Okay, so moving on to the gastrointestinal system now.
So first thinking about anatomical changes.
Well, the stomach and the intestines are displaced
by the enlarging uterus.
And then there's decreased tone of the lower
esophageal sphincter.
This is the reason woman in the 1st trimester specially.
But again in the 3rd trimester experience with a lot of issues
with acid reflux because of this decreased lower esophageal
sphincter tone.
Now, moving on to the renal system.
Few things here that we need to take note of.
First, the kidney size.
It is slightly larger in pregnancy.
And then next the ureter is compressed in pregnancy causing
hydronephrosis.
This is common after the 2nd trimester and is usually
more common on the right than the left.
And that's just because as the uterus grows,
it tends to rotate to the right.
Now these things are important because of the hydronephrosis
that we see in pregnancy because of that compression.
Meaning it's physiologic.
Pregnant women are at increased risk for urinary tract
infection.
That along with the affect of progesterone slows down
the mortality of the ureter, puts women at increased again,
increased risk for urinary tract infection.
Now, the renal system also have some physiologic changes.
Serum creatinine is decreased in pregnancy.
Whereas the creatinine clearance is -- which do you think ?
increase or decrease?
It's actually increased in pregnancy.
And the glomerular filtration rate that also changes.
But it increase or does it decrease?
It increases because everything is moving through the kidney
so much faster and because of this glomerular filtration rate
increasing, sometimes you will see women have glucose in their
urine when they come for their routine visits.
This can be a sign of gestational diabetes at times.
But most often it's a physiologic change
because of increased risk -- increased risk of the GFR.
Alright, so let's go through another question.
A 23 year old Gravdia 1 Para 0 female at 22 week gestation
is seen in the emergency room for severe right lower
quadrant pain.
On non-contrasted CT scan, she is found to have hydronephrosis
of the right kidney.
The most likely cause of the hydronephrosis is
A. ...pyelonephritis due to the increased risk
of urinary tract infection.
B. ...pyelonephritis from a stone not visible due to
non-contrasted CT scan.
C. ...physiologic due to increased vascular flow
through the renal artery.
or D. ...physiologic due to compression of the ureter
by the enlarged uterus.
What do you think the answer is.
The answer is D.
Remember that as the uterus grows, it rotates to the right
and compresses that ureter on the right causing
a hydronephrosis.
That is again physiologic not pathologic.
Important to know.
So now let's think about the changes that we see
within the metabolic system during pregnancy.
First the basal metabolic rate or the BMR increases
by 10 to 20%.
If you think about the amount of growth in the cell turnover
that's happening in pregnancy, this will make sense.
Because it is increased,
the chloric demand is also increased.
And this changes throughout the trimester.
As our patients get further along in the pregnancy,
the chloric demand increases.
Again if you think about the growth of the fetus,
the cell turnover always happening,
this will make sense as well.
We also notice that there is increased water retention
up to 6.5 liters.
Now this is due to decreased plasma osmolalities.
So some deem in pregnancy can be normal.
Though our times it is pathologic and we will discuss
that in another slide set.
But to have water retention is very common in pregnancy.
So moving on to the endocrine system.
There are some hormone changes that happen in pregnancy
and we need to discuss what those are.
First we notice that there is an increase and not only for
progesterone as we previously discussed
but also in estrogen.
We also notice that aldosterone and renin increase.
And we notice that relaxin increases.
And relaxin is a hormone that's responsible for loosening
the ligaments in our hips, in the pubic surfaces.
Getting things ready for the endo pregnancy
when that baby is going to come out.
So there are other anatomical changes that happen
throughout the pregnancy.
First let's talk about the breasts.
The breasts size and the areola increase in size and tenderness
and that is normal.
It is normal for pregnant women to go up two cup sizes
throughout their pregnancy.
Because of increase size of the breasts.
Obviously the uterine size increases because of the growth
of the fetus.
But it increases to 5 litres or 1100 grams by the time
a patient is term.
Now, let's think about the genitourinary structures.
The cervix will soften, eversion of the endocervical glands.
And this is important because this is a common reason
that we see women have bleeding throughout pregnancy.
Bleeding is not always a problem,
it's not always pathologic.
But because of the eversion in the cervical glands,
the cervix can have a little bit of bleeding.
And then there are other changes that don't really have
a function that we know of but there are things
that we see happen to the skin in pregnancy.
Stretch marks may or may not form.
And there's also melasma known as the pregnancy mask.
More common in Asian Hispanic women.
And then the linea nigra.
Now that's that line that you see depicted in the picture here
that is between the belly button and the fundal.
And it's just a dark line that happens
because of increase melanasites during pregnancy.