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Maternal Physiology Chapter 05 –Williams Obstetrics 23rd Edition
dr. Tizar Dwi Satyoputro
-ZIO
Physical adaptations during pregnancy
Anatomical and functional changes
• Metabolic Changes
• Hematological Changes
• Reproductive Tract
• Respiratory Tract
• Gastrointestinal Tract
• Cardiovascular System
• Urinary System
• Endocrine System
• Breast Changes
Metabolic changes
Water metabolism Carbohydrate metabolism Weight gain
Hematological changes
Iron turnover Blood volume Coagulation & Fibrinolysis
Blood volume (polymorphonuclear) +40%
Dilutional anemia Hb 110 g/L
Leukocytosis 15,000/ml
Platelet not change
Sedimentation rate increase, 100m/h
Clotting factors: hypercoagulable, throboembolism
Fibrinogen (factor I) +50% (4.5 vs 3 g/L)
Factor VIII increase
Factors VII, IX, X and XII increase
Prothrombin time, PT shortened
ATPP activated partial thromoplastin time shortened
Fibrinolytic activity decrease
Reproductive Tract
Weight: 70 g (before pregnancy) – 1100 g (during pregnancy) Volume: 5 L to 20 L or more – 2500 L to 5000 L or more Shape: pear (beginning) spherical (12w) ovoid Uterine contractions: intensity 5 and 25 mm Hg; frequency 10 to 20 minutes (near term) Uteroplacental Blood Flow: 450 to 650 mL/min near term regulation: estradiol and progesteron administration to modify vascular resistance
Shape: pronounced softening and cyanosis (1m after conception) Increased vascularity and edema, hypertrophy and hyperplasia of the cervical glands Containment: >50% of cervical mass cervical glands (end of pregnancy) Cervical mucus: soon after conception, acts as immunological barrier
Progesterone production: a single corpus in pregnant women (max. 6w to 7w of pregnancy – 4w to 5w postovulation) Diameter of ovarian vascular: 0.9 cm to 2.6 cm (at term)
Appearance: Violet color characteristic of Chadwick sign. Wall: increase in mucosal thickness, loosening of the connective tissue, and hypertrophy of smooth muscle cells pH: 3 to 6 (acidic)
Musculature of the fallopian tubes: a little hypertrophy (during pregnancy) Fallopian tube torsion: increasing size of the gravid uterus
Respiratory Tract
• Mucosal hyperemia
• Subcostal angle
• Chest circumference and diameter
• Diaphragmatic excursion
• Tidal volume +30-40%
• PO2 is increased, PCO2 is decreased.
• Total lung capacity decrease -15%
• Minute ventilation +30-40%
• Mild respiratory alkalosis
Gastrointestinal Tract • Morning sickness
• Hyperremesis gravidarum (weight loss, ketonemia and electrolyte imbalance)
• Dietary craving: pica
• Decreased gastrointestinal motility: reflux and heartburn
• Gallbladder function, cholestasis
• Hyperemia and softening of the gums (epulis)
• Hemorrhoid
• Appendix displaced
Cardiovascular System
Cardiac outline: 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
Cardiac output
Circulation & Blood pressure
Stroke volume +30% Heart rate +15% Cardiac output +40% Oxygen consumption +20% SVR (systemic vascular resistance) -5% Systolic BP -10mmHg Diastolic BP -15mmHg Mean BP -15mmHg
Blood volume +30%
Plasma volume +40%
Red blood cell volume +20%
Dilutional anemia
Increase cardiac output
Decrease blood viscosity
Vasodilatation
Right shift oxyhemoglobin dissociation curve
Urinary System
GRF – ERPF – Filtration fraction
Protein excretion
Endocrine System
Thyroid physiology Andrenal Glands: Cortisol Thyroid Glands
Breast changes
• Engorgement and venous prominence
Increase in size by 2nd mo –hypertrophy of mammary alveoli
• Tenderness and tingling occur in early weeks of pregnancy
Mastodynia (breast ternderness): tingling to frank pain caused by hormonal responses of the mammary ducts and alveolar system
• Nipples become larger, more deeply pigmented, more erectile
Colostrum, a thick yellow fluid can be expressed from the nipples, may be expressed by the 2nd trisemester
• Montgomery’s tubercles: enlargement of circumlacteal sebaceous glands of the areola
Thank you!