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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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