Immune System

• factors inhibited local and general immunity in the mother's body. Reactions caused by the action of hCG, placental lactogen, glucocorticoids, estrogen, progesterone, alpha-fetoprotein, alpha-2-glycoprotein trophoblast specific globulin; •formed immunological tolerance between mother body and fatus.

Endocrine System

• hypothalamus: supraoptic and paraventricular nucleus increases the formation oxytocin and vasopressin, they are also involved in regulating the secretion adenohypophysis folitropin, lutropin, corticotropin and tyrotropinu;

• pituitary gland: an increase in the anterior pituitary gland due to hyperplasia and hypertrophy of its cells, increases secretion of gonadotrophins increases the production of prolactin, growth hormone production is suppressed;

• thyroid gland: increases in size (in 35-40% of pregnant women) function yiyizbilshuyetsya but remains euthyroid, amplified products thyroxine-binding globulin (estrogen effect), increased levels of total T3 and T4, free T4 level is within normal limits ;

• parathyroid gland function with increased activity in the case of reducing their function develops hipokaltsiemiya, manifesting convulsions, spasms pyloric stomach, asthmatic symptoms;

- strengthen the adrenal glands produce glucocorticoids, which regulate carbohydrate and protein metabolism and mineralocorticoids, which regulate mineral metabolism;

- increased insulin resistance (insulin sensitivity is reduced by 50-80%), decreased tissue glucose use, decreased blood glucose levels;

- ovaries: new forms of endocrine glands - corpus luteum, which produces progesterone (reduces excitability and contractile ability of the uterus, creates conditions for the implantation of a fertilized egg and the proper development of pregnancy), operates the first 3.5-4 months pregnant;

- placenta: with 7 days of pregnancy has been an increasing concentration of human chorionic gonadotropin (beta-hCG) and progesterone estroeeny synthesized predominantly complex placenta-fetus from the mother cholesterol metabolites, and their products are steadily increasing rate that ensures the growth and development of the uterus, the regulation of biochemical processes in the myometrium, increased activity of enzyme systems, improving energy metabolism, the accumulation of glycogen and ATP. Placental lactogen (PL) - formed syntsytiotrofoblaetom placenta with 5-6 weeks of pregnancy (90% SW is in the plasma of pregnant women and 10% - in the amniotic fluid) and its maximum concentration determined at 36-37 weeks of pregnancy, then the level has stabilized and began to decline from 40-41 weeks of pregnancy. Concentration TL directly correlated with fetal weight and dramatically increases with kidney disease in the mother.

Central Nervous System

• excitability of the cerebral cortex is reduced to 3-4 months, and then a gradual increase in excitability (due to the formation of the cerebral cortex foci of increased excitability - gestational dominant, manifested some halmovanistyu pregnant and direction of its interests in pregnancy);

• reduced CNS excitability departments that are below and the turn-reflek apparatus uterus. Before birth excitability of spinal cord and nerve elements of the uterus increases;

• changes the tone of the autonomic nervous system, which leads to early pregnancy symptoms such as drowsiness, irritability, tearfulness, dizziness.

Cardiovascular system

• notes: reduction of adaptation to physical stress, increase blood jugular veins, edema peripheral tissues;

• Heart: systolic murmur (95%) and systolic gallop rhythm (90%);

• central hemodynamics: an increase in the volume of blood circulating (BCC) begins with 6 weeks of pregnancy, increased rapidly to 20-24 weeks and at 36 weeks an increase of 35-45%. The increase in CBV occurs by increasing the volume of plasma that circulates (ORC);

• cardiac output (CO): increased by 30-40% since early pregnancy and peaking at 20-24 weeks of pregnancy. In the first half of pregnancy increases cardiac output by increasing stroke volume of the heart (at thirty - 40%). In the second half of pregnancy pe ¬ preferably by increasing the heart rate (HR) by 15%. Rising CO explain the action on the myocardium of placental hormones (estrogen and progesterone) and partly as. Consequent formation uteroplacental circulation;

• reduction in systolic and diastolic ATZ early pregnancy before 24 weeks of pregnancy (at 5-15 mm Hg from baseline), decreased systemic vascular resistance ¬ ing a 21% reduction in pulmonary vascular resistance by 35% (due sudynoroz ¬ shyryuvalnoyu action of progesterone) ;

• peripheral vascular resistance decreases (relaksyvna effect on the vascular wall hCG, estrogen, progesterone and formation uteroplacental circulation, which has a low vascular resistance);

• central venous pressure (CVP) in the third trimester is on average 8 (4-12) cm of water. century., in nonpregnant 3.6 (2-5) cm water column;

