Pregnancy-Physiology-edited-13-09-10.ppt

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  • Total Lung Capacity (TLC) Functional Residual Capacity (FRC) Residual Volume (RV) Forced Expiratory Volume in 1 sec (FEV1)
  • Pregnancy-Physiology-edited-13-09-10.ppt

    1. 1. PHYSIOLOGY IN PREGNANCY
    2. 4. On the Brink of Birth <ul><li>A full term fetus, is shown in its mother’s womb in this Leonardo da vinci drawing. One of the first accurate renderings of a part of the human anatomy. The smaller sketches depict details of the uterus. Of all the triumphs of the body, its crowning glory is the power to reproduce its kind and pass some of its hereditary characteristics on to later generations. </li></ul>
    3. 5. Embryo to Fetus fifteen days twenty-one days thirty days thirty-four days six wks eight wks Life: One Seed + One Egg Life begins when an egg, previously released from one of the two ovaries, merges with just one of the hundreds of millions of sperm cells supplied through the vagina by the male reproductive system. The fertilized egg then descends to the wall of the uterus, where it implants itself to begin gestation .
    4. 6. Fetus
    5. 7. The average weight of the Indian baby at 40 weeks of pregnancy is 2,750Gms at birth.
    6. 8. New Born A healthy new born cries vigorously as soon as he is born, kicking his limbs actively, giving the greatest joy to the tired mother.
    7. 9. INTRODUCTION <ul><li>Pregnancy causes physiologic changes in all maternal organ systems; most return to normal after delivery. </li></ul><ul><li>In general, the changes are more dramatic in multifetal than in single pregnancies. </li></ul><ul><li>Major adaptations in maternal anatomy, physiology, and metabolism. </li></ul>
    8. 10. BODY WATER METABOLISM <ul><li>Condition of chronic water overload </li></ul><ul><li>Active Na and water retention </li></ul><ul><li>1. Changes in osmoregulation </li></ul><ul><li>2. Renin-angiotensin system </li></ul><ul><li>Body water increase 6.5L  8.5L </li></ul><ul><li>1. 1500 cc increase in blood vol </li></ul><ul><li>2. RBC increase ~400cc </li></ul>
    9. 11. OSMOREGULATION <ul><li>Na retention increases 900 mEq but serum Na decreases 3-4 mmol/l </li></ul><ul><li>Plasma osmolarity decreases 10 mOsm/kg </li></ul><ul><li>Enhanced tubular reabsorption of Na secondary to aldosterone,estrogen and deoxycorticosterone. </li></ul>
    10. 12. CARDIOVASCULAR CHANGES <ul><li>Heart </li></ul><ul><li>Displaced to the left and upward </li></ul><ul><li>Apex is moved laterally </li></ul><ul><li>Apparent cardiomegaly on chest x-ray </li></ul><ul><li>Increase in left ventricular end-diastolic dimension </li></ul><ul><li>Cardiac output (CO) increases </li></ul>
    11. 13. RESPIRATORY CHANGES <ul><li>Upper Respiratory Tract </li></ul><ul><li>Hyperemia and edema induced by estrogen </li></ul><ul><li>Nasal stuffiness and epistaxis </li></ul><ul><li>Mechanical changes </li></ul><ul><li>earlier than mechanical pressure of rising uterus </li></ul><ul><li>Chest circumference expands 5-7 cm </li></ul><ul><li>Subcostal angle increases from 68 to 103 degrees </li></ul><ul><li>Transverse diameter increases 2cm </li></ul><ul><li>Level of diaphragm rises 4cm but excursion is not impeded </li></ul><ul><li>Respiratory muscle function is not affected by pregnancy </li></ul>
    12. 14. LUNG VOLUME AND PULMONARY FUNCTION <ul><li>Elevation of the diaphragm decreases the volume of the lungs in the resting state, reducing Total Lung Capacity (TLC) by 5% </li></ul><ul><li>Functional Residual Capacity (FRC) by 20% FRC mainly decreased by Residual Volume (RV) </li></ul><ul><li>Vital capacity does not change </li></ul><ul><li>Spirometry is not changed in pregnancy </li></ul><ul><li>Forced Expiratory Volume in 1 sec (FEV1) is unchanged </li></ul><ul><li>Peak flow is unchanged </li></ul>
    13. 15. HEMATOLOGIC CHANGES <ul><li>40-50% increase in blood volume beginning at 6 weeks and plateaus at 30 weeks </li></ul><ul><li>Both plasma volume and cell mass increase </li></ul><ul><li>Physiologic anemia of pregnancy at 30 weeks </li></ul><ul><li>Increase in erythropoietin and reticulocyte count </li></ul>
    14. 16. IRON METABOLISM <ul><li>Iron (Fe)  bound transferrin  transported to liver, spleen, muscle and bone marrow  incorporated into hemoglobin and myoglobin </li></ul><ul><li>1000mg iron requirement, about 3.5 mg/dL of Fe </li></ul><ul><li>Requirements increase in third trimester </li></ul><ul><li>Fetus receives Fe through active transport </li></ul>
