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8/2/2019 Physiologic Changes Pregnancy
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PHYSIOLOGICALPHYSIOLOGICAL
CHANGES INCHANGES IN
PREGNANCYPREGNANCY
Dr. Nizamuddin Abdul AzizDr. Nizamuddin Abdul AzizMBBS, MRCOGMBBS, MRCOG
Obstetrician & GynaecologistObstetrician & Gynaecologist
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1. General Changes
2. Metabolism
3. CVS
4. Respiratory System
5. Haematology
6. Renal System
7. GIT
8. Endocrine System
9. Nutrition
PHYSIOLOGICAL CHANGES IN
PREGNANCY
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GENERAL CHANGESGENERAL CHANGES
Vulva
Superficial varicosites may appear
Labia minora are pigmented and hypertrophied
Vagina
blood supply of venous plexus Surrounding walls give bluish colouration of mucosa -
JACQUEMIERS SIGN /CHADWICKS SIGN
Secretion in vaginal secretion pH is acidic (3.5-6)
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GENERAL CHANGESGENERAL CHANGES UterusUterus
weight from 50g to 1kg at termweight from 50g to 1kg at term length from 7.5cm to 35cm at termlength from 7.5cm to 35cm at term Hyperplasia & hypertrophy of myometrium- Oestrogen andHyperplasia & hypertrophy of myometrium- Oestrogen and
Progesterone mediated. Gap junctionsProgesterone mediated. Gap junctions Hypertrophy of uterine arteriesHypertrophy of uterine arteries
BreastsBreasts
Best evident is primigravidaBest evident is primigravida
Marked hypertrophy and proliferation of ductsMarked hypertrophy and proliferation of ducts Hypertrophy of connetive tissue stromaHypertrophy of connetive tissue stroma
Nipples become pigmentedNipples become pigmented
Sebaceous glands may be visible ( Montgomerys tubercles)Sebaceous glands may be visible ( Montgomerys tubercles)
Role of prolactin. Colostrum . LactationRole of prolactin. Colostrum . Lactation 44
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GENERAL CHANGESGENERAL CHANGES
Face
Chloasma gravidarum :symmetrical hypermelanosis orpigmentation around cheek, forehead and eyes, disappearsafter delivery
Due to in MSH secretion resulting in melanin depositionin dermis or epidermis
Abdomen
Linea nigra brownish black pigmentation area in the
middle stretching from xiphisternum to symphysis pubis Striae gravidarum represents mechanical stretching ofdeeper layer of cutis and may develop in abdomen andbreasts. Due to effect of corticosteriod, relaxin, oestrogen,abdominal distension, weight gain
55
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GENERAL CHANGESGENERAL CHANGES
Sebaceous gland activity acne and greasy skinSebaceous gland activity acne and greasy skin
Hirsutism seenHirsutism seen
Thickening of scalp hair during pregnancy-prolonged anagenThickening of scalp hair during pregnancy-prolonged anagen
phase. Post partum hair shedding hair enters telogen phase-phase. Post partum hair shedding hair enters telogen phase-telogen effluviumtelogen effluvium
Palmar erythema and spider naevi may develop due toPalmar erythema and spider naevi may develop due to
oestrogen effect.oestrogen effect.
Itchy papules develop pregnancy prurigo which wouldItchy papules develop pregnancy prurigo which would
disappear after deliverydisappear after delivery 66
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METABOLISMMETABOLISMCALORIC REQUIREMENTCALORIC REQUIREMENT
Normal caloric requirement in female 1600-2100 kcal/day.Normal caloric requirement in female 1600-2100 kcal/day.
Well nourished individual or those whose diet isWell nourished individual or those whose diet is
supplemented no change in first 10 weeks of pregnancy.supplemented no change in first 10 weeks of pregnancy.
Thereafter caloric requirement increases 50-100 kcal/day tillThereafter caloric requirement increases 50-100 kcal/day till
36 weeks.36 weeks.
200-300 kcal/day final 4 weeks of pregnancy200-300 kcal/day final 4 weeks of pregnancy
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METABOLISMMETABOLISM
WEIGHT GAINWEIGHT GAIN
Weight gain 10-12 kg. Recommended wt gain BMI
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METABOLISMMETABOLISM
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METABOLISMMETABOLISM
Fall in weight during first trimester resulting from morningFall in weight during first trimester resulting from morning
sickness. Thereafter steady gain throughout pregnancysickness. Thereafter steady gain throughout pregnancy
0.4 kg/week.0.4 kg/week.
