Detailed account of the various changes that occur in maternal anatomy, physiology, and metabolism of pregnant women. These physiological changes are often very precise, and deviations of physiological responses can be a prelude to possible disease/infectious states. In this second part of Labor, we will examine the various systems of the human body,its altered states during pregnancy, and how those changes affect the woman preparing for delivery. Special care is imperative in properly determining the needs of an expecting mother, so developing an intimate, trusting relationship between the mother and fully understanding her physiological output will lead to the best chances of a successful delivery.
This document describes the physiological changes that occur in a woman's body during pregnancy. It discusses changes in the vulva, vagina, uterus, breasts, skin, blood, metabolism, respiratory and cardiovascular systems, urinary system, alimentary system, nervous system, and weight gain. The major changes include increased blood volume and cardiac output, softening of tissues like the cervix, hypertrophy of organs like the breasts, and temporary changes to skin pigmentation and the distribution of weight gain.
The document summarizes the major physiological changes that occur during pregnancy across multiple body systems. Hormonal changes including increased progesterone, estrogen, prolactin, and cortisol levels help prepare the body for pregnancy. The pancreas produces higher insulin levels to regulate increased blood sugar levels and fuel metabolism. The uterus grows substantially larger to accommodate the fetus, and other organs like the cervix, vagina, blood vessels, and respiratory system also undergo changes. Weight gain during pregnancy of 11-16 kilograms is distributed between increased fluid, tissues, the placenta and developing baby. Most systems return to their pre-pregnancy state after delivery.
Endcrinological changes during pregnancyArya Anish
After fertilization, the zygote implants in the uterus by day 5 and the corpus luteum secretes progesterone and hCG to maintain pregnancy until week 8. The placenta becomes fully functional by week 10, taking over hormone production. Pregnancy causes changes in maternal endocrine glands, including increased production of progesterone, estrogens, hCG, hPL, and other placental hormones by the corpus luteum and placenta. Levels of pituitary, thyroid, adrenal, and other hormone levels also increase during pregnancy to support development.
This document discusses fetal distress, also known as nonreassuring fetal status. It can be defined as hypoxia that may result in permanent brain damage or death for the fetus if the cause is not addressed immediately. Some potential causes of fetal distress include maternal hypoxia, placental issues, obstetric complications, and prolonged compression of the fetal head. Effects on the fetus can include growth issues, decreased movement, low amniotic fluid, stillbirth, and effects on the infant like brain injury and meconium aspiration. Assessment methods discussed include monitoring fetal movement, ultrasounds, amniocentesis, biophysical profile testing, and electronic fetal monitoring during labor.
Endocrinology in relation to reproductionSalini Mandal
Endocrine glands play an important role in reproduction by secreting hormones that regulate maturation of follicles, ovulation, and formation and function of the corpus luteum during the menstrual cycle. The corpus luteum secretes progesterone and other hormones to prepare the uterus for potential implantation. During pregnancy, the placenta takes over hormone production from the corpus luteum by secreting human chorionic gonadotropin, human placental lactogen, and pregnancy-specific beta-1 glycoprotein to support the transforming, breast development, and gonadal functions required to maintain pregnancy.
The document discusses various physiological changes that occur in pregnancy across multiple body systems. The uterus increases dramatically in size from 70g and 10mL non-pregnant to approximately 1100g and 5L by the end of pregnancy. Hormonal changes include increased estrogen, progesterone, hCG, hPL, prolactin, IGF, and decreased hGH levels. This leads to adaptations in various organ systems like increased blood volume by 45%, enlarged heart and increased cardiac output, mild anemia and thrombocytopenia, immunosuppression to tolerate the fetus, and metabolic changes in carbohydrate and fat metabolism. Respiration is also altered to support higher oxygen demands.
Physiological changes in pregnancy include changes in the central nervous, respiratory, and cardiovascular systems. The minimum alveolar concentration of anesthetic gases decreases by up to 40% due to hormonal and endogenous changes. Oxygen consumption and minute ventilation increase while functional residual capacity decreases, increasing the risk of desaturation. Blood volume and plasma volume increase substantially, elevating cardiac output and stroke volume and decreasing systemic vascular resistance.
This document describes the physiological changes that occur in a woman's body during pregnancy. It discusses changes in the vulva, vagina, uterus, breasts, skin, blood, metabolism, respiratory and cardiovascular systems, urinary system, alimentary system, nervous system, and weight gain. The major changes include increased blood volume and cardiac output, softening of tissues like the cervix, hypertrophy of organs like the breasts, and temporary changes to skin pigmentation and the distribution of weight gain.
The document summarizes the major physiological changes that occur during pregnancy across multiple body systems. Hormonal changes including increased progesterone, estrogen, prolactin, and cortisol levels help prepare the body for pregnancy. The pancreas produces higher insulin levels to regulate increased blood sugar levels and fuel metabolism. The uterus grows substantially larger to accommodate the fetus, and other organs like the cervix, vagina, blood vessels, and respiratory system also undergo changes. Weight gain during pregnancy of 11-16 kilograms is distributed between increased fluid, tissues, the placenta and developing baby. Most systems return to their pre-pregnancy state after delivery.
Endcrinological changes during pregnancyArya Anish
After fertilization, the zygote implants in the uterus by day 5 and the corpus luteum secretes progesterone and hCG to maintain pregnancy until week 8. The placenta becomes fully functional by week 10, taking over hormone production. Pregnancy causes changes in maternal endocrine glands, including increased production of progesterone, estrogens, hCG, hPL, and other placental hormones by the corpus luteum and placenta. Levels of pituitary, thyroid, adrenal, and other hormone levels also increase during pregnancy to support development.
This document discusses fetal distress, also known as nonreassuring fetal status. It can be defined as hypoxia that may result in permanent brain damage or death for the fetus if the cause is not addressed immediately. Some potential causes of fetal distress include maternal hypoxia, placental issues, obstetric complications, and prolonged compression of the fetal head. Effects on the fetus can include growth issues, decreased movement, low amniotic fluid, stillbirth, and effects on the infant like brain injury and meconium aspiration. Assessment methods discussed include monitoring fetal movement, ultrasounds, amniocentesis, biophysical profile testing, and electronic fetal monitoring during labor.
Endocrinology in relation to reproductionSalini Mandal
Endocrine glands play an important role in reproduction by secreting hormones that regulate maturation of follicles, ovulation, and formation and function of the corpus luteum during the menstrual cycle. The corpus luteum secretes progesterone and other hormones to prepare the uterus for potential implantation. During pregnancy, the placenta takes over hormone production from the corpus luteum by secreting human chorionic gonadotropin, human placental lactogen, and pregnancy-specific beta-1 glycoprotein to support the transforming, breast development, and gonadal functions required to maintain pregnancy.
The document discusses various physiological changes that occur in pregnancy across multiple body systems. The uterus increases dramatically in size from 70g and 10mL non-pregnant to approximately 1100g and 5L by the end of pregnancy. Hormonal changes include increased estrogen, progesterone, hCG, hPL, prolactin, IGF, and decreased hGH levels. This leads to adaptations in various organ systems like increased blood volume by 45%, enlarged heart and increased cardiac output, mild anemia and thrombocytopenia, immunosuppression to tolerate the fetus, and metabolic changes in carbohydrate and fat metabolism. Respiration is also altered to support higher oxygen demands.
Physiological changes in pregnancy include changes in the central nervous, respiratory, and cardiovascular systems. The minimum alveolar concentration of anesthetic gases decreases by up to 40% due to hormonal and endogenous changes. Oxygen consumption and minute ventilation increase while functional residual capacity decreases, increasing the risk of desaturation. Blood volume and plasma volume increase substantially, elevating cardiac output and stroke volume and decreasing systemic vascular resistance.
Changes occur in several body systems during pregnancy, including the cardiovascular, respiratory, gastrointestinal, and urinary systems. The cardiovascular system experiences an increased cardiac output of around 40% due to higher stroke volume and heart rate. Respiration increases through a 40% rise in tidal volume without changing breath frequency. The gastrointestinal system exhibits nausea, increased appetite, and constipation. The urinary system shows an enlarged kidney and dilated ureters along with higher glomerular filtration rate and decreased serum creatinine.
- Induction of labor is recommended for post-term pregnancies (greater than 42 weeks) due to increased risks of complications. Risks increase further as pregnancy progresses beyond 42 weeks.
- For low-risk pregnancies between 41-42 weeks, induction can be considered but is not necessarily recommended since perinatal outcomes do not significantly differ from 40-41 weeks. The risks and benefits should be discussed with the patient.
- Fetal surveillance with non-stress tests and ultrasound amniotic fluid measurements twice weekly is recommended for pregnancies beyond 42 weeks declining induction. Delivery is recommended if any test results cause concern for the fetal environment.
The document summarizes several key anatomical changes that occur during pregnancy. The uterus expands significantly to accommodate the growing fetus, increasing 20 times in weight and size. The cervix closes to protect the fetus and later dilates during labor. Ligaments and joints relax to ease childbirth but can cause back pain. The center of gravity shifts forward, stressing the back. Skin pigmentation and weight gain also occur as the body accommodates the developing fetus over the course of pregnancy.
Up to half of women will develop pelvic organ prolapse during their lifetime, which is caused by weakening of the pelvic floor muscles and fascia due to factors like aging, childbirth, and endocrine changes. Common symptoms include a feeling of pressure or bulge in the vagina. Treatment options range from conservative measures like pessaries and pelvic floor exercises to various surgical repairs depending on the type and severity of prolapse.
