The Fallopian tubes and ovaries are drawn nearer to the body of the uterus; the former, instead of being on level with the fundus, now correspond to the upper fourth, or even to the middle of the uterus. This results form the ascent of the womb above the pelvis, by which the folds of the peritoneum, called the broad ligaments, prolonged into the pelvic cavity to reach and support the uterus, are shortened and caused to disappear. The round ligaments are carried forward by the greater development of the anterior than of the posterior wall of the uterus, so that insertions, instead of being at the sides of the womb, are not found at the point of union of the anterior fifth with the posterior four-fifths of the antero-posterior diameter.
The bladder, during the early months of pregnancy, is gradually pushed above the superior strait; the urethra is elongated, and its orifice concealed behind the border of the symphysis pubis. The anterior projection of the bladder renders the line of the urethra much more curved; so that its course will be more readily followed by the male catheter, with its convex surface backwards and its concave surface, than with the nearly straight one ordinarily used for females. The gravid uterus rests down upon the posterior surface of the urethra, and by compression it against the arch of the pubis often causes an obstruction in its circulation. This may be known by the tumor to be found in such cases behind the symphysis, and by the severe and painfully distressing tenesmus, and even strangury, which not infrequently arise form such compression and irritation of the meatus urinarius. In some of these cases the catheter is requisite, in order to afford temporary relief, until, from quite and rest in the horizontal position, the cause may be removed long enough to allow the irritation to subside, or proper remedies to cure it.
The rectum is pressed upon in a similar posteriorly; hence, in part from the mechanical obstruction, there results the constipation, so common in pregnancy. A similar obstruction of the blood-vessels and lymphatics tends to develop the hemorrhoids and oedema of the vulvae and of the lower extremities, which are so common under such circumstances. These deviations, partaking of a pathological nature, will be more particularly considered, with the other morbid conditions of pregnancy, in the following chapter.
The relaxation of the various pelvic symphyses, especially that of the pubis, which, during pregnancy, occurs in some peculiar constitutions, and which renders locomotion difficult, if not impossible, also results from a morbid condition subsequently to be considered.
The abdomen becomes very much enlarged as pregnancy advances; its parietes being thinned, and on the inferior portion often marked by broad or bluish streaks, which form parallel curved lines, with the convexity towards the pubis. On the median line, from the pubis to the umbilicus, may be observed a brownish streak, which in primiparae, has been deemed a certain sign of pregnancy; a similar dark-colored line has been seen, however, in non-gravid females and in males. After delivery, an oblong tumor is sometimes seen on the median line, especially during any severe exertion. This results from the projection of the bowels where the abdominal parietes have been permanently thinned and weakened by the separation of the aponeurotic fibres. With each subsequent pregnancy, this enlargement becomes greater, until, in some instances, it becomes necessary to bandage it.
The thorax also, with the upward ascent of the large volume of the gravid uterus, experiences important changes. Its base is enlarged; the diaphragm is pressed upward and distended by the stomach and contents of the abdomen; the crowding together obstructs the circulation of the heart and great vessels; respiration is visibly affected, and sometimes the irritability of the distended diaphragm occasions a more or less constant cough.
The mammae, both from original sympathy with the genital organs and in preparation for the performance of their own future function, exhibit remarkable changes during gestation, which may also become diagnostic of the pregnancy itself. These changes are of two kinds, those relating to increase in size, and those which affect the color of the surrounding the nipple. Very soon after the commencement of pregnancy, in many women, the breasts become more full and somewhat tender, they have evidently assumed a more vigorous physiological activity. This increase in the volume of the mammae will sometimes diminish towards the fourth or fifth month, but to return again and become still greater towards the close of gestation. The nipples also become turgid and more prominent; the same increased activity already mentioned as apparent in the mammae in general, is particularly evident in the nipple; their erectile tissue becomes more permanently developed, as if in sympathy with the corresponding hypertrophy of the mucous coat of the uterus.
The areola around the nipples becomes much darker. And in the centre of the areola, immediately surrounding the base of the nipple, may be seen quite a number of minute glands, from which may be squeezed a serous, and, in the advanced stages of pregnancy, a sero-lactescent liquid. These changes in the size of the nipple, in the color of the areola, and in the development of the glandules, make their appearance in the course of the third month.
About the same time with these, blue veins begin to make their appearance over the surface of the bosom; from which numerous branches are given off to the areola. In connection with these venous trunks may sometime be seen certain shining silver lines, linea albicantes; both the enlarged veins and the silvery streaks are more prominent in the breasts of primiparae. The change of the areola from the delicate pink tinge of the virgin to a more or less dark shade in the first pregnancy, remains permanent thereafter; thee color becoming darker at the accession of each subsequent pregnancy. But a more particular statement of the changes in the structure and appearance of the mammae will be given when we come to study them in the next chapter as signs of pregnancy.
Generally speaking, these changes in the external form of the female in pregnancy, but partially disappear after parturition. Where the abdomen has been so greatly distended, certain folds or wrinkles will still remain as consequences. So the hernia-like protrusion of the bowels along the median line below the umbilicus, which has been mentioned as resulting form the separation of the fibres of the aponeurosis on that line, unless remedied by appropriate treatment, will tend to increase rather than to diminish. Neither does the discoloration of the areola every entirely fade away; it always remains as evidence that pregnancy has existed. and yet not as of itself affording conclusive evidence, for this discoloration may be the result of uterine irritation, in females who have never been enceinte, just as the breasts may enlarge form sympathy with enlargements of the uterus, which are caused by the development of tumors or other morbid growths.
