Changes in the body during pregnancy. General body changes during pregnancy

Pregnancy is a special state of a woman during which there are constant changes. 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 clear signs as the rounding of the forms of the expectant mother, pigmentation on the skin, the release of colostrum from the breast in the later stages.

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

Indeed, there are many questions. Why does mood change so fast? Why did you go to the toilet more often? Why did such unpleasant phenomena as heartburn, shortness of breath, swelling appear? And so on…

To begin with, emotional instability is a normal condition during pregnancy. Future mothers - they are like that, they will always find a reason to worry. Even if it's hard to find one. And we'll talk about that 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 about how an already realized pregnancy affects the female body.

Changes in the female body during pregnancy:

From the side of the cardiovascular system

The volume of circulating blood increases to ensure the blood flow of already two organisms. Such an increased volume is much more difficult for the heart to pump. For this reason, the heart muscle thickens a little. There is also a slight increase in heart rate.

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

Blood pressure in the early stages, as a rule, decreases moderately. In the later stages, many women have a tendency to increase 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 the blood and an increase in 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 spasms.

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

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

From the respiratory system

To provide oxygen to mother and child, a 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 tight in the chest, they cannot fully straighten with a deep breath. To solve these problems, the respiratory center in the brain gives the command to breathe more frequently. As a result, respiratory movements become 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 often worries. It appears due to an increase in 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 concerned about toxicosis. The severity of its manifestations is individual. Someone notes nausea only in the morning. Someone suffers from nausea around the clock. Some people experience nausea and vomiting. Many people don't experience these symptoms at all.

Toxicosis occurs due to temporary poisoning of the mother's body with metabolic products of the baby. 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 have 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 mother's body. Therefore, it is necessary to tell the attending physician about such a situation.

Another common symptom that accompanies pregnancy is heartburn. Due to the change in the position of the stomach in the abdominal cavity due to the enlarged uterus, there is often a reflux of the acidic contents of the stomach into the esophagus. The acid irritates the walls of the esophagus, and this causes pain in the sternum.

An alkaline drink, such as milk, will partly help to cope with such a problem. Why does it help a little? 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 eat at least two hours before bedtime.

From 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 necessary 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 go to the development of the crumbs.

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

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

The connective tissue of the ligaments, cartilage, 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 apart.

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

From the endocrine system

Pregnancy is considered to be 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 proper hormonal levels, 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 starts to work more actively.

In the pituitary gland, the production of follicle-stimulating and luteinizing hormones, which regulate the hormonal work of the sex glands, 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 pituitary gland actively produces the hormone prolactin. 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. It is responsible for the production of progesterone. This 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 influence all metabolic processes of both the mother and the fetus. The thyroid gland itself increases in size during pregnancy.

The lack of its hormones can lead to a disruption in the formation of the baby's brain. And their excess can provoke an abortion in the early stages.

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

The hypothalamus (hypothalamic region of the diencephalon) produces a very important hormone oxytocin. From the hypothalamus, it enters the posterior lobe of the pituitary gland and from there begins its work.

Peak concentrations of oxytocin are reached late in pregnancy. It is he who is responsible for the onset of labor, contraction of the uterus during childbirth and stimulation of the secretion of milk from the mammary glands.

From the urinary system

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

Due to the growing 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 retention of urine in the urinary organs.

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

In women who are 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 the hormonal background, physiological swelling appears.

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

Edema can be physiological (manifestation of the norm) or pathological. The difference between physiological 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 promotes the outflow of urine through the ureters to the bladder, and thereby facilitates the work of the kidneys.

From the side of the immune system

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

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

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

Against the background of a decrease in the body's immune defenses, pathogenic microorganisms “crawl out of hiding” and become more active, which until then “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 used products.

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

The general patterns here 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, the 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 activated. A woman may notice increased sweating and the appearance of a greasy sheen on the skin.

More dark-skinned representatives of the beautiful half of humanity may develop age spots on the skin. Freckles also become more distinct or there are 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 peripapillary region. 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 the resulting gap in the thin layer of the skin - the dermis. Stretch marks are brown in color at first. But gradually they turn white and resemble scars. The appearance of stretch marks directly depends on the elasticity of a 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 lengthens. 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 childbirth, women often complain of profuse hair loss. This is due to the normalization of estrogen levels after childbirth. Accordingly, hair growth and hair life expectancy returns to its original level.

If your hair and nails have become dull, brittle, then most likely you have a deficiency of any trace elements and vitamins. Be sure to tell your doctor about such changes. These may be the first manifestations of deficiency conditions during pregnancy (for example, 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, and a sense of double responsibility, and anxiety for the well-being of the ongoing pregnancy, and the restructuring of habitual ways of life, and a reassessment of priorities lead to this state.

At the very beginning of pregnancy, powerful hormonal changes occur. Initially, female hormones - estrogens - predominate. Then estrogen yields its dominant role to the pregnancy-preserving hormone, progesterone.

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

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

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 future mother who can support, calm, dispel anxieties and doubts. After all, she needs positive emotions so much.

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

How does a pregnancy affect a woman's health?

Many scientific studies have proven that a history of pregnancy significantly reduces the risk of ovarian cancer. According to current data, 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, a microtrauma is formed in the ovary. After each tear heals, a small whitish scar forms.

According to some researchers, violations of 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 that occur due to pregnancy should not be afraid. After all, after childbirth, all processes quickly normalize. And let the figure, forms, sleep and wakefulness patterns change. If desired, you can cope with a change in shape.

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

Pregnancy causes significant changes in your body. Many of these changes are caused by hormones.

Human gonadotropin, which we have already talked about, is secreted by the developing placenta and ensures that the female ovaries produce estrogen and progesterone, hormones necessary for the normal course of pregnancy.

Estragen contributes to the thickening of the uterine mucosa and improves its blood supply, as well as the development of the milk ducts. Progesterone not only relaxes the uterus, preventing it from contracting excessively, but also releases relaxin, a substance that softens the ligaments, cartilage, and cervix, allowing them to stretch during childbirth.

In addition to hormonal changes, there are others. Your entire body is rebuilding, mobilizing all the forces so that you can give birth to a healthy and strong baby.

Some changes are also observed in the genitals of a pregnant woman - the large and small labia of pregnant women acquire a bluish tint. There may be a secretion from the vagina, sometimes profuse. The biggest changes occur in the uterus, in which your baby develops and grows stronger over the course of 9 months.

Before the onset of pregnancy, the uterus weighs approximately 40-50 g and has a length of 7-8 cm. By the end of pregnancy, its average weight is 1 kg, and the length from the neck to the bottom is 40-50 cm.

The growing uterus gradually leaves the pelvic area and pushes other organs. This explains most of the ailments - such as indigestion, constipation, varicose veins, shortness of breath.

Preparation for breastfeeding should not begin after childbirth, but immediately after you find out about your pregnancy

Big changes are taking place with your breasts, and this is not surprising, because it is on it that for several months, or even a whole year, the main function will be assigned - feeding the baby. The breast increases significantly in size, the areolas become dark brown. The blood supply to the nipples also increases - you may notice that when they come into contact with something, they protrude faster. Around the third month of pregnancy, a few drops of future milk can be squeezed out of the breast - yellow colostrum. Now is the best time to prepare the nipples for breastfeeding, as often mothers are forced to transfer babies to artificial nutrition due to the fact that they did not take care of it in time. And how many babies are deprived of the most important and healthy food - mother's milk! Read below to find out what steps you need to take to ensure that you can breastfeed your baby.

Share YOUR thoughts and feelings with your husband to help you through this transition. Remember that he is the father of the child and, just like you, worries about your baby.

Along with physical changes in the first months of pregnancy, mental ones are often observed. You notice that you have tears in your eyes at the slightest provocation. You either want to laugh or cry. These changes in behavior cannot but embarrass, and sometimes - let's be honest with ourselves - annoy your husband. Often, our men do not represent the fact that a whole revolution is taking place in our body, and they attribute everything to an ordinary female whim. Feel free to try to explain your condition to your husband. And be sure to say that soon it will all be over. The time will come when both of you will laugh, remembering the inconvenience caused to you by the first weeks of pregnancy.