Gestational diabetes mellitus (GDM) is glucose intolerance that develops during pregnancy. Risk factors include obesity, family history of diabetes, and ethnicity. During pregnancy, hormones cause insulin resistance and the pancreas must produce more insulin to maintain blood glucose levels. Untreated GDM can lead to complications for both mother and baby like preeclampsia, macrosomia, and neonatal hypoglycemia. Screening and tight glucose control are important. Pre-gestational diabetes also requires careful management to reduce risks of birth defects, complications, and future diabetes in the child.
Physiological changes in pregnancy. It includes changes in the genital organs, uterus, cardiovascular changes, respiratory, metabolic, alimentary, skin, skeleton, psychological changes, urinary changes and weight gain in pregnancy.
This document discusses cardiac disease in pregnancy. It notes the physiological changes of increased cardiac output during pregnancy and describes common cardiac conditions like rheumatic heart disease and congenital heart defects. It provides details on managing specific conditions like mitral stenosis. Guidelines are presented for monitoring high-risk patients and minimizing cardiac stress during labor and delivery. The importance of a multidisciplinary approach between obstetricians and cardiologists is emphasized.
3 hormonal and metabolic changes during pregnancymariam hamzah
Hormonal and metabolic changes occur during pregnancy to support the growth and development of the fetus. The placenta produces hormones including human chorionic gonadotropin (hCG), human placental lactogen (hPL), progesterone, and estrogen. These hormones help maintain the corpus luteum after fertilization and control placental and fetal growth. Metabolic changes include increased total metabolism to support the fetus. Carbohydrate metabolism increases insulin secretion and decreases insulin sensitivity to ensure a continuous glucose supply to the fetus. Iron and protein metabolism also change to meet the needs of the growing fetus.
A normal pregnancy lasts about 40 weeks and is divided into three trimesters. The first trimester is weeks 0-12, the second is weeks 13-28, and the third is weeks 29-40. Signs of pregnancy include missed periods, breast changes, nausea, frequent urination, and darkening of the skin. Positive signs that confirm pregnancy are a positive urine test, visualization of the fetus by ultrasound, and detection of the fetal heartbeat with Doppler or fetoscope from 10 weeks onward.
Labour is defined as the process of expelling the products of conception from the uterus through the vagina. Normal labour meets specific criteria including spontaneous onset at term, vertex presentation, natural termination with minimal assistance, and no complications. Abnormal labour deviates from these criteria and risks maternal and fetal health. Labour is initiated by various mechanical, hormonal and neurological factors that trigger uterine contractions and cervical changes over time, eventually resulting in delivery.
The document summarizes the management of hypertensive disorders in pregnancy. It defines hypertension and the different types of hypertensive disorders that can occur during pregnancy including gestational hypertension, preeclampsia, eclampsia, chronic hypertension, and preeclampsia superimposed on chronic hypertension. It discusses the risk factors, pathogenesis, clinical manifestations, diagnostic criteria, and management approaches for non-severe and severe preeclampsia, including antihypertensive treatment and seizure prophylaxis.
This document discusses the prevention and management of uterine prolapse. Key points include:
1. Prevention focuses on limiting pelvic floor injury during childbirth through measures like avoiding prolonged labor and encouraging postnatal exercises.
2. Treatment is usually only when prolapse causes symptoms that interfere with daily activity.
3. Management options include conservative measures like pelvic floor exercises and pessaries, as well as surgical procedures like vaginal hysterectomy with pelvic floor repair to correct defects.
4. Surgical repair aims to tighten the anterior, middle/apical, and posterior compartments using techniques such as anterior and posterior colporrhaphy.
This document discusses postpartum complications, beginning with an introduction to the postpartum period and its significance. It then covers non-bleeding complications that can occur, including pain, breast engorgement, urinary retention, preeclampsia/eclampsia, and postpartum fever. Two case studies are presented involving a patient with postpartum fever and another with symptoms of postpartum thyroiditis. Management options are provided for various complications like endometritis, mastitis, septic thrombophlebitis, and postpartum thyroiditis.
Physiology of pregnancy. cardiovascular, respiratory and hematologykr
The document discusses the physiological changes that occur during pregnancy across multiple body systems. Key changes include an increase in cardiac output and blood volume to support the developing fetus. This leads to displacement of the heart and enlargement of the cardiac silhouette on chest x-rays. Shortness of breath is normal due to respiratory changes. Increased iron needs occur due to a rise in red blood cell and plasma volume. The document also provides guidance on diagnosing and managing anemia during pregnancy.
physiological changes during pregnancyRoyceMathew3
This document summarizes physiological changes that occur during pregnancy. It discusses changes to the duration of pregnancy, genital organs, ovaries, uterus, cervix, cardiovascular system, breasts, and skin. Key changes include increased blood volume, heart rate, and uterine and breast growth to support the developing fetus. The cervix softens and produces mucus to protect against infection. Pigmentation changes often occur on the face, breasts, and abdomen. Overall, the document outlines the normal anatomical and physiological adaptations involved in sustaining a healthy pregnancy.
1) Vaginal birth after cesarean section (VBAC) has been a controversial issue in obstetrics, as opinions have changed over time on whether a scarred uterus can support a vaginal birth.
2) While it was once believed that "once a cesarean, always a cesarean" was necessary, research now shows that 70-80% of women with a prior low transverse incision can have a successful VBAC, as endorsed by ACOG.
3) Factors such as the type of prior incision, prior vaginal delivery, interdelivery interval, and indication for prior cesarean impact the likelihood of a successful VBAC trial. Close monitoring is important to
An ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, usually in the fallopian tubes. Risk factors include previous ectopic pregnancy, infections, scarring of the fallopian tubes, and fertility treatments. Ectopic pregnancies can cause life-threatening bleeding if not treated properly. Diagnosis involves beta-hCG levels and ultrasound imaging. Treatment options include medication with methotrexate, expectant management with close monitoring, or surgery depending on the stability of the patient and characteristics of the ectopic pregnancy.
The document describes the Manchester Repair procedure, which is designed to correct uterine prolapse while preserving the uterus. The key steps are: 1) preliminary dilation and curettage of the uterus, 2) amputation of the cervix, 3) plication of the Mackenrodt's ligaments in front of the cervix, 4) anterior colporrhaphy, and 5) colpoperineorrhaphy. Additional details provided include techniques for covering the amputated cervix with vaginal flaps and suturing the Mackenrodt's ligaments to the cervix to elevate it. Potential complications of the surgery are also outlined.
Physiological changes in pregnancy include increased blood volume, cardiac output, and kidney function to support the developing fetus. The uterus grows dramatically throughout pregnancy. Hormonal changes like increased estrogen, progesterone, and HCG levels from the placenta help prepare the body for pregnancy and childbirth. Diagnosis of pregnancy is suggested by missed periods and confirmed by tests detecting HCG in urine or blood within 4-5 weeks of conception.
During pregnancy, the female body undergoes many physiological changes to support the growing fetus. The genital organs like the uterus, cervix, and breasts enlarge and the vascularity increases. The cardiovascular system works harder - blood volume, heart rate, and cardiac output increase. Respiration also increases to supply more oxygen to the mother and fetus. Hormonal changes driven by the placenta result in further physical adaptations like skin pigmentation and breast development. These changes help create a healthy environment for the baby to develop over the 9 months of pregnancy.
Physiological changes during pregnancy can be extensive. The uterus grows dramatically in size and the cervix softens. The breasts enlarge and darken. Throughout pregnancy, the body retains more fluid and blood volume increases. Respiration increases to support higher oxygen needs. The heart works harder pumping more blood. The kidneys and liver increase in size. Many hormonal changes prepare the body for childbirth and nurturing a baby.
Changes occur in several body systems during pregnancy, including the cardiovascular, respiratory, gastrointestinal, and urinary systems. The cardiovascular system experiences an increased cardiac output of around 40% due to higher stroke volume and heart rate. Respiration increases through a 40% rise in tidal volume without changing breath frequency. The gastrointestinal system exhibits nausea, increased appetite, and constipation. The urinary system shows an enlarged kidney and dilated ureters along with higher glomerular filtration rate and decreased serum creatinine.
- Induction of labor is recommended for post-term pregnancies (greater than 42 weeks) due to increased risks of complications. Risks increase further as pregnancy progresses beyond 42 weeks.
- For low-risk pregnancies between 41-42 weeks, induction can be considered but is not necessarily recommended since perinatal outcomes do not significantly differ from 40-41 weeks. The risks and benefits should be discussed with the patient.
- Fetal surveillance with non-stress tests and ultrasound amniotic fluid measurements twice weekly is recommended for pregnancies beyond 42 weeks declining induction. Delivery is recommended if any test results cause concern for the fetal environment.
The document summarizes several key anatomical changes that occur during pregnancy. The uterus expands significantly to accommodate the growing fetus, increasing 20 times in weight and size. The cervix closes to protect the fetus and later dilates during labor. Ligaments and joints relax to ease childbirth but can cause back pain. The center of gravity shifts forward, stressing the back. Skin pigmentation and weight gain also occur as the body accommodates the developing fetus over the course of pregnancy.
Up to half of women will develop pelvic organ prolapse during their lifetime, which is caused by weakening of the pelvic floor muscles and fascia due to factors like aging, childbirth, and endocrine changes. Common symptoms include a feeling of pressure or bulge in the vagina. Treatment options range from conservative measures like pessaries and pelvic floor exercises to various surgical repairs depending on the type and severity of prolapse.