Maternal weight gain has positive association withMaternal weight gain has positive association with
birthweight of infantbirthweight of infant
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METABOLISMMETABOLISM
CARBOHYDRATE AND INSULIN RESISTANCECARBOHYDRATE AND INSULIN RESISTANCE
Pregnancy brings about changes in hormones and insulinPregnancy brings about changes in hormones and insulinresistance that leads to increase in blood glucose level.resistance that leads to increase in blood glucose level.
In first half of pregnancy, the increase in blood glucose levelIn first half of pregnancy, the increase in blood glucose level
after carbohydrate food is less than non pregnant state.after carbohydrate food is less than non pregnant state.
ThisThis in sensitivity stimulates glycogen synthesis andin sensitivity stimulates glycogen synthesis and
storage, deposition of fat and transport of amino acids intostorage, deposition of fat and transport of amino acids into
cells.cells.
After mid pregnancy, insulin resistance gradually develops.After mid pregnancy, insulin resistance gradually develops.
This results in the increase in glucose level afterThis results in the increase in glucose level after
carbohydrate food is higher than non pregnant state and thecarbohydrate food is higher than non pregnant state and the
rise lasts longer.rise lasts longer.1111
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METABOLISMMETABOLISM
Rise in maternal glucose beneficial for fetus.Rise in maternal glucose beneficial for fetus.
Despite higher and prolonged rise in postprandial glucose,Despite higher and prolonged rise in postprandial glucose,
fasting glucose reduces below non pregnant statefasting glucose reduces below non pregnant state
Fasting plasma insulin levelFasting plasma insulin level and reaches maximum leveland reaches maximum level
about 32 weeks.about 32 weeks.
insulin resistance which persists till term, reducesinsulin resistance which persists till term, reduces
maternal utilization of glucose and induces glycogenolysis,maternal utilization of glucose and induces glycogenolysis,
gluconeogenesis as well as utilization of lipids as energygluconeogenesis as well as utilization of lipids as energy
source.source.
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METABOLISMMETABOLISM
Insulin resistance - secretion of diabetogenic hormonesInsulin resistance - secretion of diabetogenic hormones
- cortisol- cortisol reduces peripheral insulin sensitivityreduces peripheral insulin sensitivity
- renin and aldosterone- renin and aldosterone
- hPL- hPL
- Oestrogen and Progesterone- Oestrogen and Progesterone
- Glucagon and cathecolamines- Glucagon and cathecolamines
- Growth decrease- Growth decrease
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METABOLISMMETABOLISM
AMINO ACIDSAMINO ACIDS
Required by mother and fetus for growth and energy.Required by mother and fetus for growth and energy.
AA.AA.
Fall is most marked with gluconeogenic amino acids eg.Fall is most marked with gluconeogenic amino acids eg.
alanine.alanine.
Transport across placenta.Transport across placenta.
insulin resistance in pregnancy accelerate AA uptake byinsulin resistance in pregnancy accelerate AA uptake by
mother for gluconeogenesis.mother for gluconeogenesis.
Concentration of protein in maternal serum falls by 20Concentration of protein in maternal serum falls by 20
weeks, protein concentration has fallen from 7g to 6g/100ml.weeks, protein concentration has fallen from 7g to 6g/100ml.
Most of this fall is in serum albumin.Most of this fall is in serum albumin. 1515
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METABOLISMMETABOLISM
LIPIDSLIPIDS
3 fold increase in triglycerides and fatty acids.3 fold increase in triglycerides and fatty acids. LDL (50%)LDL (50%)
HDL (10-20%)HDL (10-20%)
Total cholesterol falls by 5% in early pregnancy, reducingTotal cholesterol falls by 5% in early pregnancy, reducing
lowest at 6-8 weeks. Thereafter there is progressivelowest at 6-8 weeks. Thereafter there is progressive (20-(20-
200%).200%).
Hyperlipidaemic in normal pregnancy is not atherogenicHyperlipidaemic in normal pregnancy is not atherogenic
because the pattern is not that of atherogenesis.because the pattern is not that of atherogenesis.
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LIPIDSLIPIDS
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CARDIOVASCULAR SYSTEMCARDIOVASCULAR SYSTEM
Heart rotated forward and pushed upwards as diaphragmHeart rotated forward and pushed upwards as diaphragm
rises.rises.
