Professional Documents
Culture Documents
PREGNANCY
N (of 1354)
Percentage
Hypertension
20
21.5
Pulmonary
20
21.5
Cardiac
11
11.8
Hemorrhage
8.6
CNS
8.6
Sepsis/Infection
6.4
Malignancy
6.4
Pregnancy physiology
Cardiovascular adaptations:
10% by 7th week
Important
for fetal growth
Increased cardiac output (HR
x SV)
(IUGR with lower PV)
SVR variability
Pregnancy physiology
Cardiovascular adaptations:
RBC mass < PV
SVR variability
Pregnancy physiology
Cardiovascular adaptations:
BP = CO x SVR
SVR variability
Points of concern:
Method & Position
Pregnancy physiology
Cardiovascular adaptations:
20% in pregnancy
Likely 2 to SVR
Some impact from FT4
Playsximportant
Increased cardiac output (HR
SV) role in certain
SVR variability
diagnoses
(i.e. mitral stenosis)
Pregnancy physiology
Cardiovascular adaptations:
CO = HR x SV
Reflects LV capacity
Increases by 10th week
2 to HR before 20 weeks
SVR variability
2 to SV after 20 weeks
Pregnancy physiology
Cardiovascular adaptations:
Measure of impedance to
maternal after load
Decreases in 1st/2nd trimester
(Nadir by 14-24 weeks)
Increases in 3 trimester
Inversely proportional to CO
SVR variability
Pregnancy physiology
Cardiovascular adaptations (during labor):
during contractions:
Pregnancy physiology
Cardiovascular adaptations (post partum):
Vaginal
Loss
Hct
500 ml
+5.2%
vs.
Cesarean
1000 ml
-5.8%
Pregnancy physiology
Pulmonary adaptations:
Mucosal edema
Upper airways
Mechanics of respiration
Physiologic changes
Acid-base changes
Mucosal vascularity
Rhinitis & Epistaxis
Pregnancy physiology
Pulmonary adaptations:
8% thoracic circumference
Upper airways
Mechanics of respiration
Physiologic changes
Acid-base changes
5 cm elevation of diaphragm
Increase in dyspnea
15% by 10 weeks
50% by 19 weeks
76% by 31 weeks
Pregnancy physiology
Pulmonary adaptations:
Upper airways
Mechanics of respiration
Physiologic changes
Acid-base changes
FEV1
Unchanged
FRC
10-25%
TLC
minimally
Minute Vent
20-40%
Alveolar Vent
50-75%
Pregnancy physiology
Pulmonary adaptations:
Upper airways
Mechanics of respiration
Physiologic changes
Acid-base changes
Pregnancy=Compensated
respiratory alkalosis
PaO2 (101-104)
A-a gradient (14.3)
Pregnancy physiology
Other adaptations:
Genitourinary
Gastrointestinal
Hematologic
Endocrine
Immune
Pulmonary-Pulmonary Edema
Causes:
Hydrostatic
Systolic dysfunction
Diastolic dysfunction
Valvular disease
Permeability
Pneumonia
Septic shock
ARDS
Pulmonary-Pulmonary Edema
Treatment (general):
Sit patient upright
Administer oxygen (may use CPAP until diuresis)
Furosemide (aim for 2L diuresis in 3-4 hours)
Morphine (2-5 mg IV)
Treatment (Specific):
Systolic dysfunction (afterload reduction/inotrop/diuretic)
Diastolic dysfunction (anti-HTN)
Management
Acute pulmonary edema requires emergency
management. Furosemide is given in 20- to 40-mg
intravenous doses along with therapy to control
dangerous hypertension.
Ante/post artum? Fetus dead/alive?
cardioactive drugs lower peripheral resistance and
in turn severely diminish uteroplacental circulation.
The cause of cardiogenic failure echocardiography,
Not an indication for emergency cesarean delivery.
Indeed, in most cases, these women are better served
by vaginal delivery.