Ukukhulelwa kuhambisana nokuzuza kwesisindo okuhluka phakathi kwabesifazane, kodwa isilinganiso se-9 ne-12 kg kowesifazane one-BMI evamile (phakathi kuka-19 no-24). Lokhu kuzuza kwesisindo kuhambisana nesisindo somntwana, ama-appendages ayo (i-placenta, i-amniotic cavity), izicubu ezinomzimba wazo okhulayo ngesikhathi sokukhulelwa (isibeletho, amabele), uketshezi lomzimba kanye nemithombo yamafutha.

Ngokuya ngokulingana okujwayelekile komzimba nokuma komzimba, lokhu kuzuza kwesisindo okugxilile esiswini kubangela ukuguquguquka kwesikhungo sokudonsela phansi phambili. Ngesikhathi esifanayo, ama-hormone okukhulelwa (i-relaxin, i-estrogen, i-progesterone) abangela ukuphumula kwe-ligament okunomthelela kulo lonke uhlelo lwe-musculoskeletal futhi kungabangela izinhlungu ezihlukahlukene esifundeni se-lumbar kanye ne-pubic symphysis ikakhulukazi.

Ezingeni elishisayo, ngaphansi komphumela wokukhishwa kwe-progesterone, kukhona ukwanda okuphawulekayo kokushisa komzimba (> noma = aÌ € 37 ° C) phakathi ne-trimester yokuqala yokukhulelwa.

Ngokuqondene nesimiso somzimba sokuzivikela ezifweni, ukukhulelwa kudinga isimo sokuzivikela komzimba ukuze kunganqabi umbungu othakwe “nomzimba wangaphandle” ngumzimba kamama. Abesifazane abakhulelwe ngakho-ke bangenwa kalula yizifo.

I-basal metabolism ikhuphuka ngesilinganiso esingama-20% ukuze kuqinisekiswe umsebenzi owengeziwe wenhliziyo namaphaphu futhi inikeze amandla adingekayo ku-fetus kanye nezijobelelo zayo. Ngesikhathi sokukhulelwa okumbili kokuqala kokukhulelwa, umama okhulelwe uzoqongelela izinqolobane, ikakhulukazi i-lipid, ezohlanganiswa ku-trimester yesithathu ukuqinisekisa ukukhula okusheshayo kwengane. Izidingo zamandla ngakho-ke zandiswa cishe ngama-300 kcal ku-trimester yesibili kanye nama-400 kcal ku-trimester yesithathu.

Ukuze kuqinisekiswe ukutholakala kweglucose okuzinzile (umthombo oyinhloko wamandla ku-fetus), kwenziwa izindlela ezahlukahlukene: i-glycemia (izinga likashukela egazini) liyehla, ukukhiqizwa kwe-insulin (ihomoni ekhiqizwe amanyikwe futhi ebhekele ukulawula ushukela wegazi) kuyenyuka. , kanjalo nokumelana ne-insulin.

Ngesikhathi sokukhulelwa, umzimba uvame "ukudla ngokweqile".

Umphumela wenhliziyo ukhuphuka kusukela ku-trimester yokuqala cishe ngama-20%, bese kuba ngu-40% ekupheleni kwenyanga yesithupha yokukhulelwa. Lokhu kuphumela ekwenyukeni kwezinga lokushaya kwenhliziyo okungu-10 kuye kwayi-15 ngomzuzu.

Kuma-trimesters wokuqala nowesibili, umfutho wegazi uyancipha ngenxa yesimo se-vasodilation ngenxa yamahomoni akhulelwe. Phakathi namasonto, isibeletho sicindezela imithambo emikhulu kakhulu ikakhulukazi i-inferior vena cava. Kulandela ukwehla kokubuya kwe-venous, ngakho-ke i-hypotension.

Ezingeni lokuphefumula, izidingo ze-oxygen zikhuphuka ngo-20 kuya ku-30% ukuhlangabezana nezidingo ze-fetus kanye ne-placenta. Kozoba umama, lokhu kuphumela ekungeneni umoya ngokweqile: izinga lokuphefumula kwakhe kanye nevolumu yokuphefumula (inani lomoya ophefumulelwe futhi okhishwe ngokunyakaza ngakunye kokuphefumula) kuyakhuphuka. Ngakho-ke umuzwa wokuphelelwa umoya uvamile.

