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Describe photos - month of pregnancy + anatomical changes

  • a) non pregnant
  • b) 5th month
  • c) 9th month
  • d) prior to birth

many organs compressed (bladder, lungs, etc) - not always externally visible, but felt by pregnant women. 


how is corpus luteum maintained? 


production of hcg by trophoblasts. CL continues to produce progesterone, which maintains the uterine lining for implantation. AFter 6-10w post fertilization, placenta takes over. 

Placenta produces estrogen and hcg and hpl, which stimulates breast development


Blackburn (2013) Maternal, Fetal, & Neonatal Physiology


How is pregnancy dated?

first day of LMP + 7 - 3mths +1year

40 weeks from first date of LMP


hcg, estrogen, progesterone levels

hcg peaks at 11-12 w, whereas estrogen and progesterone continue to rise until term and birth


Hematologic & Hemostatic changes - blood volume

  • Hypervolemia: BV ↑ 30-45%
  • Plasma volume
    • ↑ starts 6-8 wks
    • Peaks 28-32 wk
    • 75% of total BV ↑ due to plasma
  • RBCs
    • ↑ 20-30%
    • Lags behind plasma
  • Hemodilution, physiologic anemia


Hematologic & Hemostatic changes: WBCs 


  • —WBC volume ↑ 8%, up to 15,000/mm3




Hematologic & Hemostatic changes: PLTs

  • —Platelets largely unchanged
    • Mild-moderate thrombocytopenia


Hematologic & Hemostatic changes: coagulation


  • Hypercoagulable state
  • Starts 11-15 weeks
  • Clotting Factors
    • Increase: I, VII, VIII (increase then decrease), IX, XII, von willebrand.
    • decrease: XI, and VIII later in pregnancy (to about 50% of nonpregnant)


normal labs in pregnancy

different from nonpregnant and may change throughout pregnancy


normal labs in pregnancy 2

same idea - may be different from nonpregnant


Anemia in pregnancy - risks

  • Yes - blood loss in birth, etc
  • —Lab values differ from non-pregnant
  • —Risk for iron-deficiency anemia
  • —↑ Risk for thromboembolic disorders
    • Increases further with age, parity, C/S
  • Increase in coagulopathies (PIH - disrupts clotting)

*iron supplements w/vit c. Warn about dark stool & constipation


Cardiovascular changes : position of <3

  • starts at 3-4w, plateaus 2nd or early 3rd T
  • Diaphragm elevates --> —Heart displaced to left, rotated (apex displaced laterally)
  • most women tolerate changes unless CV dz


Cardiovascular changes: CO & systemic vascular resistance

—Cardiac Output

◦↑ 30-50%
◦50% of that ↑ by 8 weeks GA
◦↑ HR 10-20 BPM

—↓ Systemic vascular resistance (--> inc BF to uterus)

most women tolerate well


Cardiovascular changes: skin

—↑ Skin perfusion (d/t vasodilitation)


CV changes: RAAS



  • —Renin-angiotensin-aldosterone (all components increase)
    • ◦Enhanced sodium and water retention
    • help maintain BP


CV changes: vessels

  • —↑ Vascular distensibility
  • —Aorto-caval compression (increases venous pressure in lower extremities - leakage from vasculature)
  • —Decreased baroreflex (impaired BP regulation - difficulty responding to OH and blood loss)
  • —BP decreases


Cardiac exam on pregnant women: what might you see?


  • Jugular venous distension
  • Split S1, sometimes split S2
  • 3rd sound audible at times
  • SEM along LSB (92-95% of women) >grade 2 or thrill must be evaluated
  • Soft, transient diastolic (20% of women)
  • ↑ Mammary blood flow, veins dilate
  • Mammary souffle (14% of women)
  • —MVP common – may ↓ murmur


BP in pregnancy: worried about low or high?



BP in pregnancy - normal changes


  • Lowest second trimester: lowest 24-32 weeks, returns to nonpregnant values near term
  • Measurement changes


BP in pregnancy - what compounds effects?

physiologic but can be compounded by other pregnancy changes

  • Positional effects
    • –Supine hypotensive syndrome (uterus compress great vessels)
    • –Orthostatic hypotension (perhaps d/t decreased baroreflex sensitivity)
  • Other hypotensive effects (heat, long hot showers, etc.)
  • Hypertensive disorders of pregnancy


aortocaval compression relief, image


Clinical implications of CV changes in pregnancy: multiple pregnancies 

—even greater increase in CO, stroke volume
increase in HR, anemia, PIH, MVP (tend to be asymptomatic)


Clinical implications to increased skin perfusion

  • —Vascular spiders, palmar erythema
  • —Nasal hyperemia: congestion


Exercise in pregnancy

  • shorter labors, fewer perinatal complications, inhibits clot formation, varicosities, weight gain
  • ◦30” daily 2-3x/wk
  • ◦Aerobic walking, stretching, biking, weights
  • ◦Benefits swimming
  • ◦Cautions:
    • no lifting >25lbs,
    • balance (biking in 3rd T),
    • redistributes blood to skin and muscles, so may cause dizziness;
    • high heat (hyperthermia can be teratogenic, so also stay away from saunas & hottubs),
    • avoid jumping, deep flexion of joints, blunt abdominal trauma, aortocaval compression (supine)


Respiratory: anatomical changes

  • ◦Position of diaphragm shifts
  • ◦↑ Subcostal angle
  • ◦↑ Chest diameter & circumferences
  • ◦ Hyperemia oro- & nasopharynx

probably due to relaxation of ligaments btwn rib cage and sternum


Respiratory: physiologic changes


  • ◦Progesterone respiratory stimulant
    • ◦Chronic mild hyperventilation (increased alveolar O2, drop in arterial CO2)
      • ◦Favors transfer CO2  fetus → mom 


Progesterone & PGs in respiration

  • prog: decrease airway resistance up to 50%
  • both relax smooth muscles of resp tract - reduced WOB


O2 consumption in pregnancy

O2 consumption increases d/t metabolic demands of mother, placenta, fetus, and lung capacity changes


Which of the following increase during pregnancy?

Respiratory rate (RR)

Vital capacity (VC)

Inspiratory capacity (IC)

Tidal volume (TV)

Inspiratory reserve volume (IRV)

Functional residual capacity (FRC)

Expiratory reserve volume (ERV)

Residual volume (RV)

Total lung capacity (TLC)

Inspiratory capacity, tidal volume, 


Which of the following decrease during pregnancy?

Respiratory rate (RR)

Vital capacity (VC)

Inspiratory capacity (IC)

Tidal volume (TV)

Inspiratory reserve volume (IRV)

Functional residual capacity (FRC)

Expiratory reserve volume (ERV)

Residual volume (RV)

Total lung capacity (TLC)