    15. 17. IRON SUPPLEMENTATION <ul><li>Iron supplementation usually not needed before 20 weeks </li></ul><ul><li>30mg of elemental FE  325 mg ferrous gluconate </li></ul><ul><li>Fe supplements </li></ul><ul><li>Ferrous sulfate ( 65mg elemental Fe) </li></ul><ul><li>Ferrous gluconate (35mg of elemental Fe) </li></ul>
    16. 18. PLATELETS <ul><li>Progressive decline in count from 1 st -3 rd tri </li></ul><ul><li>Increased platelet destruction </li></ul><ul><li>Gestational thrombocytopenia of pregnancy </li></ul>
    17. 19. OTHER HEMATOLOGIC CHANGES <ul><li>Leukocytosis secondary to neutophils </li></ul><ul><li>Estrogen induced </li></ul><ul><li>Cortisol induced </li></ul><ul><li>Altered immune status </li></ul><ul><li>Modulation away from cellular immunity towards humoral immunity </li></ul><ul><li>Paradoxical decline of immunoglobins A,G,M </li></ul><ul><li>Only IgG crosses the placenta </li></ul>
    18. 20. URINARY SYSTEM <ul><li>Anatomic Changes </li></ul><ul><li>Renal hypertrophy </li></ul><ul><li>Dilation of renal pelvis/calyces </li></ul><ul><li>15mm on the right in 3 rd trimester </li></ul><ul><li>5mm on the left </li></ul><ul><li>Predisposition to pyelonephritis in the presence of asymptomatic bacteriuria </li></ul><ul><li>Dilation of ureters to 2 cm </li></ul><ul><li>Mechanical compression </li></ul><ul><li>Progesterone-induced smooth muscle relaxation </li></ul>
    19. 21. BLADDER CHANGES <ul><li>Bladder trigone elevation occurs with increased vascular tortuousity throughout the bladder leading to microhematuira </li></ul><ul><li>Decrease bladder capacity </li></ul><ul><li>Increased frequency of micturition. </li></ul>
    20. 22. DIGESTIVE TRACT CHANGES <ul><li>Addition of 300 kcal/day </li></ul><ul><li>Gingivitis of pregnancy </li></ul><ul><li>Stomach </li></ul><ul><li>Gastroesophageal reflux </li></ul><ul><li>Gastric compression due to enlarging uterus </li></ul><ul><li>Decrease sphincter tone </li></ul>
    21. 23. <ul><li>Small bowel </li></ul><ul><li>Motility is reduced due to progesterone allowing for more efficient absorption </li></ul><ul><li>Large bowel </li></ul><ul><li>Decreased transit times allows for both water and sodium absorption </li></ul>
    22. 24. <ul><li>Liver </li></ul><ul><li>Size and histology are unchanged </li></ul><ul><li>Clinical and laboratory changes mimic disease states </li></ul><ul><li>Palmar erythema </li></ul>
    23. 25. SKELETAL AND POSTURAL CHANGES <ul><li>Lordosis of pregnancy~ progressive increase in anterior convexity of the lumbar spine </li></ul><ul><li>Preserves center of gravity </li></ul><ul><li>Ligaments of the symphysis and sacroiliac joints loosen during pregnancy due to relaxin </li></ul>
    24. 26. ENDOCRINE CHANGES <ul><li>Thyroid Physiology </li></ul><ul><li>Euthyroid state </li></ul><ul><li>Increase in thyroxine-binding globulin </li></ul><ul><li>Slight thyromegaly </li></ul><ul><li>T4 and T3 remain normal </li></ul><ul><li>Fetal thyroid active by 12 weeks gestation </li></ul>
    25. 27. <ul><li>Adrenal function </li></ul><ul><li>Increases in corticosteroid-binding globulin </li></ul><ul><li>Increases in free cortisol </li></ul><ul><li>Zona fasciculata is increased </li></ul><ul><li>Marked increase in CRH from placental sources </li></ul><ul><li>Delayed plasma clearance of cortisol due to renal changes </li></ul><ul><li>Resetting of hypothalamic-pituitary sensitivity to cortisol feedback on ACTH production </li></ul>
    26. 28. <ul><li>Pituitary gland </li></ul><ul><li>Enlarges due to proliferation of prolactin-secreting cells </li></ul><ul><li>Enlargement makes it more susceptible to alterations in blood flow, ie PPH </li></ul><ul><li>Prolactin levels are increased (ten times higher at term) to prepare breasts for lactation </li></ul>
    27. 29. <ul><li>Pancreas and Fuel Metabolism </li></ul><ul><li>Physiologic glucose intolerance to ensure continuous transport of nutrients from mother to fetus </li></ul><ul><li>Fasting hypoglycemia </li></ul><ul><li>Postprandial hyperglycemia </li></ul><ul><li>Hyperinsulinemia </li></ul>
    28. 30. <ul><li>Diabetogenic effects of pregnancy </li></ul><ul><li>Cortisol </li></ul><ul><li>Prolactin </li></ul><ul><li>Estrogen and progesterone </li></ul><ul><li>Fetal glucose levels are 20 mg/dl less than maternal values </li></ul>
    29. 31. INTEGUMENTAL CHANGES <ul><li>Hyperpigmentation </li></ul><ul><li>90% of pregnancies </li></ul><ul><li>Localized to areas of increased melanocytes </li></ul><ul><li>Chloasma of pregnancy </li></ul>
    30. 32. Thank You

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