PHYSIOLOGICAL CHANGEGS OF PREGNANCY

1
PHYSIOLOGICAL CHANGEGS OF PREGNANCY

• AHMED ABDULWAHAB

2

• 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.

3

• 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.

4

• 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.

5

• 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

6

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

7

• 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

8

• 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

9

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

10

• 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 .

11

• 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

12

• 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

13

• Cardiovascular system.
• There is a change in the position of the heart.
• Normal changes in heart sound include.
• Exaggerated splitting of S1
• Gallop pulse in 90 of normal pregnancy
• Systolic ejection murmur .
• Mammary souffle

14

• 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.

15

• 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 .

16

• 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.

17

• 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 V11 ,V111,1X,and X all increases

18

• 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.

19

• 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 T3, T4,and TSH , thyroid immunoglobulins
  crosses the placenta as well ass anti thyroid
  medication

20

• 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