Apex beat shifts to the 4Apex beat shifts to the 4thth ICSICS
Systolic ejection murmurs are common in mid pregnancySystolic ejection murmurs are common in mid pregnancy
Palpitations, loud 1Palpitations, loud 1stst heart sound, 3heart sound, 3rdrd heart soundheart sound
ECG:ECG: left axis deviationleft axis deviation
Low QRS complexLow QRS complex
Flattened or even inverted T wave in lead IIIFlattened or even inverted T wave in lead III
PAC ,VEPAC ,VE
1818
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CARDIOVASCULAR SYSTEMCARDIOVASCULAR SYSTEM
Total peripheral vascular resistance reduces by 6 weeks ofTotal peripheral vascular resistance reduces by 6 weeks of
gestation and reaches a nadir of 30% below non pregnantgestation and reaches a nadir of 30% below non pregnantvalue by mid pregnancy.value by mid pregnancy.
Cardiac outputCardiac output by 50% from baseline of 4-5 l/min toby 50% from baseline of 4-5 l/min to7l/min7l/min
Heart rateHeart rate by 10%by 10%
Stroke volumeStroke volume by 10% (10 to 20 mls )by 10% (10 to 20 mls )Most changes reach maximum value by end of firstMost changes reach maximum value by end of firsttrimestertrimester
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CARDIOVASCULAR SYSTEMCARDIOVASCULAR SYSTEM
2020
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CARDIOVASCULAR SYSTEMCARDIOVASCULAR SYSTEM
Small fall in systolic and greater fall in diastolic blood pressureSmall fall in systolic and greater fall in diastolic blood pressure
during first half of pregnancy resulting induring first half of pregnancy resulting in in pulse pressurein pulse pressureThe blood pressure steadily rises in 2The blood pressure steadily rises in 2ndnd half of pregnancy backhalf of pregnancy back
to pre-pregnant state as term approachesto pre-pregnant state as term approaches
Plasma volumePlasma volume by 50-60% from baseline of 2600mls.by 50-60% from baseline of 2600mls.Plasma volume expansion is greater in multiple pregnancyPlasma volume expansion is greater in multiple pregnancy
Bigger plasma volume expansion, bigger the birth weight of theBigger plasma volume expansion, bigger the birth weight of the
baby.baby.Conversely plasma volume expansion is less in smaller babiesConversely plasma volume expansion is less in smaller babies
as in pre-eclampsia and IUGR.as in pre-eclampsia and IUGR.
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CARDIOVASCULAR SYSTEMCARDIOVASCULAR SYSTEM
2222
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CARDIOVASCULAR SYSTEMCARDIOVASCULAR SYSTEM
Total extracellular fluid volume increase by 16%Total extracellular fluid volume increase by 16%
Venous pressure in the legsVenous pressure in the legs from 9cm H2O in earlyfrom 9cm H2O in earlypregnancy to 24cm H2O at termpregnancy to 24cm H2O at term
Mechanical pressure of uterus on iliac veinsMechanical pressure of uterus on iliac veins
In late gestation pressure of fetus head also contributes.In late gestation pressure of fetus head also contributes.
Combination ofCombination of pressure andpressure and distensibility of veinsdistensibility of veinspredispose to varicose veins of the legs, vulva, rectum andpredispose to varicose veins of the legs, vulva, rectum and
pelvispelvis
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CARDIOVASCULAR SYSTEMCARDIOVASCULAR SYSTEM
Pulmonary resistance falls in early pregnancyPulmonary resistance falls in early pregnancy
Pressure in the pulmonary arteries, capillaries and rightPressure in the pulmonary arteries, capillaries and right
ventricle does not change because the pulmonary circulation isventricle does not change because the pulmonary circulation is
able to absorb high flow rate without change of pressure.able to absorb high flow rate without change of pressure.
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RESPIRATORY SYSTEMRESPIRATORY SYSTEM
Neck and oropharyngeal tissues are affected by weightNeck and oropharyngeal tissues are affected by weight
gain in pregnancygain in pregnancy
Airway oedema and difficult visualisation of larynx duringAirway oedema and difficult visualisation of larynx during
intubationintubation
Vascularity of respiratory mucosa increasesVascularity of respiratory mucosa increases
Nasal mucosa is oedematous , vascular and tends toNasal mucosa is oedematous , vascular and tends to
bleedbleed
2525
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RESPIRATORY SYSTEMRESPIRATORY SYSTEM
Vital capacity remained unchangedVital capacity remained unchanged
Tidal volumeTidal volume40% Inspiratory capacity Expiratory reserve
Residual volume FRCFRCPeak expiratory flow rate unchanged. FEV1 unchanged.Peak expiratory flow rate unchanged. FEV1 unchanged.
