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PHYSIOLOGY
Chukwuma I. Onyeije, M.D.
Atlanta Perinatal Associates
Clinical Assoc. Professor
Morehouse School of Medicine
http://maternalfetalmedicineblog.com
http://onyeije.net/present
Objectives
Detail normal physiologic changes in the
following maternal systems:
Cardiovascular
Respiratory
Renal
Hematologic
Gastrointestinal
Reproductive systems.
Describe the implications for these changes
for normal and abnormal pregnancies.
Objectives
Review nutritional requirements
normal pregnancy
Dilutional anemia of
pregnancy:
Pregnancy is a
Hypercoagulable state:
Hegar's sign:
Bacterial vaginosis:
An antibody preparation
of anti-Rh factor given to
Rh negative women to
prevent Rh
isoimmunization
BULLET POINTS:
Neural tube defect (NTD):
An abnormality in closure of
the neural tube, resulting in
a spectrum of anomalies
from anencephaly (no
cranium or cerebrum) to
spina bifida
BULLET POINTS:
Intrauterine growth restriction
(IUGR): pathological
condition of abnormal
placentation resulting in an
undergrown fetus
Small-for-gestational age
(SGA): the lower 10% of
birthweights
BULLET POINTS:
Large-for-gestational age
(LGA): the upper 10% of
birthweights
Macrosomia: an
abnormally large infant
(usually > 4000 gm)
The primary goal of
prenatal care is to
deliver a healthy term
infant without impairing
the mothers health and
to identify and
optimally treat the
high-risk mother.
The vast majority of
pregnancies are
uncomplicated.
Excessive intervention
during pregnancy can
result in less than
optimal outcome
THE
CARDIOVASCULAR
SYSTEM:
THE CARDIOVASCULAR
SYSTEM:
Respiratory rate,
Vital capacity,
Inspiratory reserve
volume
DECREASED:
Functional residual capacity
Expiratory reserve volume
Residual volume
Total lung capacity
INCREASED:
Inspiratory capacity
Tidal volume
BLOOD GASES:
CLINICAL
SIGNIFICANCE:
Creatinine clearance
increases to 150-200
cc/min
METABOLIC RENAL CHANGES
BUN and serum creatinine
decrease by 25%
Increase in tubular
reabsorption of sodium
Increase in glucose
excretion
METABOLIC RENAL CHANGES
END RESULT:
Dilutional anemia of
pregnancy",
Platelet count
decreases, but stays
within normal limits
COAGULATION SYSTEM:
Pregnancy is a
"hypercoagulable state"
Increased levels of
fibrinogen, factor VII-X
CLINICAL SIGNIFICANCE:
A pregnant woman is
considered to have a full
stomach even if she has had
nothing to eat or drink for
several hours.
Fetus: 7 pounds
Placenta and amniotic fluid-- 3 pounds
Blood volume-- 4 pounds
Breasts-- 2 pounds
Maternal fat-- 4 pounds
THERE IS NO SUCH
THING AS OPTIMAL
WEIGHT GAIN
Protein: An additional 10 to 30 gm
/day ~ 75 gm/day total
Iron supplementation 30 to 60 mg
per day
Calcium: 1200 mg needed per
day, usually provided by a quart
of milk per day or 2 Tums/day,
Decide: Is this
patient normal
or high-risk?
COMMON
COMPLAINTS
OF
PREGNANCY
Nausea and
vomiting:
usually
dissipates
by 15
weeks
Constipation:
common
throughout
pregnancy
Heartburn: often
worsens as
pregnancy
progresses
Vaginitis:
treat only if
symptomatic
Varicose veins: treat
symptomatically
Headaches
Lower extremity
edema is very
common
Backache:
Lordosis is common with
change in the center of
gravity
Faintness and light-
headedness
Carpal
tunnel
syndrome
REVIEW QUESTIONS:
Whichof the following
INCREASES in
pregnancy?
FRC
ERV
RV
TV
During which of the
following states is
the blood pressure
lowest?
First trimester
Second trimester
Third trimester
Non pregnant
All
of the following are
increased in pregnancy
except:
Renal plasma flow
GFR
Serum creatinine
Tubular sodium
resorption
CONCLUSION:
Understanding maternal
physiology is crucial in
understanding the
changes associated in
pregnancy
CONCLUSION:
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