The document summarizes various anatomical, physiological, and biochemical changes that occur during pregnancy across multiple body systems. Key anatomical changes include uterine enlargement, breast changes, skin changes like lineae nigra and striae gravidarum. Physiological changes impact the cardiovascular, respiratory, renal and endocrine systems to support the nutritional and oxygen needs of the growing fetus. Hematological changes include increased blood volume and mild anemia. Biochemical changes involve iron metabolism and increased production of hormones like estrogen, progesterone, human placental lactogen and relaxin.
The second stage of labor begins when the cervix is completely dilated (open), and ends with the birth of your baby. Contractions push the baby down the birth canal, and you may feel intense pressure, similar to an urge to have a bowel movement. Your health care provider may ask you to push with each contraction.
Puerperium is the period following childbirth during which the body tissues, specially the pelvic organs revert back approximately to the pre-pregnant state both anatomically and physiologically. puerperium begins as soon as the placenta is expelled and lasts for approximately 6 weeks when the uterus becomes regressed almost to the non-pregnant size.
The second stage of labor begins when the cervix is completely dilated (open), and ends with the birth of your baby. Contractions push the baby down the birth canal, and you may feel intense pressure, similar to an urge to have a bowel movement. Your health care provider may ask you to push with each contraction.
Puerperium is the period following childbirth during which the body tissues, specially the pelvic organs revert back approximately to the pre-pregnant state both anatomically and physiologically. puerperium begins as soon as the placenta is expelled and lasts for approximately 6 weeks when the uterus becomes regressed almost to the non-pregnant size.
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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
Maternal Physiology & Related Conditions refers to the physiological changes that occur in a woman's body during pregnancy, childbirth, and the postpartum period. These changes include hormonal fluctuations, cardiovascular and metabolic changes, and structural changes in the reproductive system. Maternal physiology also encompasses the study of any potential complications that may arise during this time, such as gestational diabetes or preeclampsia.
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. It includes changes in the genital organs, uterus, cardiovascular changes, respiratory, metabolic, alimentary, skin, skeleton, psychological changes, urinary changes and weight gain in pregnancy.
Similar to Physiological changes in pregnancy (20)
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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2 Case Reports of Gastric Ultrasound
7. Genital changes
- Uterine ligaments: Hypertrophy
Dextro-rotation of Uterus:
the uterus is tilted and twisted to the right in 80%
of cases
Levorotation of Cervix
- Uterine Peritonium: Deepening of the pouch of Doughlas
- Lower uterine segment (LUS)
the LUS is formed from the isthmus
formed from the 4th month to reach 10 cm at full term
9. BRAXTON HICKS CONTRACTION:
Irregular
Infrequent
Spasmodic
Painless
Without any effect on dilation of cervix
Intra uterine pressure < 8 mmHg
Detected bimanually by 2nd trimester.
Intensity- 5-25 mmHg
Not Seen in ABDOMINAL PREGNANCY.
11. Genital changes
• The cervix
• Changes seen after 1 month of pregnancy.
- edema and congestion, and becomes soft
- Hypertrophy and hyperplasia of cervical gland
- mucus plug (operculum): cervical mucus closing the cervical
canal
- act as immunoglobulin barrier to protect uterine content
against infection
- increased secretion from its glands
12. • The vulva
shows increased vascularity and
varicosities
Labia minora: pigmented & hypertrophied.
Fallopian tube:
Hypertrophy.
Flattened epithelium.
Torsion
13. Genital changes
• The vagina
- shows increased vascularity soft, moist and bluish
- distention of vagina at birth
pH- 3.5-6
• The ovary
shows increased vascularity and size
one ovary contains the corpus luteum
Extrauterine decidual reaction beneath
the surface.
• Pelvic ligaments
- relaxation of the ligaments
- relaxation of the pelvic joints
- the pelvis become more mobile and increases in capacity
JACQUEMIER’S SIGN
15. Breasts: increase in circulation
Engorgement and venous prominence
Mastodynia (breast ternderness): tingling to frank
pain caused by hormonal responses of the mammary
ducts and alveolar system
Montgomery’s tubercles: enlargement of
circumlacteal sebaceous glands of the areola
Colostrum secretion: can be sqweezed out at
about 12 weeks.
By 16 weeks become thick and YELLOWISH.
16. Montgomery tubercles
non pigmented nodules
(12-20) around the areola
in 2nd month (enlarged
sebaceous glands or
rudimentary lactiferous
ducts).
17. Skin changes• Pigmentation
due to increased melanocyte stimulating hormone:
- linea nigra: pigmentation of the linea alba, more marked below
the umbilicus
- chloasma gravidarum: Butterfly pigmentation of the face (mask
of pregnancy)
• Striae gravidarum
- stretch of the abdominal wall
rupture of the subcutaneous elastic fibers
pink lines in flanks
- become white after labor
18.
