As they write in all articles about pregnancy, first of all, the expectant mother's taste preferences change. In fact this is not true. Many women during pregnancy give up their favorite foods and begin to actively consume what they have never eaten. Some pregnant women combine incongruous (herring and jam, ice cream and cucumbers, etc.) and enjoy it. But there are also those who adhere to the usual diet.

One of the most noticeable changes during pregnancy is weight gain and abdominal growth. Normally, a woman gains about 10-12 kg during pregnancy, of which 4-4.5 kg falls on the fetus, amniotic fluid and placenta, 1-1.5 kg - for an increase in the uterus and mammary glands, 1.5 kg for an increase the amount of blood and 1 kg of intercellular fluid. As a rule, the body of the expectant mother also stores adipose tissue, which is necessary for successful breastfeeding.

Bones, muscles, skin

During pregnancy, a woman's body produces a special hormone - relaxin. It is he who provides a safe and physiological divergence of the pelvic bones during childbirth, which is necessary for the passage of the fetus through the birth canal.

In late pregnancy, a woman may feel an increase in joint mobility, and some expectant mothers even complain of pain in the hands, knees and elbows. After giving birth, these problems disappear.

Many women notice that in the second trimester of pregnancy, the line from the navel to the pubis darkens, becoming brown; areola darkens and increases in diameter. The pigment produced by the adrenal glands during pregnancy can cause freckles or age spots.

While waiting for the baby, the skin on the abdomen is very stretched, stretch marks (striae) may appear. With high skin elasticity, stretch marks may disappear a few months after giving birth. If the elasticity of the skin is reduced, stretch marks remain on the woman's body for life.

Respiratory system

During pregnancy, the content of the hormone progesterone in the blood increases, which provides additional relaxation of the muscles of the bronchial walls. This causes the airway to dilate, which is necessary to increase the amount of air inhaled by the mother by 40%. Interestingly, 30% of them go to the needs of the fetus, and the remaining 10% are used in the body of the expectant mother.

Heart, vessels and blood

The cardiovascular system, without exaggeration, takes on the main load while waiting for a child. To deliver all the necessary nutrients to the uterus, hypertrophy occurs, that is, an increase in the left ventricle, an increase in heart rate and an increase in the minute volume of blood.

Blood pressure in the first trimester may even decrease slightly, which causes lethargy, weakness and drowsiness (pregnant women often complain about them at the beginning of their journey). Somewhere in the middle of the second trimester, each woman's pressure increases by an average of 10 mm. rt. Art. However, in pathological cases, these numbers can increase significantly. In such situations, we are talking about gestosis - a complication of the second half of pregnancy, fraught with such dangerous conditions as eclampsia. Blood pressure spikes to high numbers are known to cause or.

A pregnant woman provides food not only for herself, but also for the baby. And despite the fact that the blood of the mother and the fetus does not mix during pregnancy, the woman requires increased volumes of this fluid. As a result, during the period of waiting for the child, hematopoiesis increases, the number of erythrocytes and hemoglobin increases. By the end of pregnancy, the total amount of blood increases by 40%.

Urinary organs

The problem of an urgent visit to the toilet is quite acute for almost every pregnant woman. By the middle of the second trimester, the enlarged uterus puts noticeable pressure on the woman's bladder. This situation is quite physiological, but it makes the expectant mother "run to the toilet" quite often. Moreover, the more, the stronger the pressure, and, consequently, the more frequent trips to the toilet.

The growing uterus presses not only on the bladder, but also on the intestines. However, in this situation, it does not work as a plus, but as a minus. Compression of the intestines interferes with normal peristalsis, which ensures the movement of food. As a result, constipation occurs - a rather unpleasant condition, especially during pregnancy.

Discussion

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With the onset of pregnancy, the beginning of a new period in a woman's life is observed. By this time, nature has provided for a number of physiological changes in the body of the expectant mother, designed to create optimal conditions for bearing a child. Thus, optimal conditions are created for the development of the fetus. A lot can change in 9 months - self-awareness, mood, life goals.

