Physiological changes in the reproductive system The uterus The uterus is an essential role in pregnancy by protecting and supporting

the fetus,placenta and amniotic fluid.in 40 weeks of pregnancy,it expands to accommodate the growing fetus and remain relatively quiescent,at time labour it is able to contract regularly and forcibly to expel the fetus due unique properties of contractility and elasticity.Uterine wall consists of three muscle. Perimetrium: is a thin layer of peritoneum that protect the uterus.During pregnancy,the peritoneal sac is greatly distorted as the uterus enlarged and rises out of the pelvis.The increasing tension on the broad ligament causes to become longer and wider.The round ligament undergo considerable hypertrophy and increase in length and diameter.spasm of the round ligaments causing sharp groin pain when movement. Myometrium: enlargement of the uterus during pregnancy,involved in contraction during labour.human myometrium is not composed of well defined circular and longitudinal layer.Myometrium lying under the serosal perimetrium,very thin muscle.increase in elastin will resulting increase in elasticity to allows the uterus grow and stretch to accommodate the growing fetus.

DECIDUA Can be seen as early day 23 of the normal menstrual cycle.Decidualization prepares the uterine lining for the invading trophblast.Decidua in the cervix and isthmus are less well developed.1st trimester,deciduas basalis approximately 5mm thick at 6 week to 1mm thick at 14 week.The gland within the deciduas provide a nutrients,growth factor and cytokines for the fetoplacental unit.Relaxin produced by the deciduas.The deciduas also produces large amount of prostaglandin which enhance uterine quiescence or initiated labour. BLOOD SUPPLY Uterine blood flow supplies the myometrium,endometrium and placenta.receiving 90% of total uterine blood flow.diameter of uterine arteries dilate to 1.5 times in noon pregnant state.The arcuate artery supply the placental bed 10 times larger.Coiled spiral arteries of the deciduas and myometrium marked physiological changes that disrupt their muscular and elastic element.Increased blood volume needed within the intervillous spaces of the placenta leding to a large pool of blood. The first 10-12 week blood supply into the intervillous space is limited.The action of the invasive trophoblasts on the maternal spiral arteries lead to very low resistance..Increase in maternal cardiac output and decline in uterine vascular resistance.Uterine blood flow increases during gestation approximately 50ml/min at 10 week gestation,increasing to 200ml/min by 28 week and 750ml/min at term.The passage of blood through the dilated uterine vessels produces a soft blowing sound.

CHANGES IN UTERINE SIZE

The uterus and fruit has become a fairly reliable. 5 weeks gestation-like a small unripe pear 8week 12 week -feel like a large orange -size of grapefruit.Increase in uterine size

is limited principally to the anteroposterior diameter and the uterus maintains its original pear shape.Physical movement,allowing the uterus to move relatively 16 week -Fundus become dome shaped,with the ascent of the uterus from pelvis.Internal os relaxes and the lower uterine segment develops from the greatly expended and thinned out muscular isthmus. 20 weeek -Uterine rises in the abdomen,assumes an ovoid shape.Isthmus has fully develop into the lower uterine segment and the cervical canal expands from above downwards in wedge shapes fashion 30 week -Displacing intestines laterally and superiorly and continue to rise.In supine position the uterus fall back to rest on vertebral column 36 week and round ligament is -Insersation of the uterine tubes and broad located slightly above the

middle of uterus.Decent of the fetal head into the pelvic brim.

CERVIX The cervix becomes softer and cyanosed dur to oedema and increased vascularity 1 month of conception.The elastin cologne ratio is greatest at the internal os.The glands of the cervix marked hyperthrophy and hyperplasia.The cervical canal shorten from above downwards from about 2cm long.Effacement can be compared with a funneling process.In this formulation the weakest point of the sphere.bulges,thin and dilate.Nitric oxide production increases in the cervix at the end of pregnancy.

VAGINA Increased in vascularity and hyperaemia develop in the skin and muscle of perineum and vulva with softening of the underlying connective tissue.Increased volume of vaginal secretion due to hight oestrogen result in thick white discharge.Glycogen is metabolized to lactic acid by lactobacillus acidophilus a normal commensal of the vagina.This leads to increased vaginal acidity.