The document discusses changes to the gastrointestinal tract and endocrine system during pregnancy. The gastrointestinal tract is displaced by the enlarging uterus, which can alter findings for certain diseases. Gastric emptying time is prolonged during labor and after analgesics. The liver increases blood flow but does not increase in size. Hormone and enzyme levels in the blood change. The pituitary gland enlarges and increases production of growth hormone, prolactin, and other hormones. The thyroid gland increases production to meet maternal and fetal needs. Parathyroid and adrenal gland function is also altered to meet calcium and other regulatory needs for both mother and fetus.
Anatomical & physiological changes in pregnancy & their clinical implications...alka mukherjee
• Women undergo several changes during pregnancy, including cardiovascular, hematologic, metabolic, renal, and respiratory changes that provide adequate nutrition and gas exchange for the developing fetus.
• Progesterone and estrogen levels rise continually through pregnancy, together with blood sugar, breathing rate, and cardiac output.
• The body’s posture changes during pregnancy to accommodate the growing fetus and the mother will experience weight gain.
• Breasts grow and change in preparation for lactation once the infant is born. Once lactation begins, the woman’s breasts swell significantly and can feel achy, lumpy, and
heavy (engorgement). This is relieved by nursing the infant.
• Plasma and blood volume increase over the course of the pregnancy and lead to changes in heart rate and blood pressure. Women may also have a higher risk of blood clots, especially in the weeks following labor.
• During pregnancy, both protein metabolism and carbohydrate metabolism are affected. One kilogram of extra protein is deposited, with half going to the fetus and placenta, and another half going to uterine contractile proteins, breast glandular tissue, plasma protein, and hemoglobin.
• Circulatory Changes
• Plasma and blood volume slowly increase by 40–50% over the course of the pregnancy (due to increased aldosterone) to accommodate the changes, resulting in an increase in heart rate (15 beats/min more than usual), stroke volume, and cardiac output. Cardiac output increases by about 50%, primarily during the first trimester.
• The systemic vascular resistance also drops due to the smooth muscle relaxation and overall vasodilation caused by elevated progesterone, leading to a fall in blood pressure. Diastolic blood pressure consequently decreases between 12–26 weeks, and increases again to pre-pregnancy levels by 36 weeks.
• Edema (swelling) of the feet is common during pregnancy, partly because the enlarging uterus compresses veins and lymphatic drainage from the legs.
• The platelet count tends to fall progressively during normal pregnancy, although it usually remains within normal limits. In a proportion of women (5–10%), the count will reach levels of 100–150 × 109 cells/l by term and this occurs in the absence of any pathological process. In practice, therefore, a woman is not considered to be thrombocytopenic in pregnancy until the platelet count is less than 100 × 109 cells/l.
• Pregnancy causes a two- to three-fold increase in the requirement for iron, not only for haemoglobin synthesis but also for for the foetus and the production of certain enzymes. There is a 10- to 20-fold increase in folate requirements and a two-fold increase in the requirement for vitamin B12.
Changes in the coagulation system during pregnancy produce a physiological hypercoagulable state (in preparation for haemostasis following delivery).
Anatomical & physiological changes in pregnancy & their clinical implications...alka mukherjee
• Women undergo several changes during pregnancy, including cardiovascular, hematologic, metabolic, renal, and respiratory changes that provide adequate nutrition and gas exchange for the developing fetus.
• Progesterone and estrogen levels rise continually through pregnancy, together with blood sugar, breathing rate, and cardiac output.
• The body’s posture changes during pregnancy to accommodate the growing fetus and the mother will experience weight gain.
• Breasts grow and change in preparation for lactation once the infant is born. Once lactation begins, the woman’s breasts swell significantly and can feel achy, lumpy, and
heavy (engorgement). This is relieved by nursing the infant.
• Plasma and blood volume increase over the course of the pregnancy and lead to changes in heart rate and blood pressure. Women may also have a higher risk of blood clots, especially in the weeks following labor.