Gestational diabetes mellitus (GDM) is glucose intolerance that develops during pregnancy. Risk factors include obesity, family history of diabetes, and ethnicity. During pregnancy, hormones cause insulin resistance and the pancreas must produce more insulin to maintain blood glucose levels. Untreated GDM can lead to complications for both mother and baby like preeclampsia, macrosomia, and neonatal hypoglycemia. Screening and tight glucose control are important. Pre-gestational diabetes also requires careful management to reduce risks of birth defects, complications, and future diabetes in the child.
Physiological changes in pregnancy. It includes changes in the genital organs, uterus, cardiovascular changes, respiratory, metabolic, alimentary, skin, skeleton, psychological changes, urinary changes and weight gain in pregnancy.
This document discusses cardiac disease in pregnancy. It notes the physiological changes of increased cardiac output during pregnancy and describes common cardiac conditions like rheumatic heart disease and congenital heart defects. It provides details on managing specific conditions like mitral stenosis. Guidelines are presented for monitoring high-risk patients and minimizing cardiac stress during labor and delivery. The importance of a multidisciplinary approach between obstetricians and cardiologists is emphasized.
3 hormonal and metabolic changes during pregnancymariam hamzah
Hormonal and metabolic changes occur during pregnancy to support the growth and development of the fetus. The placenta produces hormones including human chorionic gonadotropin (hCG), human placental lactogen (hPL), progesterone, and estrogen. These hormones help maintain the corpus luteum after fertilization and control placental and fetal growth. Metabolic changes include increased total metabolism to support the fetus. Carbohydrate metabolism increases insulin secretion and decreases insulin sensitivity to ensure a continuous glucose supply to the fetus. Iron and protein metabolism also change to meet the needs of the growing fetus.
A normal pregnancy lasts about 40 weeks and is divided into three trimesters. The first trimester is weeks 0-12, the second is weeks 13-28, and the third is weeks 29-40. Signs of pregnancy include missed periods, breast changes, nausea, frequent urination, and darkening of the skin. Positive signs that confirm pregnancy are a positive urine test, visualization of the fetus by ultrasound, and detection of the fetal heartbeat with Doppler or fetoscope from 10 weeks onward.
Labour is defined as the process of expelling the products of conception from the uterus through the vagina. Normal labour meets specific criteria including spontaneous onset at term, vertex presentation, natural termination with minimal assistance, and no complications. Abnormal labour deviates from these criteria and risks maternal and fetal health. Labour is initiated by various mechanical, hormonal and neurological factors that trigger uterine contractions and cervical changes over time, eventually resulting in delivery.
The document summarizes the management of hypertensive disorders in pregnancy. It defines hypertension and the different types of hypertensive disorders that can occur during pregnancy including gestational hypertension, preeclampsia, eclampsia, chronic hypertension, and preeclampsia superimposed on chronic hypertension. It discusses the risk factors, pathogenesis, clinical manifestations, diagnostic criteria, and management approaches for non-severe and severe preeclampsia, including antihypertensive treatment and seizure prophylaxis.
This document discusses the prevention and management of uterine prolapse. Key points include:
1. Prevention focuses on limiting pelvic floor injury during childbirth through measures like avoiding prolonged labor and encouraging postnatal exercises.
2. Treatment is usually only when prolapse causes symptoms that interfere with daily activity.
3. Management options include conservative measures like pelvic floor exercises and pessaries, as well as surgical procedures like vaginal hysterectomy with pelvic floor repair to correct defects.
4. Surgical repair aims to tighten the anterior, middle/apical, and posterior compartments using techniques such as anterior and posterior colporrhaphy.
This document discusses postpartum complications, beginning with an introduction to the postpartum period and its significance. It then covers non-bleeding complications that can occur, including pain, breast engorgement, urinary retention, preeclampsia/eclampsia, and postpartum fever. Two case studies are presented involving a patient with postpartum fever and another with symptoms of postpartum thyroiditis. Management options are provided for various complications like endometritis, mastitis, septic thrombophlebitis, and postpartum thyroiditis.
Physiology of pregnancy. cardiovascular, respiratory and hematologykr
The document discusses the physiological changes that occur during pregnancy across multiple body systems. Key changes include an increase in cardiac output and blood volume to support the developing fetus. This leads to displacement of the heart and enlargement of the cardiac silhouette on chest x-rays. Shortness of breath is normal due to respiratory changes. Increased iron needs occur due to a rise in red blood cell and plasma volume. The document also provides guidance on diagnosing and managing anemia during pregnancy.
physiological changes during pregnancyRoyceMathew3
This document summarizes physiological changes that occur during pregnancy. It discusses changes to the duration of pregnancy, genital organs, ovaries, uterus, cervix, cardiovascular system, breasts, and skin. Key changes include increased blood volume, heart rate, and uterine and breast growth to support the developing fetus. The cervix softens and produces mucus to protect against infection. Pigmentation changes often occur on the face, breasts, and abdomen. Overall, the document outlines the normal anatomical and physiological adaptations involved in sustaining a healthy pregnancy.
1) Vaginal birth after cesarean section (VBAC) has been a controversial issue in obstetrics, as opinions have changed over time on whether a scarred uterus can support a vaginal birth.
2) While it was once believed that "once a cesarean, always a cesarean" was necessary, research now shows that 70-80% of women with a prior low transverse incision can have a successful VBAC, as endorsed by ACOG.
3) Factors such as the type of prior incision, prior vaginal delivery, interdelivery interval, and indication for prior cesarean impact the likelihood of a successful VBAC trial. Close monitoring is important to
An ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, usually in the fallopian tubes. Risk factors include previous ectopic pregnancy, infections, scarring of the fallopian tubes, and fertility treatments. Ectopic pregnancies can cause life-threatening bleeding if not treated properly. Diagnosis involves beta-hCG levels and ultrasound imaging. Treatment options include medication with methotrexate, expectant management with close monitoring, or surgery depending on the stability of the patient and characteristics of the ectopic pregnancy.
The document describes the Manchester Repair procedure, which is designed to correct uterine prolapse while preserving the uterus. The key steps are: 1) preliminary dilation and curettage of the uterus, 2) amputation of the cervix, 3) plication of the Mackenrodt's ligaments in front of the cervix, 4) anterior colporrhaphy, and 5) colpoperineorrhaphy. Additional details provided include techniques for covering the amputated cervix with vaginal flaps and suturing the Mackenrodt's ligaments to the cervix to elevate it. Potential complications of the surgery are also outlined.
Physiological changes in pregnancy include increased blood volume, cardiac output, and kidney function to support the developing fetus. The uterus grows dramatically throughout pregnancy. Hormonal changes like increased estrogen, progesterone, and HCG levels from the placenta help prepare the body for pregnancy and childbirth. Diagnosis of pregnancy is suggested by missed periods and confirmed by tests detecting HCG in urine or blood within 4-5 weeks of conception.
During pregnancy, the female body undergoes many physiological changes to support the growing fetus. The genital organs like the uterus, cervix, and breasts enlarge and the vascularity increases. The cardiovascular system works harder - blood volume, heart rate, and cardiac output increase. Respiration also increases to supply more oxygen to the mother and fetus. Hormonal changes driven by the placenta result in further physical adaptations like skin pigmentation and breast development. These changes help create a healthy environment for the baby to develop over the 9 months of pregnancy.
Physiological changes during pregnancy can be extensive. The uterus grows dramatically in size and the cervix softens. The breasts enlarge and darken. Throughout pregnancy, the body retains more fluid and blood volume increases. Respiration increases to support higher oxygen needs. The heart works harder pumping more blood. The kidneys and liver increase in size. Many hormonal changes prepare the body for childbirth and nurturing a baby.
This document discusses the physiological changes that occur during pregnancy to promote maternal health and support fetal development. It covers changes in various body systems including the reproductive, cardiovascular, respiratory, renal, gastrointestinal, endocrine, integumentary, and musculoskeletal systems. Key changes include increased blood volume and cardiac output, skin pigmentation, weight gain, and adaptations in organs and tissues to accommodate the growing fetus. The document provides information on signs and symptoms of pregnancy and details nutritional needs that increase to support the demands of pregnancy.
Physiological changes during pregnancy allow the mother's body to support fetal growth and development. The cardiovascular, respiratory, gastrointestinal, urinary, and endocrine systems undergo remodeling. The cardiovascular system increases blood volume and cardiac output by 40% by the third trimester. Respiration increases to meet higher oxygen needs. Hormonal changes, like increased progesterone and estrogen, prepare the uterus and breasts for birth. Overall, the adaptations sustain a healthy environment for the fetus throughout pregnancy.
Maternal changes during pregnancy can affect many body systems. The reproductive tract undergoes significant changes, including enlargement of the uterus from 50g to 1100g and a change in shape from pyriform to globular. The cardiovascular system also changes substantially, with a 40% increase in cardiac output and a 10-15% decrease in blood pressure. Renal changes include a 50% increase in glomerular filtration rate and increased frequency of urination. Many other systems are impacted as well, such as a slight enlargement of the kidneys and changes in skin pigmentation and elasticity.
obstetric and gyneacology; Changes in pregnancy, cardiovascular changes, respiratory changes, endocrine changes, gastrointestinal changes, related organ changes in pregnancy. hormonal changes during pregnancy.