In the first three to four months, most pregnant women experience nausea and vomiting. In order to alleviate your condition, after consulting with your doctor, you can take the following herbal infusions:

2 teaspoons mint, 1 teaspoon valerian root, 2 teaspoons dried marigold flowers, 1 teaspoon yarrow herb, 2 teaspoons chamomile flowers, 2 teaspoons shepherd's purse. All components (the absence of one or two is quite acceptable), pour one and a half glasses of boiling water and insist for half an hour. After that, strain the infusion and take 4 cups 6 times a day. After 25 days, take a break for 10-15 days, then resume treatment.

2 tbsp. spoons of crushed rose hips, 2 teaspoons of St. John's wort, 1 teaspoon of crushed hawthorn fruits, 1 tbsp. spoon of motherwort grass, 1 teaspoon of birch buds, 1 tbsp. pour a spoonful of bearberry leaves, strawberry fruits and leaves with two and a half glasses of boiling water, put on fire for a minute and a half, then insist for 20 minutes, strain.

The infusion should be taken hot half a glass three times a day half an hour before meals.

Many women feel so bad that sometimes they begin to regret that they are carrying a child. Cheer up, the nausea will pass in a couple of months, and you will feel fine for the rest of the time until the birth. The main thing during this period is to avoid crowded places, because the defenses of your body are significantly weakened. In the event that you catch a cold during pregnancy, remember that the flu virus itself does not affect the baby, but the disease is terrible primarily because it is accompanied by high fever and the release of toxic substances and can lead to premature birth or miscarriage.

The teeth of pregnant women are most susceptible to caries, so they must be especially carefully looked after - not only brush twice a day, but also rinse your mouth every time after eating or drinking, especially sweet ones.

Great changes occur in the oral cavity, where the process of digestion begins. During this period, the salivary glands secrete saliva more intensively. Its chemical composition also changes, and this can lead to the destruction of tooth enamel.

The most significant changes occur in the pelvic area - the joints of the pelvic bones and spine become more elastic and flexible, thereby facilitating the process of childbirth.

In the second trimester, your pregnancy becomes visible to your friends and acquaintances. In the future, your belly - the subject of your pride - increases even more due to the uterus, which seems to pull you forward, and this leads to the fact that the center of gravity moves. Watching the pregnant woman, everyone notices that she involuntarily leans back, as if she is carrying something heavy in her hands. This is what is called the "proud posture of pregnant women."

Remember that in the second half of pregnancy, the muscles of the abdominal wall are strongly stretched. If pregnancies follow one after another, the muscles will remain stretched. Some women develop bluish-reddish streaks on the skin of the abdomen, breasts, and thighs due to the tightness of the skin. After childbirth, these stripes noticeably lighten, sometimes leaving barely noticeable traces, and sometimes scars.

Along with the darkening of the nipples, as we have already mentioned above, some women have pigmentation of the entire skin - dark freckles appear, the genitals, arms and legs darken. This pigmentation is called chloasma - pregnancy spots. Quite often, a dark stripe appears on the skin from the pubis to the sternum through the navel - it is jokingly called the “mother-in-law path”.

You can try to prevent scarring of the skin with moisturizing creams and lotions. At the pharmacy, you can buy a special lotion to prevent stretch marks during pregnancy. However, I want to warn that there is still no evidence of the effectiveness of these funds. In about half of women, they still appear, regardless of whether they used creams or not. But you can still try. An annotation is usually attached to each such tool.

In no case should you use baby creams and oils to combat stretch marks - they will bring the opposite effect, since they are designed to fight various skin rashes and dry the skin.

By the ninth month of pregnancy, you or the father of your baby will begin to have some concerns about your health or the health of your baby. This is quite natural. You may have depressing thoughts that your life is in serious danger - and this is also normal, since both pregnancy and childbirth are associated with certain difficulties and dangers, which are reduced with careful attention to your health and timely prenatal care. The times when women in childbirth died are over. Statistics say that the death rate of women in childbirth is now almost zero, and the death rate of newborns is constantly decreasing. Do not forget that you will give birth to your child under the supervision of qualified specialists, in a well-equipped maternity hospital, where both you and your baby will be provided with timely assistance, if necessary. In addition, all maternity hospitals have resuscitation devices for newborns, so all your fears are groundless.

Since pregnancy, in the understanding of a specialist - from the moment of implantation of a fertilized egg (zygote) in the tissues of the mother's body, a complex of changes occurs in the woman's body, which covers the functions of all organs and systems, is regulated by the central nervous system, is observed throughout pregnancy and is within physiological boundaries, peculiar only to the state of pregnancy.

The set of changes includes:

• cessation of menstruation (changes occur in the mucous membrane of the uterine cavity caused by a change in the functional state of the ovary)
• prolonged increase in rectal temperature (the effect of progesterone, an ovarian hormone, on the thermoregulation center in the brain)
• the formation of the placenta - a new endocrine gland
• changing the appearance of a woman
• the emergence in the cerebral cortex of the dominant pregnancy, which provides a clear coordination of the functions of all organs and systems in the interests of the developing fetus
• changes in the function of the pituitary, adrenal, thyroid, parathyroid and pancreas glands
• changes in the uterus (greatest changes compared to other organs)
• changes in the function of the kidneys, liver, gastrointestinal tract
• metabolic change
• changes in hematological (blood) and hemodynamic (blood flow) parameters
• change in circulating blood volume
• change in the hemostasis system (stop bleeding): change in the system of coagulation (clotting) and fibrinolysis (dissolution, anticoagulation)
• changes in iron metabolism, folate metabolism (folic acid)
• changes in the functioning of the cardiovascular system
• change in the colloid-osmotic state, etc., etc.

That is, with the onset of pregnancy, your body begins to completely rebuild its work.
He is preparing to bear the fetus, give birth and nourish the child.
Therefore, such a restructuring is a normal state for a pregnant woman.

The doctor controls the condition of any person through laboratory and instrumental studies.

• Healthy man- has some indicators (the numbers that you see on the analysis form are the norms), for example, blood, urine, etc.
• For a sick person- there are indicators, they change depending on the patient's condition and his disease
• Pregnant woman- is a song. She, like a sick person, depending on the condition, has her own normal indicators, characteristic of the physiological course of pregnancy. Moreover, in different trimesters of pregnancy, each indicator has its own norm, and these norms for a pregnant woman do not coincide with the norms for a healthy person.

  Moreover, sometimes what is normal for a pregnant woman is assessed as a pathology in a non-pregnant woman. And for a man - generally fatal, they don’t live with this.

Dear men, loving husbands!

Remember that your pregnant wife is a "critically ill" person all the time she is carrying your child. That is why a loving husband should not allow his wife to overwork "housework". Well, what a sick person is forced to work. The most favorable conditions are created for a sick person so that he recovers faster. And a pregnant woman needs to create favorable conditions so that she can safely bear and give birth to a child, i.e. so that her body can qualitatively adapt to changing conditions as pregnancy develops (the baby grows, develops, eats, "breathes", etc. - conditions are constantly changing).

If the body of a pregnant woman cannot adapt normally, then she has various unfavorable conditions, first of all, for the child. For a woman, this is also an unfavorable condition. In especially severe cases, they sacrifice pregnancy to save a woman, because. termination of pregnancy in this condition immediately leads to recovery (conditionally to recovery), but your child will no longer be born.

Take care of women always! And especially during pregnancy!

The fetoplacental system is like a new endocrine gland.

After the implantation of the zygote in the uterine cavity (we are considering the normal development of pregnancy with you, but, in principle, the following is true for any place where the zygote is introduced), a new endocrine gland, the placenta (children's place), begins to form in the woman's body.

The placenta has two parts: fetal and maternal, the circulation of which never mixes. These parts of the placenta are as close as possible, which allows the exchange of substances between the body of the mother and the fetus, i.e., in fact, allows the child to "eat, write and breathe", and, therefore, grow and develop.

The exchange of substances between the body of the mother and the fetus is a major factor for its development. The exchange is carried out due to the permeability of the placenta, which is disturbed in most acute and chronic complications during pregnancy. Violation of the integrity of the parts of the placenta and the deterioration of its permeability leads to the death of the fetus and termination of pregnancy.