• During pregnancy, both protein metabolism and carbohydrate metabolism are affected. One kilogram of extra protein is deposited, with half going to the fetus and placenta, and another half going to uterine contractile proteins, breast glandular tissue, plasma protein, and hemoglobin.
• Circulatory Changes
• Plasma and blood volume slowly increase by 40–50% over the course of the pregnancy (due to increased aldosterone) to accommodate the changes, resulting in an increase in heart rate (15 beats/min more than usual), stroke volume, and cardiac output. Cardiac output increases by about 50%, primarily during the first trimester.
• The systemic vascular resistance also drops due to the smooth muscle relaxation and overall vasodilation caused by elevated progesterone, leading to a fall in blood pressure. Diastolic blood pressure consequently decreases between 12–26 weeks, and increases again to pre-pregnancy levels by 36 weeks.
• Edema (swelling) of the feet is common during pregnancy, partly because the enlarging uterus compresses veins and lymphatic drainage from the legs.
• The platelet count tends to fall progressively during normal pregnancy, although it usually remains within normal limits. In a proportion of women (5–10%), the count will reach levels of 100–150 × 109 cells/l by term and this occurs in the absence of any pathological process. In practice, therefore, a woman is not considered to be thrombocytopenic in pregnancy until the platelet count is less than 100 × 109 cells/l.
• Pregnancy causes a two- to three-fold increase in the requirement for iron, not only for haemoglobin synthesis but also for for the foetus and the production of certain enzymes. There is a 10- to 20-fold increase in folate requirements and a two-fold increase in the requirement for vitamin B12.
Changes in the coagulation system during pregnancy produce a physiological hypercoagulable state (in preparation for haemostasis following delivery).
Dr Anil Arora address the liver diseases that are specific during pregnancy. The presentation contains case discussions on diagnosis, treatments & take home messages
Biochemical changes in pregnancy, Physiological changes in pregnancy, maternal and fetal health assessment, assessment of complications in pregnancy, hormonal changes and physiological evaluations in pregnancy
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.
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2. 2
PREGNANCY
PROGRESS
Stomach and
intestines are
displaced
(enlarging uterus)
The phisical
findings in certain
diseases are
altered
Gastric
emptying
time.
During labor
and especially
after
administration
of analgesic
agents
Danger!!!
General
anesthesia for
delivery
Regurgitation
and aspiration
PROLONGE
D
8. Endocrine System
8
- Pituitary Gland :
- Thyroid Gland
- Parathyroid Gland:
+Growth
Hormone
+Prolactine
+Parathyroid Hormone and Calcium
+Calcitonin and Calcium
+Vitamin D and Calcium
-Adrenal Gland
-Androgen
9. 9
Pituitary
Gland
Enlarged 135%
compress optic
chiasma
Time Maternal Fetal
First Trimester GH secreted predominantly from
maternal pituitary gland
8 weeks pregnancy GH from placenta becomes
detectable
10 weeks pregnancy Maternal serum values increase
slowly from approximately 3.5
ng/mL
14 to 15 weeks Growth hormone peaks in
amnionic fluid
17 weeks pregnancy Placenta is the principal
source of GH
after 28 weeks plateau at approximately 14
ng/mL
after 36 weeks GH in amniotic fluids
slowly declines at baseline
values
GROWTH HORMONE
10. Promotes mammary alveolar cell RNA synthesis,
galactopoiesis, and production of casein and
lactalbumin,
lactose, and lipids
increases the number of estrogen and prolactin
receptors in these same cells
Initiate DNA synthesis and mitosis of glandular
epithelial cells and the presecretory alveolar cells
of the breast
(in early pregnancy)
To ensure lactation
Pituitary Gland - ProlactinPituitary Gland - Prolactin
10
Maternal plasma prolactin increase tenfold greater at term (150 ng/
11. up to 10,000 ng/mL