19. Skeletal changes
• Increased lumbar
lordosis
• Relaxation of pelvic
joints and
ligaments due to
progesterone and
relaxin
20. EYES
Increased vitreous outflow Decrease in Intraocular
pressure
Corneal sensitivity is decreased
Increase in corneal thickness thus may have difficulty with
previously comfortable contact lenses.
Brownish-red opacities on the posterior surface of the
cornea—Krukenberg spindles—have also been observed
Increased pigmentation
Transient loss of accommodation
Visual function is unaffected
21.
22. Weight increase
•There is an increase
weight of approximately
12.5 Kg at term.
•The main increase
occurs in the 2nd half of
the pregnancy, 0.5
Kg/week
1st Trimester 2nd Trimester 3rd Trimester
1 kg 5 kg 5 kg
26. Position and size of heart:
Due to elevation of diaphragm heart moves to left and upward, apex
shifted laterally.
Chest X-ray changes:
Larger cardiac silhouette with horizontal positioning.
Staightening of left upper cardiac border.
Small benign pericardial effusion
ECG changes
Increased heart rate (+15%) i.e Sinus
tachycardia
15-degree left axis deviation i.e
QRS deviation.
Lead III: small Q wave & inverted
P wave.
V1 and V2: Increase R/S ratio
27. ECHOCARDIOGRAM CHANGES:
Slightly increased End diastolic and
End systolic volume.
Slightly improved LV function.
Slightly increased venticular
dimension with
Spherical left ventricular
remodelling.
Small pericardial effusion.
Increased tricuspid annulus
diameter.
Physiological tricuspid
regurgitation.
No change in septal thickness or
ejection fraction
28. HEART SOUNDS:
Apex beat shifted to 4th intercostal space, 2.5 cm lateral to
midclavicular line.
SYSTOLIC MURMER: Apical or pulmonary area: Due to
decreased blood viscosity & torsion of great vessels.
MAMMARY MURMER:
Continous hissing murmer at tricuspid area i.e left 2nd & 3rd
ICS due to increased blood flow
through internal mammary vessels.
S3 or THIRD HEART SOUND:
due to rapid diastolic filling.
29. Cardiovascular changes (cont)
Stroke volume +30%
Heart rate +15%
Cardiac output +40%
Oxygen consumption +20%
SVR (systemic vascular resistance) -5%
Systolic BP -10mmHg
Diastolic BP -15mmHg
Mean BP -15mmHg
30. SUPINE HYPOTENSION SYNDROME:
During pregnancy, cardiac output is
very sensitive to positional
alterations. In the supine position,
the inferior vena cava is compressed
by the enlarged uterus, resulting in
decreased cardiac output.
Although most women do not
become overtly hypotensive when
lying supine due to opening of
collateral circulation
In some cases (10%) may have
symptoms that include dizziness,
light-headedness, tachycardia and
syncope.
Cardiac output increases 1.2L/min
i.E 20% when woman moves from
Supine to left lateral position.
31. Unchanged in the upper body
Significantly increases in the lower extremities,
esp. during supine, sitting or standing position,
returns to near normal in lateral recumbent position
Venous pressure: Venous blood flow
34. Haematological changes
• Circulating red cell mass increases by 20-
30%
( rises more in multiple pregnancies and iron
supplement)
• Serum iron concentration falls
absorption from gut and iron-binding
capacity rise
• Plasma folate concentration halves by term
( due to increased renal clearance)
red cell folate concentration falls less
• Mild maternal anaemia associated with
increased placental/birthweight ratio
decreased birthweight
35. Haematological changes
• Erythropoietin rises especially if iron supplement not taken
• Human placental lactogen may stimulate haematopoiesis
• Fall in packed cell volume from 36% in early pregnancy to 32% in the 3rd
trimester ( normal plasma volume expansion)
• WBC count rises ( increase in polymorphonuclear leucocytes)
• Neutrophil number rises with oestrogen
peak at 33 weeks
stabilizing after that
until labour and the puerperium, when they rise sharply
Platelet count and platelet volume are largely unchanged
36. Iron metabolism
Only 10% of ingested iron is absorbed.
Total iron requirement in pregnancy is 1000 mg.
Iron loss in menstrual bleeding is 30mg/ cycle.
Thus saving of 300mg of iron due to 10 months of
amenorrhea.
Iron requirement mostly increased in 3rd trimester.