Physiological Changes in Pregnancy and Its Anaesthetic Implications.Mohtasib Madaoo
This document summarizes the physiological changes in pregnancy and their implications for anesthesia. It discusses how pregnancy causes increased blood volume, cardiac output, oxygen consumption and acidity levels. These changes can cause issues like supine hypotension syndrome when the mother lies on her back. The document also covers respiratory, coagulation, gastrointestinal and central nervous system changes in pregnancy and how they impact drug dosages and anesthesia techniques. Special considerations are discussed for intubation, regional anesthesia and placental drug transport.
Physiological changes in pregnancy & its anaesthetic implicationsSwadheen Rout
This document discusses the physiological changes that occur during pregnancy and how they impact anesthesia practice. It notes that pregnancy results in increased blood volume, cardiac output, respiratory rate and oxygen consumption to support the growing fetus. Regional and general anesthesia can impact the mother's cardiovascular and respiratory physiology, with risks of supine hypotension, hypoxemia and decreased uterine blood flow. Careful anesthetic management is needed to support both mother and fetus simultaneously during pregnancy and delivery.
Physiological changes in pregnancy affect many body systems. The cardiovascular system adapts to support the growing fetus through increased blood volume, cardiac output, and stroke volume. The respiratory system increases minute ventilation and oxygen consumption while functional residual capacity decreases. The placenta allows passage of most anesthetic drugs from mother to fetus through passive diffusion. Anesthesiologists must consider these physiological alterations when planning anesthetic care for pregnant patients.
This document summarizes maternal alterations in pregnancy that affect the gastrointestinal and genitourinary systems. It discusses increased appetite and changes in food cravings during pregnancy. It also covers constipation, heartburn, and changes in the stomach, intestines, liver and gallbladder during pregnancy. Increased risk of urinary tract infections is discussed due to hormonal changes that cause urinary stasis.
The document discusses various physiological changes that occur during pregnancy including changes to body water metabolism, cardiovascular system, respiratory system, hematologic system, endocrine system, and other organ systems. It also discusses conditions like intrauterine growth restriction (IUGR) and hypertension that can arise during pregnancy. IUGR is defined as birth weight below the 10th percentile and can be symmetrical or asymmetrical. Hypertension in pregnancy includes chronic hypertension, gestational hypertension, and preeclampsia.
Antenatal care & changes during pregnancy1302011987
antenatal care with including all the changes during pregnancy with signs & symptoms of pregnancy. in this presentation i had cover all the topics related to pregnancy unit.
Physiological changes during pregnancyDeepa Mishra
PHYSIOLOGICAL CHANGES DURING PREGNANCY
Deepa Mishra
Assistant Professor (OBG)
Pregnancy
Pregnancy usually occurs during 15-44 yrs of a woman.
Duration of pregnancy from LMP is 280 days or 40 weeks or 9 months and 7 days
Three trimester-
1st Trimester -0 -12 weeks
2nd trimester – 13-28 weeks
3rd trimester -29-40 weeks s
Physiological changes
Reproductive system
Hematological and Cardiovascular changes
Respiratory, Acid base balance, electrolyte changes
Urinary changes
GI changes
Metabolic changes
Skeletal and neurological changes
Skin changes
Endocrinal changes
Psychological changes
The document discusses the physiological changes that occur during pregnancy across multiple organ systems. Hormonal changes caused by increased estrogen and progesterone lead to adaptations in the cardiovascular, respiratory, gastrointestinal, genital, urinary, endocrine and skin systems. Notable effects include increased blood volume, heart rate, and oxygen consumption. The uterus grows substantially and other organs are displaced. Renal function increases along with risk of urinary tract infections. Common skin changes are stretch marks, line nigra, and melasma. All changes help support the nutritional and oxygen needs of the developing fetus.
Physiological changes during pregnancy include changes in the genital organs, breasts, skin, abdomen, blood, metabolism, cardiovascular and urinary systems. The genital organs like the uterus, cervix and breasts enlarge and the blood volume increases significantly. Metabolism increases to support the growth of the fetus. The heart enlarges and cardiac output increases. Kidney function is enhanced and urinary frequency rises, especially later in pregnancy. Respiration is also impacted with higher oxygen needs.
Pregnancy causes significant physiological changes in nearly every organ system of the mother's body in order to support the development of the fetus. Major adaptations include increased blood volume and cardiac output, respiratory and renal changes, hormonal alterations, and metabolic shifts to provide adequate nutrients to the growing baby. Most changes resolve after delivery, though some like skin pigmentation may persist in some women. Understanding normal maternal physiology is important to distinguish it from potential pathological conditions that could impact the health of the mother or fetus.
Physiology of Pregnancy for Undergraduatesthezaira
The document summarizes the physiological changes that occur throughout a woman's body during pregnancy. Key changes include enlargement and increased blood flow to the uterus, breasts, and major organs. Other changes are weight gain and fluid retention, increased blood volume and altered metabolism to support the growing fetus. The various body systems also adapt to pregnancy through respiratory alkalosis, circulatory adjustments and neurological/hormonal responses.
This document discusses the extensive physiological and anatomical changes that occur during normal human pregnancy. It provides details on adaptations in multiple organ systems to support the growth and development of the fetus. The main changes include increased blood volume and cardiac output, anatomical changes to the uterus and cervix, hormonal changes involving hCG and estrogen, and metabolic adaptations to provide optimal nutrition for the fetus. All major body systems are impacted in ways that precisely meet the needs of pregnancy.
The document summarizes various metabolic changes that occur during pregnancy across several body systems. There is an increased total metabolism and basal metabolic rate to support the growth of the fetus. Protein metabolism shifts to an anabolic state to support increased protein needs. Carbohydrate metabolism involves increased insulin resistance and secretion to ensure glucose supply to the fetus. Fat storage increases by 3-4 kg to support energy needs. Iron metabolism is in an inevitable deficient state to meet the 1000mg of iron needs transferred to the fetus and placenta. Respiratory and renal systems expand to accommodate the growing uterus while hormonal changes like human chorionic gonadotropin and placental lactogen influence maternal physiology.
Physiologic changes of pregnancy lect 2.pptDeepak734373
The document discusses the physiological changes that occur during pregnancy. It covers changes to various body systems including anatomical changes to the uterus and pelvis. The cardiovascular system adapts through increased blood volume, cardiac output, and heart rate. Respiration is also impacted through higher oxygen needs. Digestion slows due to hormonal effects. Metabolism increases to support the growing fetus and placental development. The reproductive system undergoes significant changes as the uterus enlarges over the course of pregnancy.
Physiologic changes of pregnancy lect 2.pptTemGemechu
The document discusses the physiological changes that occur during pregnancy across multiple body systems. Key changes include increased blood volume, cardiac output, and respiration to support the growing fetus. The uterus enlarges dramatically under the influence of hormones. Other systems like digestion and urination are impacted to accommodate pregnancy. Understanding these normal changes is important for health care providers to recognize pathological deviations and advise women appropriately during this period.
Physiologic changes of pregnancy lect 2.pptTemGemechu
The document discusses the physiological changes that occur during pregnancy across multiple body systems. Key changes include increased blood volume, cardiac output, and respiration to support the growing fetus. The uterus grows enormously under the influence of hormones like estrogen and progesterone. Other systems like digestion and urination are also affected as the body adapts to accommodate the pregnancy. The document provides an overview of normal anatomical and physiological adaptations to help medical professionals understand and monitor pregnancies.
The document discusses the various adaptations that occur in a woman's body during pregnancy. The hormones of pregnancy, enlarging uterus, and other factors cause adaptations in many body systems. The cardiovascular, respiratory, urinary, gastrointestinal, and musculoskeletal systems all undergo changes to support the metabolic demands of the mother and developing fetus. The reproductive system, including the uterus, cervix, ovaries, vagina, and breasts, experience significant growth and changes to nurture fetal growth. Pregnancy results in signs and symptoms that can be detected through presumptive, probable, and positive evidence.
This document discusses the diagnosis and management of hypertensive disorders in pregnancy. It defines various types of hypertension including gestational hypertension, preeclampsia, and eclampsia. It covers the signs and symptoms, potential complications, risk factors, diagnostic tests, and treatment approaches including antihypertensive medications and magnesium sulfate administration. Treatment involves controlling blood pressure, preventing seizures, administering steroids to promote fetal lung maturity, and carefully monitoring fluid balance, with the goal of optimizing outcomes for both the mother and baby.
PREGNANCY AND PHYSIOLOGICAL CHANGES.pptxAshraf Shaik
During pregnancy, the female body undergoes many physiological changes to support the growing fetus. The genital organs like the uterus, cervix, and breasts enlarge and the vascularity increases. The uterus grows enormously and its shape changes from globular to spherical. Other changes include increased blood volume and cardiac output, skin and cutaneous changes, weight gain, respiratory alkalosis, and hormonal changes mediated by the placenta and pituitary gland. These changes help provide nutrients and oxygen to the developing fetus and prepare the body for childbirth.
During pregnancy, the female body undergoes many physiological changes to support the growing fetus. The genital organs like the uterus, cervix, and breasts enlarge and the vascularity increases. The cardiovascular system works harder - blood volume, heart rate, and cardiac output increase. Respiration also increases to supply more oxygen to the mother and fetus. Hormonal changes driven by the placenta result in further physical adaptations like skin pigmentation and breast development. These changes help create a healthy environment for the baby to develop over the 9 months of pregnancy.