levels decrease and reach a
nadir
decrease even in women
who are breast feeding
pulsatile bursts of prolactin
secretion occur apparently
in
response to suckling
11
Pituitary Gland -
Prolactin
20-26 weeks
> 34 weeks
After
delivery
Early
Lactation
at amnionic fluid
12. 12
the uterine decidua is the site of prolactin synthesis in
amnionic fluid
Suggest amnionic fluid prolactin impairs the transfer of
water from the fetus into the maternal compartment
Pituitary Gland -
Prolactin
preventing fetal
dehydration
13. Thyroid Gland
1. Pregnancy induces a marked increase in
circulating levels of the major thyroxine
transport protein, thyroxine-binding globulin,
in response to high estrogen levels
2. Several thyroidal stimulatory factors of
placental origin are produced in excess
3. Accompanied by a decreased availability of
iodide for the maternal thyroid
13
Production of thyroid increase 40 to 100%to
meet maternal and fetal need
15. 15
early in the first
trimester, thyroxine-
binding globulin
increases, reaches its
zenith at
about 20 weeks
Total serum
thyroxine (T4)
increases
sharply beginning
between 6 and 9
weeks and plateau
at 18 weeks
Free serum T4 levels
rise slightly and peak
along with hCG levels,
then they return to
normal
As a result structural
similarity, hCG has
intrinsic thyrotropic
activity, and thus,
high serum levels
cause thyroid
stimulation
• begin to concentrate
iodine 10-12 wks
gestation
• Synthesis and secretion
20 wks
• At birth 30% of T4 in
umbilical cord is of
maternal origin
16. 16
Thyrotropin-releasing hormone (TRH) increases the secretion of thyrotropin (TSH), which stimulates the
synthesis and secretion of trioiodothyronine (T3) and thyroxine (T4) by the thyroid gland. T3 and T4 inhibit the
secretion of TSH, both directly and indirectly by suppressing the release of TRH. T4 is converted to T3 in the liver
and many other tissues by the action of T4 monodeiodinases. Some T4 and T3 is conjugated with glucuronide
and sulfate in the liver, excreted in the bile, and partially hydrolyzed in the intestine. Some T4 and T3 formed in
the intestine may be reabsorbed.
17. Parathyroid Glands – Parathyroid
Hormone
Fetal skeleton : 30 g calcium
need calcium absorption (400 mg/day)
17
Acute/chronic decreases Ca or Mg ↑ PTH release
bone resorption, intestinal absorption,
and kidney reabsorption
ADDITIONAL
CALCIUM
↑extracellular fluid Calcium and ↓ phosphate levels
18. 18
Estrogens appear to block the action of parathyroid hormone on bone resorption,
resulting in another mechanism to increase parathyroid hormone during pregnancy. The
net result of these actions is a physiological hyperparathyroidism of pregnancy,
likely to supply the fetus with adequate calcium
19. - to oppose those of parathyroid hormone and vitamin D
- to protect skeletal calcification during times of calcium
stress
Pregnancy
and lactation
Parathyroid Glands –
Calcitonin and Calcium
19
• Various gastric hormones
(gastrin, pentagastrin,
glucagon, pancreozym)
• Food ingestion
calcitonin levels are
appreciably
higher than in non
pregnant women
increase calcitonin
plasma levels
21. ADRENAL GLANDSADRENAL GLANDS
• Increase in serum level but bounded by
CBG (transcortin)
• Metabolic clearance rate decreased
half life increase by almost two fold
• Estrogen and contraseptive oral
changes kortisol serum level and
transcortin09/06/15 22
25. DeoxycorticosteroneDeoxycorticosterone
Increase in pregnancy
(1500 рg/ml, more than 15 fold )
09/06/15 27
ADRENAL GLANDS
Increased kidney
production
Estrogen
stimulation
Concentration at fetus is bigger than it
mother
Transfer deoxycorticosterone from fetus to
mother
28. Androstenedion & TestosteronAndrostenedion & Testosteron
• Production increase unknown source
(likely originates in the ovary)
• Clearance increase converted to estradiol
in
the placenta
• Retardation testosteron clearance
increase sex hormon binding globulin
• Testosteron is undetectable in umbilical
cord venous plasma conversion of
testosterone to 17β-estradiol by trophoblast09/06/15 30
ADRENAL GLANDS
