12-PHYSIOLOGICAL CHANGEGS OF PREGNANCY
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Transcript 12-PHYSIOLOGICAL CHANGEGS OF PREGNANCY
PHYSIOLOGICAL CHANGEGS
OF PREGNANCY
AHMED ABDULWAHAB
Maternal physiologic adjustment to
pregnancy are designed to support the
requirements of fetal needs without affecting
maternal well-being.
The normal values of several hematologic,
biochemical, and physiologic indices during
pregnancy differ markedly from those in the
non pregnant range and also according to
duration of pregnancy.
ALIMENTARY TRACT.
Appetite is usually normal without changes
Pica. Dietary craving or aversion for non
nutritional substances .
Mouth , ptyalism usually associated with
nausea of pregnancy.
Dentition , gum become soft and edemtous.
STOMACH.
Tone and motility decreases because of the
effect the PROGESTERONE hormone and
emptying time of the stomach is prolonged
Gastro esophageal junction sphincter tone
decreases leading to heart burns
Gastric acid secretion decreases and peptic
ulcer disease decreases.
Small bowel motility decrease and increases
iron absorption .
Colon, there is decrease motility resulting in
constipation ,increase water and sodium
absorption and dilatation of hemorrohdial
veins .
Liver
Signs of normal pregnancy that may mimic
liver disease
Spider angiomata and palmer erythema due
to increase estrogen level .
Decrease albumin and increase alkaline
phosphatase .
Nausea and vomiting usually in first
trimester
Respiratory system .
Mechanical changes .
Subcostal angles transverse chest diameter,
and chest circumference increases and the
diaphragm level is pushed up .
Lung volume and pulmonary function .
Tidal volume increase inspiratory capacity
increases, vital capacity decreases
Skin .
Vascular changes , due to estrogen.
Spider angiomata ,palmer erythema.
Striae gravidarum
Pigmentation changes ,increases
melanocyte- stimulating hormones .
Darkening of nipples, areolae ,umbilicus,
axillae , perineum and linea nigra
Chloasma or mask of pregnancy.
Pigmented navi.
Abdominal wall there is separation of the
recti muscles
Urinary system.
Anatomic changes.
Kidneys increase in both length and weight.
Renal pelvis increase resulting in
physiological hydro nephrosis .
Ureters dilate starts by 8 weeks gestation.
Right ureter is larger than the left causing
hydroureter and urinary stasis .
Dilatation is commonly above the pelvic brim.
Consequences.
Increase risk of pyelonephritis and asymptomatic
bacteriuria
Renal function tests.
Renal plasma flow, glomerular filtration rate and
creatinine clearance are all increase more than
50%,
Blood urea creatinine and uric acid all decrease
Glucosuria is common in normal pregnancy
and has no correlation with blood sugar
level .
Aminoaciduria .
Increase excretion of water soluble vitamin
folate and vitamin B 12
Cardiovascular system.
There is a change in the position of the
heart.
Normal changes in heart sound include.
Exaggerated splitting of S1
Gallop pulse in 90% of normal pregnancy
Systolic ejection murmur .
Mammary souffle
EKG is unchanged except for left axis
deviation.
Increase cardiac output by 40% due to
increase in both stroke volume and heart
rate .
Cardiac output depends on maternal
position ,it is lowest when in supine position
. Supine hypotension syndrome.
Blood pressure .
There is a progressive decrease in both
systolic and diastolic pressure , after 24
weeks the pressure gradually increase and
return to non pregnant level by term.
Central venous pressure remain unchanged
.
Hematological changes .
Plasma volume increase 50% by term it
begins by 10 weeks and plateaus at 30
weeks gestation there is more increase in
multiple pregnancy or larger fetuses .
Red blood cell increases by 30% at term .
Physiological anemia result because the
plasma volume increases more than RBC.
Leukocyte and platelets.
White blood cell mostly PMN granulocytes
increases progressively in pregnancy.
Platelets slightly decrease.
Coagulation system.
Pregnancy is a hyper coagulable state.
Fibrinogen increase by 50% .
Factors V11 ,V111,1X,and X all increases
Iron metabolism .
Absorption depends on pregnancy state and
bone marrow iron stores ,40% absorption in
the iron deficient state .
The total iron requirement is 1000 mg and
the daily requirement is 3.5 mg .
Maternal iron deficiency does not affect fetal
iron stores because of active iron transport
across the placenta.
Endocrine and metabolic changes.
Thyroid gland .it increase in size.
Thyroid binding globulin increases as a result of estrogen
stimulation of the liver .
The active unbound form remain unchanged or slightly
decrease.
The following thyroid hormones do not cross the placenta
T3, T4,and TSH , thyroid immunoglobulins crosses the
placenta as well ass anti thyroid medication
Adrenal gland.
Total and free cortisol increase by two fold
Aldosterone secretion is markedly increase .
Deoxycortisone level increases.
Pancreas there hypertrophy and hyperplasia
.
Fasting blood glucose is lower than in non
pregnant state