MATERNAL PHYSIOLOGI DURING PREGNANCY

AMIN NUROKHIM SMF OBSGIN RS MARGONO SOEKARJO Purwokerto Oktober 2010

PHYSIOLOGIC, BIOCHEMICAL, AND ANATOMIC CHANGES

EXTENSIVE AND MAY BE SYSTEMIC OR LOCAL TELEOLOGIC ALTERATION : maintain a helthy environment for the fetus w.o compromising the mothers health IN MOST INSTANCE, physiologic actifity is increased, but smooth muscle demonstrates decreased actifity. LABORAT ORY VALUES ARE DRAMATICALLY ALTERED FROM NONPREGNANT VALUES UNDERSTANDING OF THE NORMAL PHYSIOLOGIC CHANGES IS ESSENTIAL CIONCIDENTAL DISEASE PROCESSES

GASTROINTESTINAL TRACT
Nutritional requirement are increased. Tend to rest most often. Appetite usually increased, but some women have decreased appetite or experience nausea and vomiting. These symptom may be related to relative levels of HCG

Oral Cavity
GUMS : become hypertrophy and hyperemic, so spongy, friable and bleed easily Salivation may increase, saliva more acid --causing tooth decay

Gastrointestinal Tract
GENERAL MOTILITY is reduced due to increasied levels of progesterone. Gastric emptying is condiderably slowed, transit time of food so much slower that more water is resorbed, leading to constipation. STOMACH AND ESOPHAGUS : hydrochloric acid production exagerated, gastrin hormone increases significantly, resulting in increased stomach volume and decresased stomach pH.

Gastric mucus production increased. Esophageal peristalsis is decreased, accompanied by gastric reflux due to slower emptying time and relaxation of cardiac sphyncter , leading to hearthburn. SMALL and LARGE BOWEL and APPENDIX : As uterus grows and stomach is pushed upward, most areas of the large and small bowel moved upward and laterally Appendix is displaced superiorly.

GALLDBLADDER Hypotonia of smooth muscle wall. Emptying time is slower and often incomplete. Bile can becamo thick, and bile stasis may lead to gallstone formation. Chemical composition of bile is not appreciable altered. Plasma cholinesterase actifity ic decreased.

LIVER
No apparent morphologic change, but there are functional alterations : alkaline phosphatase activity can doble, decrease in plasma albumin and a slight decrease in plasma globulin.

KIDNEYS & URINARY TRACT

RENAL DILATATION Each kidney increase in length by 1 1,5 cm Pelvis renis is dilated up to 60 ml. Ureters are dilated and elongated, widen and become curved--- urinary stasis and residual urine may be present.

RENAL FUNCTION
RENAL FUNCTION CHANGES due to increased maternal and placental homones, including ACTH, ADH, aldosterone, cortisol, hCS , and thyroid hormone. GFR increase about 50 RPL rate increase 25 50 % Glucosuria in more than 50% Proteinuria : 200 300 mg/h is normally, if more than 500mg/h a disease process is suspected.

BLADDER
Displaced upward and flatened in the anterior posterior diameter Uterus pressure leads to increased

urinary frequency. Vascularity increases and muscle tone decreases, increasing capacity up to 1500 ml.

HEMATOLOGIC SYSTEM
BLOOD VOLUME Magnitude of the increase varies according to the size of the women. Hypervolemia begins in the first TM, increases rapidly in the second TM, and palteaus at about 30th week. RED BLOOD CELLS Increase about 33%, depend on iron supplement.

WHITE BLOOD CELLS

Leukocity count increases from 4300 4500/ul to 5000 12.000 /ul In the last TM leuckocyte count : 25000 30000/ul

PLATELETS
THROMBOCYTOPOIESES increases accompanied by progressive platelet consumption. Increases levels of prostacycline, thromboxane, a platelet aggregation factor.

CARDIOVASCULAR SYSTEM
POSITION AND SIZE : displaced upward and somewhat to the left with rotation. Cardiac capacity increases by 70 80 ml, may be

due to hypertrophy . Cardiac output : increases 40 %, reaching maximum at 20 24 weeks. Stroke volume increases 25 30 %. BLOOD PRESSURE : decline slightly . Peripheral resistance = BP : CO --- decline.

PULMONARY SYSTEM
ANATOMIC & PHYSIOLOGIC CHANGES
Capillary dilatation occurs throughout the respiratory tract, leading engorgement of nasopharynx , larynx , trachea, and bronchi.

Causes change voice and breathing trhough the nose difficult Respiratory infection Chest X-rays reveal increased vascular marking in the lun

Diaphragm is elevated as much as 4 cm, rib cage is displaced upward and widen, lower thoraxic diameter is increased by 2 cm.

LUNG VOLUME & CAPACITIES

TIDAL VOLUME : is the volume of gas inspired or expired during each respiration. INSPIRATORY RESERVE VOLUME : is the maximum amount of air that can be inspired beyond normal tidal volume. Expiratory Reserve Volume : is the maximum amount of air that can be expired from resting end-expiratory position. RESIDUAL VOLUME : is the volume of gas remaining in the lung at the end of maximum expiration.

TOTAL LUNG CAPACITY : is total amount of gas in the lung at the end of maximum inspiration VITAL CAPACITY : is maximum volume of gas that can be expired after maximum inspiration. INSPIRATORY CAPACITY : is the TV + IRV, its the maximum volume of gas can be inspired from the resting end-expiratoty position. FUNCTIONAL RESIDUAL CAPACITY = ERV +

RV, its the amount of gas remaining in the lungs at the resting end-expiratory position and the volume of gas with which the tidal air must mix.

TIDAL VOLUME increases gradually ( 35 50%) as prgenancy prgresses. TLC is reduced 4 5% by the elevation of the diaphragm. FRC, RV, and ERV all decrease by about 20%. IC increase 5 10%, reaching a maximum at 22 24 weeks gestation. Hyperventilation of Pregnancy occurs, causing a decrease in alveolar CO2

METABOLISM
WEIGHT GAIN is due to the uterus and its contents, increased breast tissue, blood volume, and water volume in the form of extravascular and extracellular fluid. Average weight gain during pregnancy is 12,5 kg. during normal pregnancy, approximately 1000 g of the weight gain is protein. Plasma lipids increase (plasma cholesterol increases 50%), plasma triglyceride concentration may triple. Ratio LDL/HDL increases during pregnancy