• increased venous pressure (7-10 mm Hg) in the lower extremities (due to mechanical pressure of the uterus on the inferior vena cava and pelvic more than 10 times increasing uterine blood flow during pregnancy), relaxing effect of progesterone on the vascular wall, lower osmotic blood pressure, increased permeability of capillaries (the action of progesterone and aldosterone) ZRO ¬ a handling interstitial pressure (sodium retention), which explains the tendency to edema, varicose veins and hemorrhoids;

• shift the position of the heart shine to the horizontal and reducing the angle of the arc aorta ¬ ty, which is associated with the raising of the diaphragm and increases the load on the left shlunochyek tion of the heart;

• ECG-shifting electrical axis of the heart to the left

The system of blood

• plasma volume increased from 2600 ml of 45% (1250 ml - first pregnancy, and 1500 ml during subsequent pregnancies) and of 3900-4000 ml;

• total volume of red blood cells increased from 1400 ml of 33%, which is due to erythropoietin, human chorionic gonadotropin and placental lactogen;

• physiological hyperplasmia characterized by reduced numbers of hematocrit 30%, hemoglobin from 135-140 to 110-120 g / l. and necessary for the needs of the mother and fetus, prevents syndrome lower abdominal veins compensate hemorrhage during childbirth, reduces blood viscosity and thereby reduces peripheral resistance;

• The level of hematocrit and albumin decreased by 25% (the result of hemodilution);

• changing the hemoglobin level and on average it is up to 12 weeks of pregnancy 1227L, up to 28 weeks - 1187L, 1297P up to 40 weeks;

• increased number of leukocytes in peripheral blood and in the first trimester of their number is 3000-15000/mm3 in the second and the third trimesters th 6000-16000/mm3 during childbirth WBC count may reach 20 000-30 000/mm3;

• platelet count is within normal (for pregnant women) values, but with the progression of pregnancy, there is a gradual decline in their level;

• hemostasis system: inherent hypercoagulable state (during the pregnancy progresses constantly increasing level of fibrinogen (factor I) 2 times (up to 600 mg%) and factors \ LI-X fibrinolytic activity levels decrease, ESR increased to 40 - 50 mm / h ;

Metabolism

basal metabolic rate is increased by 20%;

increasing need for kilocalories an average of 2000 - 3200 calories per day (150 kcal / day in the first trimester and 350 kcal / day in the II and III trimester of pregnancy);

reinforced plastic processes' (benefits of anabolic processes of catabolism);

increases the synthesis of RNA, which leads to increased protein synthesis in ribosomes;

fat metabolism - increased assimilation of fat, reduced process of oxidation, which leads to the accumulation of ketone bodies in the blood, in-aminobutyric acid and atsetouksusnoyi, increased fat deposition in various organs and tissue (adrenals, placenta, skin, mammary gland and etc.).

carbohydrate metabolism - labile blood sugar (slight excess of normal) and the periodic appearance of sugar in the urine;

obmsh vitamins and minerals increases due to significant activation rotsesiv cellular metabolism in the mother and fetus.

Kidneys

anatomical changes: an increase in the size of the kidneys (on average by 1-1.5 cm), expansion pyelocaliceal system (15 mm on the right and 5 mm in the left kidney), increasing the diameter of the urethra 2 cm (usually right urethra by rotation and displacement of the uterus to the right and pressing the urethra to the terminal line of pelvis), causing an increased risk of pyelonephritis. Dilatation of urinary tract begins in first and reaches a maximum in the I! and III trimester of pregnancy (due to the action of placental progesterone and less compression urinary tract uterus);

functional changes: changing kidney filtration capacity - up to 16 weeks of pregnancy increases renal blood flow by 75%, glomerular filtration increases since 10 days of pregnancy to 50% (due to arteriodilatatsiyeyu and secondary delay N3 and water in the body). In II and NO trimesters of pregnancy reduced glomerular filtration and tubular reabsorption remained unchanged, resulting in an increase of the total amount of fluid in pregnant (up to 7 liters). Creatinine clearance increased by 40%, increases the excretion of glucose, protein filtering does not change. Sometimes it may be physiological (orthostatic) albuminuria (traces of protein) and glycosuria, due to increased capillary permeability.

Genitals

• uterine size increases, volume increases in 1000, the weight of the uterus increases from 50-60 g in non-pregnant state to 1000 g in late pregnancy (increase due mainly hypertrophy myometrial cells);

• shape of the uterus elongated, spherical at 8 weeks and again extended to 16 weeks of pregnancy;

• position of the uterus - a uterus comes from the pelvic cavity, turns and bends to the right;

• consistency of the uterus progressively softened, due to increased vascularization and the presence of amniotic fluid;

