Maternal Physiology During Pregnancy

8/8/2019 Maternal Physiology During Pregnancy

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Maternal physiologyMaternal physiology

during pregnancyduring pregnancy


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Reproductive tract (1)Reproductive tract (1)

UterusUterus: from 50g: from 50g--1100g1100g

from


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BraxtonHickscontraction:BraxtonHickscontraction:

sporadic, irregular, asymmetrical, andsporadic, irregular, asymmetrical, and

painless, low pressure, lasting < 30painless, low pressure, lasting < 30

secsec



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Characteristics of True andCharacteristics of True and

False LaborFalse Labor Regular ContractionsRegular Contractions

Stronger, longer, closerStronger, longer, closertogethertogether

Bloodyshow oftenBloodyshow oftenpresentpresent

Cervix effaced andCervix effaced anddilateddilated

Head is fixed betweenHead is fixed betweencontractionscontractions

Sedation does notstopSedation does notstoptrue labortrue labor

IrregularIrregular

No change inNo change incontractioncontractioncharacteristicscharacteristics

No showNo show

No cervical changeNo cervical change

Head may be ballotableHead may be ballotable

Sedation stops falseSedation stops falselaborlabor


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CervixandvulvaCervixandvulva ChadwickssignChadwickssign

congestion of the pelvic vasculature, cause bluish orcongestion of the pelvic vasculature, cause bluish or

purplish discoloration of the cervix and vulvapurplish discoloration of the cervix and vulva

Leukorrhea:Leukorrhea: increase in vaginal discharge, rich inincrease in vaginal discharge, rich in

glucose, lactic acid, low vaginal pHglucose, lactic acid, low vaginal pH

Ovary:Ovary: slightly enlarged, corpus luteum regressesslightly enlarged, corpus luteum regresses

after 10 weeksgestationafter 10 weeksgestation



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Breasts:Breasts: increase in circulationincrease in circulation

EngorgementandvenousprominenceEngorgementandvenousprominence

Mastodynia (breastternderness):Mastodynia (breastternderness): tinglingtingling

to frank pain caused by hormonal responses ofto frank pain caused by hormonal responses of

the mammary ducts and alveolar systemthe mammary ducts and alveolar system

Montgomerystubercles:Montgomerystubercles: enlargement ofenlargement of

circumlacteal sebaceous glands of the areolacircumlacteal sebaceous glands of the areola

Colostrumsecretion:Colostrumsecretion:


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Cardiovascular changes (1)Cardiovascular changes (1)

Position and size of heartPosition and size of heart

ECG changesECG changes

Increased heart rate (+15%)Increased heart rate (+15%)

1515--degree left axis deviationdegree left axis deviation

Inverted TInverted T--waves in lead IIIwaves in lead III

Q in lead III and AVFQ in lead III and AVF

Unspecific ST changesUnspecific ST changes

Appear larger on roentgenogramAppear larger on roentgenogram


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Cardiovascular changesCardiovascular changes

(2)(2) Heart rhythms and murmurs: soft ,Heart rhythms and murmurs: soft ,

transienttransient

Caution: How to interpret these murmursCaution: How to interpret these murmurs

Inferiorvenacavasyndrome:Inferiorvenacavasyndrome:

In the supine position, the inferior vena cava iscompressed by the enlarged uterus, resulting in

decreased cardiac output. Some women may have

symptoms that include dizziness, light-headedness, and

syncope.


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(3)(3) Stroke volume +30%Stroke volume +30%

Heart rate +15%Heart rate +15%

Cardiac output +40%Cardiac output +40%

Oxygen consumption +20%Oxygen consumption +20%

SVRSVR(systemic vascular resistance)(systemic vascular resistance) --5%5%

Systolic BPSystolic BP --10mmHg10mmHg Diastolic BPDiastolic BP --15mmHg15mmHg

Mean BPMean BP --15mmHg15mmHg


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Blood volume +30%Blood volume +30%

Plasma volume +40%Plasma volume +40%

Red blood cell volume +20%Red blood cell volume +20%

Dilutional anemiaDilutional anemia

Increase cardiac outputIncrease cardiac output

Decrease blood viscosityDecrease blood viscosity

VasodilatationVasodilatation

Rightshift oxyhemoglobin dissociation curve

Rightshift oxyhemoglobin dissociation curve


(4)(4)


