IN THE NAME OF GOD

Ahvaz Jundishapur University of Medical Science Nesioonpour Sholeh,MD 2012 DEC

PHYSIOLOGIG CHANGES OF PREGNANCY

*HORMONAL ALTERATION *MECHANICHAL EFFECT OF GRAVID UTERUS *METABOLIC & OXYGEN REQUIREMENT *METABOLIC DEMANDS OF FETOPLACENTAL UNIT *HEMODYNAMIC ALTERATION WITH PLACENTAL CIRCULATION

CARDIOVASCULAR SYSTEM

 HEART RATE 20-30%  STROKE VOLUME 20-50%  CARDIAC OUTPUT 30-50%

CVP UNCHANGED  SVR BP UNCHANGED  PVR  PAP

Tachyarrhythmias are more common in pregnancy

SUPINE HYPOTENTION SYNDROME

SEVERE HYPOTENTION IN SUPINE POSITION Inf vena cava obstruction

15-20 degree left uterine displacement with small pillow or wedge

shortness of breaths palpitation dizziness edema poor exercise tolerance

further investigation chest pain syncope severe arrhythmia systolic murmur > 3 diastolic murmur further investigation

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

Electrocardiogram Electrocardiogram right axis deviation right bundle branch block Q wave in lead III

Echocardiography Echocardiography Tricuspid Regurgitation Pulmonary Regurgitation Mitral Regurgitation Pericardial Effusion

HEMATOLOGIC SYSTEM

 Total body water 8/5 Lit Sodium retention

Physiologic anemia HB : 11/6 gr/dl  blood volume 45%  red cell volume 30% oxygen transport not impaired

Hypercoagulability  Fibrinogen  VII factor  VIII,IX,X,XII Platelets unchanged

 Protective adaptation to lessen hemorrhage risk at delivery - thromboembolism, a maternal mortality cause DVT 5 – 6 times higher than general female at chilbearing age

Platelets Neuraxial Block Platelets ? ? ?

Gradual return to prepregnancy blood volume 6-9 weeks postpartum

RESPIRATORY SYSTEM

 WORKING OF BREATHING

The most impressive change  FRC 20% at term

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

Desaturation Faster than Nonpregnant  O2 consumption  Basal metabolic rate  FRC Desaturation Faster than Nonpregnant

Fully preoxygenated nonpregnant desaturation 100%  90% 9min healthy pregnant  3-4 min morbid obese pregnant  98 S

Administration of 100% oxygen 3-5 minutes before induction of anesthesia

Emergency : 4 maximal capacity breathing with 100% o2

difficult intubation Capillary engorgement of mucosa edema of Oropharynx Larynx & Trachea  difficult intubation

17 times higher mortality rate among parturient women undergo general anesthesia than regional

Upper airway manipulation suctioning, airway laryngoscopy edema, bleeding, trauma

Endotracheal tube 6 - 7

GASTROINTESTINAL SYSTEM

GI function in pregnancy & labor is contraversy

 Risk of aspiration with GA  Risk of aspiration with GA Progestrone relax smooth musle  impairs esophaseal & intestinal motility during pregnancy Opioids delay gastric emptying

 Bile secretion progestrone change of bile composition  stasis  gall stone formation cholecystectomy 2th surgery in pregnancy

RENAL SYSTEM

Major changes in pregnancy

 Urea  creatinine  uric acid clearance

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

lower Normal renal indices in pregnancy are lower than in nonpregnancy glycosuria is a common finding

CENTRAL NERVOUS SYSTEM

REGIONAL & GENERAL INCREASED SENSITIVITY TO REGIONAL & GENERAL ANESTHETICS

MULTIFACTORIAL EXPLANATION

 CSF UNCHANGED ICP

 Progestrone  Endorphine   Pain Treshold

THANKS FOR YOUR ATTENTION