OTHER HEMATOLOGIC CHANGES: WBC count increases Platelet count decreases, but stays within normal limits
COAGULATION SYSTEM: Pregnancy is a "hypercoagulable state" Increased levels of fibrinogen, factor VII-X The placenta produces a plasminogen activator inhibitor
CLINICAL SIGNIFICANCE: Blood loss is well-tolerated during labor. However: maternal vital signs DO NOT change for blood loss of up to 1500 cc, Therefore: vital signs cannot be trusted as an indicator of blood loss.
Gastrointestinal System Decreased motility, due to influence of progesterone Reduced gastric acid secretion
Gastrointestinal System CLINICAL SIGNIFICANCE: A pregnant woman is considered to have a full stomach even if she has had nothing to eat or drink for several hours. Peptic ulceration is rare during pregnancy.
Reproductive System Weight of the Uterus increases from 70 gm to 1100 gm Blood flow: increases to about 750 cc/min, or 10-15% of cardiac output
PREGNANCY WEIGHT GAIN BY ORGAN SYSTEM: Fetus: 7 pounds Placenta and amniotic fluid -- 3 pounds Blood volume-- 4 pounds Breasts-- 2 pounds Maternal fat-- 4 pounds ANTICIPATED TOTAL: 20 pounds
Average weight gain THERE IS NO SUCH THING AS “OPTIMAL” WEIGHT GAIN Normal BMI: 20 lbs Underweight BMI: 30 lbs Overweight BMI 16 lbs
Daily dietary requirements Calories: Increased 15% to ~ 2200 cal/day Protein: An additional 10 to 30 gm /day ~ 75 gm/day total Iron supplementation 30 to 60 mg per day
Calcium: 1200 mg needed per day, usually provided by a quart of milk per day or 2 Tums/day, Folate: supplement 200 to 400 mcg per day In women with a prior history of having a baby with a neural tube defect, supplementing with 4 mg per day (4000 mcg) has been shown to decrease the risk of a recurrence in the next pregnancy
The pregnant patient is best served by having a healthy balanced diet with iron and folate supplementation. Only rarely are other vitamin supplements necessary