Pregnancy is rightfully considered a special state of the body, characterized by a whole range of typical transformations.

You can observe the following changes in the body during pregnancy:

• absence of menstruation - due to functional changes in the ovary, changes in the state of the mucous membrane lining the uterine cavity are observed;
• a prolonged increase in basal temperature is due to the influence of the hormone progesterone produced by the ovary;
• the formation of the placenta occurs;
• the appearance of the expectant mother also undergoes changes, the weight increases markedly;
• the cerebral cortex ensures the coordination of the functioning of various organs and systems in a direction that provides suitable conditions for bearing a fetus;
• changes in metabolism are observed, as well as the volume of blood circulating in the body;
• the indicators of the composition of the blood, as well as the systems of its coagulation and stopping bleeding, change;
• the functioning of the cardiovascular and nervous systems also undergoes changes.

Thus, the body completely rebuilds its functioning, taking into account the new state of the woman.

What are the changes in the body for during pregnancy?

Carrying a child is a natural process, which is accompanied by the physiological restructuring of a woman's body. The woman's body during this period functions in a new mode, there are increased loads on it.

During pregnancy, from the first days, a number of structural physiological changes in a woman's body during pregnancy are observed, which are aimed at achieving the following results:

• supplying the developing fetus with the necessary amount of oxygen, as well as nutrients important for the full development of the fetus and bearing the child;
• elimination of fetal waste products from the body of a pregnant woman;
• preparation of various systems of the woman's body for the upcoming birth of a baby, as well as his breastfeeding.

These tasks are generally aimed at maintaining the reproductive function of a person, therefore, changes in a woman's body during pregnancy can be called quite natural and physiological. If the body is not able to fully adapt, conditions that are unfavorable for the health of the child and the pregnant woman may develop. Under the influence of increasing loads on the body, in the presence of chronic diseases or disorders in the work of certain organs, a deterioration in the state of a woman's health, as well as the development of pathologies of pregnancy, can be observed. In order to avoid possible problems, it is necessary to come to the antenatal clinic in the early stages for registration, pass the necessary tests and get expert advice.

The condition of a pregnant woman can be monitored and corrected by a doctor as a result of examinations, as well as laboratory and instrumental studies. Having passed the tests, you will need to determine the indicators of blood, urine, etc. Taking into account the information received, preventive measures can be taken to avoid the development of any complications during the course of pregnancy, and to most effectively prepare for the upcoming birth. It should be noted that the physiological course of pregnancy is characterized by its own indicators, which generally do not coincide with the norms for a healthy person. In addition, for each trimester of pregnancy, the rates of these indicators differ.

What changes can be observed in the body during pregnancy

There is a point of view that this period is a kind of endurance test for the female body. Thus, overstrain and overwork should be avoided during pregnancy. In everyday life, it is necessary for a pregnant woman to create conditions so that she can successfully adapt to the changing conditions of pregnancy and safely bear the baby.

Changes in the body during pregnancy: body weight and metabolism

During pregnancy, weight gain is normally about 10 kg, generally reaching from 8 to 18 kg.

In this case, the weight gain is dispersed approximately according to the following principle:

• the fetus along with the placenta, including also membranes and amniotic fluid - from 4000 to 4500 g;
• the uterus, as well as the mammary glands - a kilogram. The weight of the uterus from 50-100 g increases to 1000-1200 g;
• blood - about one and a half kilograms;
• adipose tissue - 4000 g and tissue fluid - 1000 g.

In the first half of pregnancy, the increase is about four kilograms, in the second half - twice as much. In the presence of a body weight deficit before pregnancy, with its onset, a more significant weight gain may be observed. In connection with this phenomenon and in order to fully develop the fetus, attention should be paid to the diet of the expectant mother. You will need to provide a balanced diet, including the required amount of nutrients. It may be necessary to supplement it with calcium preparations, which is necessary for the development of the child's skeleton, as well as iron for optimal hematopoiesis.