Respiratory rate unchangedRespiratory rate unchanged
Diaphragm raises and breathing is more diaphragmatic inDiaphragm raises and breathing is more diaphragmatic innaturenature
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RESPIRATORY SYSTEMRESPIRATORY SYSTEM
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RESPIRATORY SYSTEMRESPIRATORY SYSTEM oxygen consumption of 30 40 ml /min in late pregnancyoxygen consumption of 30 40 ml /min in late pregnancyfrom baseline of 300ml/min partitioned between motherfrom baseline of 300ml/min partitioned between mother(extra cardiac, renal, respiratory work, breast development)(extra cardiac, renal, respiratory work, breast development)and fetoplacental unit (a third )and fetoplacental unit (a third )
Pulmonary blood flowPulmonary blood flowin tandem with cardiac output.Minute ventilation 30- 50 % - achieved by tidal volumewhereas respiratory rate remains consistent.Perceived asshortness of breath
Driven by progesterone mainly
pCo2 because of the above. pCO2 at term 30mm Hg (4kPa)compared to 35-40mm Hg (4.7 5.3 kPa) in non pregnantstate
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RESPIRATORY SYSTEMRESPIRATORY SYSTEM
pCO2 activates carbonic anhydraseRenal compensation ensues by excretion of bicarbonate.
Plasma bicarbonate falls to 18-22mmol/L (from 24-28 mmol/Lin non pregnancy) pH is maintained at 7.4 to7.45
Fall in maternal pCO2 allows more efficient CO2 transferfrom fetus (pCO2 of 55mmHg) alveolar ventilation results in pO2 from 96.7 to101.8mmHg (12.9-13.6kPa)
Rightward shift of maternal oxyhemoglobin dissociation curvecaused by 2, 3 DPG in erythrocytes in pregnancy facilitates oxygen unloading to fetus ( which has much lowerpO2 25-30mmHg and leftward shift of oxy hemoglobin
dissociation curve) 2929
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RESPIRATORY SYSTEMRESPIRATORY SYSTEM
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COMPOSITION OF BLOOD -COMPOSITION OF BLOOD - Haematology
Plasma volumePlasma volume 50%
Red cell mass 20-30% depending on Fe intake
Packed cell volume (from 36% early pregnancy to 32%)(from 36% early pregnancy to 32%)
MCHCMCHC
Red cell count , HbRed cell count , Hb
Rise in red cell mass results fromRise in red cell mass results from both no of red cell and
size of red cell.
MCV from 82-85fl to 87-88fl.(femtoliters )Advantage of the large red cell better transport of O2 & CO2
Disadvantage reduce deformability in capillary circulation
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COMPOSITION OF BLOOD -COMPOSITION OF BLOOD - Haematology
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COMPOSITION OF BLOOD -COMPOSITION OF BLOOD -HaematologyBone marrow
- Hyperplastic with immature erythryoid precursors
Total white cell countNeutrophil count to a peak at 33 weeks then stabiliseEosinophil, basophil and monocyte count remain unchangedLymphocyte count remains unchanged but their function issuppressed therefore more susceptible to infection
Platelet count remains within normal non-pregnant range8-10% normal pregnancies, platelet count falls below150x109/L without ill effects on mother or fetus.
Probably resulting from physiological fibrinolysis withinuteroplacental circulation to maintain blood flow
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COAGULATION
Normal pregnancy is a state of continuing low grade
hypercoagulopathy
factors VII, VIII , IX, X, XIIFibrinogen ( x 2), von Willebrand factorAntithiombin III (inhibitor of coagulation) unchanged
Activated protein C resistance, protein S activityD dimer,ESR due to fibrinogen levelPAI 1 and PAI 2 ,PAI 1 and PAI 2 , Alpha 2 antiplasminAlpha 2 antiplasmin
3434
RENAL SYSTEMRENAL SYSTEM
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RENAL SYSTEMRENAL SYSTEM
Anatomic ChangesAnatomic Changes
Kidneys increase in size 1-2 cm in lengthKidneys increase in size 1-2 cm in length
Dilatation of renal pelvis, renal calyces, and the ureters andDilatation of renal pelvis, renal calyces, and the ureters and
these remain enlarged for several weeks after pregnancy.these remain enlarged for several weeks after pregnancy.
Predisposes to UTIPredisposes to UTI
Caused by progesterone and compression of ureters byCaused by progesterone and compression of ureters by
enlarging uterus.enlarging uterus.
