1. IN THE NAME OF GOD

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

3. PHYSIOLOGIG CHANGES OF PREGNANCY

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

5. CARDIOVASCULAR SYSTEM

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

7. CVP UNCHANGED  SVR BP UNCHANGED  PVR  PAP

8. Tachyarrhythmias are more common in pregnancy

9. SUPINE HYPOTENTION SYNDROME

10. SEVERE HYPOTENTION IN SUPINE POSITION Inf vena cava obstruction

12. 15-20 degree left uterine displacement with small pillow or wedge

13. shortness of breaths palpitation dizziness edema poor exercise tolerance

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

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

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

17. Echocardiography Echocardiography Tricuspid Regurgitation Pulmonary Regurgitation Mitral Regurgitation Pericardial Effusion

19. HEMATOLOGIC SYSTEM

20.  Total body water 8/5 Lit Sodium retention

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

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

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

24. Platelets Neuraxial Block Platelets 50000 ? 75000 ? 100000 ?

25. Gradual return to prepregnancy blood volume 6-9 weeks postpartum

26. RESPIRATORY SYSTEM

27.  WORKING OF BREATHING

28. The most impressive change  FRC 20% at term

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

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

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

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

33. Emergency : 4 maximal capacity breathing with 100% o2

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

35. 17 times higher mortality rate among parturient women undergo general anesthesia than regional

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

37. Endotracheal tube 6 - 7

39. GASTROINTESTINAL SYSTEM

40. GI function in pregnancy & labor is contraversy

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

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

43. RENAL SYSTEM

44. Major changes in pregnancy

45.  Urea  creatinine  uric acid clearance

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

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

48. CENTRAL NERVOUS SYSTEM

49. REGIONAL & GENERAL INCREASED SENSITIVITY TO REGIONAL & GENERAL ANESTHETICS

50. MULTIFACTORIAL EXPLANATION

51.  CSF UNCHANGED ICP

52.  Progestrone  Endorphine   Pain Treshold

53. THANKS FOR YOUR ATTENTION