Kusukela ekuqaleni kokukhulelwa, kukhona i-hypervolemia, okusho ukuthi ukwanda kwevolumu yegazi. Umthamo we-plasma ukhuphuka kancane kancane usuka emavikini ama-5 kuye kwayi-9 we-amenorrhea kuze kube amasonto angama-32 ngaphambi kokuzinza. Ku-trimester yesithathu, umthamo wegazi uphakeme ngo-30 kuya ku-40% kunokukhulelwa kwangaphandle. Le hypervolemia yenza kube nokwenzeka ukunxephezela ukwanda kokuphuma kwenhliziyo, ukumboza izidingo ze-oxygen eyengeziwe kanye nokunciphisa imiphumela yokopha okungenzeka ngesikhathi sokubeletha.

Isibalo samangqamuzana abomvu egazi nawo ayanda kodwa ngokwesilinganiso angaphansi kwevolumu ye-plasma, ngakho-ke sibona ukuncipha kokuhlushwa kwe-hemoglobin okubangela lokho okubizwa ngokuthi i-physiological anemia yokukhulelwa.

Uma kubhekwa ukubeletha nokubeletha, izimo ezimbili ezinengozi enkulu yokopha, izici eziningi ze-coagulation zanda kancane kancane ngesikhathi sokukhulelwa.

Ngesikhathi sokukhulelwa, ubukhulu nesisindo sezinso kuyanda. Ukusebenza kwabo kuyanda impela ukuze kunxeshezelwe ukwanda kokugeleza kwegazi. Ngakho-ke, inani legazi elihlungwa yizinso zowesifazane okhulelwe lenyuka ngo-25 kuya ku-30%. Esontweni lama-20 lokukhulelwa, isenzo esiphumuzayo se-progesterone sibangela ukuthi izinso nama-ureters avuleke, okuthuthukisa ukumila komchamo, okwandisa ingozi yokutheleleka ngomgudu womchamo. Ngesikhathi esifanayo, isibeletho sicindezela isinye ngokuqhubekayo, okuholela ekwehleni kobukhulu baso futhi ngenxa yalokho izifiso ezivamile zokuchama (pollakiuria).

Umsebenzi wesisu wehlisa ijubane ngenxa yokwehla okungama-40% kokuphuma kwesisu, ukuhamba kanye nethoni yesisu. Okuhlotshaniswa nokuncipha kwethoni ye-cardia (imisipha ye-valve eqinisekisa ukuvala i-orifice engenhla yesisu) ngaphansi komphumela wama-hormone, ukwanda kwesikhathi sokuthulula kukhuthaza i-reflux yesisu (pyrosis) kwabesifazane abakhulelwe.

Isikhathi sokuthutha siphinde selulwe emathunjini. Embuzweni, umphumela wokuphumula we-progesterone obangela ukufinyela okuncane kwemisipha ebushelelezi yamathumbu. I-peristalsis yamathumbu (ukunyakaza kwemisipha okuvumela ukuthi i-bolus yokudla iqhubekele phambili emathunjini) ngakho-ke ayisebenzi kahle, okukhuthaza ukuqunjelwa.

Ukukhulelwa kwe-Hormonal kanye nezinguquko ze-metabolic, immunological and circulatory kungaholela ekubonakalisweni kwesikhumba okuhlukile kozoba ngumama:

• hyperpigmentation, ikakhulukazi kwabesifazane abane-phototype emnyama. Ithinta kakhulu izindawo ezinemibala eminingi: i-mammary areola, i-nito-anal region, i-peri-umbilical region kanye ne-bebdominal midline (noma i-linea nigra). Ebusweni, le hyperpigmentation ingabonakaliswa imaski yokukhulelwa (chloasma);
• ama-moles amasha;
• i-stellate angiomas (izilonda zesikhumba ezincane ezibomvu noma ezinsomi ngesimo senkanyezi);
• i-palmar erythema (izandla ezibomvu, ezishisayo);
• hyperpilosity;
• ukujuluka okukhulu kakhulu ngenxa yokwanda kokushisa komzimba, okwenzeka ngenxa yokwanda kokugeleza kwegazi;
• i-acne ngenxa yokungasebenzi kahle kwezindlala ze-sebaceous;
• amamaki anwebekayo ngenxa yokuphazamiseka kwemishini ngenxa yesisindo somzimba kanye nokuguqulwa kwemicu ye-collagen ngaphansi komphumela wamahomoni okukhulelwa.