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CAMBIOS FISIOLOGICOSDURANTE EL EMBARAZO
NORMAL
DRA YAHIRIS RODRIGUEZRESIDENTE G/O
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APARATO REPRODUCTOR OVARIOS
CERVIXVAGINA Y PERINEUTERO
TROMPAS
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OVARIOSSolo se forma un cuerpo lteo.
Cesa la ovulacin en el embarazo.Luteoma del embarazo.Hormonas: * Relaxina
* Inhibina
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UTEROAumenta sucapacidad de 10cc a 5lt.Aumenta su peso de70gr a 1100gr.
Se producehipertrofia del msc.Uterino
Puede haber dextrorrotacin delteroSemana 12 empieza acomprimir el
contenidointraabdominal
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PARED UTERINACAPAS DEL UTERO:
* SEROSA* MIOMETRIO: Capas: externa media interna
* ENDOMETRIO
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CONTRACTIBILIDADLeves contracciones en el primer trimestre.
(frecuencia e intensidad disminuida).Falso trabajo de parto ( contracciones deBraxton Hicks).Ultimo mes aumento de la contractibilidad.Trabajo de parto.
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FLUJO UTERINO YPLACENTARIO
Aumenta el volumen minuto: 40%
Aumento del flujo tero placentario450cc a 650cc/min
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CERVIXMarcado edema delcervix, aumento devascularizacin: signode Hegar.Produccin y cambios
del moco cervical.Aumenta el tejidoglandular.
Cambio de posicin:vertical
Colgeno y elastinase reorganizan para la
adaptacin requeridaen el T. de parto
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VAGINA Y PERINE
* Signo de Chadwick * Aumento de la produccin de glucgeno* ph vaginal cido
* Engrosamiento de la mucosa vaginal, ehipertrofia del msculo liso vaginal.
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MAMASIngurgitacin vascular:dolor + sensacin de
hormigueo.Estrgenos: desarrollodel sistema ductalmamario.
Progesterona: estimula eldesarrollo del sistemaalveololobulillar.
Cada mama exhibe 200cm3.
Prolactina iniciadora dela lactancia.En post parto: lactancia.
Prolactina necesita deoxitocina para suexcrecin.
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APARATO CARDIOVASCULAR
Con el aumento del tamao uterino, hacedesplazamiento hacia arriba del diafragma,resultando elevacin y desplazamiento
anterolateral del corazn.
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APARATO CARDIOVASCULAR
RUIDOS CARDIACOS:* 1 2 Ruido son msfuertes, condesdoblamiento del 1R.
* Se puede desarrollar 3R
o ritmo de galope.
Soplo de eyeccinsistlico en el bordeesternal izquierdo.* Se puede auscultar unsoplo mamario al final
del embarazo y puerperio.* soplos diastlicos: noson fisiolgicos
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APARATO CARDIOVASCULAR
VOLUMEN MINUTO:
Fc X Vol sistlicoAumenta 30 50% en el embarazo.La Fc aumenta 20% ( 10 15 lt/min)
Aumento del vol sistlico: dado por la precarga.
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APARATO CARDIOVASCULAR
FUNCION VENTRICULAR IZQUIERDA
* Se conserva durante todo el embarazonormal.* Aumento del vol sistlico proporcional alaumento de volumen de fin de distole
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APARATO CARDIOVASCULAR
DISTRIBUCION DEL FLUJOSANGUINEO:* El flujo sanguneo aumenta de 50ml a500ml: 15 18% del vol min.* Flujo sanguneo renal: aumenta 30%* el flujo sanguneo aumenta hacia lasextremidades, mamas y piel.
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APARATO CARDIOVASCULAR
POSTURA:
Decbito dorsal el tero grvido comprimela vena cava inferior, disminuyendo elretorno venosoTercer trimestre: sndrome de hipotensinsupina: compresin de la VCI y la aorta
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APARATO CARDIOVASCULAR
POSTURA:* En tercer trimestre: decbito dorsal:
compresin de la vena cava produciendodisminucin del retorno venoso,disminucin precarga y reduccin delvolumen minuto.
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APARATO CARDIOVASCULAR
TRABAJO DE PARTO:
* Aumenta el volumen minuto.* 300 500ml de sangre con c/
contraccin lleve hacia la circulacinsistmica.
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APARATO CARDIOVASCULAR
POSPARTO:Aumento adicional 20 60% vol. Min(9lt/min), dado x aumento del vol. SistlicoVol. Sistlico, incrementado x el aumento deprecarga x autotransfusin, a partir del tero
contradoDisminuye posterior: volemia vol. Min vol.sistlico
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APARATO CARDIOVASCULAR
PRESION ARTERIAL:
T.A. Sistlica: 10mmHgT.A. Diastlica: 20mmHgResultado de RVS
RVS 2 trimestre retorna a su lnea de base al trmino.