In order to meet the needs of the bearing fetus, the woman's metabolism is largely rebuilt. The amount of digestive enzymes produced by her body increases. The lungs are saturated with a large amount of oxygen due to the higher concentration of erythrocytes and hemoglobin in the blood. In addition, it increases the amount of nutrients that are transported by the placenta into the blood of the fetus. Due to increased metabolism and the need to provide for the needs of the fetus, a woman needs to consume more vitamins.

Changes in the body during pregnancy: the nervous system and respiratory organs

During the course of pregnancy, the work of the endocrine and nervous systems of the woman's body is rebuilt. In the first few months, a reduced excitability of the cerebral cortex can be observed, as a result, the reflex activity of the subcortical part and the spinal cord increases. Further, the excitability of the cerebral cortex increases and remains in this state almost until the end of pregnancy. By the time of childbirth, the opposite phenomenon can be observed, while the activity of the spinal cord increases, which leads to an increase in the reflex and muscular activity of the uterus. It is often possible to notice that pregnant women are kind of immersed in themselves. Perhaps the appearance of irritability, mood swings, drowsiness. In addition, it is known that until the end of pregnancy, most of the impulses coming from the uterine receptors are blocked. These mechanisms are provided by the central nervous system to preserve the pregnancy.

Due to the increase in the content of progesterone, the smooth muscles of the bronchial walls are additionally relaxed, while the lumen in the airways increases. The body's need for oxygen in the expectant mother increases. In order to supply oxygen to the growing fetus, the volume of air inhaled in one movement increases, as well as (towards the end of pregnancy) the respiration rate. Thus, the rate of ventilation of the lungs increases significantly (by about 40%). About a third of this amount of air is used to supply the fetus, 10% - for the placenta, the rest is used in the woman's body. If shortness of breath or other breathing disorders occurs, a pregnant woman should consult a doctor.

Changes in the body during pregnancy: cardiovascular system, blood pressure and blood composition

We can say that the main load in the course of pregnancy falls on the cardiovascular system. To supply the pregnant woman and the fetus with the necessary amount of oxygen and nutrients, the heart and blood vessels pump more blood - its volume increases by about one and a half liters, reaching its maximum value at about the seventh month of pregnancy. In this case, there is an increase in the left ventricle, heart rate increases and the minute volume of blood increases. Thus, the heart and blood vessels function under increased stress. At the same time, the occurrence of systolic murmurs is not considered a pathology; in most cases, these phenomena disappear after pregnancy.

Blood pressure during normal pregnancy does not change in most cases. In the first trimester, it can be slightly lowered (with lethargy and drowsiness). At about the 16th week, the pressure may increase by 5-10 mm Hg. Art. The initial value of the woman's blood pressure before pregnancy should be taken into account in order to judge its changes over time. An increase in systolic pressure by 30% is regarded as a pathological symptom. In addition, it is believed that diastolic pressure should not exceed 70-80 mm Hg. Art.

The processes of hematopoiesis during this period proceed in an enhanced mode, the composition of the blood also changes - there is an increase in the number of erythrocytes, hemoglobin, and blood plasma. To enhance the synthesis of red blood cells and improve blood viscosity, it is necessary to consume a sufficient amount of protein in food. In addition, iron supplementation is often indicated. During pregnancy, the number of leukocytes in the blood may slightly increase. The platelet count, as a rule, does not change significantly.

Changes in the body during pregnancy: genitals, endocrine system, endocrine glands

In the area of ​​the external genital organs, there is an increased blood supply, the cervical canal of the uterus is expanded. The tissues of her, the uterus itself and the vagina are characterized by significant looseness, acquire softness and elasticity necessary for subsequent childbirth.

The endocrine system influences future pregnancy even before fertilization. The normal functioning of the hypothalamus, pituitary and ovaries ensures the development of the egg and promotes fertilization. For the normal development of the fetus, hormones produced by the endocrine system of a woman also play an important role - they stimulate the development of its bone tissue, brain development, and energy production.