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Venouspressure:Venouspressure:

1.1. unchanged in the upper bodyunchanged in the upper body2.2. Significantly increases in the lowerSignificantly increases in the lower

extremities, esp. during supine, sitting orextremities, esp. during supine, sitting or

standing position, returns to near normalstanding position, returns to near normalin lateral recumbent positionin lateral recumbent position

Cardiovascular changes(5)Cardiovascular changes(5)


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Hematologic system (1)Hematologic system (1)

Blood volumeBlood volume (polymorphonuclear)(polymorphonuclear) +40%+40%

Dilutional anemia Hb 110 g/LDilutional anemia Hb 110 g/L Leukocytosis 15,000/Leukocytosis 15,000/QQll

Platelet not changePlatelet not change

Sedimentation rate increase, 100m/hSedimentation rate increase, 100m/h


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Clotting factors:hypercoagulable,Clotting factors:hypercoagulable,

throboembolismthroboembolism

Fibrinogen (factor I) +50% (4.5 vs 3 g/L)Fibrinogen (factor I) +50% (4.5 vs 3 g/L)Factor VIII increaseFactor VIII increase

Factors VII, IX, X and XII increaseFactors VII, IX, X and XII increase

Prothrombin time, PT shortenedProthrombin time, PT shortened

ATPP activated partial thromoplastin time shortenedATPP activated partial thromoplastin time shortened

Fibrinolytic activity decreaseFibrinolytic activity decrease


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Iron : active transplacental transferIron : active transplacental transfer

Requirement 1000mgRequirement 1000mg

increase maternal red cell mass 500mgincrease maternal red cell mass 500mg

fetal development 300mgfetal development 300mg

compensate for normal iron loss 200mgcompensate for normal iron loss 200mg

To supply, 300 mg of ferroussulfate is needed, andTo supply, 300 mg of ferroussulfate is needed, and

twice the dose for anemic patients.twice the dose for anemic patients.


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Renal changes (1)Renal changes (1)

Kidney slightly enlargedKidney slightly enlarged

Renal plasma flow +35%Renal plasma flow +35%

Glomerular filtration rate +50%Glomerular filtration rate +50%

Serum creatinine, uric acidSerum creatinine, uric acid

and urea nitrogenand urea nitrogen

Renin, angiotensin I and IIRenin, angiotensin I and IIRenin substrateRenin substrate

Glucosuria (50%) +Glucosuria (50%) +


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Renal changes (2)Renal changes (2)

renal pelves dilatedrenal pelves dilated

Ureters (esp. rightside) dilatedUreters (esp. rightside) dilated

Bladder tone reducedBladder tone reduced

Bladder capacity reducedBladder capacity reduced

Residual volume increased

Residual volume increased

Chance of pyelonephritis increaasedChance of pyelonephritis increaased


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Pulmonary changesPulmonary changes

Mucosal hyperemiaMucosal hyperemia

Subcostal angleSubcostal angle

Chest circumference and diameterChest circumference and diameter

Diaphragmatic excursionDiaphragmatic excursion

Tidal volume +30Tidal volume +30--40%40%

POPO22 is increased, PCOis increased, PCO22 is decreased.is decreased.

Total lung capacity decreaseTotal lung capacity decrease --15%15%

Minute ventilation +30Minute ventilation +30--40%40%

Mild respiratory alkalosisMild respiratory alkalosis


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Gastrointestinal changeGastrointestinal change

Morning sicknessMorning sickness

hyperremesisgravidarumhyperremesisgravidarum (weight loss,(weight loss,

ketonemia and electrolyte imbalance)ketonemia and electrolyte imbalance)

Dietary craving: picaDietary craving: pica

Decreased gastrointestinal motility: reflux andDecreased gastrointestinal motility: reflux and

heartburnheartburn

Gallbladder function, cholestasisGallbladder function, cholestasis

Hyperemia and softening of the gums (epulis)Hyperemia and softening of the gums (epulis)