• cervix softens and becomes cyanotic;

o distinction between endo- and ectocervix - limit transitional epithelium shifted outwards and formed ectopia columnar epithelium, which can not be regarded as "erosion";

o contractions in the first trimester irregular and painless (Braxton-Hixson), but in later stages it causes discomfort and can cause false maternity pain;

o uterine capacity increases of 4-8 ml in nonpregnant state to 5000 ml in late pregnancy;

o myometrium hypertrophy (estrogen effect) hiperplazuyetsya (progesterone effect), individual muscle fibers elongate 15 times;

o uterine blood vessels dilate, elongate, especially venous, and formed, through which uterine blood flow increases more than 10 times (before pregnancy, it is 2 - 3% of cardiac output (CO), and in later stages of pregnancy 20 - 30% CO - 500-700 ml / min). Formed uterine circulation - "second heart", which is closely associated with placental flow and fruit;

o nerve elements uterus - the number of sensitive baro-, osmotic-, chemo-and other receptors;

o biochemical changes - a significant increase in actomyosin, creatine and glycogen, increasing the activity of enzyme systems (actomyosin ATPase, etc.)., accumulate high-Reunion (glycogen macroergic fossraty), muscle proteins and electrolytes (calcium ions, sodium, potassium, magnesium , chlorine, etc..)

o fallopian tubes - become thicker, blood circulation in them is greatly enhanced;

o ovarian-slightly enlarged, but cyclic processes are terminated. Corpus luteum that after 16 weeks of pregnancy undergoes involution;

o ligament of the uterus - are much thicker and extended, especially round and sacro-uterine;

o cyanosis vulva - the result of increased blood flow, difficulty outflow of blood through the veins to constrict enlarged uterus, and reducing vascular tone;

o skin hyperpigmentation vulva and perineum - due giperestrogeniey and increased concentration of melanin stimulating hormone;

o increase in vaginal white and lower their pH (4.5-5.0) - the result of vaginal epithelial hyperplasia, increased circulation and transudation;

Body Weight

• average increase of 10 - 12 kg, depending on the constitution;

• increase in mass occurs mainly in the second and third trimesters (350 - 400 g / week);

• typed with mass slightly more than half goes to the mother's tissues (blood, uterus, fat, breast), and the rest on the fetus (3000-3500 g), placenta (650 g), amniotic fluid (800 g) and uterus (900 g) .

Skin

• spider veins - on the face, arms, upper trunk;

• palmar erythema - due to an increase of 20% of total metabolism by 16% and the number of capillaries that have never functioned;

• stretching band (zihiae dhauisiahyt) - the lower abdomen, dairy ¬ these glands and thighs that are initially pink or purple color (due to the stretching of connective tissue and elastic fibers of the skin);

hyperpigmentation - in the area of ​​the navel, halos breast, white line of the abdomen, vulva and perineal skin may appear "mask of pregnancy" or chloasma (Melasma);

navel - smoothed out in the second half and stuck the end of pregnancy; nevi - increase in size and become more pigmented (sharp increase requires specialist advice);

sweat and sebaceous glands hyperproduction sometimes leads to acne; hair - sometimes on the face, abdomen and thighs marked hair growth, due to increased production of adrenal androgens and partly placenta. There is a significant loss in the first 2-4 months of renovation and upgrade system normal hair growth after 6-12 months after delivery.

Mammary gland

tingling and fullness - is associated with a significant increase in blood supply to the breast;

development ductless (estrogen effect) and alveoli (progesterone effect); activation of smooth muscle nipples and increase monthomerovyh follicles and small bumps near halos;

mass increase - from 150-250 g (before pregnancy) and 400-500 g (end it); Colostrum is produced - often in women who gave birth (combined effect of estrogen, progesterone, prolactin, placental lactogen, cortisol and insulin).

Musculoskeletal system

compensatory increase in lumbar lordosis, which is manifested by pain in the lower back;

development relative weakness Communications - Action relaxin and progesterone. Lonnie vaults becomes agile and diverges at 0.5-0.6 cm at about 28-30 weeks, which leads to an unstable gait, loss of balance and falling (simfiziopatiya); increase the lower aperture of the chest;

calcium metabolism - the concentration of ionized forms of calcium in serum is not changed by increasing production of parathyroid hormone, reduced the total amount of calcium through its mobilization to the needs of fetus.

During physiological pregnancy exchange of salts in the bones increased (influence calcitonin), but bone density is not lost;

• increase hernial defects, especially in the area of ​​the navel and the midline - diastase direct muscles (the result of uterine enlargement and its stamping on the anterior abdominal wall from the inside).

Hygiene and dietary nutrition of pregnant women.

Nutrition during pregnancy should be balanced. Intelligence, culture and spirituality of the modern woman does not allow her to use the principle of "eating for two". Caloric diet pregnant with an average weight of about 2400 kcal / day, which is 300 calories than normal to keep vahitnosti.Vazhlyvo diet, optimal number and ratio of protein, carbohydrates. Vitamins and minerals.

Survey methods of pregnancy: