1.1B MATERNAL PHYSIOLOGY.pdf

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REPRODUCTIVE TRACT UTERUS 

 

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Non Pregnant - 70g - Solid - Cavity of 10 mL or less Pregnant - 1100g - 5-20 L or more - Hypertrophy of muscle cells - Fundus becomes globular, almost spherical by 12 weeks - Braxton Hicks - Increased blood flow

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Delicate veins become visible Nipples become larger, more erectile Areola become darker Colostrum can be expressed from the nipples Glands of Montgomery - Hypertrophic sebaceous glands

SKIN AND VASCULAR CHANGES Striae gravidarum (stretch marks) Diastasis recti Hyperpigmentation Linea nigra Chloasma or melasma gravidarum aka mask of  pregnancy Vascular spiders or angiomas No clinical Palmar erythema significance - Consequence of hyperestrogenemia •

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CERVIX 

 

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Non Pregnant - Firm - Closed - Pinkish Pregnant - Softening - Cyanosis - Increased vascularity - Hypertrophy and hyperplasia of cervical glands - Produce copious tenacious mucus (mucus plug) OVARIES

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Non Pregnant - Ovulation Pregnant - Ovulation ceases - Corpus luteum - Decidual reactions - Theca lutein cysts

METABOLIC CHANGES  

Metabolic changes are numerous and intense No other physiologic event induces such profound alterations

VAGINA AND PERINEUM Increased vascularity and hyperemia Softening of underlying abundant connective tissue Chadwick sign Increased volume of cervic al secretions, pH is acidic Increase in mucosal thickness loosening of connective tissues Smooth muscle hypertrophy BREASTS

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Breast tenderness Parestheisas Increase breast size (After the 2nd month)

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WEIGHT GAIN

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Ghrelin - secreted by the stomach in response to hunger - Has a role in fetal growth and cell proliferation Maternal hyperlipidemia ELECTROLYTE & MINERAL METABOLISM

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Increase in weight - uterus and its contents, the breasts and increases in blood volume & extravascular extracellular fluid. Maternal reserves - accumulation of cellular water, fat and protein

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WATER METABOLISM •

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PROTEIN METABOLISM Increased amino acid concentration Increased protein metabolism 500 g protein, products of conception, uterus, maternal blood CARBOHYDRATE METABOLISM Mild fasting hypoglycemia Postprandial hyperglycemia Hyperinsulinemia  Accelerated starvation FAT METABOLISM

     

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HEMATOLOGICAL CHANGES BLOOD VOLUME Hypervolemia averages 40-45 percent above the non pregnant blood volume Functions: - Meet metabolic demands - Provides nutrients - Protection Hematocrit and hemoglobin decreases during pregnancy Iron metabolism - Of the approximate 1000mg of iron required for normal pregnancy, 300 mg are actively transferred to the fetus & placenta and another 200 mg are lost through excretion. - Most iron is used during the latter half of pregnancy - Mother can have anemia while the baby is normal Puerperium - Not all maternal iron in the form of hemoglobin is lost with normal delivery. Normal losses are from the placental implantation site, episiotomy, or lacerations.

Plasma osmolality/ term: 3.5 L from fetus, placenta and amnionic fluid, 3.0 L from maternal blood volume and size of the uterus and breasts: TOTAL 6.5 L

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Sodium 1000 mEq is retained Potassium 300 mEq is retained Total serum calcium declines Magnesium level declines Iodine requirements increase

Lipids Lipoproteins Apolipoproteins Leptin - secreted by adipose tissue - For body fat & energy expenditure regulation

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IMMUNOLOGICAL FUNCTION Pregnancy is both proinflammatory and antiinflammatory Inflammatory markers cannot be used reliably during pregnancy COAGULATION & FIBRINOLYSIS Augmented during pregnancy but remain balanced to maintain homeostasis Increased concentration of clotting factors EXCEPT XI and XIII Platelets are slightly decreased

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RESPIRATORY TRACT

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CARDIOVASCULAR SYSTEM

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 A B Chest wall measurements in nonpregnant (A) and pregnant women (B). With pregnancy, the subcostal angle increases, as does the anteroposterior and transverse diameters of the chest wall and chest wall circumference. These changes compensate for the 4-cm elevation of the diaphragm so that total lung capacity is not significantly reduced.

Change in cardiac radiographic outline that occurs in pregnancy. The blue lines represent the relations between the heart and thorax in the nonpregnant woman, and the black lines represent the conditions existing in pregnancy. These are based on radiographic findings in 33 women. (Redrawn from Klafen, 1927.)

URINARY SYSTEM

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Changes in cardiac function become apparent during the first 8 weeks of pregnancy. Cardiac output is increased as early as 5th week.

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GASTROINTESTINAL TRACT Pregnancy Gingivitis Pyrosis aka heartburn Gastric emptying time is unchanged Hemorrhoids Reduced Gallbladder contractility -> Increased residual volume

Pituitary gland

Thyroid gland

Parathyroid gland Calcitonin

ENDOCRINE SYSTEM Enlarges by about 135% Increased growth hormone secretion Prolactin increases Increased oxytocin Increased thyroid homrmone production Moderate enlargement of thyroid gland Increase in secretion of PTH during the later part of pregnancy Increased levels CENTRAL NERVOUS SYSTEM

 

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Memory - Changes are few and mostly subtle. - Problems with attention, concentration and memory throughout pregnancy and early puerperium Eyes - Intraocular pressure decreases during pregnancy ->Increased vitreous outflow - Krukenberg spindles - brownish-red opacities on the posterior surface of the cornea - Visual function is unaffected Sleep - Difficulty with going to sleep, frequent awakening,s fewer hours of night sleep and reduced sleep efficiency - beginning as early as approx 12 weeks' gestation up to first 2 months postpartum. - Greatest disruption of sleep is encountered postpartum and may contribute to Postpartum blues or frank depression

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"Opportunities don't happen, you create them." -Chris

Grosser 

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