Ans: a (Increased peripheral resistance) Ref: Dutta, 6th ed, p.In pregnancy due to the effect of progesterone, NO, prostaglandins or ANP there will be smooth muscle relaxation leading to decrease in systemic vascular resistance. So there is an overall decrease in diastolic BP and mean arterial BP.Changes in pregnancySkin changes around- Chloasma gravidarum or pregnancy mask is an extreme form of pigmentation the cheek, forehead and eyes.Linea nigra- Brownish black pigmented area in the midline, stretching from the xiphistemum to the pubis symphysis. Cutaneous changes are due to melanocyte stimulating hor mone from anterior pituitaryWeight gain- Total wt gain in a singleton pregnancy: 11 kg (average)Amount ot water retained during pregnancy at term is estimated at 6.5 litres.Hematological changesBlood volume is markedly raised to 30 - 40 %Plasma volume increases by 40- 50%Red cell volume increases by 20 - 30%Because plasma volume increases by 40-50% and red cell volume only by 20-30% there is haemodilution in pregnancy.Fibrinogen is raised by 50%ESR shows 4 fold increaseCardiovascular changesApex beat shifted to 4th ICSPulse rate increasedSplit 1st soundSystolic murmurMammary murmurStroke volume increasesCardiac output increased by 40%Mid pregnancy - drop in diastolic BPVenous pressure is increasedPeripheral resistance is decreasedX - ray--enlarged cardiac shadowECG--left axis deviationNote:Cardiac output starts to increase from 5th week of pregnancy reaches its peak (40-50%) at 30-34 weeks. Cardiac output further increases during labour (+50%) and immediately following delivery (+70%) over the prelabour values.Indicators of heart disease during pregnancyCyanosisClubbingPersistent neck vein distensionSystolic murmur greater than grade 3Diastolic murmurCardiomegaly