Pregnancy causes widespread physiological changes in the mother's body affecting nearly every organ system. These changes prepare the mother's body for pregnancy and support fetal growth and development. Major adaptations include increased blood volume and cardiac output, respiratory and renal changes, hormonal and metabolic alterations to support increased nutritional demands, and anatomical changes in organs like the uterus and breasts. Most of these changes resolve after delivery, though some like skin changes may persist. Understanding normal physiological changes helps distinguish them from potential pathological conditions.
With the use of fertility enhancing medications, advance maternal age pregnancies and just the natural order od twinning, this pregnancy presentation has become more common among providers. Here we explore the etiology, presentation and management of twin pregnancies.
This document discusses intrauterine growth restriction (IUGR), defined as restricted fetal growth where the fetus does not reach its growth potential. IUGR complicates 5-10% of pregnancies and is a leading cause of stillbirths. It can be difficult to diagnose and distinguish SGA babies from those with true IUGR. The document outlines various causes of IUGR including maternal, fetal, and placental factors. Screening involves fundal height measurements, ultrasound assessments of biometric measures and Doppler of umbilical artery blood flow. Abnormal Doppler readings and estimated fetal weight below the 3rd percentile are strongly associated with adverse neonatal outcomes. Management involves surveillance and timing of delivery depends on underlying etiology and gestational age.
A normal pregnancy results in a number of important reversible physiological and hormonal changes that alter thyroid structure and more importantly function.
Understanding these change are important to interpreting, identifying and managing of thyroid disease in pregnancy.
An inspirational, self-help book designed to assist women in improving their lifestyle, physically, mentally, spiritually and emotionally. Through small but successful changes, women can find untapped roadways that lead to happier lifestyles. This book will make you laugh, cry, explore, investigate and scrutinize, but ultimately understand that it only takes simple steps to get to a better you.
The book is also designed as a journal, where you can interact with the information and maintain a personal memoir of your success. After completing this unique adventure, you will have a treasured keepsake and reference to always stay on that positive road...to a better you.
The amniotic fluid cushions the fetus, protects it from infection and trauma, and allows freedom of movement. It maintains a stable temperature and permits lung development. Amniotic fluid volume is normally 500-1000cc at term. It is produced by the amniotic membranes and passes across the fetal skin and through fetal urination, swallowing, and respiratory secretions. Abnormal volumes can indicate fetal problems and complications in pregnancy.
Parvovirus B-19 in Pregnancy Parvovirus is a member of the family Parvoviridae. The virus contains a single-stranded DNA. It can only infect humans. 50% of all adults have been infected sometime during childhood or adolescence.
Parvovirus B-19 in Pregnancy Epidemiology Congenital infection rates vary depending on the prevalence in the community. Approximately 50 to 75% of adult women are immune. 20% to 30% of susceptible adults in school settings will become infected. Day-care workers have a 20% to 50% risk of seroconversion. The risk of infection among susceptible adults following household exposure to an infected person is approximately 50%.
Obstetrical ultrasound uses sound waves and computer imaging to safely examine the fetus without radiation. It can assess gestational age and fetal growth, check for anomalies, and monitor high-risk pregnancies. The exam involves measuring fetal anatomy and evaluating blood flow to check for signs of fetal distress. Abnormal findings may indicate conditions like growth issues or structural defects requiring further investigation.
In-depth explanation of labor divided into two extensive parts. A thorough examination of proper procedure, care, and health for expecting mothers. Delicate consideration must be taken to insure the safety of the baby and promote the best chances for a healthy delivery. Topics such as biochemical messengers, hormonal balance, preterm conditions, fetal position, and cardinal movements.
In-depth explanation of labor divided into two extensive parts. A thorough examination of proper procedure, care, and health for expecting mothers. Delicate consideration must be taken to insure the safety of the baby and promote the best chances for a healthy delivery. Topics such as biochemical messengers, hormonal balance, preterm conditions, fetal position, and cardinal movements.
Allopurinol, a uric acid synthesis inhibitor acts by inhibiting Xanthine oxidase competitively as well as non- competitively, Whereas Oxypurinol is a non-competitive inhibitor of xanthine oxidase.
Storyboard on Skin- Innovative Learning (M-pharm) 2nd sem. (Cosmetics)MuskanShingari
Skin is the largest organ of the human body, serving crucial functions that include protection, sensation, regulation, and synthesis. Structurally, it consists of three main layers: the epidermis, dermis, and hypodermis (subcutaneous layer).
1. **Epidermis**: The outermost layer primarily composed of epithelial cells called keratinocytes. It provides a protective barrier against environmental factors, pathogens, and UV radiation.
2. **Dermis**: Located beneath the epidermis, the dermis contains connective tissue, blood vessels, hair follicles, and sweat glands. It plays a vital role in supporting and nourishing the epidermis, regulating body temperature, and housing sensory receptors for touch, pressure, temperature, and pain.
3. **Hypodermis**: Also known as the subcutaneous layer, it consists of fat and connective tissue that anchors the skin to underlying structures like muscles and bones. It provides insulation, cushioning, and energy storage.
Skin performs essential functions such as regulating body temperature through sweat production and blood flow control, synthesizing vitamin D when exposed to sunlight, and serving as a sensory interface with the external environment.
Maintaining skin health is crucial for overall well-being, involving proper hygiene, hydration, protection from sun exposure, and avoiding harmful substances. Skin conditions and diseases range from minor irritations to chronic disorders, emphasizing the importance of regular care and medical attention when needed.
Gene therapy can be broadly defined as the transfer of genetic material to cure a disease or at least to improve the clinical status of a patient.
One of the basic concepts of gene therapy is to transform viruses into genetic shuttles, which will deliver the gene of interest into the target cells.
Safe methods have been devised to do this, using several viral and non-viral vectors.
In the future, this technique may allow doctors to treat a disorder by inserting a gene into a patient's cells instead of using drugs or surgery.
The biggest hurdle faced by medical research in gene therapy is the availability of effective gene-carrying vectors that meet all of the following criteria:
Protection of transgene or genetic cargo from degradative action of systemic and endonucleases,
Delivery of genetic material to the target site, i.e., either cell cytoplasm or nucleus,
Low potential of triggering unwanted immune responses or genotoxicity,
Economical and feasible availability for patients .
Viruses are naturally evolved vehicles that efficiently transfer their genes into host cells.
Choice of viral vector is dependent on gene transfer efficiency, capacity to carry foreign genes, toxicity, stability, immune responses towards viral antigens and potential viral recombination.
There are a wide variety of vectors used to deliver DNA or oligo nucleotides into mammalian cells, either in vitro or in vivo.
The most common vector system based on retroviruses, adenoviruses, herpes simplex viruses, adeno associated viruses.
Storyboard on Acne-Innovative Learning-M. pharm. (2nd sem.) CosmeticsMuskanShingari
Acne is a common skin condition that occurs when hair follicles become clogged with oil and dead skin cells. It typically manifests as pimples, blackheads, or whiteheads, often on the face, chest, shoulders, or back. Acne can range from mild to severe and may cause emotional distress and scarring in some cases.
**Causes:**
1. **Excess Oil Production:** Hormonal changes during adolescence or certain times in adulthood can increase sebum (oil) production, leading to clogged pores.
2. **Clogged Pores:** When dead skin cells and oil block hair follicles, bacteria (usually Propionibacterium acnes) can thrive, causing inflammation and acne lesions.
3. **Hormonal Factors:** Fluctuations in hormone levels, such as during puberty, menstrual cycles, pregnancy, or certain medical conditions, can contribute to acne.
4. **Genetics:** A family history of acne can increase the likelihood of developing the condition.
**Types of Acne:**
- **Whiteheads:** Closed plugged pores.
- **Blackheads:** Open plugged pores with a dark surface.
- **Papules:** Small red, tender bumps.
- **Pustules:** Pimples with pus at their tips.
- **Nodules:** Large, solid, painful lumps beneath the surface.
- **Cysts:** Painful, pus-filled lumps beneath the surface that can cause scarring.
**Treatment:**
Treatment depends on the severity and type of acne but may include:
- **Topical Treatments:** Such as benzoyl peroxide, salicylic acid, or retinoids to reduce bacteria and unclog pores.
- **Oral Medications:** Antibiotics or oral contraceptives for hormonal acne.
- **Procedures:** Such as chemical peels, extraction of comedones, or light therapy for more severe cases.
**Prevention and Management:**
- **Cleanse:** Regularly wash skin with a gentle cleanser.
- **Moisturize:** Use non-comedogenic moisturizers to keep skin hydrated without clogging pores.
- **Avoid Irritants:** Such as harsh cosmetics or excessive scrubbing.
- **Sun Protection:** Use sunscreen to prevent exacerbation of acne scars and inflammation.
Acne treatment can take time, and consistency in skincare routines and treatments is crucial. Consulting a dermatologist can help tailor a treatment plan that suits individual needs and reduces the risk of scarring or long-term skin damage.
Can Traditional Chinese Medicine Treat Blocked Fallopian Tubes.pptxFFragrant
There are many traditional Chinese medicine therapies to treat blocked fallopian tubes. And herbal medicine Fuyan Pill is one of the more effective choices.
Congestive Heart failure is caused by low cardiac output and high sympathetic discharge. Diuretics reduce preload, ACE inhibitors lower afterload, beta blockers reduce sympathetic activity, and digitalis has inotropic effects. Newer medications target vasodilation and myosin activation to improve heart efficiency while lowering energy requirements. Combination therapy, following an assessment of cardiac function and volume status, is the most effective strategy to heart failure care.
