Physiologic changes in pregnancy

Nikolai Kolotiniuk, PGY-2

Cardiovascular System
CO increases 30-50%, with half occurring in the first 8wks
Increase in preload (BV) increase SV and Increase HR (15-20bpm)
Reduced afterload (decrease in SVR) 1st-2nd trimester - ?decreased
responsiveness to vasopressin and NE (also ?increase NO, PGI2)
Dependence on sympathetic system for HD stability increases progressively
throughout pregnancy, reaching peak at term pharmacologic
sympathectomy could significantly drop BPs
Respiratory System
Mechanical - thoracic cage circumference enlarges by 5-7cm. (relaxation of
ligamentous attachment)
Inspiration almost total attributable to diaphragmatic excursion (chest wall
already expanded, diaphragm sits higher)
FRC decrease by 20% 2/2 upward movement in diaphragm, decrease in
RV, ERV. TV goes up by 45%. Dead space up by 45%
Rightward shift of oxyhemoglobin curve (P50 = 30 mmHg)
Capillary engorgement in larynx/NP/OP --> increased risk for epistaxis
O2 consumption increases by almost 20% to meet metabolic demands. CO2
production increases by 30% to 300ml/min
o O2 consumption continues to increase throughout pregnancy and CO
increases to a lesser extent ==> decreased mixed venous O2
Minute ventilation (50%)
o Progesterone increases sensitivity of resp center to CO2 +/- direct stim
of respiratory center, normally would cause resp. alkalosis but renal
excretion of bicarbonate is in pregnant
TV (40%) & RR (10-15%)
Chronic Resp alkalosis: PCO2 40-->27-32?helps the fetus to eliminate CO2.
Renal compensation by HCO3 excretion
Hypoxic ventilator response doubles despite an already present alkalosis in
CSF/blood
Rate of uptake & elimination of inhaled anesthetics due to MV & FRC
Hematology
Rightward shift in oxygen-Hgb dissociation curve + 2,3 DPG (favor
offloading of O2 at tissues)
Plasma volume increases by 50% by 34 weeks (starts at 6wks), RBC volume
up by 30% (physiologic anemia)
Estrogens --> stimulate RAAS --> NaCl/H2O retention
Reduction of PT/PTT by 20%, increased resistance to aPC, decrease Prot S,
increase in F I, II, V, VII, VII, X, XII. Decrease in antithrombin III.
Enhanced platelet turnover. Increase in PF-4 and B-thromboglobulin signal
elevated platelet activation, and the progressive increase in platelet
distribution width and platelet volume are consistent with greater platelet
consumption during pregnancy. Platelet aggregation is increased in response
to collagen, epi, ADP, arachidonic acid. Bleeding time not altered

Physiologic changes in pregnancy

Nikolai Kolotiniuk, PGY-2

Leukocytosis with bandemia, PMN function is depressed however --> increase

incidence of infections and lower incidence of Sx in patients with autoimmune
diseases

GERD --> stomach pushed up, rotated 45 degrees to the right, LES relaxes
Constipation 2/2 decreased peristalsis and intestinal transit
Biliary stasis,higher cholesterol content in bile secretion, hypomotility
increased gallbladder dz

GI

Renal/Endocrine
GFR increases 50%
o avg proteinuria ~ 200mg
Thyroid follicular hyperplasia (increase by 50-70%), estrogen raises
TBGincrease total T3/T4 by 50%
Exaggerated starvation ketosis, insulin resistant
Increase in corticosteroid binding globulin by 100% by 2 nd trimester to 200%
by third trimester
Neuro
MAC , (50% at term)
sensitivity to local anesthetics