00:01
Okay, so moving on to
the gastrointestinal system now.
00:04
So first thinking about
anatomical changes.
00:06
Well, the stomach
and the intestines are displaced
by the enlarging uterus.
00:11
And then there's decreased
tone of the lower
esophageal sphincter.
00:15
This is the reason woman in
the 1st trimester specially.
00:18
But again in the 3rd trimester
experience with a lot of issues
with acid reflux because of this
decreased lower esophageal
sphincter tone.
00:29
Now, moving on to
the renal system.
00:32
Few things here that we
need to take note of.
00:34
First, the kidney size.
00:36
It is slightly
larger in pregnancy.
00:38
And then next the ureter is
compressed in pregnancy causing
hydronephrosis.
00:43
This is common after the 2nd
trimester and is usually
more common on the right
than the left.
00:49
And that's just because as
the uterus grows,
it tends to rotate to the right.
00:53
Now these things are important
because of the hydronephrosis
that we see in pregnancy
because of that compression.
00:59
Meaning it's physiologic.
01:00
Pregnant women are at increased
risk for urinary tract
infection.
01:04
That along with the affect
of progesterone slows down
the motility of the ureter,
puts women at increased again,
increased risk for
urinary tract infection.
01:15
Now, the renal system also have
some physiologic changes.
01:18
Serum creatinine is
decreased in pregnancy.
01:22
Whereas the creatinine clearance
is -- which do you think ?
increase or decrease?
It's actually
increased in pregnancy.
01:32
And the glomerular filtration
rate that also changes.
01:34
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.
01:50
This can be a sign of
gestational diabetes at times.
01:53
But most often it's a
physiologic change
because of increased risk --
increased risk of the GFR.
02:02
Alright, so let's go
through another question.
02:05
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.
02:16
On non-contrasted CT scan, she
is found to have hydronephrosis
of the right kidney.
02:22
The most likely cause of
the hydronephrosis is
A. ...pyelonephritis due to
the increased risk
of urinary tract infection.
02:30
B. ...pyelonephritis from a stone
not visible due to
non-contrasted CT scan.
02:36
C. ...physiologic due to increased
vascular flow
through the renal artery.
02:41
or D. ...physiologic due to compression
of the ureter
by the enlarged uterus.
02:46
What do you think the answer is.
02:49
The answer is D.
02:51
Remember that as the uterus grows,
it rotates to the right
and compresses that ureter
on the right causing
a hydronephrosis.
02:58
That is again physiologic
not pathologic.
03:01
Important to know.
03:02
So now let's think about
the changes that we see
within the metabolic system
during pregnancy.
03:08
First the basal metabolic rate
or the BMR increases
by 10 to 20%.
03:14
If you think about the amount
of growth in the cell turnover
that's happening in pregnancy,
this will make sense.
03:20
Because it is increased,
the chloric demand
is also increased.
03:25
And this changes
throughout the trimester.
03:27
As our patients get further
along in the pregnancy,
the chloric demand increases.
03:31
Again if you think about
the growth of the fetus,
the cell turnover always happening,
this will make sense as well.
03:38
We also notice that there is
increased water retention
up to 6.5 liters.
03:43
Now this is due to decreased
plasma osmolalities.
03:46
So some deem in pregnancy
can be normal.
03:49
Though our times it is
pathologic and we will discuss
that in another slide set.
03:54
But to have water retention
is very common in pregnancy.
04:00
So moving on to
the endocrine system.
04:02
There are some hormone changes
that happen in pregnancy
and we need to discuss
what those are.
04:06
First we notice that there is
an increase and not only for
progesterone as we previously
discussed
but also in estrogen.
04:14
We also notice that
aldosterone and renin increase.
04:18
And we notice that
relaxin increases.
04:20
And relaxin is a hormone that's
responsible for loosening
the ligaments in our hips,
in the pubic surfaces.
04:26
Getting things ready
for the endo pregnancy
when that baby is going
to come out.
04:32
So there are other anatomical
changes that happen
throughout the pregnancy.
04:35
First let's talk
about the breasts.
04:37
The breasts size and the areola
increase in size and tenderness
and that is normal.
04:42
It is normal for pregnant
women to go up two cup sizes
throughout their pregnancy.
04:47
Because of increase
size of the breasts.
04:50
Obviously the uterine size
increases because of the growth
of the fetus.
04:54
But it increases to 5 litres
or 1100 grams by the time
a patient is term.
05:01
Now, let's think about
the genitourinary structures.
05:05
The cervix will soften,
eversion of the endocervical glands.
05:09
And this is important because
this is a common reason
that we see women have bleeding
throughout pregnancy.
05:16
Bleeding is not always
a problem,
it's not always pathologic.
05:19
But because of the eversion in
the cervical glands,
the cervix can have a little bit
of bleeding.
05:24
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.
05:32
Stretch marks may
or may not form.
05:35
And there's also melasma
known as the pregnancy mask.
05:38
More common in Asian
Hispanic women.
05:40
And then the linea nigra.
05:42
Now that's that line that you
see depicted in the picture here
that is between the belly button
and the fundal.
05:47
And it's just a dark line
that happens
because of increase melanasites
during pregnancy.