Daily iron requirement to compensate the avg daily loss:
Fetus & placenta
300 mg
Expanded RBC mass
400 mg
Obligatory loss
200 mg
Non menstruating woman 1 mg
In 2nd half of pregnancy 6-7 mg
37. Plasma protein changes
Parameter Nonpregnant Pregnancy near
term
Change
Total proteins (g) 180ased 230 Increased
Plasma protein
conc.
(g/100 ml)
7 6 Decreased
Albumin
(g/100 ml)
4.3 3 Decreased
( 30%)
Globulin
(g/100 ml)
2.7 3 Increased
Albumin:
Globulin
1.7: 1 1: 1 Decreased
38.
39. IMMUOLOGICAL FUNCTION:
Early pregnancy: Proinflammmatory
Mid Pregnancy: Anti inflammatory
Parturition: Recrudencence of an inflammatory process
Suppresion of T-helper (Th 1) and T-cytotoxic 1 cells leads to:
Decrease secretion of interleukin-2 (IL-2), interferone γ
and TNF-β
Pregnancy related remission of autoimmune diseases.
Failure of Th1 supression leads to pre-eclampsia
development.
Upgradation of Th2 cells: Increased production of IL-4, IL-6 &
IL-13
10 times increase in interleukin 1β in cervical and vaginal mucus
in 1st trimester.
• T and B lymphocyte counts do not change but their function is
suppressed ( women become more susceptible to viral
infections, malaria and leprosy)
47. • Increased salivation (ptyalism)
• Taste is often altered very early in pregnancy
• Increase appetite & thirst: frequent small snacks are adviced
• Gums: Hyperemic, softens and bleeds easily.
Localised vascular swelling known as Eppulis of Pregnancy
• Heart burn (reflux oesophagitis) due to relaxation of the cardiac sphincter due to
progesterone and relaxin
• Emesis gravidarum, morning sickness in 50 %
• Decreased gastric acidity, which interfere with iron absorption
• Constipation
reduced gut motility due to progesterone
increased water and salt absorption
• Hemorrhoids due to elevated venous pressure due compression by gravid uterus.
48. • Liver
- Hepatic synthesis of albumin, plasma globulin and fibrinogen increases
- Total hepatic synthesis of globulin increases stimulated by estrogen
- Hepatic arterial and portal venous flow increases.
- Total serum Alkaline phosphatase activity almost doubles:
mostly due to Heat stable placental Alkaline phosphatase isoenzymes
• Gallbladder
Gall bladder increases in size and empties more slowly
Progesterone potentially impairs gallbladder contraction by
inhibiting cholecystokinin-mediated smooth muscle stimulation,
which is the primary regulator of gallbladder contraction
Relaxation of gall bladder increases the tendency of stone
formation
Cholestasis is almost physiological
Secretion of bile is unchanged
49. Urinary changes
• Kidneys
- 1.5 cm increase in size
- hydronephrosis
- increase in GFR
25% by 2nd week
50% by 2nd trimester
- 80% increase in effective renal plasma flow before the end of 1st
trimester.
Renal Function Test:
Decrease serum creatinine level (Even >0.9mg/dl considered abnormal)
30% higher creatnine clearance.
Glucosuria.
Protenuria—
non pregnant woman- > 150 mg/dl
pregnant woman- >300 mg/dl
50. Relaxin
Endothelin and NO production
•Renal vasodilation
• Renal afferent and efferent arteriolar
resistance
Renal blood flow.
GFR
Urinary
Frequency
51. URETER:
BLADDER:
•Dilatation of the ureters due to compression.
•Unequal dilation due to cushoning effect of sigmoid colon on left
and dextro-rotation of uterus.
•Atony of the ureteric muscles caused by progesterone and relaxin
causing hydro-ureter
• Vesico-ureteric reflux increased due to pressure of the uterus on
the ureter
Changes in the ureter in pregnancy leads to urinary stasis
and pyelitis
HYPERPLASIA of bladder muscles elevates the Trigone
Cause thickening of its posterior or intraureteric margins
Deepening and widening of the trigone.
53. PITUITARY GLAND:
Enlarge by 135 percent.
Primarily due to estrogen-stimulated hypertrophy and
hyperplasia of lactotropes.
Gonadotrophes decline in number.
Corticotrophes and thyrotropes remain constant.
Somatotrophes are suppressed.
Growth Hormon:
17 weeks: placenta is the main source of secretion.
Maternal serum values increases from 3.5 ng/ml at 10
wks to 14 ng/mi at 28 wks
Placental GH differs from pituitary GH by 13 aminoacid
–secreted by syncytiotrophoblast in nonpulsatile
fashion.
54. Thyroid Gland
Hyperplasia and slight generalised enlargement of
gland.