The death of the fetus and termination of pregnancy is also possible for another reason, when the mother's body suddenly decides that the fetus is a foreign protein for it. But it really is. However, nature has provided a protective mechanism that does not allow the mother's immune system to recognize the antigens of paternal origin inherent in the child (and we remember from school that the child receives half of the chromosomes from the mother, and the other half from the father).

This protective mechanism consists of certain factors that block the mother's immune system and provide local immunological comfort. In spontaneous abortions, blocking factors in the mother's blood are reduced or absent.

The placenta produces a wide range of hormones and specific proteins that enter the mother's blood and amniotic fluid. They regulate the normal course of pregnancy and fetal development by changing the function of other endocrine glands, metabolic and excretory organs, the function of the nervous system and the body as a whole.

By the level of hormones and specific proteins of the placenta, determined in the blood of the mother, in the blood of the fetus or in the amniotic fluid, it is possible to assess the condition of the fetus and the function of the placenta, which is what obstetric endocrinology does. Thus, the study of the endocrine function of the fetoplacental complex can significantly improve the diagnosis of the fetus at various stages of pregnancy, conduct antenatal therapy or early delivery in the interests of the newborn.

The appearance of a new endocrine gland leads to other changes in the female body.

The appearance of a woman is changing.
Appears:

• pigmentation of the skin (forehead, cheeks, chin, upper lip, white line of the abdomen, nipples and peripapillary areas), which is associated with a significant stimulation of the formation of pigment by skin cells. The formation of the pigment depends on the melanoform hormone of the adrenal gland, the increased production of which occurs during pregnancy.
• subfebrile body temperature is noted, which can last up to 16-20 weeks of pregnancy and is associated with hormonal fluctuations. An increase in basal (rectal) temperature is an early diagnostic symptom of pregnancy (production of progesterone by the corpus luteum of pregnancy).

  From the moment the placenta begins to produce progesterone, the temperature decreases and returns to normal.

• there is engorgement and soreness of the mammary gland due to an increase in its volume as a result of the growth of glandular tissue, an increase in the nipples and protrusion of the areolar glands. In the second half of pregnancy, colostrum may be released.
• violation of the proportions of the face (enlargement of the nose, lips, chin, thyroid gland, especially in the second half of pregnancy), some enlargement of the limbs
• stretching of the tissues of the anterior abdominal wall, mammary gland, thighs and the appearance of striae (“pregnant stripes”) in these areas (stria gravidarum). Their occurrence is associated with excessive stretching of the abdominal wall; this is more often observed in persons with a large volume of the abdomen (large fetus, polyhydramnios, multiple pregnancy) or with some lack of elastic fibers in the skin.

  Pregnancy scars usually appear during the first pregnancy. Fresh areas have a cyanotic color due to the translucence of small vascular formations.

• varicose veins are aggravated or appear for the first time, especially of the lower extremities
• The "proud posture and gait" of a pregnant woman is due to a shift in the center of gravity of the body, an increase in the mobility of the pelvic joints and a limitation of the mobility of the hip joints.
• A progressive increase in body weight, which is due to both the growth of the fetus and uterus, and the peculiarities of metabolic processes, fluid retention in the tissues. The average weight gain during pregnancy is 10-12 kg, of which 5-6 kg falls on the fetal egg (fetus, placenta, amniotic fluid), 1.5-2 kg for an increase in the uterus and mammary glands, 3-3.5 kg - for an increase directly in the body weight of a woman.

  Before childbirth (for 3-4 days), the body weight of a pregnant woman falls by 1.0-1.5 kg, due to the peculiarities of metabolic processes.

Changes in the structure of the external (and internal) genital organs

• the external genitalia become edematous and hyperemic. There is cyanosis of the mucous membranes of the vaginal part of the cervix, the vagina and its vestibule, which indicates vasodilation and blood stasis, which facilitates the serous impregnation of tissues necessary for the deposition of nutrients at the site of attachment of the fetal egg to the uterine wall
• The vagina expands and lengthens somewhat during pregnancy. The walls of the vagina are edematous and thickened. The discharge becomes more abundant, mucous in nature, milky white or yellowish in color with an acidic reaction. In a healthy pregnant woman, the vagina has I-II degrees of purity.

The uterus during pregnancy changes to the greatest extent compared to other organs.
Its dimensions increase during pregnancy in all respects:

• weight - from 50-100 g to 1000-1200 g,
• length - from 7-9 cm to 38-40 cm,
• anteroposterior size - from 2-3 cm to 23-25 ​​cm,
• transverse size from 3-4 cm to 25-26 cm,
• volume - 500 times, reaching 2000 cm 3 and more.

Accordingly, changes occur in all tissues, blood supply and innervation of the uterus:

• The shape and position of the uterus changes during pregnancy. The uterus, as it grows, leaves the small pelvis into the abdominal cavity, rising at the 9th month of pregnancy to the xiphoid process. The shape of the uterus is asymmetrical due to the bulging of the part where the placenta is attached.
• Thin arteries and veins of the uterus turn into powerful trunks that become corkscrew-shaped tortuous, which allows you to maintain normal blood supply with pronounced changes in the uterus during pregnancy and with contraction of its muscles during childbirth
• The volume of blood circulation in the uterus during pregnancy increases tenfold, providing uteroplacental blood flow, which is carried out according to the principle of blood supply to vital organs and remains relatively optimal even under various stresses (blood loss, anemia). This ensures the survival of the fetus in extreme situations.
• The receptor system of the uterus changes: during pregnancy, the sensitivity of the uterus to exciting factors decreases, before childbirth, the excitability of the uterus increases, part of the nervous structures are lost in order to reduce pain information from the uterus during childbirth.

With the appearance of the placenta in the cerebral cortex, the dominant of pregnancy appears, which provides a clear coordination of the functions of all organs and systems in the interests of the developing fetus.

Women note a decrease in efficiency, an increase in drowsiness, or vice versa, they are irritated, they have nausea, salivation, periodic vomiting, which is classified as mild and the occurrence of which corresponds to the phase of functional changes in the nervous system (the phase of neurosis).

During this period, dear husbands, your wife urgently needs increased attention and care: bring her breakfast in bed, feed her your favorite food and fulfill all her whims, all the same, the phase of neurosis.

In pregnant women, suggestibility and autosuggestibility increase, which is taken into account when conducting psychoprophylactic preparation for childbirth.

There may be phenomena of paresthesia, pain of a neuralgic nature, cramps of muscle groups, numbness of the fingers and other disorders. An increase in the excitability of peripheral nerves is also manifested by an increase in knee reflexes.

With all this, sexual excitability decreases and you, dear husbands, must be prepared for this. No, no way!!! (remember the increased suggestibility and self-hypnosis) do not show your resentment that your wife is cold and inattentive to you, which means she has fallen out of love. She still loves you, she is already carrying your child and she has a dominant in the cerebral cortex - to endure pregnancy at all costs. And there is no getting away from it.

But if you, for your own sake, try to overcome this dominant, then in some cases there will be no one to guarantee the preservation of pregnancy.

In a pregnant woman, the functions of some analyzers change - hearing, vision, smell. A pregnant woman's sense of smell can be so enhanced that a woman will react to the lightest (subtly perceptible) smells brought by her beloved husband as a result of, say, out-of-family adventures.

I foresee the righteous wrath of men. But I hasten to assure you that the beloved wife will think that way and it is very unlikely that it will be otherwise. An alien smell from you, and if this smell is still associated with a woman’s (even if at work you went to the director and stood next to the secretary, or she was with you, next to you, in a cloud of perfume), the increased self-hypnosis of the pregnant woman will finish her dirty deed.

Keep in mind, dear men, when a woman feels sick, sick and the world is in gray tones, for some reason, joyless thoughts come into her head, which can lead to a deterioration in her condition and, as a result, to termination of pregnancy.

During pregnancy, changes also affect other organs.

adrenal glands during pregnancy, they increase in size due to hyperplasia of the cortex, respectively, the glucocorticoid and mineralocorticoid function of the adrenal glands increases.

Strengthening the function of the adrenal cortex during pregnancy is aimed at increasing the protective and adaptive mechanisms, including in childbirth.

