester of pregnancy.

In addition, during pregnancy, there is a regional redistribution of blood. Its inflow to the uterus by 16 weeks is 400 ml / min higher than that of non-pregnant women and remains at this level until the term of delivery.

What are the main hemodynamic parameters during pregnancy is shown in Fig. 28.

Rice. 28. The main hemodynamic parameters during pregnancy

The blood flow through the capillaries of the skin and mucous membranes also increases, reaching a maximum - 500 ml / min - by 36 weeks. The increase in cutaneous blood flow is associated with peripheral vascular dilatation. This explains the frequent occurrence of a feeling of heat in pregnant women, increased sweating, some pregnant women may complain of nasal congestion.

RESPIRATORY SYSTEM

During pregnancy, a number of adaptive reactions occur, aimed at satisfying the increased metabolic activity. The development of compensatory reactions (they are similar to the mechanisms that contribute to the adaptation of the body to hypoxia) is primarily associated with the activity of the lungs (hyperventilation, respiratory alkalosis), the cardiovascular system (hemodynamic shifts, increased cardiovascular output) and the red blood system (activation of erythropoiesis, an increase in the volume of circulating erythrocytes).

With an increase in the uterus, there is a gradual displacement of the abdominal organs and a decrease in the vertical size of the chest, which is compensated by the expansion of its circumference, increased excursion of the diaphragm. During pregnancy, there is an increase in respiratory rate by 10%. All these factors lead to

a gradual increase in tidal volume by the end of pregnancy by 30-40%.

Oxygen consumption by the end of pregnancy increases by 30-40%, and during attempts - by 150-250% of the original. Due to the fact that the need for oxygen during pregnancy increases, it is more difficult for a pregnant woman than for a non-pregnant woman to tolerate hypoxia of any genesis and severity. Physiological decrease in the level of pO 2 in the mother's blood does not affect the saturation of fetal blood with oxygen. This is due to the higher concentration of hemoglobin in the fetal blood and the higher affinity of fetal hemoglobin for oxygen.

The main changes in the respiratory system during pregnancy are shown in table. 7.

Table 7

The main changes in the respiratory system during pregnancy

ORGANS OF HEMOPOTIOLOGY

Hemopoiesis increases; increase: the number of erythrocytes, the amount of hemoglobin, leukocytes and blood plasma. ESR during pregnancy increases slightly - up to 20-30 mm / h, which is mainly associated with an increase in the concentration of fibrinogen.

During normal pregnancy, changes in the acid-base state of the blood are observed, which is expressed in the accumulation of acidic

exchange products. As the gestation period increases, the phenomena of metabolic acidosis and respiratory alkalosis increase. It is believed that maternal acidosis may be a consequence of the primary acidosis of the fetus due to the predominance of anaerobic glycolysis in its body. In most pregnant women, these changes are compensated, and no shift in pH occurs, which indicates a sufficient capacity of the body's buffer systems during physiological pregnancy.

HEMOSTASIS SYSTEM

Under normal conditions, hemostasis depends on the state of the vascular wall, platelets, coagulation factors and fibrinolysis. During pregnancy, there are significant changes in the coagulation system and fibrinolysis. The hemostasiological status is characterized by an increase in blood coagulation potential, an increase in the structural properties of a clot, and inhibition of enzymatic fibrinolytic activity. These changes, together with an increase in BCC, prevent bleeding during placenta separation, the formation of an intravascular thrombus, and play an important role in the prevention of pregnancy complications such as thromboembolism, bleeding after the development of disseminated intravascular coagulation. In normal pregnancy, there is an increase in the level of VII (proconvertin), VIII (antihemophilic globulin), X (Stewart factor) coagulation factors (from 50 to 100%), the level of prothrombin and IX factor (Christmas factor by 20-40% and especially the level of plasma fibrinogen The concentration of fibrinogen increases by 50%, which is the main reason for a significant increase in ESR during pregnancy. By 38-40 weeks of pregnancy, the prothrombin index also significantly increases. The number of platelets slightly decreases due to their increased consumption.

Fibrinolytic activity of plasma decreases during pregnancy, becomes the lowest during childbirth and returns to the initial level 1 hour after the birth of the placenta.

Changes in the hemostatic system are a unique feature of the gestational process, they are supported by the existence of the fetoplacental complex and, after the completion of pregnancy, undergo

regression. However, in the case of the development of pathological conditions during pregnancy, the hemostatic system universally and nonspecifically reacts to them in the form of the formation of a blood internal combustion syndrome, the trigger points of which lie in physiological hemostatic reactions.