CLASSIFICATION OF H1 ANTIHISTAMINICS-
FIRST GENERATION ANTIHISTAMINICS-
1)HIGHLY SEDATIVE-DIPHENHYDRAMINE,DIMENHYDRINATE,PROMETHAZINE,HYDROXYZINE 2)MODERATELY SEDATIVE- PHENARIMINE,CYPROHEPTADINE, MECLIZINE,CINNARIZINE
3)MILD SEDATIVE-CHLORPHENIRAMINE,DEXCHLORPHENIRAMINE
TRIPROLIDINE,CLEMASTINE
SECOND GENERATION ANTIHISTAMINICS-FEXOFENADINE,
LORATADINE,DESLORATADINE,CETIRIZINE,LEVOCETIRIZINE,
AZELASTINE,MIZOLASTINE,EBASTINE,RUPATADINE. Mechanism of action of 2nd generation antihistaminics-
These drugs competitively antagonize actions of
histamine at the H1 receptors.
Pharmacological actions-
Antagonism of histamine-The H1 antagonists effectively block histamine induced bronchoconstriction, contraction of intestinal and other smooth muscle and triple response especially wheal, flare and itch. Constriction of larger blood vessel by histamine is also antagonized.
2) Antiallergic actions-Many manifestations of immediate hypersensitivity (type I reactions)are suppressed. Urticaria, itching and angioedema are well controlled.3) CNS action-The older antihistamines produce variable degree of CNS depression.But in case of 2nd gen antihistaminics there is less CNS depressant property as these cross BBB to significantly lesser extent.
4) Anticholinergic action- many H1 blockers
in addition antagonize muscarinic actions of ACh. BUT IN 2ND gen histaminics there is Higher H1 selectivitiy : no anticholinergic side effects
BBB and BCF
control the entry of compounds into the brain and
regulate brain homeostasis.
restricts access to brain cells of blood–borne compounds and
facilitates nutrients essential for normal metabolism to reach brain cells
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
Selective alpha1 blockers are Prazosin, Terazosin, Doxazosin, Tamsulosin and Silodosin majorly used to treat BPH, also hypertension, PTSD, Raynaud's phenomenon, CHF
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
2. Maternal Physiology in Pregnancy Major adaptations in maternal anatomy, physiology, and metabolism are required for successful pregnancy. Nearly every organ system is affected. Understanding these changes helps to distinguish the normal physiology of pregnancy from pathological disease states.
3. Maternal Physiology in Pregnancy These changes create a myriad of pregnancy symptoms that include Nausea/Emesis (morning sickness) Headaches Backaches Urinary frequency Hemorrhoids/Constipation Leg Cramps Edema more common lower extremity Breast tenderness Paresthesis Varicose veins
4. Maternal Physiology in Pregnancy Due to the pregnancy effect on major organ systems including: Nutritional Digestive Tract Changes Urinary System Cardiovascular System Respiratory System Metabolism Skeletal Endocrine Integument Ocular
5. Maternal Physiology in Pregnancy: Nutritional During pregnancy, nutritional requirements, including those for vitamins and minerals, are increased, and several maternal alterations occur to meet this demand. Addition of 300 kcal/day. The mother`s appetite usually increases, so that food intake is greater, although some women have a decreased appetite or experience nausea and vomiting. These symptoms may be related relaxation of smooth muscle, increasing levels of human chorionic gonadotrophin (hCG) and estrogen.
6. Maternal Physiology in Pregnancy Complicates 70% of pregnancies normally from 4-16 weeks True Hyperemesis gravidarum (HG) is a severe form of morning sickness, with "unrelenting, excessive pregnancy-related nausea and/or vomiting that prevents adequate intake of food and fluids, “that may requiring hospitalization, IV fluids, anti-emetics even protonics or TPN Pica: craving for substances that are not food Etiology unknown Check for poor weight gain and refractory anemia South - clay or starch (laundry or cornstarch) UK – coal Also soap, toothpaste and ice
7. Maternal Physiology in Pregnancy: Digestive Tract Changes If the pH of the oral cavity decreases, tooth decay may occur linked to pre-term deliveries. Tooth decay during pregnancy, however, is not due to lack of calcium in the teeth, dental calcium is stable and not mobilized during pregnancy as is bone calcium. The gums may become hypertrophic, hyperemic and friable; this maybe due to increased systemic estrogen. Vitamin C deficiency also can cause tenderness and bleeding of the gums.
8. Maternal Physiology in Pregnancy: Digestive Tract Changes Gingivitis of pregnancy: vascular swelling of the gums can lead to the development of pyogenic granulomas : Epulis gravidarum: regress 1-2 mos after delivery excise if persistent or excessive bleeding
9. Maternal Physiology in Pregnancy: Digestive Tract Changes Gastrointestinal Motility Reduced during pregnancy due to increased levels of progesterone, which decrease the production of motilin, a hormonal peptide that is known to stimulate smooth muscle in the gut. Transit time of food throughout the gastrointestinal tract much slower, more water than normal is reabsorbed, leading to constipation.
10. Maternal Physiology in Pregnancy: Digestive Tract Changes Decreased tone and motility secondary to progesterone Esophagus :dysmotility Esophageal peristalses is deceased, accompanied by gastric reflux because of the slower emptying time and dilatation or relaxation of the cardiac sphincter. Stomach Reduced tone of the gastroesophageal junction sphincter Production of the hormone gastin increases significantly, resulting in increased stomach volume and decreased stomach pH.
11. Maternal Physiology in Pregnancy Gastric compression due to enlarging uterus with decrease sphincter tone increasing incidence GERD This reflux is more prevalent in later pregnancy owing to elevation of the stomach by the enlarged uterus, making the use of anesthesia, especially general anesthesia more hazardous because of the increased possibility of regurgitation and aspiration. Lower incidence of PUD (peptic ulcer disease) may be due to decreased gastric acid secretion delayed emptying, increase in gastric mucus, and protection of mucosa by prostaglandins
12. Maternal Physiology in Pregnancy: Digestive Tract Changes Small bowel : Reduced motility and tone are allow for more efficient absorption, especially iron Large Bowel: Decreased transit times allows for both water and sodium absorption. Increased portal hypertension with dilation wherever there are porto-systemic venous anastamoses (varices) affecting esophagus, vulva and increase varicose veins and hemorrhoids may lead to ovarian vein thrombosis
13. Maternal Physiology in Pregnancy: Gastrointestinal Changes Gallbladder Decreased rate of emptying and hypotonia of the smooth muscle wall Emptying time is slowed and often incomplete Bile can become thick, and bile stasis Cholesterol saturation is increased while chenodeoxycholic acid is decreased in bile These changes favor the development of gallstones
14. Maternal Physiology in Pregnancy: Gastrointestinal Changes Liver Liver size and histology are unchanged Serum albumin and total protein decrease so there is a decrease in the albumin/globulin ratio Serum alkaline phosphatase increases due to placental and some hepatic production No change in serum bilirubin, AST, ALT Clinical and laboratory changes mimic disease states Spider angiomas and palmar erythema
15. Maternal Physiology in Pregnancy: Urinary System Anatomic Changes Renal hypertrophy Dilatation renal pelvis/calyces 15mm on the right in 3rd trimester 5mm on the left. Each kidney increases in length by 1-1.5cm, with a concomitant increase in weight. The ureters are dilated to 2 cm resulting in hydroureter from: progesterone-induced smooth muscle relaxation causing hypotonia mechanical compression above the brim of the bony pelvis by the ovarian vein complex in the suspensory ligament of the ovary dextorotation of the uterus during pregnancy, may explain why the right ureter is usually more dilated than the left.
16. Maternal Physiology in Pregnancy: Urinary System Hyperplasia of smooth muscle in distal one-third of the ureter may cause reduction in the luminal size The ureters also elongate, widen, and become more curved: there is an increase in urinary stasis This may lead to infection and predispose to pyelonephritis in the presence of asymptomatic bacteriuria (30%)
17. Maternal Physiology in Pregnancy: Urinary System Bladder As the uterus enlarges, the urinary bladder is displaced upward and flattened in the anterior-posterior diameter Bladder vascularity increases and muscle tone decreases, increasing capacity up to 1500ml. Trigone elevation occurs with increased vascular tortuousity throughout the bladder leading to microhematuira Decrease bladder capacity Increased frequency of urinary incontinence
18. Maternal Physiology in Pregnancy: Urinary System Renal Hemodynamic Renal blood flow increases 50% . GFR increases 50% (120cc/min180cc/m.) The renal plasma flow rate increases by as much as 25-50%.. Serum Creatinine and BUN levels decrease. Urinary flow and sodium excretion rates in late pregnancy can be altered by posture, being twice as great in the lateral recumbent position as in the supine position. Even thought the GFR increased dramatically during pregnancy, the volume of the urine passed each day is not increased.
19. Maternal Physiology in Pregnancy: Urinary System With the increase in GFR, there is an increase in endogenous clearance of creatinine. The concentration of creatinine in serum is reduced in proportion to increase in GFR, and concentration of blood urea nitrogen is similarly reduced. Glucosuria during pregnancy is not necessarily abnormal, may be explained by the increase in GFR with impairment or exceeding tubular reabsortion capacity for filtered glucose. Increased levels of urinary glucose also contribute to increased susceptibility of pregnant women to urinary tract infection. Proteinuria changes little during pregnancy and if more than 300mg/24h is lost, a disease process should be suspected.