Noticeable changes in the female body during pregnancy are caused by the influence of the endocrine glands. The ovaries are slightly enlarged, one of them contains the corpus luteum, functioning until the fourth month of pregnancy. Further, the production of hormones (progesterone and estrogen) is taken over by the placenta. The number of blood vessels expanding and braiding the uterus increases, which increases and by the end of the gestation period reaches more than 30 cm in height. By the beginning of the second trimester, it goes beyond the pelvic zone, with the approach of childbirth, it appears at the hypochondrium. The volume of the uterine cavity increases significantly, its weight increases to 1-1.2 kg (excluding the fetus). The enlarging uterus is held in the desired position of the ligaments (while their thickening and stretching is observed). Sometimes, especially when changing the position of the body, pain occurs in these ligaments, caused by their stretching.

Changes in the body during pregnancy: digestive organs and excretions

In the first trimester of pregnancy, you can often observe manifestations of early toxicosis - nausea, dizziness, and sometimes vomiting in the morning refers to its characteristic signs. Taste sensations may also change, and strange food addictions may appear. Most often, these phenomena stop by the beginning of the second trimester of pregnancy, sometimes later. Under the influence of hormones produced by the placenta, intestinal tone decreases, therefore, a tendency to constipation is often observed. Over time, the enlarging uterus displaces the intestines upward, while the stomach also moves, which can cause some of its contents to be thrown into the esophagus. Hence the emerging feeling of heartburn, which can be dealt with by taking antacids. In addition, the last meal is recommended no later than two hours before bedtime, as well as placement on a bed with a raised headboard.

During this period, the kidneys function in a mode of increased loads, ensuring the excretion of urea from the body, maintaining optimal pressure indicators and regulating water-electrolyte metabolism. If inflammatory diseases were previously present in them, their exacerbations are possible with the onset of pregnancy. In the process of gestation, the uterus exerts tangible pressure in the bladder area, therefore, there may be an urge to urinate more often. Renal filtration of the blood is enhanced, while the appearance of the amount of sugar in small quantities can be observed. Nevertheless, the appearance of protein in the urine may indicate the presence of an inflammation process or gestosis. At the final stage of gestation, the appearance of small edema can be noted.

Changes in the body during pregnancy: musculoskeletal system, skin, mammary glands

Due to the influence of the hormone relaxin, the ligaments of the joints are loosened. Thus, the joints of the pelvis become softer, which increases their mobility and prepares the conditions for childbirth. Sometimes there is a slight discrepancy of the pubic bones - when a so-called "duck" gait appears in a pregnant woman, you should inform the doctor about it. Peculiar changes during this period can be observed on the skin. Quite often, pregnant women notice an increase in facial pigmentation, in the area around the nipples, as well as on the abdomen along the line that rises to the navel. There is an increase in the mammary glands, an increase in the number of lobules and adipose tissue in them, coarsening of the nipples. Closer to childbirth, the production of colostrum is started - when the nipple is squeezed, a few drops of thick, light liquid may appear. Sometimes on the skin in the navel and lower abdomen, as well as on the chest and thighs, you can observe the appearance of arcuate stretch marks.

Changes of this kind indicate the physiological adaptation of a pregnant woman to bearing a fetus. In order to prevent the development of pathologies, it is recommended to take measures that contribute to the creation of suitable conditions for the development of pregnancy. These include developing a balanced diet, drinking enough fluids, eliminating bad habits, ensuring an adequate level of physical activity and staying in the fresh air.

Changes in the body during pregnancy - video

Hello dear women, in this article I will tell you about what happens to the body during pregnancy, what you can expect from your body for the next 9 months, discuss the heart and blood vessels, kidneys, pressure, stretch marks, dark spots on the face, hormones and restructuring psyche.

Read this article to the end and, having discovered some changes in yourself, you at least keep calm understanding what processes are now going on inside you.

Hormones that change both the body and the psyche

From the very beginning of pregnancy, in the very early stages, as soon as the egg is attached to the walls of the uterus, cardinal changes in the body occur - all systems are preparing to form a new life.