Thyroid- increases in volume, function increases. Pregnant goiter is observed, especially in endemic goiter zones (little iodine in soil and water) and hyperthyroidism without thyrotoxicosis. Strengthening the function of the thyroid gland is associated with the influence of placental hormones on it. Clinical thyrotoxicosis does not develop due to an increase in the binding of free hormones to plasma proteins. The protein-bound form of the hormone is further utilized by the fetus and the mother's body, since the need for it increases with the development of pregnancy, before the onset of fetal thyroid function.

Parathyroid glands(calcium metabolism), undergo hypertrophy, their functional activity increases due to an increase in the need for calcium, which is a plastic material for the formation of the fetal musculoskeletal system. With a lack of intake or a violation of absorption, the fetus receives calcium from the tissues of the mother's body (bones, teeth), which can be manifested by osteoporosis, brittleness and caries of the teeth. During pregnancy, the concentration of calcium in the blood increases. In the blood plasma, the content of phosphorus compounds, iron and a number of trace elements (cobalt, iodine, manganese, copper) also decreases. The deficiency of these substances is due to the needs of the fetus and the intensification of metabolic reactions, the enzyme systems of which include some of the micro and macro elements.

Pancreas- strengthening the function of the insulin-producing apparatus. As a result, carbohydrates are absorbed very well and are deposited in the mother's liver and in the tissues of the fetus. Women with diabetes always have large children due to the utilization of excess carbohydrates by the fetus. In some pregnant women, glucosuria (sugar in the urine) is observed, which is not pathological in nature and manifests itself with a normal or even low content of carbohydrates in the blood.

Pituitary in pregnant women, it increases in volume and hardly fits in the Turkish saddle, hyperproduction of growth hormone (GH) is observed, which, penetrating the placenta, stimulates the growth of the embryo. This hormone also affects the lactogenic function of the mammary gland, causing in some cases an increase in the nose, lips, fingers. There is an increased secretion of all tropic hormones by the pituitary gland, although some of them can be formed by the placenta (LH, ACTH).

Effect of pregnancy on kidney function

Renal blood flow increases and glomerular filtration increases (maximum in the middle of pregnancy) - due to the excretion of metabolic products of the woman herself and the fetus.

The permeability of the kidneys to protein and carbohydrates increases (proteinuria (protein in the urine), glucosuria and lactosuria - lactose, unlike glucose, is not absorbed by the kidney tubules).

Excretion of 140 mg/day of glucose in the urine is considered the upper limit of physiological glucosuria. The peak of glucose release was found at the ninth month of pregnancy.

The peristaltic function of the ureters is sharply suppressed, as a result of which they expand and urine is retained in them. Atony of the ureters leads to a violation of urine diversion from the pelvis, which creates favorable conditions for the development of pyelitis in pregnant women. In the postpartum period, these phenomena soon disappear.

Effect of pregnancy on liver function

The liver during pregnancy is in a state of high functional stress. However, in healthy women during the physiological course of pregnancy, the functioning of the liver is not disturbed.

noted

• a slight increase in the size of the liver in the absence of pronounced histological changes
• there is a decrease in the antitoxic function of the liver
• the level of protein in the blood serum decreases, by childbirth it can reach 60 g / l
• the ratio of albumin to globulins changes. These changes occur due to a decrease in the level of albumin and an increase in the content of alpha and beta globulins, the level of gamma globulins decreases
• The result of changes in the composition of whey proteins is an increase in ESR
• Changes in blood clotting and fibrinolysis. These changes increase blood clotting ability.
• Some women with normal pregnancies have palmar erythema or petechial hemorrhages. They are not considered a manifestation of liver damage, but are only a clinical symptom of an increased concentration of estrogens and disappear 5-6 weeks after birth.

Function of the gastrointestinal tract.

There are changes in the function of the gastrointestinal tract. A number of women have a perversion of taste sensations such as aversion to certain types of food (meat, fats), the appearance of taste whims (the desire to eat even clay, chalk), an increase in appetite, and in some cases a decrease in it. In connection with a decrease in gastric secretion, the evacuation capacity of the stomach slows down. Intestinal function in pregnant women is characterized by a decrease in tone and a decrease in intestinal motility, which determines the tendency to bloating, constipation, and hemorrhoids. Intestinal atony can cause pathological conditions (intestinal obstruction).

Metabolism.

It is characterized by an increase in metabolic processes with some predominance of assimilation over dissimilation.

• Basal metabolism and oxygen consumption increase, especially in the second half of pregnancy and in childbirth.
• Changes in water-electrolyte metabolism are characterized by a delay and an increased content of intravascular and intercellular fluid.
• The need for the absorption of calcium, phosphorus, iron and other inorganic substances increases.
• In protein metabolism, a positive nitrogen balance is noted (nitrogen is excreted from the body less than consumed with food). Excess nitrogen is spent on plastic processes in the uterus, mammary gland and other tissues of the birth canal. During pregnancy, specific proteins also appear (alpha-fetoproteins, etc.).
• Carbohydrate metabolism is characterized by an increase in blood glucose, and when the body is overloaded with carbohydrates, it appears in the urine (glucosuria). Depot for glycogen are not only the liver and muscles, but also the placenta and uterus. During pregnancy, latent forms of diabetes appear.
• The content of lipids and cholesterol in the blood increases, but the pathological manifestation of this condition is not observed. There is an increased deposition of fat with its characteristic distribution in the subcutaneous tissue, mammary glands, lower abdomen, thighs, buttocks. Lipids are spent on the construction of tissues of the mother and fetus, they are also an energy material. In bile, the cholesterol content decreases.

  Pregnant women have a tendency to disconnect the energy metabolism between carbohydrates and fats, and therefore products of impaired metabolism (butyric acid, acetoacetic acid, acetone) can accumulate.

• During pregnancy, there is an increased need for vitamins (A, B, D, C, E, K, PP).
• In some women, due to pregnancy, sweating increases and the release of liquid salts from the vagina increases, which are a mixture of mucus and transudate of the vascular network of the genital organs.

A variety of external and internal changes in a woman's body increase with increasing gestational age, are characteristic only of the state of pregnancy and are aimed at creating optimal conditions for the development of the fetus and the course of childbirth. That is why the norms characteristic of non-pregnant women cannot be transferred to pregnant women.

Each trimester of pregnancy has its own rules. Knowledge of the norms allows you to avoid unreasonable actions that can cause a violation of the dynamic physiological balance established between the fetus and the mother's body and the emergence of pathological ("conflict") conditions that can result in the death of both the fetus (more often) and the mother (less often).

Thus, we found out that with the development of a new endocrine gland in a woman’s body and the beginning of the production of hormones and specific proteins by it, the woman’s body begins to rearrange and change itself under their action.

I draw your attention once again to the fact that all these changes result from a complex restructuring in connection with the emergence of a new endocrine gland - the placenta.

According to the changes, frankly, in some cases not very good (it's like getting sick), woman's body like the body of a sick person, includes adaptation mechanisms. Only in a patient they are aimed at recovery, and in a pregnant woman they are aimed at maintaining pregnancy, which the sick organism cannot save.

If the adaptive mechanisms are not included in the work in full force, then we will get a "complete gentleman's set" of the type of unfavorable course of pregnancy and complications in childbirth.

Why can't they get involved in the work in full force?

The answer lies in the history of the woman's life and the history of her illnesses: the girl was often ill, there are chronic diseases - the probability of failure in the work of adaptation mechanisms is high.

That is why, at least eat, at least drink, at least stay hungry, (only from where will the body take "worthy" material for its needs and the needs of the fetus? It will take it from its "reserves", "destroy" itself, it will not have intake of nutrients from the outside on a starvation diet) - this will have little effect on chronic or congenital diseases of a woman, which are the cause of the malfunction of adaptive systems.

And what is the conclusion from this? That's right: prevention and treatment.

Do you think why a pregnant woman visits a doctor every 2-3 weeks? The fetus grows, pregnancy develops, the woman's body is rearranged, and then everything that is stated above.

Do not self-medicate! But it is necessary to carry out personal control over your condition.

During the period of bearing a child, a woman changes dramatically in physiological and psychological terms. All organs and systems, appearance, well-being undergo changes. What you need to know about the upcoming changes during pregnancy?

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

The expectant mother does not yet know about her interesting position, and her body is already rebuilding its work. Changes in the body begin from the first days after successful conception. This is fine. The expectant mother does not yet feel toxicosis, and chorionic gonadotropin (hCG), the pregnancy hormone, is already beginning to increase in her blood. It is his doctors who call the main identification mark of a successful conception. HCG starts the process of bearing a baby, preparing the body for childbirth.

