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Physiological Changes in Pregnancy

Physiological Changes in Pregnancy

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Published by: subvig on Aug 06, 2009
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3.8.2.1. Cardiovascular changes in pregnancy
Cardiovascular changes in pregnancy
[Ref: PK1:p346-368] 
HaemodynamicsHeart rate
Occurs as early as 4 weeks after conception
Increases by 17% by end of 1st trimester
Increases to 25% at the middle of 3rd trimester 
Stroke volume
Increased by 20-30%
Most of the increase occurs in 1st trimester 
Total peripheral vascular resistance
Decreases by 30% at 12th week
By 35% by 20th week
Due to vasodilation mediated by progesterone, prostaglandins, and down-regulation of alpha-adrenergic receptors
Also due to placental blood flow, which acts as an AV-shunt* [KB2:p248]
Cardiac output
Increase progressively throughout pregnancy
40-45% above non-pregnant values at 12th to 28th week
Reach peak of 50% during 32-36th week
Then decrease slightly to 47% above non-pregnant level at termNB:According to [KB2:p248], cardiac output increases by 30% only
Causes of cardiac output increase
Venodilation
Increased vascular volume* Caused by oestrogen
Blood pressure
Decreased in mean arterial blood pressure
Systolic BP and diastolic BP decrease by 10%
????Stable after 20weeks
 
 
Others
Central venous pressure and pulmonary capillary wedge pressure--> UnchangedOncotic pressure falls by 14%--> Predisposition to oedema
Blood flow and volumeBlood flow changes
Uteroplacental blood flow increase to 750mL/min at term* 85% goes to the placenta
Renal blood flow increase by 80% in the first trimester
Also increased blood flow to skin, breast, and GIT
Cerebral and hepatic blood flow unchanged
Aortocaval compression syndrome
Occurs in about 15% of women near term
When supine--> Compression of inferior vena cava--> Decreased venous return and cardiac output--> Hypotension, pallor, nausea, and vomiting
May develop as early as the 20th week
May also be associated with uterine arterial hypotension and reduceduteroplacenta perfusion
May be prevented by lying on the left side
Maternal blood volume
Near term
Maternal blood volume is increased by 35-40% (about 1000-1500mLs)
Plasma volume increases by 45%* Due to sodium and water retention by oestrogen stimulation of renin-angiotensin system.
RBC volume increases by 20%* Due to increased renal erythropoietin synthesisThus
The increase in RBC volume is relatively less than the increase in plasmavolume--> Haematocrit falls to 33%--> Physiologic anaemia of pregnancyNB:According to [KB2:p248],* Blood volume increase by 40-45%* Plasma volume increase by 50%
 
* RBC volume increase by 30%* Most of the increase occurs in the first 2 trimester
Labour
During labour, each uterine contraction squeezes about 300mL of blood into thecentral maternal circulationDuring labour, cardiac output:
Increase by 15% during latent phase of labour
Increase by 30% during the active phase
Increase by 45% during the expulsive stage Maternal systolic and diastolic arterial BP increase by 10-20mmHg during uterinecontraction
After delivery
Cardiac output and BP returns to non-pregnant level by 2 weeks after delivery
Respiratory changes in pregnancy
[Ref: PK1:p349-350] 
Changes to anatomyDiaphragm
Diaphragm is displaced upwards by about 4cm* Contraction is NOT marked restricted
Thoracic cage
Anteroposterior and transverse diameters increase by 2-3 cm* Due to lower ribs flare out and increase in subcostal angle (from 68 to 103degrees)
Circumference increase by 5-7cmThese changes are due to relaxin* Secreted by corpus luteum* Relaxes ligament attachments of the ribs
Other changes
Capillary engorgement throughout respiratory tract--> Vocal cord may be swollen/oedematous
According to [AA4:p630]* Difficult intubation in term pregnant women is 1 in 300, compared with 1

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