Physiologic changes in pregnancy

Skin changes in pregnancy 1. Striae gravidarum: stretch marks - Changes in collagen - More of genetics - Can be seen as early as 1st trimester but may not be seen in pregnant with twins. Note: do not look for cold and calmy hand as signs for hypotension in pregnant women.

4. Linea nigra: inc pigmentation - Usually in dark complexion women 2. Spider angiomata: inc. vascularity - Due to smooth muscle relaxation caused by progesterone - Men can also get it if they have liver failure and if they have high level of estrogen - When pressed it blanches, when released come back 5. Chloasma: inc pigmentation in face - May resolve but usually once you get it, you get it

3. Palmar erythrema; inc. vascularity - Inc blood flow to hand/fingers - Occurs in order to relief from the excessive heat produce due to presence of fetus

CARDIOVASCULAR CHANGES

Plasma volume goes up by about 50%, heart rate and stroke volume are significantly increased which increase cardiac output significantly. Plasma volume also determine the weight of fetus.

Increase femoral venous pressure can lead to: i. Varicose veins Cardiac output varies with the: 1. Maternal position

ii.

Hemorrhoids

2. Stages of labor

These are considered normal changes in pregnant.-

Note: there is maximum increase in cardiac output immediately postpartum. It is due to autotransfusion of blood. It happens when there is increase in peripheral venous blood flow from the uteroplacental vessels. Because the placenta is cut and all the blood is reflected back to right hear of mother. [The midsystolic ejection murmurs are normal during pregnancy but diastolic and pan systolic are not normal.]

GI TRACT CHANGES

NOTE: Increase in emptying time and residual volume results in: 1. Reflux esophagitis 2. Cholesthiasis dec. contractility of gall bladder 3. Constipation: major issue; should be given stool softner PULMONARY CHANGES HEMATOLOGIC CHANGES

NOTE: I. II. III. INCREASE IN FACTORS VII, VIII, IX AND X will increase the risk of thrombosis. Albumin level is unchanged. Low level of hemoglobin and hematocrit does not mean the mother is anemic because there is increase in red cell mass which increases the oxygen carrying capacity.[physiologic anemia] 1. Tidal volume only goes up 2. Respiratory rate unchanged so minute ventilation goes up. [= tidal volume*RR] which cause respiratory alkalosis and as a result may lead to UTIs due to increase in urine pH.

Note: right side of ureter increase more. RENAL FUNCTIONS

GLUCOSURIA: inc glucose output in urine; diabetic??????=====NO Note: diabetes is checked by level of blood glucose level not urine glucose. Proteinuria: no change in urine protein RENAL ANATOMY IN PREGNANCY ENDOCRINE PHYSIOLOGY 1. PITUITARY Increase in size due to increase in blood supply inc. risk of Sheehans syndrome which is caused due to inc. blood loss during parturition. It causes infarction of pituitary glanddec prolactin, and other hormones 2. ADRENALS NO change in size but increase in hormones which disposes the mother to gestational diabetes 3. THYROID