DIGESTIVE ORGANS

Many women in the early stages of pregnancy experience nausea, vomiting in the morning, taste sensations change, these phenomena gradually disappear. Progesterone helps to reduce the tone of smooth muscles. Due to the relaxation of the lower esophageal sphincter, intraesophageal pressure also decreases, with increased intra-abdominal and intragastric pressure, heartburn appears. The listed factors determine the danger of endotracheal anesthesia in pregnant women and women in labor - regurgitation and aspiration of gastric contents (Mendelssohn's syndrome) occur with a frequency of 1: 3000. Mechanical compression of the large intestine by the growing uterus leads to congestion and deterioration of peristalsis, constipation. Pregnant women often develop hemorrhoids due to constipation and an increase in venous pressure below the level of the growing uterus. There is an upward displacement of the anatomical structures, making it difficult to diagnose diseases of the abdominal cavity.

During pregnancy, liver function changes. Laboratory tests give results that are sometimes similar to those in liver pathology:

Alkaline phosphatase activity doubles (placental alkaline phosphatase isoenzyme);

The level of albumin and the albumin-globulin coefficient decrease.

The amount of glycogen in the liver decreases slightly, because a lot of glucose is transferred from the mother to the fetus. The intensity of fat metabolism changes (increased lipemia, high cholesterol content, increased fat deposition in hepatocytes). The protein-forming function of the liver also changes, aimed at providing the fetus with the necessary amount of amino acids. The synthesis of fibrinogen in the liver increases, the processes of inactivation of estrogens and other steroid hormones produced by the placenta are enhanced. Some

women with normal pregnancies have skin changes such as palmar erythema and petechial hemorrhages. They are considered not a manifestation of liver disease, but only a sign of an increase in the concentration of estrogen, and completely disappear by the 5-6th week after childbirth. The detoxification function of the organ is somewhat reduced. In addition, one should take into account the progesterone effect on the tone and motility of the biliary tract, which contributes to the occurrence of cholelithiasis and cholestasis even in healthy women.

ORGANS OF URINARY

The main changes in kidney function during pregnancy are as follows:

Increased renal blood flow by 60-75%;

Increase in glomerular filtration by 50%;

Acceleration of the clearance of most substances;

Decrease in the level of creatinine, urea and urate in the blood plasma;

Possible glucosuria.

The urinary function of the kidneys is based on three main processes:

Glomerular filtration;

Tubular reabsorption;

Tubular secretion.

The kidneys function with increased stress, removing from the mother's body not only the products of her metabolism, but also the metabolic products of the fetus. Glomerular filtration increases by 30-50%. Typical for physiological pregnancy, the concentration of creatinine and urea in the blood plasma is low compared to the norm for non-pregnant women.

An increase in glomerular filtration with a decrease in tubular reabsorption of filtered glucose may be accompanied by the development of glucosuria even in the physiological course of the gestational process, which is more often observed in the third trimester of pregnancy.

One of the main tests for diagnosing kidney pathology during pregnancy is proteinuria. It should be noted that during physiological pregnancy, the amount of protein excreted in daily urine is increased to 0.05 g / day, and therefore the diagnostic value of this test decreases.

Changes in the concentration and clearance indicators of renal function are accompanied by an increase in the indicators of the sodium / potassium ratio of urine, the clearance of endogenous creatinine, and osmotically free water.

The tone of the urinary tract decreases mainly as a result of the influence of placental progesterone, the capacity of the bladder increases slightly. Atony and expansion of the lumen of the ureters disrupt the passage of urine and can cause the onset or exacerbation of infectious diseases. Mechanical pressure in combination with the action of progesterone sometimes contributes to hydronephrosis, expansion of the lumen of the ureter (86% on the right).

BONE-MUSCULAR SYSTEM

The load on the spine of the pregnant woman increases, the gait changes ("proud step" of the pregnant woman). Progressive lordosis with an enlarging uterus shifts the center of gravity to the lower extremities. Changes during pregnancy are characterized by serous impregnation and loosening of the articular ligaments, symphyseal cartilage and synovial membranes of the pubic and sacroiliac joints, due to the effects of relaxin produced in the placenta. In this regard, there is a slight increase in mobility in the joints of the pelvis and the possibility of a slight increase in the capacity of the pelvis during childbirth, including due to the divergence of the pubic bones (normally - no more than 1 cm).

