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Pregnancy Physiology 2

Prepared by:

Dr. Gehanath Baral


MBBS,DGO,MD
Senior Consultant Gynecologist & Obstetrician: Government of Nepal
Visiting Professor: CTGU
15th March,2007
Pregnancy changes in
organs/systems

 Skin  Pulmonary
 Wt gain  Renal
 CVS  Endocrine
 Hematology  Lipid
 GIT  Iron
 Shunts
Skin

1. Stria gravidareum

2. Spider angiomata/palmer erythema

3. Linea nigra

4. Chloasma
Weight gain=11kg(at term)
 Reproductive=6kg  Maternal =5kg
1. Fetus =3 kg
1. Blood vol = 1 kg
2. Placenta =0.5kg
2. ECF = 1 kg
3. Liquor =1 kg
3. Fat & protein =3 kg
4. Uterus =1 kg

5. Breast =0.5kg
Rate of wt gain

 Rapid   Stationary/Falling
>0.5kg/wk  pre- IUGR/IUFD
eclampsia
CVS: Arterial BP
 Normally never elevated

 S&D BP both decrease in 1st trimester 

 lowest by 24-28 weeks 

 slow rise towards term

 D falls>S fall
CVS: Venous BP

1. CVP unchanged

1. FVP increases 2-3x by 30 weeks


Plasma vol/PVR
 Plasma volume  PVR
1. Increases up to 1. Decreases by
50% 30%

2. Maximum by 30 2. Lowest by 20
weeks weeks

3. More on multiple 3. Enhances


pregnancy uteroplacental
perfusion
Cardiac output
(SV x HR=BP/PVR)
 High  SV increase by
1. Up to 50% by 20 30% by end of 1st
weeks trimester
2. Lateral position
3. Labor

 Low Supine  HR increases by


position 20bpm by 3rd
trimester
Regional blood flow

 Uterine  50750ml/min

 Kidney  8001200ml/min

 Lungs  68.5L/min
Murmurs:

1. Systolic ejection Murmur at A&P


valve Normal

2. Diastolic murmur  Abnormal


Hematologic:1/2
 Physiologic dilution  Apparent anemia

1. RBC mass 1. + 30%

2. Plasma 2. + 50%

3. Hb/Hct 3. - 15%

 WBC  + 16000/cmm
Hematologic:2/2
1. ESR 1. + due to gamma
globulin

2. Platelets 2. Unchanged

3. Coagulation 3. +1, 7,8,9,10


factors
4. - (till15 min after
4. Fibrinolysis delivery)
GIT: Stomach

1. - Motility &

2. + Emptying time

3. + Residual volume&

4. Upward pressure by gravid uterus

5. Aspiration
GIT: Large bowel

1. - motility

1. +transit time

2. +fluid absorption

3. Constipation
Pulmonary:volumes

 Tidal vol(VT)  + 40%

 Minute vol(VE)  + 40%


(VE=VTxRR) (RR unchanged)

 Residual vol  - 20%


Pulmonary: Blood gas

 Respiratory alkalosis:
1. Pco2=4035
2. pH=7.407.45

 Alkalotic urine:
Renal loss of HCO3
Renal anatomy

1. Kidney  + RBF  + size


(Till3months
postpartum)

2. Ureter  + Diameter
Renal function
1. GFR, RBF,  +50%
CrClearance
2. Urea,Cr,Uric  -25%
acid
3. Glucose:  195mg/dl155
tubular mg/dl
reabsorption
threshold
4. Proteinuria  Unchanged
Endocrine:Pituitary

 Pituitary size  +100%

1. Prolactin 1. +10x

2. E,P,GH,CRH/ACTH 2. +

3. TSH,ADH 3. unchanged
Endocrine:Adrenal

 Adrenal

1. Size 1. Unchanged

2. Cortisol production 2. +2-3x


Endocrine:Thyroid

 Thyroid

1. Size 1. +15%

2. TBG 2. +

3. Total T3T4 3. +

4. Free T3T4,TSH 4. Unchanged


Lipid

 Fat store  3kg

 LDL  +40%

 HDL  +15%

 Triglyceride  +50%
Iron

 Non-pregnant  Pregnancy
1. Menstrual loss 1. Need= 1gm
=30mg/month fetus,placenta,RB
2. Need =1mg/day C,obligatory loss
2. 6-7mg/day in 2nd
half of pregnancy
3 shunts
Umbilical Ductus Inferior
vein  venosus  venacava

Rt atrium  Foramen Lt atrium


ovale 

Pulmonary Ductus Descending


artery  arteriosus aorta

3 shunts : 1of 3

 Umbilical
vein 
 Ductus
venosus 
 Inferior
venacava
3 shunts : 2 of 3
 Rt atrium

 Foramen
ovale 
 Lt atrium
3 shunts :3 of 3

Pulmonary
artery 
 Ductus
arteriosus 
 Descending

aorta