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The physiological changes

of pregnancy


Introduction
n Cardiovascular System
n Respiratory System
n Gastrointestinal System
n Haematology
n Endocrine System
n Renal Function
n Central Nervous System
Cardiovascular System
n Multiple changes, many of which are
compensatory designed to cope
with growing fetus, uterus and
placenta
n Increased cardiac output is main
overall result of changes
n


Changes in haemodynamic
parameters
Cardiac out put Increases by 50%
Stroke volume Increases by 30%
Heart rate Increases by 25%
Ejection Fraction Increases by 20%
Left ventricular mass Increases by 50%
Systemic VR Decreases by 20%
Pulmonary VR Decreases by 34%
Systolic BP Decreases by 6-8%
Diastolic BP Decreases by 20–25%
Haemodynamic changes
n Cardiac output n Aorto caval
- HR / SV compression
n SVR - low - positional -
resistance can cause severe
vascular beds and hypotension
hormonal effects  - dependent on
n Blood Pressure gestation
- decreased
peripheral
resistance
Respiratory system
n Anatomical changes
n Lung mechanics and Volume
n Blood gases
n Pulmonary circulation
Respiratory system – Anatomical
changes
n Capillary engorgement in upper
airway
n Increased circumference of
thoracic cage due to flaring of
ribs
n Upward displacement of
diaphragm by enlarging uterus
Respiratory System – Lung
Mechanics and Volumes
n Tidal volume increases by up to 45% at term
n FRC is decreased by 20 – 30% at term due to
reduction in expiratory reserve volume and
residual volume
n Closing capacity can become greater than FRC
causing V/Q mismatch and ready occurrence
of hypoxia
n Minute Volume increased by up to 50%, this is
stimulated by high progesterone levels and
increased carbon dioxide production
Respiratory System -
Blood Gases
n pCO2 decreases secondary to
alveolar hyperventilation (3.7 –
4.2kPa)
n Metabolic compensation reduces
bicarbonate to about 18-
21mmol/l
n pO2 rises to approx 14kPa whilst
upright, may fall when supine
n
Respiratory System –
Pulmonary circulation
n Pulmonary vascular resistance
reduced
n Pulmonary blood flow increased
n Pulmonary blood volume increased
n Oxygen consumption increased by
30 – 60 % due to metabolic
demands of fetus, uterus and
placenta. (therefore hypoxia can
develop rapidly)
Gastrointestinal system
n Reduced barrier pressure (LOS
pressure – gastric pressure)
n Heartburn in 55-80%
n Reduced gastric secretion
n Delayed gastric emptying during labour,
particularly if opiates used

Haematology
n Plasma volume, red cell mass,
and
 total blood volume all increase
 - increased intravascular
space
 - increased demand for
oxygen
 - proportionally less
increase in red cell mass
therefore reduced haemoglobin
concentration
n Coagulation -
Concentration of most coag
Endocrine System
n Thyroid gland enlarges but mother
remains euthyroid
n Cortisol and other corticosteroids
increase up to 5 times non pregnant
level
n Insulin resistance develops, small rise in
blood glucose
n Many anatomical changes due to
production of hCG, oestrogen,
progesterone and hPL by placenta
Renal Function
n Renal blood flow increases, and GFR
increases by about 50%. Clearance of
creatinine, urea and amino acids
increased
n Sodium and water retention due to
increased production of renin
n Smooth muscle relaxation in renal
pelvis, ureters, and bladder, therefore
increased risk of urinary stasis and
UTI.
Central Nervous System
PARAMETER CHANGE

MAC of volat iles Decrease


Volum e of epidural space Decrease
Pressure of epidural space Increase
CSF volum e Decrease
CSF pressure Increase
Sensit ivit y t o local anaest het ics Increase
Local anaest het ic dose Decrease
Finally……
n

n Most body systems affected


n Physiological changes may lead to
different disease presentations
n Anaesthetic technique must be
altered as appropriate