HemorrhoidHemorrhoid

Appendix displacedAppendix displaced


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Skin changesSkin changes

Vascular spidersVascular spiders

Striae gravidarumStriae gravidarum

Hyperpigmentation (estrogen and melanocyteHyperpigmentation (estrogen and melanocyte--

stimulating hormone)stimulating hormone)

Linea albaLinea albalinea nigralinea nigra

ChloasmaChloasma

Skin neviSkin nevi


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MetabolismMetabolism

Basal metabolism rate, BMR +15Basal metabolism rate, BMR +15--20%20%

Weight gain 12.5Weight gain 12.5

Fetus 3400gFetus 3400gPlacenta 650Placenta 650

Amniotic Amniotic

Uterus 960Uterus 960

Plasma, red cells 1450Plasma, red cells 1450Mammary glands 405Mammary glands 405

Extracellular, extravascular water 1480Extracellular, extravascular water 1480

Deposition of fat and protein 3345Deposition of fat and protein 3345

Insulin resistanceInsulin resistance


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A quizA quiz

DefinitionsDefinitions

1. fetus1. fetus

2. hyperemesis gravidarus2. hyperemesis gravidarus

3. Morula3. Morula

4. Inferior vena cava syndrome4. Inferior vena cava syndrome

5. Chadwickssign5. Chadwickssign6. Capacitation6. Capacitation

7. Lower segment of uterus7. Lower segment of uterus


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1. Fetal membrane is composed of ______and______.1. Fetal membrane is composed of ______and______.

2. The prerequisites for successful implantation2. The prerequisites for successful implantation

are________, _______ and ___________.are________, _______ and ___________.

3. Placenta is composed of _______, _________and3. Placenta is composed of _______, _________and

___________.___________.

4. Maternal4. Maternal--fetalfetal--placenta unit is a concept usuallyplacenta unit is a concept usuallyused to describe the production of ________andused to describe the production of ________and

can be used to evaluate the placental function.can be used to evaluate the placental function.


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True or falseTrue or false

1. Supplement of iron during pregnancy is primarily to1. Supplement of iron during pregnancy is primarily to

prevent fetal anemia.prevent fetal anemia.

2. Because of the frequent incidence of glucosuria2. Because of the frequent incidence of glucosuria

among pregnant patients, quantitative urineamong pregnant patients, quantitative urine

glucose measurements are not clinically useful inglucose measurements are not clinically useful in

managing patients with diabetes, because they domanaging patients with diabetes, because they do

not reflect blood glucose levels.not reflect blood glucose levels.

3. The left pyelonephritis has a higher incidence in3. The left pyelonephritis has a higher incidence in

pregnant women.pregnant women.


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4.On chest x4.On chest x--ray, the heart appears toray, the heart appears to

demonstrate cardiomegaly duringdemonstrate cardiomegaly during

pregnancy.pregnancy.

5. In the fetus, the blood circulating in the IVC5. In the fetus, the blood circulating in the IVC

enters the right atrium and mix well withenters the right atrium and mix well with

the deoxygenated blood from SVC and thenthe deoxygenated blood from SVC and thengoes to the left atrium and supplies thegoes to the left atrium and supplies the

head, etc.head, etc.


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1. In a normal singleton pregnancy,maternal blood volume

A. increases by 10-15%

B. increases by 45%

C. decreases by 10-15%

D. decreases by 45%


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2. Which of the following is not characteristic of a2. Which of the following is not characteristic of a

normal pregnancy?normal pregnancy?

A. cardiac volume increases by 10%A. cardiac volume increases by 10%B. the ECG shows deviation to the leftB. the ECG shows deviation to the left

C. the rest pulse rate increases by approximately 10C. the rest pulse rate increases by approximately 10--

15% beats per min15% beats per min

D. arterial blood pressure and vascular resistanceD. arterial blood pressure and vascular resistance

increasesincreases

E. The heart is displaced upward and to the leftE. The heart is displaced upward and to the left


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3. Epulis is a pregnancy3. Epulis is a pregnancy--related vascularrelated vascularswelling of theswelling of the

A. GumsA. Gums

B. NailbedB. Nailbed

C. LarynxC. Larynx

D. NaresD. Nares

E. EpiglottisE. Epiglottis


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Maternal Physiology During Pregnancy

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