New hormones are being actively produced - pregnancy hormones.

During pregnancy, the following hormones are most active:

• human chorial gonadotropin ( may be causing nausea)
• estrogen ()
• progesterone ( promotes the growth of mammary glands and uterus)
• thyroid-stimulating hormone ( stimulates the thyroid gland)
• a hormone that stimulates cell melanocytes ( synthesizes skin pigment, or darkening of age spots on the skin).

Let's see how the body systems change under the influence of hormones.

45% increase in blood volume

The cardiovascular system adjusts to additional load. The volume of circulating blood increases by 35-45%. If the average woman's body is 3500-4000 ml of blood, then by the end of pregnancy, 5300-5550 ml of blood.

Physiological hypertrophy of the heart occurs. Heart hypertrophy is a natural way to adapt to increased stress. Why? Very simple - the third circle of blood circulation is formed- placental, separate for your baby.

Decreases blood pressure

In the first three months of pregnancy blood pressure goes down.

If before pregnancy you had a slightly low blood pressure, less than 100/80 mm Hg, then in the 1st trimester of pregnancy it may decrease even more and you will constantly want to sleep. Feelings of weakness and slight dizziness may occur.

One of the pregnancy hormones is progesterone has a direct effect on the walls of blood vessels, expanding them, thereby ensuring better blood circulation.In response to vasodilatation, pressure decreases.

If your blood pressure is low, your doctor should prescribe a blood pressure stabilization medication based on natural ingredients, such as tincture of ginseng.

Blood pressure should return to normal after 12 weeks of pregnancy., become the same as before pregnancy, at the level of 120-140 / 70-90 mm Hg.

If, on the contrary, you notice an increase in blood pressure, immediately consult a doctor, this may be a symptom of some complications.

Changes in the tone of the bladder and ureters

Changes in tone predispose to urinary stagnation. And bacteria are very fond of any stagnation..

Therefore, a pregnant woman is at risk of developing a urinary tract infection. Another reason for the development of infection can be compression of the ureters by the pregnant uterus.

To avoid developing any infections, you need to have a urine sample checked during the first months of pregnancy. bacteria in urine ().

Bacteriuria may not appear at all - no symptoms! Only a urine culture can tell if you have latent kidney disease or not.

If bacteriuria is cured in time, then in the future you can protect yourself from infections of the urinary system, in particular pyelonephritis.

Do not listen to the wrong advice, "they say, why drink antibiotics during pregnancy, it is so harmful for the child, you need to drink herbal preparations and use folk remedies."

I have a lot of respect for traditional medicine, but here this is the case when you cannot do without antibiotics... There is an infection in the kidneys that is lurking and is waiting for the right opportunity to fire. And he will shoot very accurately - the development of pyelonephritis, which leads to serious complications, or even worse to sepsis (blood poisoning). Therefore, in this case, prevention is the golden rule!

Small swelling on the legs in the evening is the norm.

The next thing to watch out for is the amount of urine.

The volume of urine depends on the volume of fluid you drink. A healthy pregnant woman excretes an average of 1200-1600 ml of urine per day, while 950-1200 ml of urine is released during the daytime, the rest of the portion - at night.

For a pregnant woman, "running" at night to the toilet is the norm, often "running" is also the norm.

If in the last months of pregnancy there are small swelling on the legs is also the norm! In no case should you reduce the volume of water.

If swelling appeared suddenly and rapidly growing, this is an alarming syndrome- run to the doctor, or even better, call him home!

The most important thing is not to reduce the amount of fluid consumed when edema appears, it can be very dangerous!

Changing taste preferences

At the beginning of pregnancy, many women change their taste preferences, various whims appear (craving for sour and salty foods), aversion to certain types of food (to meat and fatty foods); appetite increases.

You may experience nausea and vomiting in the morning. This is a normal reaction to pregnancy-related changes in the body, but only if vomiting no more than 3-4 times a day and does not cause weight loss.

