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Physiologic Changes of Pregnancy

Physiologic Changes of Pregnancy. Pouneh Taghizadeh, MD Senior Advisor: Bruce Vrooman, MD Faculty Advisor: Nina Zachariah, MD Boston University Department of Anesthesiology. Respiratory System. Upper airways Minute Ventilation Lung Volumes Oxygen consumption. Upper Airways.

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Physiologic Changes of Pregnancy

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  1. Physiologic Changes of Pregnancy Pouneh Taghizadeh, MD Senior Advisor: Bruce Vrooman, MD Faculty Advisor: Nina Zachariah, MD Boston University Department of Anesthesiology

  2. Respiratory System • Upper airways • Minute Ventilation • Lung Volumes • Oxygen consumption

  3. Upper Airways • Capillary engorgement of the mucosal lining of the respiratory tract - Nasopharynx - Larynx - Trachea - Bronchi • Anesthetic Implications

  4. Minute Ventilation MV = RR x TV • Increased circulatory progesterone • Direct ventilation stimulant • Increases central response to CO2 • Increases TV in pregnancy to dispose CO2

  5. Lung Volumes

  6. Lung Volumes

  7. Oxygen Consumption • Increased by 20% • Anesthetic Implications -Importance of pre-oxygenation

  8. Cardiovascular System • Intravascular Fluid Volume • Cardiac Output • Peripheral Circulation

  9. Intravascular Fluid Volume

  10. Intravascular Fluid Volume • Increase to 1500ml by term • 45% increase in plasma volume • 20% increase in erythrocyte volume • Anemia • Effects on blood pressure

  11. Cardiac Output CO = SV x HR • Increased to over 40% above pre-pregnancy levels when standing • 30% increase in SV • 10 % increase in HR Note: CO is decreased in supine position after 28 to 32 weeks gestation

  12. Cardiac Output

  13. Peripheral Circulation • Systemic circulation • Pulmonary circulation • Systemic vascular resistance • Effects on central venous pressure

  14. Gastrointestinal System • Increased progesterone • Relaxation of lower esophageal sphincter • Decreased gastric pH • Enlarging uterus • Delayed gastric emptying during labor • Anesthetic Implications

  15. Gastrointestinal System • Morning Sickness • Weeks 4-6 of pregnancy • Causes: • Relaxation of smooth muscle in stomach • Increased hCG • Anxiety

  16. Renal System • Increase in progesterone after 3rd Trimester • Dilation of renal calices, pelvices, ureters • Enlarged uterus • Compression of ureter at pelvic brim • Urinary stasis • Increased incidence of UTIs

  17. Renal System • GFR • Renal plasma flow • Creatinine clearance • Serum creatinine • Blood urea nitrogen • Renin/Angiotensin levels

  18. Hepatic System • Decrease in albumin:globulin ratio • Increase in free fraction of albumin bound medications • Decreased plasma cholinestrase levels • Anesthetic implications

  19. Hepatic System • Lactate dehydrogenase, bilirubin, ALT/AST, alkaline phosphatase • Gallbladder emptying • Concentration of bile

  20. Hematologic System • Increased estrogen • Increase in clotting factors • VII, VIII, X, XII, and fibrinogen • Decrease in Antithrombin III • Hypercoagulable state • DVTs

  21. Central Nervous System • Volume of epidural space • CSF volume/CSF pH • Anesthetic Implications

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