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Normally, during the first trimester, the growing uterus changes spontaneously to an anteverted position, thus allowing expansion of the enlarging uterus into the abdomen. The cervix is then inferior to the body of the uterus. Thus, the presence of an early pregnancy in a retroverted uterus is not considered a problem. [1]
The ligament pulls on nerve fibers and sensitive structures of the female reproductive system. Since the uterus tends to be oriented towards the right side of the body, the pain is also often felt on the right side. This leads to frequent confusion with appendicitis. [6] During pregnancy, the uterus expands to accommodate the growing fetus.
In the later stages of pregnancy, the cervix may already have opened up to 1–3 cm (or more in rarer circumstances), but during labor, repeated uterine contractions lead to further widening of the cervix to about 6 centimeters. From that point, pressure from the presenting part (head in vertex births or bottom in breech births), along with ...
During pregnancy, the enlarged abdomen and gravid uterus place additional strain on lumbar muscles and shift the pregnant woman's center of gravity. These postural compensations culminate in an increased load on both lumbar spinal musculature and the sacroiliac ligaments, manifesting as low back pain and/or pelvic girdle pain. [ 13 ]
During pregnancy the plasma volume increases by 40-50% and the red blood cell volume increases only by 20–30%. [22] These changes occur mostly in the second trimester and prior to 32 weeks gestation. [24] Due to dilution, the net result is a decrease in hematocrit or hemoglobin, which are measures of red blood cell concentration.
The uterus, the muscular organ that holds the developing fetus, can expand up to 20 times its normal size during pregnancy. Head engagement , also called "lightening" or "dropping", occurs as the fetal head descends into a cephalic presentation .
The myometrium stretches (the smooth muscle cells expand in both size and number [3]) during pregnancy to allow for the uterus to become several times its non-gravid size, and contracts in a coordinated fashion, via a positive feedback effect on the "Ferguson reflex", during the process of labor.
Dilation and evacuation can be offered for the management of second trimester miscarriage if skilled providers are available. [6] Some women choose D&E over labor induction for a second trimester loss because it can be a scheduled surgical procedure, offering predictability over labor induction, or because they find it emotionally easier than undergoing labor and delivery.
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