MATERNAL PHYSIOLOGI

DURING PREGNANCY
AMIN NUROKHIM
SMF OBSGIN RS MARGONO SOEKARJO
Purwokerto
Oktober 2010
PHYSIOLOGIC, BIOCHEMICAL, AND
ANATOMIC CHANGES
EXTENSIVE AND MAY BE SYSTEMIC OR LOCAL
TELEOLOGIC ALTERATION : maintain a helthy
environment for the fetus w.o compromising the mother’s
health
IN MOST INSTANCE, physiologic actifity is increased, but
smooth muscle demonstrates decreased actifity.
LABORAT ORY VALUES ARE DRAMATICALLY
ALTERED FROM NONPREGNANT VALUES
UNDERSTANDING OF THE NORMAL PHYSIOLOGIC
CHANGES IS ESSENTIAL CIONCIDENTAL DISEASE
PROCESSES
 GASTROINTESTINAL TRACT
Nutritional requirement are increased.
Tend to rest most often.
Appetite usually increased, but some
women have decreased appetite or
experience nausea and vomiting.
These symptom may be related to
relative levels of HCG
Oral Cavity

GUMS : become hypertrophy and hyperemic,

so spongy, friable and bleed easily
Salivation may increase, saliva more acid ---
causing tooth decay
Gastrointestinal Tract
GENERAL MOTILITY is reduced due to
increasied levels of progesterone.
Gastric emptying is condiderably slowed, transit
time of food so much slower that more water is
resorbed, leading to constipation.
STOMACH AND ESOPHAGUS : hydrochloric
acid production exagerated, gastrin hormone
increases significantly, resulting in increased
stomach volume and decresased stomach pH.
Gastric mucus production increased.
Esophageal peristalsis is decreased, accompanied by
gastric reflux due to slower emptying time and relaxation
of cardiac sphyncter , leading to hearthburn.
SMALL and LARGE BOWEL and APPENDIX :
As uterus grows and stomach is pushed upward, most
areas of the large and small bowel moved upward and
laterally
Appendix is displaced superiorly.

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GALLDBLADDER
Hypotonia of smooth muscle wall.
Emptying time is slower and often incomplete.
Bile can becamo thick, and bile stasis may lead to
gallstone formation.
Chemical composition of bile is not appreciable
altered.
Plasma cholinesterase actifity ic decreased.
LIVER
No apparent morphologic change, but
there are functional alterations :
alkaline phosphatase activity can
doble, decrease in plasma albumin and
a slight decrease in plasma globulin.
KIDNEYS & URINARY TRACT
RENAL DILATATION
 Each kidney increase in length by 1 –
1,5 cm

Pelvis renis is dilated up to 60 ml.
 Ureters are dilated and elongated,

widen and become curved--- urinary

stasis and residual urine may be
present.
 RENAL FUNCTION
RENAL FUNCTION CHANGES due to increased
maternal and placental homones, including ACTH,
ADH, aldosterone, cortisol, hCS , and thyroid
hormone.
GFR increase about 50
 RPL rate increase 25 – 50 %
Glucosuria in more than 50%
Proteinuria : 200 – 300 mg/h is normally, if more
than 500mg/h a disease process is suspected.
BLADDER
Displaced upward and flatened in the
anterior – posterior diameter
Uterus pressure leads to increased
urinary frequency.
Vascularity increases and muscle tone
decreases, increasing capacity up to
1500 ml.
 HEMATOLOGIC SYSTEM
BLOOD VOLUME
 Magnitude of the increase varies according to

the size of the women.

 Hypervolemia begins in the first TM, increases

rapidly in the second TM, and palteaus at

about 30th week.
RED BLOOD CELLS
 Increase about 33%, depend on iron

supplement.
WHITE BLOOD CELLS
Leukocity count increases from 4300 –
4500/ul to 5000 – 12.000 /ul
In the last TM leuckocyte count : 25000
– 30000/ul
PLATELETS
THROMBOCYTOPOIESES increases
accompanied by progressive platelet
consumption.
 Increases levels of prostacycline,

thromboxane, a platelet aggregation

factor.
CARDIOVASCULAR SYSTEM
POSITION AND SIZE : displaced upward and
somewhat to the left with rotation.
Cardiac capacity increases by 70 – 80 ml, may be
due to hypertrophy .
Cardiac output : increases 40 %, reaching
maximum at 20 – 24 weeks.
Stroke volume increases 25 – 30 %.
BLOOD PRESSURE : decline slightly .
Peripheral resistance = BP : CO --- decline.
 PULMONARY SYSTEM
ANATOMIC & PHYSIOLOGIC CHANGES
Capillary dilatation occurs throughout the respiratory
tract, leading engorgement of nasopharynx , larynx ,
trachea, and bronchi.
 Causes change voice and breathing trhough the nose difficult
 Respiratory infection
 Chest X-rays reveal increased vascular marking in the lun
Diaphragm is elevated as much as 4 cm, rib cage is
displaced upward and widen, lower thoraxic diameter
is increased by 2 cm.
LUNG VOLUME & CAPACITIES
TIDAL VOLUME : is the volume of gas
inspired or expired during each respiration.
INSPIRATORY RESERVE VOLUME : is the
maximum amount of air that can be inspired
beyond normal tidal volume.
Expiratory Reserve Volume : is the maximum
amount of air that can be expired from
resting end-expiratory position.
RESIDUAL VOLUME : is the volume of gas
remaining in the lung at the end of maximum
expiration.
TOTAL LUNG CAPACITY : is total amount of
gas in the lung at the end of maximum inspiration
VITAL CAPACITY : is maximum volume of gas
that can be expired after maximum inspiration.
INSPIRATORY CAPACITY : is the TV + IRV,
it’s the maximum volume of gas can be inspired
from the resting end-expiratoty position.
FUNCTIONAL RESIDUAL CAPACITY = ERV +
RV, it’s the amount of gas remaining in the lungs
at the resting end-expiratory position and the
volume of gas with which the tidal air must mix.
TIDAL VOLUME increases gradually ( 35 – 50%)
as prgenancy prgresses.
TLC is reduced 4 – 5% by the elevation of the
diaphragm.
FRC, RV, and ERV all decrease by about 20%.
IC increase 5 – 10%, reaching a maximum at 22 – 24
weeks gestation.
Hyperventilation of Pregnancy occurs, causing a
decrease in alveolar CO2
 METABOLISM
WEIGHT GAIN is due to the uterus and its contents,
increased breast tissue, blood volume, and water volume in
the form of extravascular and extracellular fluid.
Average weight gain during pregnancy is 12,5 kg.
 during normal pregnancy, approximately 1000 g of the
weight gain is protein.
Plasma lipids increase (plasma cholesterol increases 50%),
plasma triglyceride concentration may triple.
Ratio LDL/HDL increases during pregnancy