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Physiology of
pregnancy (Endocrine (Oestrogen
Inc breast and nipple…
Physiology of
pregnancy
Endocrine
Oestrogen
Inc breast and nipple growth, areolar pigmentation
Inc uterine blood flow, myometrial growth, cervical softening, inc myometrial oxytocin-Rs
Water retention, protein synthesis
Progesterone
Corpus luteum secretes until 35d, then placenta
Promotes smooth muscle relax, inc body temp
Maintains endometrium and prevents preterm labour
Human placental lactogen (HPL)
Similar to GH, increasing maternal metabolism
Insulin secretion
Pituitary gland
Enlarges (mostly anterior)
Inc prolactin, ACTH (thus cortisol), dec GnRH
Oxytocin from posterior during labour and suckling
Thyroid gland
Enlarges, inc iodine consumption
TBG inc during 1st trimester, T3/T4 rise, TSH dec slightly
Haemodynamics
Red cell vol
20% rise by term
Relative haemodilution due to plasma vol expansion, resulting in a physiological anaemia
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Plasma vol
Inc 10% by 12wk, by 32wk to 30-50%
Weight gain and oedema
Plts
Slightly reduced levels, normal function
Clotting factors
Increased (especially fibrinogen), hypercoagulable
Cardiovascular
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Physiology
Cardiomegaly
Inc diastolic filling, hypertrophy
BP
Reduced peripheral resistance (PGs)
BP (especially DBP) reduces in mid preg, can remain so in late preg, particularly when supine (IVC compression)
Imbalance of vsoconstrictors/dilators can result in preg-induced HTN
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Aorto-caval compression
Gravid uterus compresses the IVC when supine
Reduces venous return and CO
Left lateral positioning can improve CO
Genital tract
Uterus
Inc weight and size
Muscle hypertrophy and stretching
Inc blood flow due to artery/vein hypertrophy
Vagina
Oesttogen stimulates glycogen synthesis, stimulates lactobacilli action, lower pH to inhibit pathogens
Rich vascular supply
Cervix
Inc cervical mucus (plug/operculum) barrier to infection
Inc discharge
Reduced collagen at term allowing dilatation
Breasts
Milk production
Colostrum expressed from 3-4m
Milk stimulated by prolactin; inhib during preg by oes/prog
After birth low oes/prog allows prolactin action - lactation
Suckling - prolactin (production) and oxytocin (ejection)
Physiology
Oestrogen, progesterone and prolactin
stimulate duct and alveoli developement
Urinary
tract
Physiology
Inc renal blood flow, thus dec GFR
Glycosuria
Variable glycosuria can occur as more volume
filtered, exceeding absorptive capacity
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Gastro tract
Constipation
Reduced gstric/gut motility, tendancy for constipation
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Skin
Pigmentation
Linea nigra, nipple, areola, cholasma
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Respiratory
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Anatomy
Diaphragm level rises, breathing
becomes more diaphragmatic vs costal