Read Dr. Chen Yu Sui’s notes. This is just a brief summary of the changes in the body of a pregnant mother.
- Enlarging uterus elevates the diaphragm
- displaces heart upwards & to the left
- Increase blood volume
- plasma volume increase
- plasma renin & aldosterone increase
- but reduced sensitivity to angiotensin (less vasoconstrictive action)
- Red cell volume increase
- slower rate than plasma volume
- haemodilution: plasma volume increase at a higher rate
- physiologic anaemia
- improved in last weeks of pregnancy when there is increase in erythropoiesis
- left ventricular hypertrophy
- increase cardiac output
- Increase of venous return
- stretch of right atrium = ANF increase
- increased liver size
- increase in circulating blood volume
- Heart rate increases
- after delivery, heart rate still increased by 5%, although decreased by 15% from pregnancy
- hPL & progesterone stimulate erythropoiesis
- increased blood flow to kidney, uterus & skin
- Predipheral vasodilation, decreased resistance
- by oestrodiol, progesterone & local prostaglandins
- uteroplacental circulation, higher blood flow
- Systolic & diastolic pressure
- decrease in 1st trimester
- rise again by full term
- decrease in diastolic pressure higher
- Reduced colloid osmotic pressure
- due to haemodilution
- Increase in venous pressure in lower extremities
- vasodilation increases venous blood
- increased blood volume
- compress pelvic veins & inferior vena cava by uterus enlargement
- Dependent oedema
- reduced osmolic collid pressure
- increased venous pressure
- Respiratory adaptation
- decrease in lung height due to enlarging uterus, but compensated by increased in chest circumference (diameter)
- change from abdominal to thoracic breathing
- relaxation of smooth muscle in the tracheobronchial tree
- increase in minute ventilation
- hyperventilation due to increased progesterone
- respiratory rate might also remain unchanged
- increase in TV, decrease in FRC, RV & ERV
- O2 comsumption increases during final weeks of pregnancy
- BMR increases
- pH increase
- due to increased removal of CO2
- pCO2 decreased
- Increased immature RBC
- increased Diphosphate gylcerol
- by product of RBC metabolite
- decrease affinity of O2
- more dissociation of O2 from haemoglobin
- Increased neutrophil count
- Increased platelet consumption (decrease platelet count)
- increased hypercoagulating state
- plasma fibrinolytic activity depressed
- due to placentral inhibitors
- risk of thrombosis (immobility deep vein thrombosis)
- Renal plasma flow increased
- GFR increases
- decrease in creatinine & urea
- uterus pressure on urinary bladder
- frequent urinary
- Na+ excretion
- ANF
- progesterone
- Increased GFR
- opposed by aldosterone, oestrodiol, deoxycorticosterone
- Increased glucose excretion
- glycosuria
- max TbG reabsorption same during pregnancy
- Urinary protein excretion
- in normal person, no proteinuria
- Insulin secretion
- hyperinsulinemia in pregnancy
- insulin resistance later
- more glucose available for foetal needs
- increased mobilisation and utilisation of FA & ketones for energy production
- Later half of pregnancy, hPL, prolactin, maternal cortisol & glucagon
- oppose effects of insulin
- weight increases
- due to water retention
- higher with multiple pregnancy
- Nausea & vomiting
- Heartburn
- gastric reflux
- relaxation of lower oesophageal sphincter
- delayed gastric emptying
- increased intragastric pressure
- decreased intraoesophageal pressure
- Constipation
- decreased colon motility
- increased water absorption from colon
- pressure from enlarging uterus