It is worth noting that internal changes are felt in different ways. Some already from the first weeks of bearing a child begin to feel sick, constantly sleepy. Others may not experience signs of either early or late toxicosis at all, despite the fact that everything inside the body is changing. There are women who, almost without feeling physiological changes, change greatly psychologically. They become touchy, whiny, angry, nervous. These are also symptoms of hormonal changes.

How the body changes during pregnancy month by month

If we talk about the first two months of gestation, then the external parameters of the female body do not change yet. Not felt in the early stages and weight gain. More often the opposite. Toxicosis leads to the fact that the expectant mother loses a kilogram or two.

At the end of the second or third month, some pregnant women are concerned about increased urination, which is caused by pressure from the uterus on the bladder and a general increase in the volume of fluid in the body.

Also, in the first two months, a woman may feel swelling of the mammary glands. This is due to an increase in the level of estrogen and progesterone in the blood. Also, the area around the nipples darkens and increases. The sensitivity of the breast increases. In some women, the vascular network may even come out. So the mammary glands prepare to supply the baby with milk.

In the first two months, women sometimes experience bleeding. The degree of their danger can only be determined by a doctor.

By the end of the third month, the external parameters of the body hardly change. If a woman had early toxicosis, then her health improves. She continues to go to the toilet more often, but already because of the formation of the baby's excretory system.

The first constipation and heartburn may begin. As for weight, the increase can be a kilogram and a half. Before 12 weeks, many women notice by their clothes that their pelvis has expanded.

Inconvenience in the third month of bearing a baby can be caused by a lack or vice versa, an increase in appetite, headaches, and pigmentation on the face.

From the fourth month of the joint life of the fetus and mother, it is already time to think about looser clothes. The tummy begins to grow, but others do not notice it yet. By the end of the fourth month, the bottom of the uterus is 17-18 centimeters above the pubic bone. It is during this period that a woman's gait begins to change. The upper part of the body leans back a little, and the stomach moves forward.

The inconveniences of this period are indigestion, bleeding gums, fainting and dizziness, nosebleeds, slight swelling of the feet and ankles.

The fifth month of pregnancy, many women feel a lack of calcium in the body. This is manifested by problems with the teeth. If a woman consumes little calcium-containing foods, then fillings may fall out, her teeth may crumble.

Another symptom of calcium deficiency can be leg cramps.

The growth of the uterus is accompanied by pain in the lower abdomen, constipation, increased nighttime urination. Gums may bleed, varicose veins of the legs or hemorrhoids appear.

Another thing that happens in a woman's body is skin pigmentation on the abdomen.

By the end of the fifth month of bearing a baby, a woman feels the first movements of her child. Her growing tummy is noticeable to others. And she herself sees how the hips are rounded, fat deposits appear on them.

At the sixth month of the term, there is a risk of squeezing large veins. This is manifested by progressive varicose veins, pain in the legs, their swelling.

By the 24th week of intrauterine development, the child filled the entire uterine cavity. It increases, stretches, which is felt by all organs of the small pelvis. The woman is noticeably rounder.

During this period, many pregnant women can feel training contractions (or, as they are also called by gynecologists, Braxton Geeks contractions). They are not painful or dangerous.

Seventh month of pregnancy. The uterus rises high and already supports the diaphragm. The whole body feels a load and regular swelling appears. Many women complain of pain in the lower abdomen, increased vaginal discharge, stuffy ears, itching of the skin of the abdomen, and back pain. During this period, as a rule, sleep problems begin, and colostrum may also appear. Most women notice stretch marks on their bodies by this time.

In the eighth month, the uterus is very sensitive to the movements of the baby. A woman feels it with muscle tension. Many begin late toxicosis. In a woman's body, the amount of blood increases by approximately one liter.

By week 36, the uterus moves away from the diaphragm, it moves forward, because the baby's head is pressed against the entrance to the pelvis.

The inconveniences of the eighth month are shortness of breath, increasing constipation, swelling of the face and hands, difficulty sleeping, heaviness when walking, fatigue. Visually, the woman becomes clumsy.

The ninth month is the period of maximum increase in the load on the body of a pregnant woman. The belly goes down. The placenta has exhausted its resources, so the baby "insists" on life outside the womb.

The expectant mother experiences severe pain in her back, legs, and lower abdomen. To maintain balance, the pregnant woman is forced to walk, leaning back. She walks more slowly, more carefully.

The mammary glands are greatly enlarged, and the appearance of colostrum already portends childbirth.

The burden on a woman's body during pregnancy

The cardiovascular system adapts to additional loads. This is due to an increase in the mass of the heart muscle. By the seventh month of the term, the volume of blood in the body increases by one liter. In the last trimester, many women are worried about high blood pressure. The activity of the lungs also increases. An increase in the volume of air that is inhaled facilitates the removal of carbon dioxide by the fetus through the placenta. By the end of the term, the respiratory rate slightly increases.

A huge load during pregnancy falls on the kidneys. A pregnant woman excretes up to 1600 ml of urine per day, 1200 of them depart during the day, the rest at night. The tone of the bladder decreases, and this can lead to stagnation of urine and contribute to infection.

Under the influence of hormones, intestinal tone also decreases, which leads to frequent constipation. The stomach is squeezed, some of its contents are sometimes thrown into the esophagus, which causes heartburn in the second half of pregnancy.

The main barrier organ, the liver, also works with a double load. It neutralizes the metabolic products of the expectant mother and fetus.

Increased pressure on the joints. Particularly mobile under the influence of growing body weight are the joints of the pelvis.

In the mammary glands, the number of lobules, the amount of adipose tissue increases. The breast can double in size. The uterus experiences the greatest changes, which complicates the work of all organs of the small pelvis. The volume of its cavity for childbirth increases by about 500 times. It does this by increasing the size of the muscle fibers.

The position of the uterus changes in parallel with the increase in its size. By the end of the first trimester, the organ "goes" beyond the pelvis. The uterus reaches the hypochondrium closer to childbirth. It stays in the right position thanks to the ligaments that stretch and thicken. But the pain that pregnant women experience in the third trimester is just caused by the tension of these ligaments.

Since the blood supply to the genital organs increases, varicose veins may appear on the labia. The growth of the fetus in the womb contributes to an increase in her body weight.

By the end of pregnancy, a healthy woman's weight increases by an average of 12 kilograms. But an increase from 8 to 18 is allowed. In the first half of the term, the weight can increase by 4-5 kilograms. In the second half of bearing a baby, this figure is twice as high. Usually visually, weight gain in overweight women is not visible, but thin women are noticeably rounded. They are more difficult to tolerate the increasing load on the body.

Especially for - Diana Rudenko

Lecture #6

Lecture plan:

1. Physiological changes in the body of a pregnant woman. The boundaries of the norm and pathology from the side:

endocrine glands,

immune system,

metabolism,

sexual organs,

Extragenital systems: sss,

respiratory organs,

urinary excretion,

digestive,

musculoskeletal,

mammary glands.

2. The concept of homeostasis. What systems maintain the acid-base state?

3. Methods of examination of a pregnant woman.

3.1. Poll data.

3.2. General examination data (by organ systems).

3.3. Special obstetric study.

a) outside

Milk glands,

The shape of the abdomen, the circumference of the abdomen, the height of the fundus of the uterus, palpation,

Receptions of Leopold-Levitsky,

Examination of the pelvis (sizes of the large pelvis, Michaelis rhombus),

Soloviev index,

Calculation of the true conjugate from the outer,

Determination of the angle of inclination of the pelvis,

information about the condition of the fetus:

Auscultation of fetal heart sounds (listening points),

Diagnosis of fetal movement.

b) internal obstetric studies

Examination of the external genital organs and the mucous membrane of the entrance to the vagina,

Technique for taking material for bacteriological and bacterioscopic examination,

Vaginal examination, its goals,

Bimanual research, its goals.

4. Additional research methods:

Determination of the presence of HCG,

Test system for diagnosing pregnancy,

Methods for studying the state of the placenta and intrauterine fetus.

