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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

Physiologic Changes of Pregnancy

Pouneh Taghizadeh, MD

Senior Advisor: Bruce Vrooman, MD

Faculty Advisor: Nina Zachariah, MD

Boston University

Department of Anesthesiology

respiratory system
Respiratory System
  • Upper airways
  • Minute Ventilation
  • Lung Volumes
  • Oxygen consumption
upper airways
Upper Airways
  • Capillary engorgement of the mucosal lining of the respiratory tract

- Nasopharynx

- Larynx

- Trachea

- Bronchi

  • Anesthetic Implications
minute ventilation
Minute Ventilation

MV = RR x TV

  • Increased circulatory progesterone
    • Direct ventilation stimulant
    • Increases central response to CO2
    • Increases TV in pregnancy to dispose CO2
oxygen consumption
Oxygen Consumption
  • Increased by 20%
  • Anesthetic Implications

-Importance of pre-oxygenation

cardiovascular system
Cardiovascular System
  • Intravascular Fluid Volume
  • Cardiac Output
  • Peripheral Circulation
intravascular fluid volume1
Intravascular Fluid Volume
  • Increase to 1500ml by term
    • 45% increase in plasma volume
    • 20% increase in erythrocyte volume
  • Anemia
  • Effects on blood pressure
cardiac output co sv x hr
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

peripheral circulation
Peripheral Circulation
  • Systemic circulation
  • Pulmonary circulation
  • Systemic vascular resistance
  • Effects on central venous pressure
gastrointestinal system
Gastrointestinal System
  • Increased progesterone
    • Relaxation of lower esophageal sphincter
  • Decreased gastric pH
  • Enlarging uterus
    • Delayed gastric emptying during labor
    • Anesthetic Implications
gastrointestinal system1
Gastrointestinal System
  • Morning Sickness
    • Weeks 4-6 of pregnancy
    • Causes:
      • Relaxation of smooth muscle in stomach
      • Increased hCG
      • Anxiety
renal system
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
renal system1
Renal System
  • GFR
  • Renal plasma flow
  • Creatinine clearance
  • Serum creatinine
  • Blood urea nitrogen
  • Renin/Angiotensin levels
hepatic system
Hepatic System
  • Decrease in albumin:globulin ratio
    • Increase in free fraction of albumin bound medications
  • Decreased plasma cholinestrase levels
    • Anesthetic implications
hepatic system1
Hepatic System
  • Lactate dehydrogenase, bilirubin, ALT/AST, alkaline phosphatase
  • Gallbladder emptying
  • Concentration of bile
hematologic system
Hematologic System
  • Increased estrogen
    • Increase in clotting factors
      • VII, VIII, X, XII, and fibrinogen
  • Decrease in Antithrombin III
    • Hypercoagulable state
      • DVTs
central nervous system
Central Nervous System
  • Volume of epidural space
  • CSF volume/CSF pH
  • Anesthetic Implications
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