20. Maternal Physiology in Pregnancy: Urinary System Levels of the enzyme renin, which is produced in kidney, increase early in the first trimester, and continue to rise until term This enzyme acts on its substrate angiotensinogen, to first form angiotensin1 and then angiotensin2, which acts as a vasoconstrictor Normal pregnant women are resistant to the pressor effect of elevated levels of angiotensin2 but those suffering from preeclampsia are not resistant, this is one of the some theories to explain this disease.
21. Maternal Physiology in Pregnancy: Cardiovascular System As the uterus enlarges and the diaphragm becomes elevated, the heart is displaced upward and somewhat to the left with rotation on its long axis, so that the apex beat is moved laterally. (apparent cardiomegaly on chest x-ray) Cardiac capacity increases by 70-80mL. This may be due to increased volume or hypertrophy of cardiac muscle. The size of the heart appears to increase by about 12%. Increase in left ventricular end- diastolic dimension. Increase in left ventricular wall mass c/w mild hypertrophy. Increase in preload with increase capacitance of the systemic and pulmonary vascular resistances prevenst rise in CVP or wedge pressure. Grade II-III systolic flow murmurs at left lower sternal border.
22. Maternal Physiology in Pregnancy: Cardiovascular System 30-35% in CO (CO= SV x HR), reaching its maximum at 20-24 weeks gestation and continuing at this level until term The increase in output can be as much as1.5L/min over the non pregnant level HR increases as early as 5 weeks GA Peaks at 32 weeks at 15-20 beats above baseline(20% increase) Stroke volume increases as early as 8 weeks GA, peaks at 20 weeks with a 20-30% increase Cardiac output is very sensitive to changes in body position.
23. Maternal Physiology in Pregnancy: Cardiovascular System This sensitivity increases with gestational age, presumably because the uterus impinges upon the inferior vena cava, thereby decreasing blood return to the heart Because blood pressure either decreases or remain the same during pregnancy and cardiac output increases appreciably, there is good evidence that peripheral resistance( Peripheral resistance equals blood pressure divided by cardiac output) declines markedly. The elevated venous pressure returns toward normal if the woman lies in the lateral recumbent position.
25. Maternal Physiology in Pregnancy: Cardiovascular System Effects of the Labor on the Cardiovascular System When a patient is the supine position, uterine contractions can cause a 25% increase in maternal cardiac output, a 15% decrease in heart rate, and a resultant 33% increase in stroke volume. However when the laboring patient is in the recumbent position, the hemodynamic parameters stabilize , with only a 7.6% increase in cardiac output, a 7% decrease in heart rate, and a 7.7% increase in stroke volume These significant differences are attributable to inferior vena caval occlusion caused by the gravid uterus
26. Maternal Physiology in Pregnancy: Cardiovascular System During contractions, pulse pressure increases 26% in the supine position but only 6% in the lateral recumbent position. Important to have laboring patients in the left lateral recumbent position
27. Maternal Physiology in Pregnancy: Cardiovascular System BP= CO x SVR SVR decreases to a minimum at midpregnancy with a gradual rise towards term but still 20% lower than non-pregnancy Decrease SVR secondary to hormonal vasodilatation (progesterone), NO, prostaglandins, ANP BP changes nadir by midpregancy Diastolic and mean pressure decrease more than the systolic Increases to baseline in third trimester
28. Maternal Physiology in Pregnancy: Cardiovascular System Other cardiovascular changes: Increases in CO, HR Decreases in SVR, PVR No change in MAP, PCWP, CVP,
29. Maternal Physiology in Pregnancy: Cardiovascular System Blood Volume ` Increase in the blood volume beginning at 6 weeks and plateaus at 30 weeks The magnitude of the increases varies according to the size of woman, the number of pregnancies she has had, the number of infants she has delivered, and whether there is one or multiple fetuses Both plasma volume (50%)and cell mass (30%) increase Physiologic anemia of pregnancy nadiring at 30 weeks
30. Maternal Physiology in Pregnancy: Cardiovascular System By term, the average increase in volume 45-50% The increase is needed for extra blood flow to the uterus, extra metabolic needs of fetus, and increased perfusion of others organs, especially kidneys Extra volume also compensate for maternal blood loss delivery The average blood loss with vaginal delivery is 500ml, cesarean section is 1000ml and C/Hyst 1500 ml 10% drop HCT can be considered post-partum hemorrhage
32. Maternal Physiology in Pregnancy: Cardiovascular System Blood Volume Singleton (n=50) 3rd trim. non-preg. % increase Blood volume 4820 3250 48 RBC volume 1790 1355 32 Hct (%) 37.0 41.7 Pritchard, JA. Changes in blood volume during pregnancy 5th percentile for hemoglobin was 11.0 g/L in the 1st trimester; in the 2nd trimester it was 10.5 g/L and 10.3 g/L in the third trimester Acta Obstet Gynecol Scand. 2000 Feb;79(2):89-98
33. Maternal Physiology in Pregnancy: Cardiovascular System Iron Metabolism Absorption in the duodenum in the divalent state Trivalent food source must be converted by ferric reductase to divalent form Febound transferrintransported to liver, spleen, muscle and bone marrow incorporated into hemoglobin, myoglobin, ferritin or hemosiderin 1000mg iron requirement, (about 3.5 mg/d) Requirements increase in third trimester Fetus receives Fe through active transport
34. Maternal Physiology in Pregnancy: Cardiovascular System With the increase in red blood cells, the need for iron for the production of hemoglobin increases, but Fe supplementation usually not needed before 20 weeks Fe supplementation Ferrous sulfate 20% ( 65mg elemental Fe) Ferrous gluconate 12% (35mg of elemental Fe) and ferrous fumarate 33%(108mg of elemental Fe) ; fumerate and gluconate better absorbed(organic Fe) For severe anemia: Preparations Iron Dextran (Imferon, Dexferrum) High rate of serious reaction (requires test dose) Intramuscular or Intravenous Dose based on estimated iron deficits
35. Maternal Physiology in Pregnancy: Cardiovascular System (Test dose)[25 mg] [100 ml] [5 min][Prescribed dose] [250 to 1000mg](Usually 500 ml NS) Total dose infusion: infuse over 2 to 6 hours.
36. Maternal Physiology in Pregnancy: Cardiovascular System Sodium ferric gluconate (Ferrlecit) Dosing: 125 mg/weekly IV for 8 weeks (total: 1 gram) Much safer than Iron Dextran (no test dose needed) Iron sucrose (Venofer) Much safer than Iron Dextran (no test dose needed) Dosing: 200 mg IV for 5 doses over 2 week period Precautions Intravenous iron must be started very slowly Adverse affects: fever, pain, headaches, Myalgias and arthralgias Anaphylaxis Occurs in 0.61% of patients given Iron Dextran Occurs in 0.04% of patients given ferric gluconate
37. Maternal Physiology in Pregnancy: Cardiovascular System Maternal requirements can reach 5-6mg/d in the latter half of pregnancy If supplemental iron is not added to the diet, iron deficiency anemia will result If iron is not readily available, the fetus, uses iron from maternal stores. Thus, the production of fetal hemoglobin is usually adequate even if the mother is severely iron deficient and anemia in the newborn is rarely a problem Maternal iron deficiency more commonly may cause preterm labor and late spontaneous abortion,
38. Maternal Physiology in Pregnancy: Cardiovascular System White Blood Cells The total blood leukocyte count increases during pregnancy from a pre-pregnancy level of 4300-4500/mL to 5000-12000/mL in the last trimester, although counts as high as 16000/mL have been observed in the last trimester Counts as high as 25000-30000/mL have been noted in a normal patient during labor Lymphocyte and monocyte numbers stay the same throughout pregnancy; polymorphonuclear leucocytes are the primary contributors to the increase.
39. Maternal Physiology in Pregnancy: Cardiovascular System Platelets Progressive decline in count from 1st-3rd trimester. Increased platelet destruction. Plts range between 70-150,000, gestational thrombocytopenia of pregnancy Burrows @Kelton reported an 8% prevalence. Diagnosis of exclusion: PIH/HELLP, ITP, viral disease, HIV, autoimmune disease, ie lupus.
40. Maternal Physiology in Pregnancy: Cardiovascular System Other Hematologic Changes Leukocytosis secondary to increase neutophils estrogen and cortisol induced Altered immune status, immunocompromised Paradoxical decline of immunoglobins A,G,M Only IgG crosses the placenta
41. Maternal Physiology in Pregnancy: Cardiovascular System Coagulation System Hypercoaguable state Increased venous stasis lead to vessel wall injury Changes in the coagulation cascade Increases in factors I,VII,VIII, IX and X Unchanged or mildly increasedfactors II, V, XII Decrease in factors XI, XIII Decrease in fibrinolysis with decreased plasminogen activator Increase in factor I (fibrinogen) causes elevated sed rate Decrease in protein S but no change in protein C and antithrombin III. Activated protein C decreases
42. Maternal Physiology in Pregnancy: Cardiovascular System Fibrinolytic activity is depressed during pregnancy and labor, although the precise mechanism is unknown The placenta may be partially responsible for this alteration in fibrinolytic status Plasminogen levels increase concomitantly with fibrinogens levels, causing an equilibration of clotting and lysing activity
43. Maternal Physiology in Pregnancy:Respiratory System Anatomic and Physiologic Changes Pregnancy produces changes that affect respiratory performance Early in pregnancy, capillary dilatations occurs throughout the respiratory tract, leading to engorgement of the nasopharnyx, larnyx, trachea, and bronchi This causes the voice to change and makes breathing though the nose difficult. Upper respiratory tract hyperemia and edema induced by estrogen leading to nasal stuffiness and epistaxis Chest X-rays reveal increased vascular makings in the lungs.
