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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
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
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
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
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
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
CSF UNCHANGED ICP
Progestrone Endorphine Pain Treshold
THANKS FOR YOUR ATTENTION
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