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IN THE NAME OF GOD

IN THE NAME OF GOD. Ahvaz Jundishapur University of Medical Science Nesioonpour Sholeh ,MD 2012 DEC. PHYSIOLOGIG CHANGES OF PREGNANCY.

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IN THE NAME OF GOD

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  1. IN THE NAMEOF GOD

  2. Ahvaz Jundishapur University of Medical ScienceNesioonpourSholeh ,MD2012 DEC

  3. PHYSIOLOGIGCHANGES OFPREGNANCY

  4. *HORMONAL ALTERATION*MECHANICHAL EFFECT OF GRAVID UTERUS*METABOLIC & OXYGEN REQUIREMENT*METABOLIC DEMANDS OF FETOPLACENTAL UNIT*HEMODYNAMIC ALTERATION WITHPLACENTAL CIRCULATION

  5. CARDIOVASCULARSYSTEM

  6.  HEART RATE20-30%  STROKE VOLUME20-50%  CARDIAC OUTPUT30-50%

  7. CVP UNCHANGED SVR BP UNCHANGED  PVR  PAP

  8. Tachyarrhythmiasare more common in pregnancy

  9. SUPINE HYPOTENTIONSYNDROME

  10. SEVERE HYPOTENTIONIN SUPINE POSITIONInf vena cava obstruction

  11. 15-20 degree left uterinedisplacement with small pillow or wedge

  12. shortness of breathspalpitationdizzinessedemapoor exercise tolerance

  13. chest painsyncopesevere arrhythmiasystolic murmur>3diastolic murmurfurther investigation

  14. Chest radiography Apparent Cardiomegaly Enlarged Left Atrium Increased Vascular Marking Postpartum pleural Effusion

  15. Electrocardiogramright axis deviationright bundle branch blockQ wave in lead III

  16. EchocardiographyTricuspid RegurgitationPulmonary RegurgitationMitral RegurgitationPericardial Effusion

  17. HEMATOLOGICSYSTEM

  18.  Total body water 8/5 LitSodium retention

  19. Physiologic anemiaHB : 11/6 gr/dl blood volume 45%  red cell volume 30%oxygen transport not impaired

  20. Hypercoagulability  Fibrinogen  VII factorVIII ,IX ,X ,XIIPlatelets unchanged

  21.  Protective adaptation to lessen hemorrhage risk at delivery-thromboembolism, a maternal mortality causeDVT 5 – 6 times higher than generalfemale at chilbearing age

  22. Neuraxial BlockPlatelets 50000 ?75000 ?100000 ?

  23. Gradual return to prepregnancy blood volume 6-9 weeks postpartum

  24. RESPIRATORYSYSTEM

  25. WORKING OF BREATHING

  26. The most impressive change FRC20% at term

  27. Minute Ventilation 45%Tidal Volume  50%Unchanged RR

  28.  O2 consumption  Basal metabolic rateFRCDesaturation FasterthanNonpregnant

  29. Fully preoxygenatednonpregnantdesaturation100%  90% 9minhealthy pregnant  3-4 minmorbid obese pregnant  98 S

  30. Administration of100% oxygen3-5 minutesbefore induction of anesthesia

  31. Emergency :4 maximal capacitybreathingwith 100% o2

  32. Capillary engorgementof mucosaedema of Oropharynx Larynx & Trachea difficult intubation

  33. 17times highermortalityrate among parturient women undergo generalanesthesia than regional

  34. Upper airway manipulationsuctioning , airway laryngoscopyedema , bleeding , trauma

  35. Endotracheal tube6 - 7

  36. GASTROINTESTINALSYSTEM

  37. GI function in pregnancy & laboris contraversy

  38.  Risk of aspiration with GAProgestrone relax smooth musle impairs esophaseal & intestinal motility duringpregnancyOpioids delay gastric emptying

  39.  Bile secretion progestronechange of bile compositionstasisgall stone formationcholecystectomy 2th surgery in pregnancy

  40. RENALSYSTEM

  41. Major changes in pregnancy

  42.  Urea creatinine  uric acid clearance

  43.  CO   RPF  GFRPLASMA CREATININE& UREA

  44. Normal renal indices in pregnancy are lower than in nonpregnancyglycosuria is a common finding

  45. CENTRAL NERVOUSSYSTEM

  46. INCREASED SENSITIVITY TOREGIONAL & GENERALANESTHETICS

  47. MULTIFACTORIALEXPLANATION

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