Although usually asymptomatic, hemorrhage into the CYStS can cause acme abdominal pain (Amoah. 2011). Maternal virilization may be seen in up to 30 percent of women, however, virilization of the fetus has only rarely been reported (Malinowski. 2015). Maternal indings that include temporal balding, hirsutism, and clitoromegaly are associated with massively elevated levels of androstenedione and testosterone. The diagnosis typically is based on sonographic findings of bilateral enlarged ovaries containing multiple cysts in the appropriate clinical settings. The condition is self-limited and resolves following delivery. Its management is reviewed by Malinowski (2015) and discussed further in Chapter 63 (p. 1199).
The fallopian rube musculature, rhat is, the myosalpinx, undergoes little hypertrophy during pregnancy. The epithelium of the mdosnpinxsomwhat Ranens. Decidual cells may develop in rhe stroma of the endosalpinx, but a continuous decidual membrane is not formed.
Rarely, a fallopian tube may twisr during uterine enlarge� mem (Macedo, 2017). This torsion is more common with comorbid pararubal or ovarian cysts (Lee, 2015).
During pregnancy, greater vascularity and hyperemia develop in the skin and muscles of the perineum and vulva, and the underlying abundant connective tissue softens. This augmented vascularity prominently afects the vagina and cervix and results in the violet color characreristic of Chadwick sign.
Within the vagina, the considerably elevated volume of cervical secretions during pregnancy forms a somewhat thick, white discharge. The pH is acidic, varying from 3.5 to 6. This pH results from increased production of lactic acid by lactobacillus acidophi/us during metabolism of glycogen energy stores in the vaginal epithelium. Pregnancy is associated with an elevated risk of vulvovaginal candidiasis. particularly during the second and third trimesters. Higher infection rates may stem from immunological and hormonal changes and from greater vaginl glycogen stores (Aguin. 2015).
The vaginal walls undergo striking changes in preparation for the distention that accompanies labor and delivery. These alterations include considerable epithelial thickening, connective tissue loosening, and smooth muscle cell hypertrophy.
Pelvic Organ Prolapse Quantiication (POP-Q) and threedimensional sonography studies show that vaginal suppOrt changes across pregnancy. In particular, vaginal lengthening, posterior vaginal wall and hiatal relaxation, increased levaror hiaral area, and greater irst-trimester vaginal elastase activity are all associated with uncomplicated spontaneous vaginal delivery (Oliphant. 2014). The larger hiatal area persists in women who deliver vaginally compared with women delivering by prelabor or early-labor cesarean delivery. However. all women show greater hiatal distensibility after delivery, which is potentially a facror in later pelvic floor dysfunction (van Veelen, 2015).
In women with apical vaginal prolapse. the cervix, and occasionally a portion of the uterine body, can protrude variably from the vulva during early pregnancy. With further growth. the uterus usually rises above the pelvis and can draw the cervix up with it. If the uterus persists in its prolapsed position, symptoms of incarceration may develop at 10 to 14 weeks' gestation (Chap. 3, p. 46). s a preventive measure. [he urerus can be replaced early in pregnancy and held in position with a suitable pessary.