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APARATO CARDIOVASCULAR
PRESION VENOSA:
tero y cabeza fetal comprimen las venasde la pelvis = presin de las venas msdistales.Extremidades inferiores aumenta de 10cc a25cc de agua al trmino del embarazo.
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APARATO CARDIOVASCULAR
EDEMA:
Es muy comn.Dado x presin venosa y de la presincoloidosmtica.
Lquido se desplace fuera del espaciointravascular.
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APARATO CARDIOVASCULAR
RVS:Vasodilatacin:* Estrgenos.* Progesterona.* Prostaglandinas
RVS:Disminucin:* Cada de la PAM* vol. Min* Falta de cambio dela PVC.
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APARATO CARDIOVASCULAR
RESUMEN:
Vol. Min, a partir del vol. Sistlico.T.A. y RVS disminuyen (2 trimestre).
Edema: dado x compresin de la V. Cava yde P. coloidosmtica
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SISTEMA HEMATOLOGICOVOLUMENSANGUINEO:
Vol. Sanguneo: 40 50% durante la
gestacin.
Variabilidad:* Mltiparas aumentoadicional ms que las primiparas* E. Mltiples: 15%
* Hay correlacincon placenta, pesoRN (RCIU)
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SISTEMA HEMATOLOGICO1 Trimestre: vol. Sanguneo x vol. plasmtico.20 semana: x aumento de la masaeritrocitaria (33%) 450ml.Vol. Plasmtico llega a meseta semana 32,
mientras la masa eritrocitaria continuaaumentando: hto 1 trimestre y en el 3.
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SISTEMA HEMATOLOGICOERITROCITOS:
Masa eritrocitaria 2 trimestre, dado x denuevos eritrocitos.VCM
Recuento de reticulocitos
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SISTEMA HEMATOLOGICOLEUCOCITOS:
El recuento con leucocitos conc/trimestre.Parto: leucocitos 30000, sin ningunainfeccin.Estrgenos, suprarenales, estrs:aumentados duranteel embarazo.
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SISTEMA HEMATOLOGICOPLAQUETAS:
Recuento de plaquetas, disminuyelevemente.150.000 400.000/mm3.
El Vol. Plaquetario aumentado debido plaquetas ms jovenes ( 9.7 a 9.2 dias vida)Plaquetas = placenta: coagulacin crnic
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FACTORES DE LACOAGULACION
Embarazo =hipercoagulabilidad.Aumenta elfibrinogno.Aceleracin
eritrosedimentacin.Aumentan los fx: V,VII, VIII, IX, X, XII.
Disminuyen los fx: IX,XIII.
Reduce la protena S y laactividad plasmtica.El plasmingenoaumenta, plasmina esta
reducida: inhibidor activacin del plasmingeno en la placenta.
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FACTORES DE LACOAGULACION
Riesgo TVP 1,8 en el embarazo, 5,5durante el puerperio.
Fibrina y fibringeno circulantes en placenta y paredes de las paredes de lasarterias espiraladas.
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APARATO RESPIRATORIOCAMBIOSANATOMICOS:
Va area alta: mucosanasofarngea hipermicay edematosa ( congestinnasal, aumentosecreciones mucosas,epistaxis).Aumento del ngulosubdiafragmtico.
Aumento del dimetrotransversal 2cm.
Aumento de lacircunferencia torcica6cmElevacin del diafragma
4cm.Reduccin de lacapacidad pulmonar.
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APARATO RESPIRATORIOVOLUMENES PULMONARES:
Vol. Corriente: 30 40%: 450 a 600 700ml.Vol. Reserva espiratorio y el vol. Residual:disminuyen 20%, disminuyendo capacidadresidual funcional 20%.
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APARATO RESPIRATORIOFR: no significativoCV: no significativo.
Capacidad inspiratoria:no significativo.Vol. Corriente: 40%.Vol. Reserva inspiratoria:
no significativo.Capacidad residualfuncional: 20%
Vol reserva espiratorio:20%
Vol. Residual: 20%Capacidad pulmonar total: 5%.Ventilacin min: 40%.
Captacin O2 min:30%.
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GASES EN SANGREPCO2: reduccin, que facilita difusinCO2 desde el feto a la mam.Alcalosis respiratoria compensada:hiperventilacin producida x la progesterona.
Ph: 7.40 a 7.47PCO2 : 25 30mmHgBicarbonato: 18 21mEq/l..
