Читать книгу Ridley's The Vulva - Группа авторов - Страница 126

Several changes occur during pregnancy, mainly related to increased production of hormones via the placenta. There are changes in blood flow, pigmentation, and in the immune response (see above). A fivefold increase in blood flow through the pelvic circulation occurs during the first two months of pregnancy, and this doubles again during the third month. Progesterone causes increased venous distension, which predisposes to vulval varicosities (see Chapter 34). There is increased blood flow in the vulva which can give a bluish appearance. One case of a spontaneous vulval haematoma is described in pregnancy [41]. Isolated vulval oedema can occur in hypoalbuminaemic patients [42].

Figure 3.1 Central loss of hair on mons pubis post menopause.

The rise in oestrogen stimulates increased melanogenesis, particularly in the areolae, nipples, and vulva. Pigmentation of the labia majora, rims of the labia minora, and the perineum can be marked. There may also be facial melasma and linear pigmentation of the anterior abdominal wall, termed linea nigra.

There is an increased incidence of candidiasis during pregnancy, probably as a result of increased glycogenation of the vaginal epithelium and a reduction in cell‐mediated immunity [43]. Candida colonisation of the vagina may be a risk factor for pre‐term birth and treating asymptomatic patients may reduce this, but larger trials are needed to confirm this [44].