PHYSIOLOGIAL CHANGES

DURING PREGNANCY
The Respiratory System

O2 is increased by about 15-20%
 This is to provide for increased cardiac, renal and respiratory
functions and for uterine, breast development and for feto-
placental unit
 To supply this increased O2 requirement the mother hyper
ventilates
 The increase is mainly in the tidal volume rather than the
respiratory rate
 Maternal CO2 falls favoring CO2 transfer from fetus to the
mother. This is probably a progestrone effect
 Dyspnea is common in pregnancy
 Late in pregnancy the diaphragm movement is restricted by the
gravid uterus
The CVS

 The cardiac output increases by 40% from3.5 L/min to 6

L/min.
 This results from increase in both heart rate and stroke volume
It reaches the maximum around 34 weeks
 There is a further increase in C.O by about 2 L in 2nd stage of
labour
 The peripheral resistance falls leading to fall in BP in 2nd
trimester
 In late pregnancy the gravid uterus compresses the IVC
especially when the mother is lying flat on her back, this leads
to hypotension and faintaing (Supine hypotnsive syndrome)
The Skin

 The rise in C.O helps heat loss by increasing blood

flow through the skin therefore compensating for the
increase in BMR .
 The Pt feels warm and it may be a factor in palmar
erythema and spider naevi of pregnancy
 Hyperpigmentation is seen in the face (cholasma),and
mid-line of the abdomen(linea nigra) and around the
nipple (1ry and 2ndry areola) as a result of high
oestrogen level and striae gravidarum or stretch occurs
over the breast and abdomen
Blood, Plasma and E.C Fluid

 RBC mass increase by 25%

 Plasma volume increases by 40%
 Hb conc drops
 Plasma colloid pressure falls this leads to shift of
fluid to extra cellular space and hence oedema
Blood Constituents

 Iron requirements increase (net increased demand

of iron during pregnancy equals 1G)
 Serum ferritin falls
 Serum folate requirements rise from 50 ug to 400
ug
Clotting System

 Pregnancy is a hypercoaguble state

 There is increase in
 serum fibrinogen,platelets,factor VIII and
 There is reduction in
 antithrombin factor III(a naturally occurring anti
coagulant)
 Fibrinolysis is also increased
The Renal System

 The renal blood flow and GFR both increase by

about 60% from early pregnancy to 4 weeks post
partum
 Serum creatinine and blood urea fall
 Glycosuria is common(due to lowered renal
threshold for glucose)
Urinary Stasis

 The renal pelvis and ureter dilate due to the

pressure of the gravid uterus and the effect of
progesterone
 There is increased incidence of UTI
The G.I.(Gastro intestinal ) System

 The gut motility is reduced and gastric emptying is

delayed
 Mandelson syndrome
 Nausea and vomiting is common (HCG effect)
 Gastric acid secretion is reduced
 Peptic ulcer improves but also reflux esophagitis
 Constipation is common
 Rectal hemorrhoids may develop
Liver and Bile Ducts

 Alkaline phosphatase level doubles

 Gall stones may form
 Oestrogen increases serum cholesterol
 Progesterone delays G.B. emptying
 fetusMetabolic Changes
 Extra energy is needed for the developing fetus
and the maternal physiological changes
 BMR is incrased by 20%
 Average weight gain during pregnancy is about 12
Kg
 Inially there is increased sensitivity to insulin but
after mid pregnancy develops insulin resistance
 Pregnancy is diabetogenic state
 Cortisol,Oestrogen,Progestron,HCG,and HPL are
all insulin anagonists
 Glyosuria is common during pregnancy
 Throid Function
 There is increase in Iodine intake during pregnancy
 The level of T3 and T4 but oestogen induces the
synthesis of thyroid binding globulin so the level of
T3 and T4 may remain normal or slightly falls

 Calcium homestasis
 Fetal skletal development requires 20-30 g of
calcium .There is increased maternal absorption of
calcium to meet this
 Calcium transfer across the placenta is an active
process ocuring against a concentration gradient
 Maternal Ca level may remain unchanged or be
slightly reduced due to fall in serum albumin