5. Diagnosis of pregnancy:

signs of pregnancy,

Determination of the gestational age according to various data,

Determining the expected due date.

1 . The emergence and development of pregnancy is associated with the formation of a new functional mother-fetus system. During the period of intrauterine development, numerous signals come from the fetus, which are perceived by the corresponding organs and systems of the mother's body and under the influence of which their activity changes. Thus, the term “mother-fetus functional system” is understood as a combination of two independent organisms united by the common goal of ensuring the correct, physiological development of the fetus. Therefore, all the activities of the mother's body during pregnancy should be aimed at maximizing the normal growth of the fetus and maintaining the necessary conditions that ensure its development according to a genetically encoded plan.

During a physiologically proceeding pregnancy, in connection with the development of the fetus and placenta in the mother's body, significant changes in the function of all the most important organs and systems are observed. These changes are of a pronounced adaptive nature and are aimed at creating optimal conditions for the growth and development of the fetus.

- Nervous system . This system of the mother plays a leading role in the perception of numerous impulses coming from the fetus. During pregnancy, the uterine receptors are the first to begin to respond to impulses from the growing fetal egg. The impact on the receptors leads to a change in the activity of the central and autonomic (vegetative) nervous system of the mother, aimed at ensuring the proper development of the unborn child. Under the influence of these impulses, a local focus of increased excitability appears in the cerebral cortex - gestational dominant. around G gestational dominant, according to the physiological laws of induction, a field of inhibition of nervous processes is created. Clinically, this process manifests itself in a somewhat inhibited state of the pregnant woman, the predominance of her interests related to the birth and health of the unborn child. Other interests fade into the background. Under stress in the central nervous system of a pregnant woman, along with the gestational dominant, other foci of persistent excitations may occur. This weakens the effect of the generic dominant and is often accompanied by a pathological course of pregnancy. Therefore, all pregnant women need to create conditions for mental peace at work and at home. During pregnancy, the state of the central nervous system changes. Until the 3-4th month of pregnancy, the excitability of the cerebral cortex is generally reduced, and then gradually increases. The excitability of the underlying parts of the central nervous system and the reflex apparatus of the uterus is reduced, which ensures the relaxation of the uterus and the normal course of pregnancy. Before childbirth, the excitability of the spinal cord and the nervous elements of the uterus increases, which creates favorable conditions for the onset of labor.

During a physiologically proceeding pregnancy, the tone of the autonomic nervous system changes, and therefore, pregnant women often experience drowsiness, irritability, sometimes dizziness and other autonomic disorders. These disorders are usually characteristic of the early period of pregnancy, and then gradually disappear.

- Endocrine system. The onset and development of pregnancy are accompanied by endocrine changes in the mother's body. The complexity of the changes is determined by the fact that the hormones of the placenta, as well as the fetus, have a great influence on the activity of the endocrine glands of the mother.

The anterior lobe of the pituitary gland increases during pregnancy by 2-3 times, the mass of the adenohypophysis by the end of pregnancy reaches 100 mg. Along with the inhibition of the production of follicle-stimulating (FSH) and luteinizing (LH) hormones, the production of prolactin (Prl) increases and increases by the end of pregnancy by 5-10 times compared with the indicators characteristic of non-pregnant women. In the postpartum period, the content of FSH and LH in the blood serum increases in parallel with the decrease in Prl production.

During a physiologically proceeding pregnancy, the content of somatotropic hormone (GH) in the blood is practically not changed, only at the end of pregnancy there is a slight increase in it.

Shortly after the onset of pregnancy, an increase in thyroid-stimulating hormone (TSH) is noted in the mother's blood, reaching a maximum before childbirth.

During pregnancy, the secretion of adrenocorticotropic hormone (ACTH) is increased, which is apparently associated with hyperproduction of corticosteroids by the adrenal glands.

The posterior lobe of the pituitary gland, unlike the anterior lobe, does not increase during pregnancy. Oxytocin produced in the hypothalamus is stored in the posterior pituitary gland. The synthesis of oxytocin especially increases at the end of pregnancy and in childbirth. It is believed that its release at the end of a full-term pregnancy is the trigger for the onset of labor.

The emergence and development of pregnancy is associated with the function of a new endocrine gland - the corpus luteum of pregnancy. It produces sex hormones (progesterone and estrogens), which play a huge role in implantation and the further development of pregnancy. From the 12th week During pregnancy, the corpus luteum undergoes involution and its function is taken over by the placenta. Stimulation of the corpus luteum is carried out by chorionic gonadotropin.

The blockade of the secretion of FSH and LH of the adenohypophysis is accompanied by a natural inhibition of the maturation of follicles in the ovaries; ovulation also stops.

During pregnancy, there is an increase in the size of the thyroid gland, due to hyperplasia and hyperemia. The concentrations in the blood of protein-bound thyroxine (T 4) and triiodothyronine (T 3) increase, which is explained by the influence of hormones of the fetoplacental system.

The function of the parathyroid glands is somewhat reduced, which is accompanied by a violation of calcium metabolism. It is manifested by convulsive phenomena in the calf and other muscles.

In the adrenal glands, hyperplasia of the adrenal cortex and increased blood flow in them are observed. This is reflected in increased production of glucocorticoids and mineralocorticoids.

-The immune system. The human embryo and fetus receive from the father 50% of the genetic information that is foreign to the mother's body. The other half of the fetus's genetic information is shared between the fetus and the mother. Thus, the fetus is always a genetically "semi-compatible transplant" in relation to the mother's body.

The earliest immune barrier is the zona pellucida, which forms a protective layer around the egg and is subsequently maintained from the moment of fertilization to the stage of implantation. In the future, the immune protection of the embryo and fetus begins to be carried out by other complex mechanisms due to changes in the maternal organism and the placenta.

-Metabolism. With the onset of pregnancy, significant changes occur in metabolism. These changes are adaptive in nature and are aimed at ensuring the proper development of the embryo and fetus. The basal metabolism and oxygen consumption increase significantly, which is especially noticeable in the second half of pregnancy.

Significant changes are observed in protein, carbohydrate and lipid metabolism. In the body of a pregnant woman, there is an accumulation of protein substances, which is necessary to meet the needs of a growing body in amino acids. The change in carbohydrate metabolism is characterized by the accumulation of glycogen in the cells of the liver, muscle tissue, uterus and placenta. Some increase in the concentration of neutral fat, cholesterol and lipids is noted. Mineral and water metabolism undergoes changes. In the body of a pregnant woman, there is a delay in calcium and phosphorus. Both of these elements pass through the placenta and are used to build the bones of the fetus. Iron also passes from the mother to the fetus, which is used in the synthesis of fetal hemoglobin. Along with these elements, potassium, sodium, magnesium, copper and some other elements are also retained in the mother's body. They cross the placenta and are actively involved in metabolic processes.

Significant changes concern water exchange. Albumin and sodium salts are retained in the tissues, which creates conditions for increasing the hydrophilicity of tissues as a result of the accumulation of interstitial fluid. This process is of great physiological importance, causing softening of tissues and ligaments and thereby facilitating the passage of the fetus through the birth canal during childbirth.

That. for the physiological course of pregnancy, fluid retention in the body is characteristic, which occurs under the action of adrenal aldosterone, corpus luteum progesterone, pituitary antideuretic hormone.

The need for vitamins is increasing. Vitamins are necessary both for the physiological course of metabolic processes in the mother's body, and for the proper development of the fetus. The intensity of the use of iron for the synthesis of hemoglobin depends on the sufficient intake of vitamins C, B 1, B 12, PP and folic acid into the mother's body. Vitamin E contributes to the proper course of pregnancy and, if it is deficient, spontaneous abortion may occur. An important role in pregnancy and other vitamins: A, D, P and others. Most vitamins pass through the placenta and are used by the fetus during its growth and development.

Sex organs. The most pronounced changes occur in the reproductive system and especially in the uterus.

The uterus increases in size throughout pregnancy and reaches an average of 1000 g (before pregnancy 50-100 g). The volume of the uterine cavity increases more than 500 times. Each muscle fiber undergoes hypertrophy and hyperplasia, as a result, it lengthens 10 times and thickens 5 times. The number of smooth muscle fibers, originating from the corresponding elements of the walls of the uterine vessels, increases. In parallel, hyperplasia of the connective tissue of the uterus occurs, as a result, the uterus acquires excitability and contractility, characteristic of this organ during pregnancy. As an adaptation to the changed volume of the uterus, lengthening of the vascular, especially the venous system, is observed, the course of the vessels becomes corkscrew.