LEATHER

Deposition of brown pigment is often observed in the skin of the face, the white line of the abdomen, nipples and areola (pregnancy mask - chloasma or melasma gravidarum). The pigmentation is caused by melanocyte-stimulating hormone, a polypeptide similar to corticotropin, under its action in zona reticularis the adrenal glands synthesize a pigment similar to melanin. Estrogens and progesterone

also give a melanocyte-stimulating effect. In the same women, hormonal contraceptives can cause similar changes.

Under the influence of mechanical stretching and under the influence of hypercortisolism, pregnancy stripes appear (striae gravidarum) blue-brown color, localized around the navel, in the lower abdomen, often on the thighs and on the mammary glands. These scars (a consequence of the divergence of the connective tissue fibers) do not disappear after childbirth, but take on the appearance of whitish scars.

Two-thirds of pregnant women develop angiomas, telangiectasias, nevi, and two-thirds have palmar erythema. They have no clinical significance, and in most women they disappear immediately after childbirth, as a consequence of hyperestrogenemia.

MAMMARY GLAND

During pregnancy, the mammary glands reach full morphological maturity, their size increases due to the growth of glandular tissue. The number of alveoli, lobules, ducts increases. In the epithelium lining the alveoli, the secretion of colostrum begins. These changes occur under the influence of estrogens, progesterone, PL and prolactin. The nipples also grow, the areola circles are intensely pigmented. Montgomery's glands - hypertrophied sebaceous glands - appear on the areoles.

GENITAL ORGANS

The genitals undergo significant changes, especially in the uterus.

The size, shape, position, consistency and excitability of the uterus change. Its mass, equal to 50-100 g before pregnancy, increases to 1000 g (without the ovum) at the end of pregnancy. The volume of the uterine cavity increases by the end of pregnancy 500 times. The dynamics of the increase in the height of the fundus of the uterus is shown in the illustration (see below). After 12 weeks, the uterus extends beyond the pelvis. Physiological dextrorotation of the uterus is due to the presence of the sigmoid colon in the left side of the pelvis.

The mucous membrane of the uterus, which was in the secretion phase before the start of implantation, from the moment of attachment of the blastocyst undergoes a complex of complex morphological and biochemical changes and is called decidual - falling away.

Hypertrophy of the nerve elements of the uterus, an increase in the number of receptors, and an increase in the vascular network are observed.

The amount of actomyosin (a complex compound of contractile proteins - actin and myosin) increases, which reduces the motor function of the uterus.

The amount of phosphorus compounds increases, as well as the energetically important creatine phosphate and glycogen.

By the time of delivery, there is an accumulation of serotonin, catecholamines. Serotonin is a progesterone antagonist and a synergist of estrogen hormones, contributes to the contractile activity of the uterus. Irregular, sporadic contractions of the uterus are called Braxton-Hyx contractions (described in 1872).

There is a hypertrophy of the ligamentous apparatus of the uterus, especially the round and sacro-uterine ligaments.

In the cervix, the processes of hypertrophy and hyperplasia are less pronounced. Due to the significant development of the venous network, the neck resembles spongy tissue, becomes cyanotic, edematous, softened. The cervical canal is filled with thick mucus (mucous plug), discharge of the mucous plug is a harbinger of childbirth. The external and internal os of the cervix in primipregnant women is closed before delivery, in re-pregnant women -

external pharynx in the last months of pregnancy with a vaginal examination misses a finger. From 4 months of pregnancy, the lower pole of the ovum stretches the isthmus of the uterus and occupies it, the isthmus becomes part of the fetus and is called the lower segment of the uterus. The lower segment is limited by the line of attachment of the peritoneum of the vesicouterine fold from above and by the level of the internal os of the cervix from below. This volume of the uterus contains fewer muscles and blood vessels, is thinner, and is usually the site of the incision for a caesarean section.

"RATE OF PREGNANCY"

In view of the above, in recent years in obstetric practice, the concept of "pregnancy rate" has been used. Under the "norm of pregnancy" should be understood the average indicators of homeostasis and functional tests, characteristic of the uncomplicated development of pregnancy in a practically healthy woman at different stages of gestation.

To identify pathological disorders during pregnancy, it is necessary to clearly understand the permissible fluctuations of certain parameters. Previously, the main indicators of homeostasis of pregnant and non-pregnant women were compared, which does not seem entirely legitimate, since it does not reflect the functional changes inherent in the gestational process.

Knowledge of physiological changes in the body during normal pregnancy is necessary for a doctor of any specialty, since it allows you to quickly identify pathology that precedes complications of childbirth and the postpartum period or determines them. If the doctor ignores the above changes, it can lead to both an underestimation of the severity of the condition and an iatrogenic overcorrection in the treatment of complications or critical conditions.