If vomiting causes a sharp deterioration in well-being and you lose weight at the same time and this is a complication of pregnancy, which is called vomiting of pregnancy. And then you need to immediately consult a doctor.

The medical arsenal now has effective remedies to relieve the symptoms of this complication.

Decreased intestinal tone

Again under the influence of hormones decreased intestinal tone, food passes through the entire digestive tract more slowly than usual so that the body can absorb the maximum nutrients from the food for the baby. And this is what often leads to constipation. You can get a list of Safe Pregnancy Laxatives.

Moreover, the intestines and stomach are pushed upward by the pregnant uterus and compressed. Stomach contents can be thrown into the esophagus and cause heartburn.

For heartburn, I recommend -Rennie. It is a mild product that does not contain aluminum. Take it 1-2 tablets 1 hour after meals, repeat if necessary. No more than 11 tablets per day. Desirable do not take it longer than 2-3 days.

In fact, proper nutrition during pregnancy can significantly reduce all these inconveniences, I will give you a number of detailed recommendations on this topic.

Already now, you can significantly improve your well-being by simply adding 200 ml to your diet. daily.

The mammary glands are preparing for feeding

They increase the number of lobules, adipose tissue, improve blood supply. The mammary glands increase in size, the nipples become coarse, the vascular network becomes clearly visible.

Colostrum is excreted - a thick yellowish liquid. Sometimes "stretch marks" may appear on the chest. No creams or medications should be used as they are not effective. Leave all activities for later - the period after feeding.

The uterus enlarges, its position changes

By the end of pregnancy, the weight of the uterus increases 500 times, and the volume - 1000 times.

The blood supply to the external genital organs is enhanced, the amount of vaginal discharge is significantly increased.

Starting from the 14th week, the uterus may begin to contract from time to time... At first, contractions are weak and irregular, you may not even pay attention to them. From the 30th week onwards, contractions become frequent and violent and are called "Braxton-Hicks contractions." They do not mean early birth at all, but they speak of the approaching date for the birth of a child.

The position of the uterus changes according to the gestational age.

• At week 14, the belly begins to protrude forward and the uterus stretches over the junction of the pubic pelvic bones (at the level of the hips).
• By the 20th week, the upper part of the uterus reaches the level of the navel, it begins to press on the lungs from below.
• By the 30th week, the uterus reaches the ribs, making breathing difficult.
• At the 34th week, the lumbar curvature of the back increases, this is due to the severity of the uterus.

Weight gain - 12 kg per pregnancy

Healthy woman by the end of pregnancy should gain an average of 12 kg with fluctuations from 8 to 18 kg, of which:

• fruit weight is 2800-3400 grams
• weight of the placenta with fetal membranes (child's place) - 680 grams
• amniotic fluid volume - 900 grams
• per uterus - 1130 grams
• the volume of blood is - 1600 grams
• breast weight - 900 grams
• fat tissue weight 4000 grams
• liquids in the lower extremities - 900-1300 grams
• extracellular fluid - 1000-1500 grams

That's the kind of arithmetic!

Dark spots may appear on the face

Some women develop brown spots on their face (called chloasma).

Sun exposure can make these stains more intense, so be sure to apply sunscreen before going outside.

Do not try to remove them during pregnancy - a waste of time and money.

Also, keep in mind that blemishes can be masked with fake tanning products or tanning powder, which will give your face a naturally tanned look and make age spots invisible against dark skin.

In the first months after the birth of a baby they brighten and then disappear.

Hair growth will increase

Increased blood flow and increased nutrient levels also result in improved skin cell nutrition. Improved skin nutrition can cause hypertrichosis - increased hair growth.

Hair can appear in places where it is completely unnecessary, for example, on the face in the lips, on the chin, on the cheeks. Hair can also appear on the shoulders, legs, back and abdomen.

Most of this hair disappears six months after giving birth. but some may stay longer.

What to do in this case?

It is best not to use a depilatory cream during pregnancy. Firstly, all the chemicals in the cream can be absorbed through the small blood vessels, which is unfavorable for the child, and secondly, the skin may not perceive them, and the result will be zero.