During pregnancy, the nervous elements of the uterus change, the number of various receptors (sensitive, baro-, osmo-, chemo-, etc.) increases. With the excitation of a number of these receptors, the onset of labor activity is associated.

With the onset of pregnancy and in the process of its development, the amount of contractile proteins (myosin, actin and actomyosin) of the myometrium increases significantly. Various phosphorus compounds accumulate in the myometrium, as well as energy-important compounds such as creatine phosphate and glycogen, the activity of enzyme systems that are directly related to the contractile properties of the myometrium increases.

With the onset of pregnancy, the activity of oxidative processes increases sharply with simultaneous inhibition of the activity of glycolytic (uneconomical) metabolism.

The excitability and mechanical activity of the neuromuscular apparatus of the uterus depends on the ionic composition of the extracellular environment (K + and Na +) and the permeability of individual electrolytes through the protoplasmic membrane.

During the physiological course of pregnancy, estrogens and progesterone of the placenta, as well as biologically active substances, maintain an optimal ionic balance and ensure the distribution of the flow of electrical charges in the required direction.

A large role in the excitability and contractility of the myometrium belongs to alpha- and beta-adrenergic receptors, which are located on the membrane of a smooth muscle cell. Excitation of alpha-adrenergic receptors leads to uterine contractions, excitation of beta-adrenergic receptors is accompanied by the opposite effect (relaxation).

Along with the uterus, other parts of the female reproductive system also undergo changes during pregnancy.

The fallopian tubes thicken, blood circulation in them is greatly enhanced. Their topography changes (by the end of pregnancy, they hang down along the ribs of the uterus).

ovaries increase in size, although the cyclic processes in them stop. In one of them up to 16 weeks. pregnancy, there is a corpus luteum, which subsequently undergoes involution. In connection with the increase in the size of the uterus, the topography of the ovaries, which are located outside the small pelvis, changes.

Ligaments of the uterus significantly thicken and lengthen, especially round and sacro-uterine.

Vagina. During pregnancy, hyperplasia and hypertrophy of the muscular and connective tissue elements of this organ occur. The blood supply to its walls increases, the serous impregnation of all its layers increases. As a result, the walls of the vagina become easily extensible. The mucous membrane of the vagina due to congestive venous plethora acquires a characteristic cyanotic color. A lot of glycogen is deposited in the protoplasm of the stratified squamous epithelium, which creates optimal conditions for the reproduction of lactobacilli. The lactic acid secreted by these microorganisms maintains the acidic reaction of the vaginal contents, which is an important deterrent to ascending infection.

external genitalia during pregnancy loosen, the mucous membrane of the entrance to the vagina has a distinct cyanotic color. Sometimes varicose veins appear on the external genitalia.

Cardiovascular system (CVS). Changes occurring in the activity of the mother's CCC make it possible to provide the necessary intensity for the fetus to deliver oxygen and various nutrients and remove metabolic products. CCC functions during pregnancy with an increased load, which is due to an increase in metabolism, an increase in the mass of circulating blood, the development of the uteroplacental circulation, and a progressive increase in the body weight of the pregnant woman. As the size of the uterus increases, the mobility of the diaphragm is limited, intra-abdominal pressure increases, the position of the heart in the chest changes (more horizontally).

The volume of circulating blood (BCC) increases by 30-50% of the initial level (before pregnancy). The percentage increase in plasma volume (by 35-47%) exceeds the increase in the volume of erythrocytes (by 11-30%), so-called physiological anemia of pregnant women occurs. It is characterized by a decrease in hematocrit (up to 30%) and hemoglobin concentration from 135-140 to 110-120 g∕l. Because during pregnancy, a decrease in hematocrit is observed, then a decrease in blood viscosity also occurs.

With a normal pregnancy, systolic and diastolic blood pressure decreases in the II trimester by 5-15 mm Hg. Art.

During pregnancy, physiological tachycardia is observed. In the III trimester, the heart rate is 15-20 beats.∕min. exceeds heart rate outside of pregnancy. That. Normally, the heart rate in pregnant women in the later stages is 80-95 per minute.

Central venous pressure rises to an average of 8 cm of water. Art. (outside of pregnancy is 2-5 cm of water. Art.). The pressure in the veins of the upper extremities does not change; in the veins of the lower extremities, it increases (7-10 mm Hg).

The pregnant uterus compresses the inferior vena cava. The deterioration of the venous outflow that occurs through the lumbar and paravertebral veins, as well as a decrease in cardiac output in a number of women causes collapse. Pregnant women prone to these conditions should avoid the supine position.

The most significant hemodynamic shift during pregnancy is an increase in cardiac output. The maximum increase in this indicator at rest is 30-40% of its value before pregnancy. Cardiac output begins to increase from the earliest stages of pregnancy, its maximum change is noted at the 20-24th week. In the first half of pregnancy, an increase in cardiac output is due to an increase in stroke volume, later a slight increase in heart rate.

An ECG performed in the dynamics of pregnancy allows you to detect a deviation of the electrical axis of the heart to the left, which reflects the deviation of the heart in this direction; at the same time, an increase in the mass of the myocardium and the size of individual sections of the heart is noted. An X-ray examination reveals changes in the heart that resemble a mitral configuration.

The processes of hemodynamics during pregnancy are greatly influenced by the new uteroplacental circulation. Although the blood of the mother and fetus does not mix with each other, changes in hemodynamics in the uterus immediately affect the blood circulation in the placenta and in the body of the fetus and vice versa. Unlike the kidneys, CNS, myocardium, and skeletal muscles, the uterus and placenta are unable to maintain their blood flow at a constant level during changes in systemic blood pressure. The vessels of the uterus and placenta have low resistance and the blood flow in them is passively regulated mainly due to fluctuations in systemic blood pressure. In late pregnancy, the vessels of the uterus are maximally dilated. The mechanism of neurogenic regulation of uterine blood flow is mainly associated with adrenergic influences. Stimulation of alpha-adrenergic receptors causes vasoconstriction and a decrease in uterine blood flow. Reducing the volume of the uterine cavity (prenatal rupture of amniotic fluid, the appearance of contractions) is accompanied by a decrease in uterine blood flow.

Despite the existence of separate circles of blood circulation in the uterus and placenta (there is a placental membrane in the way of two blood flows), the hemodynamics of the uterus is closely related to the circulatory system of the fetus and placenta. The participation of the capillary bed of the placenta in the blood circulation of the fetus consists in the rhythmic active pulsation of the chorionic capillaries, which are in constant peristaltic motion. These vessels with varying blood volume cause alternating contraction of the villi and their branches. This movement of the villi affects not only the circulation of the fetus, but also the circulation of maternal blood through the intervillous space. Therefore, the capillary bed of the placenta can be considered as the "peripheral heart" of the fetus. All these features of the hemodynamics of the uterus and placenta are usually combined under the name "uteroplacental circulation".

Respiratory system. Along with the circulatory system, the respiratory organs provide a continuous supply of oxygen to the fetus, which increases by more than 30-40% during pregnancy. As the size of the uterus increases, the abdominal organs gradually shift, the vertical size of the chest decreases, which, however, is compensated by an increase in its circumference and an increase in diaphragm excursion. However, the restriction of diaphragmatic excursion during pregnancy makes it somewhat difficult to ventilate the lungs. This is expressed in a slight increase in breathing (by 10%) and in a gradual increase in the respiratory volume of the lungs by the end of pregnancy (by 30-40%). As a result, the minute volume of breathing increases from 8 l∕min at the beginning of pregnancy to 11 l∕min at the end of it. During pregnancy, the work of the respiratory muscles increases, although airway resistance decreases towards the end of pregnancy. All these changes in the function of respiration ensure the creation of optimal conditions for gas exchange between the organisms of the mother and fetus.