Maternal serum iodine level fall due to increased renal
loss and transplacental shift to fetus.
Iodine intake increased from 100-150 µgm/day to 200
µg/day
Rise in BMR due to increased maternal and fetal
oxygen need.
Increased serum protein bound iodine and thyroxine
bound globulin due to estrogen stimulation.
Total T3, T4 increased but fT3, fT4 and TSH remain
same.
55. Contd….
Level of calcitonin increased by 20%.
Since increase in TBG is dependent on estrogen, a
failure of the PBI to rise indicate fetal compromise.
Adrenal cortex – slight enlargement of adrenal
cortex (thickness of zona fasciculata increased).
Significant increase in aldosterone,
deoxycorticosterone (DOC), corticosteroid binding
globulin, cortisol and free cortisol.
Hypercortisolism occurs due to increased plasma
cortisol half life, delayed plasma clearance
56. Changes of endocrine glands
Gland Morphological Physiological
Pituitary Increase in weight by 30-
50%. Twice in size
GH, Prolactin, ACTH, CRH
Normal – TSH
Gonadotrophin
Thyroid Hyperplasia BMR, TBG, Total T3,T4
Normal – fT3, fT4, TSH
Maternal Serum Iodine
Adrenal Cortex Minimal enlargement Aldosterone,
DOC(deoxycorticosterone), CBG,
Corisol, Free Cortisol
Parathyroid Hyperplasia Normal PTH – does not cross placenta
Pancreas Hyperinsulinism in 3rd Trimester. Anti
insulin factors and insulin resistance
modify action of insulin during
pregnancy
58. Metabolic changes
By 3rd trimester BMR increased by 10-20%.
Additional increase of 10%in twins
Total Energy Demand: 77,000 kcal
85 kcal/day. 285 kcal/day. 475 kcal/day
Water metabolism:
• Increased water retention i.e minimum 6.5 L extra.
• Fall in plasma osmomolality by 10 mOsm/kg.
• cause pitting edema of ankles and legs.
•
59.
60. Metabolic changes• Carbohydrate metabolism
- pregnancy is hyperlipidaemic and glucosuric
- after mid-pregnancy, resistance of insulin develops
- plasma glucose concentrations rise, maintained between 4.5-5.5 mmol/L
- glucose crosses the placenta, the fetus uses glucose as primary energy
substrate, transport occurs by carrier mediated mechanism
- the insulin resistance is endocrine-driven, via increase in cortisol and hPL
- concentrations of glucagons and the catecholamines are unaltered
61. Metabolic changes
• Carbohydrate metabolism
- carbohydrate deposited in the liver as glycogen
- some escapes to general circulation
- portion metabolised by the tissues:
converted to depot fat
stored as muscle glycogen
- first noticeable change occurs in blood sugar
- tested by giving a load of oral glucose (glucose tolerance test)
- the blood sugar, after meal, remains high facilitating placental
transfer
62. Metabolic changes
• Carbohydrate metabolism
- with increased placental production of steroid, less glycogen
deposited in liver and muscles
- the effect of fasting is pronounced in pregnancy
overnight fast of 12hrs
hypoglycaemia, production of ketone bodies
63.
64. Metabolic changes
• Protein metabolism
- positive nitrogen balance
additional 1000 gm protein added
feotus and placenta- 500 gm
Uterus and breast- 500 gm
- on average 500 g of protein retained by the end of pregnancy
- blood and urine urea are reduced
65.
66. • Fat metabolism
- by 30 weeks, 4Kg are stored in form of
depot fat in the abdominal wall, back and thights
modest amount in breasts
67. Metabolic changes
Electrolyte and mineral metabolism:
1000 mEq of Sodium and 300 mEq of Potassium
retained.
But serum conc. Decreased due to plasma volume.
Excreation remain unchanged.
Total serum Calcium declined bt S. ionized calcium
remain unchanged.
Serum Magnesium level declined.
Serum Phosphate remain unchanged
Iodine requirement increased
Increased maternal T4 production.
Incresed demand by feotus.
50% increased glomerular filtration rate increased.
68. Acid–Base Equilibrium The increased respiratory effort during pregnancy, and in turn the
reduction in Pco2, is likely induced in large part by progesterone which
acts centrally and lowers the threshold and increases the sensitivity of the
chemoreflex response to CO2.
Compensating resp. alkalosis
Plasma bicarbonate level
decreases to 22
pH
Shift Oxygen dissociation curve to LEFT.
affinity of maternal
Hb for oxygen,
oxygen releasing capacity
BOHR
EFFECT
2-3, DPG Shift the curve back to RIGHT.
pCO2 from maternal blood
CO2 transfer from fetus to mother