It is also better to postpone electrolysis or waxing until the baby is born, as this is a rather painful procedure that can provoke the threat of termination of pregnancy.

I advise you to pull out facial hair with tweezers (in no case should you shave them off!), And on your legs, arms - shave with a razor. These are the safest methods.

New moles and papillomas may appear

New moles may appear on the skin, and existing moles may enlarge and darken. If you have a mole that starts to change during pregnancy, be sure to consult your doctor.

If the mole grows quickly, it should be removed in the hospital.... Pregnancy has no contraindications for such an operation.

In addition to moles, papillomas may appear, these are small formations on the skin. If you already have them, they can get bigger.

Don't worry about this. There are safe ways to remove them that do not require pain relief or hospitalization. They can be removed both during and after pregnancy.

Stretch marks may appear on the skin

Stretch marks are areas of stretched skin that are reddish in color. Usually appear on the abdomen, chest, thighs, or buttocks.

Despite popular belief, stretch marks may not appear for everyone! And it depends on individual characteristics and hormonal levels.

After childbirth, stretch marks turn white and become invisible, but they will never completely disappear. Until now, no reliable way to get rid of stretch marks has been found. Women have tried a variety of lotions, but they often proved to be useless.

Stretch marks can be made less noticeable after childbirth by connecting a good program to strengthen the abdominal muscles and improve skin turgor.

Conclusion

Finally, I want to say one more thing - from the first day of life you are inextricably linked with the child, you feel fear and he receives fear hormones through the placenta, you feel joy - the body secretes the hormone of joy, it is also transmitted to the child.

Scientists have established and recorded in the photographs an amazing fact: the child, almost synchronously with the mother, smiles or makes a "grimace of sorrow", repeating her facial expressions (and hence the state!). Therefore, you experience every scandal, all your tears together! Remember this and try not to get emotional.

Thank you for reading this long article to the end. I know it was not easy :)

But now you are armed with knowledge and you will no longer be taken by surprise! Well, do not forget to subscribe to new articles, share with your friends if you liked the article. And thanks again for your attention!

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.

With 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, already 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 joints of the pelvis.

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 blood plasma increases from 6-7 weeks of gestation, reaching a peak at 14 weeks. In clinical practice, AFP is determined 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 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, as well as can cause 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 the 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, which regulate 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 of the necessary amounts of nutrients, salts and hormones to the growing fetus, which 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, disturbances in calcium metabolism are possible, leading to spastic phenomena (cramps in the calf muscles, etc.).

Rice. 21. Changes in thyroid function during pregnancy

THE IMMUNE SYSTEM

During 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 number 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. 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 latent 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 (it helps to increase renal blood flow, glomerular filtration rate, as well as reduce 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 support 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, changes 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 levels. 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 a factor of two. 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 of 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 gestation, the prothrombin index also increases significantly. 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 ICS 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-purple in 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 connective tissue fibers) do not disappear after childbirth, but take the form 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"

Taking into account the above, in recent years in obstetric practice began to apply the concept of "pregnancy rate". 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, as 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.

Pregnancy is a physiological process in which a new human body develops in a woman's uterus, resulting from fertilization.

Pregnancy in women it lasts on average 280 days(40 weeks, which corresponds to 9 calendar months or 10 lunar months). Pregnancy is also usually divided into 3 trimesters of 3 calendar months each.

Early pregnancy signs

In the early stages, pregnancy is diagnosed on the basis of doubtful and probable signs.

Doubtful signs of pregnancy- various kinds of subjective sensations, as well as objectively determined changes in the body, outside the internal genital organs: taste whims, changes in olfactory sensations, easy fatigue, drowsiness, skin pigmentation on the face, along the white line of the abdomen, nipples and areola.

Likely signs of pregnancy- objective signs on the part of the genitals, mammary glands and when staging biological reactions to pregnancy. These include: the cessation of menstruation in women of childbearing age, an increase in the mammary glands and the appearance of colostrum when squeezing out of the nipples, cyanosis of the mucous membrane of the vagina and cervix, a change in the shape and consistency of the uterus, an increase in its size.

