PHYSIOLOGICAL CHANGEGS OF PREGNANCY AHMED ABDULWAHAB Maternal physiologic

PHYSIOLOGICAL CHANGEGS OF PREGNANCY AHMED ABDULWAHAB

§ Maternal physiologic adjustment to pregnancy are designed to support the requirements of fetal needs without affecting maternal well-being. § The normal values of several hematologic, biochemical, and physiologic indices during pregnancy differ markedly from those in the non pregnant range and also according to duration of pregnancy.

§ § § ALIMENTARY TRACT. Appetite is usually normal without changes Pica. Dietary craving or aversion for non nutritional substances. Mouth , ptyalism usually associated with nausea of pregnancy. Dentition , gum become soft and edemtous.

§ STOMACH. § Tone and motility decreases because of the effect the PROGESTERONE hormone and emptying time of the stomach is prolonged § Gastro esophageal junction sphincter tone decreases leading to heart burns § Gastric acid secretion decreases and peptic ulcer disease decreases.

§ Small bowel motility decrease and increases iron absorption. § Colon, there is decrease motility resulting in constipation , increase water and sodium absorption and dilatation of hemorrohdial veins. § Liver § Signs of normal pregnancy that may mimic liver disease

§ Spider angiomata and palmer erythema due to increase estrogen level. § Decrease albumin and increase alkaline phosphatase. § Nausea and vomiting usually in first trimester

§ § § Respiratory system. Mechanical changes. Subcostal angles transverse chest diameter, and chest circumference increases and the diaphragm level is pushed up. § Lung volume and pulmonary function. § Tidal volume increase inspiratory capacity increases, vital capacity decreases

§ § § Skin. Vascular changes , due to estrogen. Spider angiomata , palmer erythema. Striae gravidarum Pigmentation changes , increases melanocyte- stimulating hormones. § Darkening of nipples, areolae , umbilicus, axillae , perineum and linea nigra

§ § § Chloasma or mask of pregnancy. Pigmented navi. Abdominal wall there is separation of the recti muscles

§ § Urinary system. Anatomic changes. Kidneys increase in both length and weight. Renal pelvis increase resulting in physiological hydro nephrosis. § Ureters dilate starts by 8 weeks gestation. § Right ureter is larger than the left causing hydroureter and urinary stasis.

§ § § Dilatation is commonly above the pelvic brim. Consequences. Increase risk of pyelonephritis and asymptomatic bacteriuria § Renal function tests. § Renal plasma flow, glomerular filtration rate and creatinine clearance are all increase more than 50%, § Blood urea creatinine and uric acid all decrease

§ Glucosuria is common in normal pregnancy and has no correlation with blood sugar level. § Aminoaciduria. § Increase excretion of water soluble vitamin folate and vitamin B 12

§ § § § Cardiovascular system. There is a change in the position of the heart. Normal changes in heart sound include. Exaggerated splitting of S 1 Gallop pulse in 90% of normal pregnancy Systolic ejection murmur. Mammary souffle

§ EKG is unchanged except for left axis deviation. § Increase cardiac output by 40% due to increase in both stroke volume and heart rate. § Cardiac output depends on maternal position , it is lowest when in supine position. Supine hypotension syndrome.

§ Blood pressure. § There is a progressive decrease in both systolic and diastolic pressure , after 24 weeks the pressure gradually increase and return to non pregnant level by term. § Central venous pressure remain unchanged.

§ Hematological changes. § Plasma volume increase 50% by term it begins by 10 weeks and plateaus at 30 weeks gestation there is more increase in multiple pregnancy or larger fetuses. § Red blood cell increases by 30% at term. § Physiological anemia result because the plasma volume increases more than RBC.

§ Leukocyte and platelets. § White blood cell mostly PMN granulocytes increases progressively in pregnancy. § Platelets slightly decrease. § Coagulation system. § Pregnancy is a hyper coagulable state. § Fibrinogen increase by 50%. § Factors V 11 , V 111, 1 X, and X all increases

§ Iron metabolism. § Absorption depends on pregnancy state and bone marrow iron stores , 40% absorption in the iron deficient state. § The total iron requirement is 1000 mg and the daily requirement is 3. 5 mg. § Maternal iron deficiency does not affect fetal iron stores because of active iron transport across the placenta.

§ § § Endocrine and metabolic changes. Thyroid gland. it increase in size. Thyroid binding globulin increases as a result of estrogen stimulation of the liver. § The active unbound form remain unchanged or slightly decrease. § The following thyroid hormones do not cross the placenta T 3, T 4, and TSH , thyroid immunoglobulins crosses the placenta as well ass anti thyroid medication §

§ § § Adrenal gland. Total and free cortisol increase by two fold Aldosterone secretion is markedly increase. Deoxycortisone level increases. Pancreas there hypertrophy and hyperplasia. § Fasting blood glucose is lower than in non pregnant state