44. Maternal Physiology in Pregnancy:Respiratory System As the uterus enlarges, the diaphragm is elevated as much as 4cm, but elevation of the diaphragm does not impede its movement. The rib cage is displaced upward and widens, increasing the lower thoracic diameter by 2cm and the thoracic circumference by up to 6cm. Chest circumference expands 5-7 cm Subcostal angle increases from 68 to 103 degrees Respiratory muscle function is not affected by pregnancy Abdominal muscles have less tone and are less active during the pregnancy, causing respiration to be more rather than less diaphragmatic.
45. Maternal Physiology in Pregnancy:Respiratory System Elevation of the diaphragm decreases the volume of the lungs in the resting state, reducing TLC by 5% and FRC by 20% FRC mainly decreased by RV Vital capacity does not change Chronic hyperventilation progesterone induced Minute volume is increased Tidal volume is increased Respiratory rate is unchanged( Increased early in the first trimester)
46. Maternal Physiology in Pregnancy:Respiratory System Dead volumes increase owing to relaxation of the musculature of conducting airways. Tidal volumes increases gradually(35-50%)as pregnancy progresses. Total lung capacity is reduced (4-5%) by the elevation of the diaphragm. Functional residual capacity, residual volume, and respiratory reserve volume all decrease by about 20%. Larger tidal volume and smaller residual volume cause increased alveolar ventilation (about 65%) during pregnancy. Inspiratory capacity increases 5-10%.
47. Maternal Physiology in Pregnancy:Respiratory System Functional respiratory changes include a slight increase in respiratory rate, a 50% increase in minute ventilation, a 40% increase in tidal volume A progressive increase in oxygen consumption of up to 15-20% above non-pregnant levels by term. With the increase in respiratory tidal volume associated with a normal respiratory rate, there is an increase in respiratory minute volume of approximately 26% . As the respiratory minute volume increases, hyperventilation of pregnancy occurs, causing a decrease in alveolar CO2
48. Maternal Physiology in Pregnancy:Respiratory System This decrease lowers the maternal blood CO2 tension; however alveolar oxygen tension is maintained within normal limits. Maternal hyperventilation is considered a protective measure that prevents the fetus from the exposure to excessive levels of CO2. Because this decrease in FRC occurs without a concomitant change in dead space, there is little residual dilution and, therefore, presumably more efficient gas exchange.
49. Maternal Physiology in Pregnancy:Respiratory System Spirometry: the most common of the Pulmonary Function Tests(PFTs), measuring lung function, specifically the measurement of the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled. FEV1 (forced expiratory pressure in 1 second), 80-100% of average values are considered normal and is unchanged Peak Expiratory Flow: is the maximal flow (or speed) achieved during the maximally forced expiration initiated at full inspiration, measured in liters per minute, also unchanged
52. Maternal Physiology in Pregnancy:Respiratory System: Gas Exchange Hyperventilation leads to deceased PCO2 Increases CO2 gradient between fetus and mother Chronic respiratory alkalosis Compensatory metabolic acidosis 20-40% increase in maternal oxygen consumption Normal arterial blood gas values Ph= 7.4-7.45 PCO2= 28-32 PO2= 101-106 HCO3= 18-21
53. Maternal Physiology in Pregnancy Metabolism As the fetus and placenta grow and place increasing demands on the mother, phenomenal alterations in metabolism occur The most obvious physical changes are weight gain and altered body shape Weight gain is due not only to the uterus and its contents but also to increase breast tissue, blood and water volume in the form of extravascular and extracellular fluid Deposition of fat and protein and increased cellular water are added to the maternal stores The average weight gain during pregnancy is 12.5Kg. (23-25 lbs)
54. Maternal Physiology in Pregnancy During normal pregnancy, approximately 1000g of weight gain is attributable to protein Half of this is found in the fetus and the placenta, with the rest being distributed as uterine contractile protein, breast glandular tissue, plasma protein, and hemoglobin Total body fat increases during pregnancy, but the amount varies with total weight gain During the second half of pregnancy, plasma lipids increase , but triglycerides, cholesterol and lipoproteins decrease soon after delivery The ratio of low density lipoproteins to high density lipoproteins increases during pregnancy
55. Maternal Physiology in Pregnancy Body Water Metabolism Condition of chronic water overload Active Na+ and water retention 1. Changes in osmoregulation 2. Renin-angiotensin system Body water increase 6.5L 8.5L 1. 1500 cc increase in blood volume 2. RBC increase ~400cc Elevation of maternal CO
56. Maternal Physiology in Pregnancy Osmoregulation Na+ retention increases 900 mEq but serum Na+ decreases 3-4 mmol/l Plasma osmolality decreases 10 mOsm/kg Enhanced tubular reabsorption of Na+ secondary to aldosterone, estrogen and deoxycorticosterone Increased GFR and Atrial Natriuretic Peptide favor Na+ excretion
57. Maternal Physiology in Pregnancy Skeletal Changes: Calcium metabolism Maternal total calcium levels decline due to decreased albumin bound concentration Serum ionized level remains unchanged Increased intestinal absorption occurs in first trimester, actively transported across the placenta Maternal serum phosphate levels are unchanged PTH levels remain unchanged Elevated levels of vitamin D allow for increase Ca++ absorption Calcitonin levels rise to preserve maternal skeleton
58. Maternal Physiology in Pregnancy Skeletal and Postural Changes Lordosis of pregnancy~ progressive increase in anterior convexity of the lumbar spine, preserves center of gravity Ligaments of the symphysis and sacroiliac joints loosen during pregnancy due to relaxin
59. Maternal Physiology in Pregnancy Endocrine Changes Thyroid Physiology Euthyroid state Increase in thyroxine-binding globulin Decrease in circulating pool of extra-thyroidal iodide Slight thyromegaly Free T4 and Free T3 remain normal Small amounts of TRH /T4 cross the placenta Fetal thyroid active by 12 weeks gestation
60. Maternal Physiology in Pregnancy Endocrine Changes Adrenal function Increases in corticosteroid-binding globulin Increases in free cortisol Zona fasciculata is increased Marked increase in CRH from placental sources Delayed plasma clearance of cortisol due to renal changes Resetting of hypothalamic-pituitary sensitivity to cortisol feedback on ACTH production
61. Maternal Physiology in Pregnancy Endocrine Changes Pituitary gland enlarges due to proliferation of prolactin-secreting cells Enlargement makes it more susceptible to alterations in blood flow Prolactin levels are increased (ten times higher at term) to prepare breasts for lactation
62. Maternal Physiology in Pregnancy Endocrine Changes Pancreas and Fuel Metabolism Physiologic glucose intolerance to insure continuous transport of nutrients from mother to fetus Fasting hypoglycemia Postprandial hyperglycemia Hyperinsulinemia
65. Maternal Physiology in Pregnancy Fuel Metabolism Pregnant prolonged fasting Increased utilization of fat stores Lipolysis generates glycerol, fatty acids and ketones for gluconeogenesis and fuel More HPL, less insulin results in increased utilization of fat stores Maternal response to starvation hypoglycemia, hypoinsulinemia , hyperlipidemia, hyperketonemia
66. Maternal Physiology in Pregnancy Fuel Metabolism Maternal response to feeding Hyperglycemia Hyperinsulinemia Hyperlipidemia Resistance to insulin Insulin secretion increases throughout Insulin resistance increases to 50-80% in third trimester Borderline pancreas function leads to GDM
67. Maternal Physiology in Pregnancy Endocrine Changes Diabetogenic effects of pregnancy HPLlipolytic and anti-insulin( Cortisol Prolactin Estrogen and Progesterone Fetal glucose levels are 20 mg/dl less than maternal values Placental glucose transport is carrier mediated facilitated transport that is energy independent
68. Maternal Physiology in Pregnancy Fuel and Metabolism Lipids and lipoproteins increase in pregnancy Total cholesterol, LDL, HDL and triglycerides all increase Necessary as precursors for steroiodgenesis Does not appear to lead to atherosclerosis unless pre-existing hyperlipidemia
70. Maternal Physiology in Pregnancy Integumental Changes Hyperpigmentation 90% of pregnancies Localized to areas of increased melanocytes Choasma of pregnancy 70% of women in all races Linea alba…Linea nigra Up to 30% of changes can persist
71. Maternal Physiology in Pregnancy Integumental Changes Hair Changes Mild hirsutism is common Excessive virilization should prompt investigation for androgen-secreting tumors Normal pregnancy increases amount of hair in anagen phase(growth) Postpartum, telogen effluvium may occur with increased amount of hair in resting phase which leads to loss
72. Maternal Physiology in Pregnancy Ocular Changes Increased thickness of the cornea secondary to fluid retention, this edema induces causing a 3% increase Affects contacts Decreased intraocular pressure Glaucoma improves Minimally decreases visual fields
73. Maternal Physiology in Pregnancy So you see there are extensive changes in maternal physiology that occur in pregnancy Be careful in interpretations of what are normal pregnancy changes, especially when parameters like lab values represent the non-pregnant state Visit our website @ secondopinion2.com or contact us at info@secondopinion2.com “CHANGE THAT’S WORTH IT”