You can preliminarily verify the presence of pregnancy at home using an express test for the content of the hormone chorionic gonadotropin in a woman's urine (the test is carried out from the first day of the delay of the next menstruation).

It allows you to confirm the fact of pregnancy.

Changes in the body of a pregnant woman

Numerous and complex changes occur in a woman's body during pregnancy. These physiological changes create conditions for the intrauterine development of the fetus, prepare the woman's body for childbirth and breastfeeding of the newborn. Menstruation stops, mammary glands increase in volume, nipples darken.

Many pregnant women in the first trimester have nausea, sometimes vomiting - these symptoms are commonly called. Weakness, drowsiness, heartburn, salivation, change in taste, and frequent urination are common. These disorders of well-being are characteristic of a healthy and normal pregnancy.

Especially great changes occur in the genitals of a woman. The uterus increases with each, the blood supply to the internal and external genital organs increases. The tissues swell, acquire elasticity, which contributes to their better stretching during childbirth. In the mammary glands, the number and volume of glandular lobules increase, their blood supply increases, they become tense from the nipples. The amount of gonadotropic hormones, as well as estrogens and progesterone, produced first by the corpus luteum (a temporary gland formed at the site of the follicle from which the mature egg came out) and then, sharply increases. The hormones secreted by the corpus luteum (progesterone and, to a lesser extent, estrogens) contribute to the creation of conditions for the proper development of pregnancy. The corpus luteum undergoes reverse development after the fourth month in connection with the formation of the hormonal function of the placenta.

For the management of pregnancy it is necessary (after 3 - 4 weeks after the delay in menstruation), where the doctor examines and examines the external and internal genital organs, and if necessary, additional examinations are prescribed.

Genitals during pregnancy

Uterus. During pregnancy, the size, shape, position, consistency and reactivity (excitability) of the uterus change. The uterus gradually enlarges throughout the pregnancy. The enlargement of the uterus occurs mainly due to hypertrophy of the muscle fibers of the uterus; at the same time there is a multiplication of muscle fibers, the growth of newly formed muscle elements of the reticular fibrous and argyrophilic "frame" of the uterus.

The uterus is not only a fruit receptacle that protects the fetus from adverse external influences, but also a metabolic organ that provides the fetus with enzymes, complex compounds necessary for the plastic processes of a rapidly developing fetus.

Vagina during pregnancy, it lengthens, expands, the folds of the mucous membrane appear sharper. The external genitals are loosened during pregnancy.

Pregnant woman lifestyle, regimen, nutrition and hygiene

The developing fetus receives all the necessary nutrients from the mother. The well-being of the fetus depends entirely on the health of the mother, her working conditions, rest, the state of the nervous and endocrine systems.

Pregnant women are released from night shifts, heavy physical work, work associated with body vibration or adverse effects on the body of chemical. substances. During pregnancy, jerky movements, heavy lifting and significant fatigue should be avoided. A pregnant woman needs to sleep at least 8 hours a day. Walking is recommended before bed.

A pregnant woman must be carefully protected from infectious diseases, which pose a particular danger to the pregnant woman's body and the fetus.

During pregnancy, you must especially carefully monitor the purity of the skin. Purity of the skin promotes the elimination of metabolic products harmful to the body through sweat.

A pregnant woman should wash her external genitals with warm water and soap twice a day. Douching during pregnancy should be administered with great caution.

During pregnancy, you should carefully monitor the state of the oral cavity and make the necessary.

The mammary glands should be washed daily with warm water and soap and wiped off with a towel. These methods prevent cracked nipples and mastitis. If, then you should massage them.

Pregnant clothes should be comfortable and loose: do not wear tightening belts, tight bras, etc. In the second half of pregnancy, it is recommended to wear a bandage that should support the abdomen, but not squeeze it.

The pregnant woman should wear low-heeled shoes.