Physiological ChangesPhysiological Changes
Effective renal plasma flowEffective renal plasma flow 80% in mid pregnancy and80% in mid pregnancy and
then falls to 65% above non pregnant value by term.then falls to 65% above non pregnant value by term.
GFRGFR 45% by 945% by 9thth week and thereafter by only 5-10% andweek and thereafter by only 5-10% and
only falls slightly to term.only falls slightly to term.3535
RENAL SYSTEMRENAL SYSTEM
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RENAL SYSTEMRENAL SYSTEM
Serum creatinine and ureaSerum creatinine and urea .Creatinine clearance.Creatinine clearance 25%25%
Total body waterTotal body water 20% during pregnancy with20% during pregnancy with in plasmain plasma
osmolality by 10 mOsmol/kgosmolality by 10 mOsmol/kg
Pregnant women accumulate 950 mmol of Na.Pregnant women accumulate 950 mmol of Na.
GFR tends to excrete more Na at distal tubules.GFR tends to excrete more Na at distal tubules.
Compensated for by activation of renin-angiotensin-Compensated for by activation of renin-angiotensin-
aldosterone mechanism which enhances distal tubularaldosterone mechanism which enhances distal tubularreabsorption of Nareabsorption of Na
Pregnant women tend to accumulate 350 mmol of K duringPregnant women tend to accumulate 350 mmol of K during
pregnancy despitepregnancy despite GFR and activation of RAS.GFR and activation of RAS.
Mechanism uncertain.Mechanism uncertain. 3636
RENAL SYSTEMRENAL SYSTEM
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RENAL SYSTEMRENAL SYSTEM
Serum uric acid falls by 25% in early pregnancy and returnsSerum uric acid falls by 25% in early pregnancy and returns
back to normal in 2back to normal in 2ndnd half of pregnancyhalf of pregnancy
Glycosuria may be present because quantity of filteredGlycosuria may be present because quantity of filtered
glucose exceeds the maximum reabsorption capacity ofglucose exceeds the maximum reabsorption capacity of
proximal tubuleproximal tubule
Excretion of amino acidExcretion of amino acid in pregnancy due to quantityin pregnancy due to quantity
filtered exceeding the tubular reabsortionfiltered exceeding the tubular reabsortion
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RENAL SYSTEMRENAL SYSTEM
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RENAL SYSTEMRENAL SYSTEM
Protein excretionProtein excretion in pregnancy due toin pregnancy due to GFR. In lateGFR. In late
pregnancy total protein excretion (upper limit) of
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GASTROINTESTINAL SYSTEM
Pregnancy gingivitis
Salivary secretion Na ,pH and proteins
Gastric secretion is . Gastric motility is . Small intestine
and large intestine motility is result in absorption of
salt, waterconstipation
Heartburn (reflux) intragastric pressure withoutintragastric pressure without
concomittentconcomittent in tone of oesophogeal cardiac sphincterin tone of oesophogeal cardiac sphincter
Delayed gastric emptying gastric aspirationDelayed gastric emptying gastric aspiration
Bile reflux into stomach because of pyloric sphincterBile reflux into stomach because of pyloric sphincter
incompetent aluminum hydroxideincompetent aluminum hydroxide
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GASTROINTESTINAL SYSTEM
Liver function
Plasma albumin
Globulin
Fibrinogen
Alkaline phosphatase mostly is enzyme of placental
origin
Gamma glutamyl transpeptidase no charge
AST
ALT
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GASTROINTESTINAL SYSTEM
Gall bladderin size and empties more slowly
Stasis of bile (cholestasis) in biliary cannaculi generalised
pruritus responds cholestyramineresponds cholestyramine
Cholestasis is probably hormonal because same effects is
observed in patients on OCP or HRT
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ENDOCRINE
Placenta produces
hCG
hPLhPL
ACTHACTH
OestradiolOestradiol
ProgesteroneProgesterone
PTH related proteinsPTH related proteins
ReninRenin
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ENDOCRINE
PLACENTAL HORMONES
hCG glycoprotein has 2 sub units and alpha and beta
subunits produced by the trophoblasts
Function of hCG maintain secretion of progesterone by corpus luteum of
pregnancy
immunosuppressive actively which may inhibit maternalprocess of immmunorejection of fetus as a homograft
Stimulates Leydig cells of male fetus to produce testosterone(in conjunction with fetal pituitary gonadotrophins) thus isindirectly involved in development of male external germtalia.
