Genital System Changes During Pregnancy

• Uterus

a) Body of uterus - 

Anatomy
Position	Pelvic organ at 1st trimester, abdominal organ after 12weeks & dextrorotated as it enlarges due to presence of left side rectosigmoid colon.
Shape	Pear shape at 1st few weeks, globular shape in the 1st trimester & ovoid shape at term.
Size	Similar to fetal head at 12th weeks, at the level of umbilicus at 24th weeks & at the level of xiphi-sternum at 36th weeks.
Consistency	Softening of the uterus is due to ↑ vascularity & presence of amniotic fluid.
Weight	↑ from 50-70 gm to 1000 gm at full term (20x ↑ in weight).
Capacity	↑ from 10 ml to 5L or more (500-1000x ↑ in capacity)

Histology
Endometrium	Differentiated into deciduas
Myometrium	- Hypertrophy & hyperplasia of the muscle fibers due to ↑ synthesis of polyamines. - Differentiated into 3 layers: outer longitudinal- push fetus during delivery, middle interlacing- preventing post-partum hemorrhage & inner circular- hold the fetus up. ↑ elastic fibers facilitating uterine distension.
Peritoneum	Hypertrophied & firmly attached to the upper uterine segment & loosely attached to the lower uterine segment. (important in caesarean section)
Uterine ligaments	Hypertrophy of the broad, round, cardinal & uterosacral ligaments.
↑ contents	Blood vessels, lymphatics & nerves.

Physiology
Palmer’s sign	Uterine contraction felt during vaginal examination in early pregnancy [these are irregular & painless]
Braxton-Hick’s	Uterine contraction felt during 2nd & 3rd trimester of pregnancy [sporadic, unpredictable, non-rhythmic & its intensity not exceeding 25mm Hg]
False labour pains	Uterine discomfort & account for false labour pain as pregnancy advances [↑ in frequency & intensity, no effects on dilation & effacement of cervix]
Uteroplacental blood flow	Progressive ↑ in uteroplacental blood flow to reach 450-650ml / minute at term

b) Isthmus - is transformed into the lower uterine segment.

Upper uterine changes during pregnancy (click at the image to enlarge)

Lower uterine changes during pregnancy (click at the image to enlarge)

• Cervix

- Hypertrophy & softening of the cervix

- Hypertrophy of cervical mucosa

- Increased vascularity of the cervix

- Cervical mucous plug closes the cervical canal due to excess cervical secretion, it is discharged as bloody show with the onset of labor

- Rearragement of collagen fibers 

• Vagina & vulva

- Hypertrophy & softening

- Varicose veins of the vulva (Kluge's sign)

- Blue or violet discoloration of the vulva (Chadwick's sign)

- Vaginal pH is acidic (3.5 - 6) due to increased production of lactic acid by lactobacilli

- Vaginal cytology show increased small intermediate cells under the effect of progesterone  

• Ovary

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1. Genital System Changes
2. Breast Changes
3. Cardiovascular Changes
4. Respiratory Changes
5. Gastrointestinal Changes
6. Liver & Gall Bladder Changes
7. Urinary Changes
8. Skin Changes
9. Skeletal Changes
10. Nervous System Changes
11. Metabolic Changes
12. Endocrinal Changes
13. Immune System Changes

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