1. Physiological changes in pregnancy

2.  Major adaptation of maternal anatomy,physiology and metabolism is required for normal pregnancy.  Undrestanding these changes help to differentite between the normal and pathology.

3. GIT changes  Increase apetite.  Nausea and vomitting.  Gum hypertrophy.  Gingivitis of pregnancy.  Decrease GIT motilityand tone.  Decrease incidence of peptic ulcer.  Increase incidence of GERD.

4.  Increase gallstone formation.  Constipation.  Haemorrhoid.

5. Urinary system:  Enlarged kidnyes.  Dilated ureters.  Increase possibility of infection.  30%asymptomatic bacteruria.  Urinary frequency.  Glucosuria.

6. Changes of CVS  Hypotension in first and second trimester.  Increase blood pressure in third trimester.  Increase heart rate.  Dependent oedema.  Increase cardiac output and stroke volume.

7. Haematological changes  Increase WBC.  Decrease RBC.  Decrease platelets count.  Decrease blood urea and serum creatinin.  Hypercoagulable state.

8. Respiratory system:  Hyperaemia of respiratory passages.  Rib cage displaced upward.  Chest circumferance expand.  Respiratory rate is unchanged.  Vital capacity is unchanged.  Tidal volume is increased.  Minute volume is increased.

9.  Functional residual capacity is reduced.  Increase dead volume.  Hyperventilation.

11. Metabolism:  Chronic water and sodium retaintion.  Decrease plasma osmolality.  Plasma lipid increased.  Total body fat increased.  Average weight gain is 12.5 kg.

12. Skeletal system:  Total calcium level decreased.  ionized calcium is unchanged.  Phosphate and PTH level unchanged.  Calcitonin level and vitamine D unchanged.

13. Endocrine changes:  Incresase thyroid binding globulin.  Euthyroid state.  Normal free thyroid hormones.  Slightly thyromegaly.

15.  Pituitary gland enlarged.  Prolactin level increase.  Increase in free cortisol.  Increase corticosteroid binding globulin.  Fasting hypoglycaemia.  Post prandial hyperglycaemia.

16. Skin:  Palmer erythema.  Spider angioma.  Linea negra.  Stria gravidarum.  Chloasma.