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DISNEA DEL EMBARAZO:
Molestia 60 70% de pacientes finales 1trimestre e inicio 2 trimestre.Vol. Corriente y PCO2.Anamnesis: descartar patologa. Cambionormal.
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g p y p y g y p g g y p y p p g pp y y g g
RESUMEN:La funcin pulmonar aumenta durante elembarazo.
La progesterona impulsa al centro respiratorio para que aumente el VC 40%.Resultado alcalosis respiratoria compensadaRespiracin diafragmtica aumenta con lagestacinReserva pulmonar protege a la embarazada y a sufeto de requerimientos adicionales
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APARATO DIGESTIVOBOCA:
Encias ms sensibles, hipermicas.Epulis: encias, tej granulacin: dolor yhemorragia ( desaparece 6-8 sem posparto)
Higiene oral, valoracin odontolgicaTialismo ( produccin excesiva de saliva):eliminar 2 lt saliva. Nuseas.
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APARATO DIGESTIVOESOFAGO: NO hay cambios en la
motilidad esofgica.Las ondas 1/3 inf.Enlentecidos. presin EIE + presin
gstrica = reflujo delcontenido gstrico: pirosis (30 70%)
Presin de reposo delesfinter inferior del
esfago (EIE) dado por la relajacin musc. Liso xla progesterona: 1trimestre 2 y 3trimestre reduce ms yluego se normaliza en el posparto.
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APARATO DIGESTIVOESTOMAGO:
2 funciones:* secretora : hidrgeno, pepsingeno ymoco.
* motora: mezcla las partculas de losalimentos para la digestin y propulsin delcontenido hacia el duodeno
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APARATO DIGESTIVOESTOMAGO:
1 y 2 trimestre: secrecin cida: mejoralos sntomas de lcera x retardo delvaciamiento gstrico, moco gstrico,estrgenos, secrecin placentariahistaminasa, fxs de prostaglandinas sobrela mucosa gstrica
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APARATO DIGESTIVOESTOMAGO:
PROGESTERONA+ Disminucin del vaciamiento gstrico(80%) y retencin del vol. 30x despusde c/ comida.+ Trabajo de parto: retencin vol 100%+ Aumenta el apetito.
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APARATO DIGESTIVO Nuseas y vmito:
1 trimestre 40 80%2 trimestre: disminuye 40% hacia la sem14 - 20% hacia la sem 16 y 10% o menoshacia la sem 20%.Dx diferencial: IVU superiores, enf heptica.
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APARATO DIGESTIVOHIGADO:
No aumenta de tamao. Se produce unarotacin superior y posterior 2 al teroSe puede formar una mnima infiltracingrasaDisminuye la irrigacin en una tercera parte dado x el shunt placentario.
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APARATO DIGESTIVOPRUEBASSANGUINEAS:Albmina: 30%Globulinas:FA: doble ( aporte de la placenta de unaisoenzima.
Niveles sricos decolesterol y otros lpidos:TGO y TGP: no semodifican.Bilirrubinas sricas: no semodifican.
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APARATO DIGESTIVOVESICULA BILIAR:
Disminucin de la contraccin yvaciamiento de la V. Biliar 2 y 3trimestre.
Volmenes residuales en ayunas y luego decomidas aumentados al doble.Clculos de la vescula.
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APARATO DIGESTIVOHIGADO:El tero desplaza al intestino delgado y al colontransverso hacia la parte superior Regurgitacin, saciedad, plenitud epigstrica.Progesterona: musc. Liso
Tiempos de trnsito GI aumentados.Constipacin: tero, absorcin de agua y Na+
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SISTEMA URINARIOCAMBIOS ANATOMICOS:Aumentan de longitud: 1 a 1.5cmAumenta el vol. Renal, dado x aumento de lavasculatura renal x la pelvis y clices renalesHidrnefrosis (2 trimestre)Uretra: se dilata ( progesterona)tero obstruir los reteres a nivel dela pelvisUreteres pueden estar ms elongados, pero no semodifica su peristaltismo
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8/8/2019 Cambios Fisiologicos Del Emb
50/51
SISTEMA URINARIOCAMBIOS ANATOMICOS:
* Puede haber reflujo vesicoureteral.
* dilatacin ureteral y pelviana.
infeccin de vas urinarias
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8/8/2019 Cambios Fisiologicos Del Emb
51/51
SISTEMA URINARIOCAMBIOS ANATOMICOS:
Capacidad de la vejiga: 410 a 460cm3 (N:500cm3)Vol. Renal: se normaliza durante la 1semana postparto.Hidronefrosis puede desaparecer pasados 2a 4 meses postparto.