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ENDOCRINE
PLACENTAL HORMONE
Human placental lactogen (hPL)
Lactogenic
Promotes mammary gland growth(alveoli ) in preparation of
lactation Also regulates maternal glucose, protein and fat levels, so
that this is always available to fetus
Steriod hormones
Oestrogen
Progesterone
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ENDOCRINE
PLACENTAL HORMONE
Sex Steriod hormones
a) Together they play role in maintenance of pregnancy.Oestrogen and progesterone causes hypertrophy andhyperplasia of uterine myometrium thereby capacity,vascularity and blood flow to uterus
b) Development of breasts. Hypertrophy and proliferation ofducts are due to oestrogen.Proliferation of glandularalveoli influenced by progesterone and hPL
c) Steroids are involved in a complex pathway in the initationof normal labour
d) Progesterone is necessary to maintain endometrial liningof uterus during pregnancy. Prevents preterm labour byreducing myometrial contraction
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ENDOCRINE
Hypothalamus and pituitary
Pituitary weight 30%- headache and increasedsensitivity of gland to haemorrhage (aided by lack of direct
arterial blood supply to anterior pituitary)
Prolactin by term level 10-20x more than non pregnantwomen. Oestrogen stimulates and hPL inhibits prolactin
ACTH- Dexamethone does not suppress this ,palcental synthesis
CRH placental origin Suppression of hGH by hPL
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ENDOCRINE
Adrenal glands
in width of zona fasciculata total and free cortisol aldosterone Weaker mineralocorticoid 11 deoxycortisol is also Plasma cathecolamines fall from 1st to 3rd trimester
Thyroid Gland
Plasma iodide because of GFR Slight thyromegaly due to follicular hyperplasia
Small fall in TSH in 1st trimester followed by raise thereafter
TBG (x 2) Free T3 and free T4 remain normal. Majority of pregnant
women are euthyroid 4747
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ENDOCRINE
Parathyroid glands
Extracellular free calcium acts on the parathyroid cells toregulate secretion of PTH
PTH 1,25 dihydroxyvitD
RENAL
SYNTHESIS
Absorption ofcalcium form gut
Absorption ofcalcium form kidneys
Mobilisation of
calcium from bones
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ENDOCRINE
In pregnancy 1,25 dihydroxycholecalciferol providing the
calcium requirement in pregnancyPTH are of two types :
iPTH and PTHrP
iPTHin pregnancy but PTHrP
Renal Hormones
Activation of renin-angiotensin system
renin & angiotensin II by the end of 1st trimester and thanplateau thereafter angiotensinogen occurs till termPancreas
size and number of Beta cells of islets of Langerhans 4949
NUTRITIONNUTRITION
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NUTRITIONNUTRITION
IronIron
a) Needed for:a) Needed for:
-- expansion of red cell massexpansion of red cell mass
- fetus and placenta- fetus and placenta
- replace blood loss at delivery- replace blood loss at deliveryb) Iron requirements double during pregnancy.b) Iron requirements double during pregnancy.
c) Estimated total iron needed in pregnancy is 1000mg.c) Estimated total iron needed in pregnancy is 1000mg.
d) Mother transfers 200-300mg iron to fetus.d) Mother transfers 200-300mg iron to fetus.
e) Iron absorptione) Iron absorption in pregnancy by 20-40%.in pregnancy by 20-40%.
f) RDA for iron in pregnancy is 30 mg/day.f) RDA for iron in pregnancy is 30 mg/day.5050
NUTRITIONNUTRITION
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NUTRITIONNUTRITION
CalciumCalcium
a)a) Calcium requirementCalcium requirement by 33% in pregnancy.by 33% in pregnancy.
b)b) Net transfer across placenta is 25-30 g (active).Net transfer across placenta is 25-30 g (active).
c)c) RDA for calcium in pregnancy is 1200mg.RDA for calcium in pregnancy is 1200mg.
Folic acid.Folic acid.
a)a) ImportantImportant incidence of NTD.incidence of NTD.
b)b) RDA 400mcg/day starting from preconceptionRDA 400mcg/day starting from preconception
- 5mg/day if previous child has NTD- 5mg/day if previous child has NTD
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RDAs of Nutrients During PregnancyRDAs of Nutrients During Pregnancy
Non pregnant Pregnant
Energy (kcal) 2200 2500
Protein (g) 44-50 60
Calcium (mg) 800 1200
Iron (mg) 15 30
Folate (mcg) 180 400
Zinc (mg) 12 15
Phosphorus 800 1200
Vitamin D 5 10
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Thank youThank you