Urinary system. Pregnant women experience specific changes in kidney function. The renal pelvis expands, the ureters expand and lengthen up to 20-30 cm. Such an ureter does not fit in its bed and bends in a loop, most often the kink is observed when the upper third of the ureter passes into the middle one. There is a violation of the tone and contractility of the muscles of small cups, pelvis and ureters. The volume of the pelvis increases from 5-10 to 50 and even up to 100 ml. As a result of this expansion of the pelvis and ureters, the volume of "dead space" increases by 2 times. The walls of the ureters change: they hypertrophy, hyperplasia of the muscular and connective tissue membranes occurs, and the vascularization of the ureter wall increases. Dilatation of the urinary tract begins at 5-6 weeks, reaching a maximum at 32 weeks. pregnancy and childbirth, decreases. The blood supply to the kidneys changes significantly. Renal blood flow in the first trimester increases by 30-50%, and then gradually decreases. In non-pregnant women, renal blood flow is 1100 ml∕min. In the first trimester - 1460 ml∕min, in the II - 1150 ml∕min, in the III - 1050 ml∕min. Three weeks before delivery, it decreases to 820 ml∕min. Glomerular filtration, like renal blood flow, increases by 30-50% in the first trimester, and then decreases: in non-pregnant women it is 105 ml∕min, in the first trimester - 135 ml∕ min, in II ml∕min, in III - 110 ml∕min., and three weeks before delivery - 90 ml∕min. Tubular reabsorption throughout pregnancy remains without visible changes. The excretion of electrolytes in the urine remains within the normal range. Some pregnant women may experience glycosuria, which is associated with an increase in glomerular filtration of glucose, exceeding its reabsorption by the tubules.

Digestive system. In part of the pregnant at the beginning of pregnancy, taste sensations change, whims appear, aversion to certain types of food. As the gestational age increases, these phenomena gradually disappear.

Pregnancy has an inhibitory effect on the secretion of gastric juice and its acidity. All sections of the gastrointestinal tract (GIT) are in a state of hypotension due to changes in topographic and anatomical relations in the abdominal cavity due to an increase in the pregnant uterus, as well as neurohormonal changes inherent in pregnancy (the effect of placental progesterone on the smooth muscles of the stomach and intestines). This explains the complaints of pregnant women about constipation.

Changes in liver function: the store of glycogen in this organ decreases due to the intensive transition of glucose from the mother's body to the fetus. The intensity of lipid metabolism changes, which is expressed by the development of lipemia, a higher content of cholesterol and cholesterol esters in the blood, which indicates an increase in the synthetic function of the liver. The protein-forming function of the liver also changes, which is aimed at providing the growing fetus with the necessary amount of amino acids, from which it synthesizes its own proteins. At the beginning of pregnancy, the content of total protein in the blood of pregnant women is within the normal range typical for non-pregnant women, and starting from the second half of pregnancy, it begins to decrease slightly. Pronounced shifts are observed in the protein fractions of the blood (a decrease in the concentration of albumin and an increase in the level of globulins). This is due to the increased release of finely dispersed albumins through the capillary walls into the mother's tissues, as well as to the increased consumption by the growing body of the fetus.

An important indicator of liver function in pregnant women is the enzyme spectrum of blood serum. It has been established that in the course of physiological pregnancy there is an increase in the activity of aspartate aminotransferase (AST), alkaline phosphatase (AP), especially its thermostable fraction. Other liver enzymes undergo somewhat smaller changes.

During pregnancy, the processes of inactivation of estrogens and other steroid hormones produced by the placenta increase in the liver. The detoxification function of the liver during pregnancy is somewhat reduced. Pigment metabolism during pregnancy does not change significantly. Only at the end of pregnancy, the content of bilirubin in the blood serum slightly increases, which indicates an increase in the process of hemolysis in the body of pregnant women.

The musculoskeletal system. During the physiological course of pregnancy, pronounced changes occur in the entire musculoskeletal system of a woman. There is serous impregnation and loosening of the ligaments, cartilage and synovial membranes of the pubic and sacroiliac joints. As a result, there is some divergence of the pubic bones to the sides (by 0.5-0.6 cm). With a more pronounced discrepancy and the appearance of pain in this area, they speak of symphysiopathy, which requires appropriate therapy.

Changes in the joints, characteristic of pregnancy, lead to some increase in the direct size of the entrance to the small pelvis, which has a positive effect during childbirth. The chest expands, the costal arches are located horizontally, the lower end of the sternum somewhat moves away from the spine. All these changes leave an imprint on the entire posture of a pregnant woman.

Leather. The skin undergoes certain changes. In many pregnant women, brown pigment is deposited on the face, nipples, areola, due to changes in the function of the adrenal glands. As the gestational age increases, a gradual stretching of the anterior abdominal wall occurs. So-called pregnancy scars appear, which are formed as a result of the divergence of the connective tissue and elastic fibers of the skin. Pregnancy scars look like pink or blue-purple bands of an arched shape. Most often they are located on the skin of the abdomen, less often - on the skin of the mammary glands and thighs. After childbirth, these scars lose their pink color and take on the appearance of white stripes. In subsequent pregnancies, against the background of old scars and pregnancy, new ones may appear, having a characteristic pink color.

The navel in the second half of pregnancy is smoothed out, and later protrudes. Rarely, in pregnant women, hair growth is noted on the skin of the face, abdomen, and hips, which is due to increased production of androgens by the adrenal glands and partly by the placenta. Hypertrichosis is temporary and gradually disappears after childbirth.

Milk glands. The glandular tissue of the mammary gland is a complex of tubular-alveolar glands, which consist of a tree-like system of ducts that drain collections of sac-like structures called alveoli, or acini. These alveoli form the basic structure unit of the secreting system. Alveoli form lobules, consisting of 10-100 alveoli. A group of 20-40 lobules form larger lobes, each with a common milk duct. The total number of milk ducts ranges from 15 to 20. Milk ducts come to the surface in the nipple area.

The mammary gland has an abundant blood supply and developed innervation, represented by sensory and autonomic nerve fibers. In the cellular elements of the mammary glands there are numerous receptors for protein and steroid hormones.

With the onset of pregnancy, pronounced changes occur in the tissues of the mammary glands, which are preparatory to subsequent lactation. The blood supply to the mammary glands increases; under the influence of hormonal changes, active cell proliferation occurs, both ducts and acinar structures (mammogenesis). Proliferative processes are usually observed from 3-4 weeks. pregnancy and decrease somewhat in the second half. These processes lead to an increase in the size of the lobules of the mammary glands due to the processes of hyperplasia and hypertrophy. From the second half of pregnancy, against the background of a decrease in proliferation, the preparation of the mammary glands for their most important function, milk secretion, begins. In the protoplasm of cells, fatty inclusions are formed, the alveoli begin to fill with protein-like substances, consisting of desquamated epithelial cells and leukocytes. However, during pregnancy, neither lipids nor proteins, which are the main components of future milk, enter the alveolar sacs from the alveoli. At the end of pregnancy, when pressing on the nipples, colostrum begins to stand out from them.

Along with changes in the epithelial structures of the mammary glands, the smooth muscles of the nipples are activated. As a result of all these physiological processes, the mass of the mammary glands increases significantly from 150-250 g (before pregnancy) to 400-500 g (at the end of it).

The function of the mammary glands mainly depends on hormonal factors. At the beginning of the process of mammogenesis, this role belongs to ovarian hormones (progesterone and estrogens of the corpus luteum of pregnancy). Then the function of the corpus luteum passes to the placenta, which secretes an ever-increasing amount of estrogens and progesterone. An important role in the processes of mammogenesis during pregnancy is played by placental lactogen, as well as thyroid and adrenal hormones. The cumulative effect of all these hormones on the corresponding receptors of the mammary glands carries out the most complex processes of preparation for lactation.

Hematopoietic organs. An increase in the mass of blood, red blood cells and hemoglobin begins from the first months of pregnancy.

Erythropoiesis is regulated by erythropoietin, the level of which increases from the second trimester of pregnancy. The action of erythropoietin is inhibited by estrogens and enhanced by placental lactogen. As noted earlier, the volume of circulating plasma by the end of pregnancy increases by 35-47%, outstripping the increase in the volume of circulating erythrocytes, which also increases starting from the 10th week of pregnancy and by the end of it increases by 18-25%, amounting to approximately 1650 ml ( in non-pregnant women - 1400 ml).

The lower limit of the norm for pregnant women is the hemoglobin content of 110 g / l.