MATERNAL ADAPTATIONS TO PREGNANCY P -1

1 . WE IG H T G AIN
 3 kg fetu s
 1 L a mnio tic flu id
 Uteru s inc rea s es in s iz e a nd its c o ntents
 Brea s ts (du c tu la r a nd g la ndu la r develo p men t)
 P ro tein dep o s itio n
 Inc rea s ed blo o d vo lu me
 O n a n a verag e the w eig ht ga in is 1 0 – 1 4 k g
 Avera g e s iz ed w o men w ith no rma l BM I ga ins a bo u t 1 2k g
 O verw eig ht w o men a re a llo w ed to g a in a bo ut 1 1 k g
 O bes e w o men a llo w ed to g a in o nly 7k g o f w eig ht

2. IN C RE ASE IN BL O O D VOL UM E : req u ir ed fo r p erfu s io n o f p la c enta a nd fetu s a nd

va rio u s s ys tem o f mo ther bo dy s imu lta neo u s ly
 Abo u t 3 0 - 40% inc r ea s e o c c u rs in blo o d vo lu me
 P la s ma vo lu me inc rea s es by 40 - 5 0%
 RBC s inc rea s e by 20 - 3 0% bec a u s e o f inc rea sed er ythro p o ies is ( w hic h
inc rea s es du e to es tro g en )
 N O T E : P las ma vo lu me inc rea s es bec a u s e o f w a ter retentio n w hic h o c c u rs
du e to s timu la tio n o f RAAS
 As inc rea s e in p la s ma vo lu me is mo re tha n inc rea s e in RBC s ,
H emo dilu t io n o c c u rs . T his hemo dilu tio n k eep s the blo o d f lo w ing du ring
p reg na nc y ins p ite o f inc rea s ed E SR a nd p ro co a g u la nt s ta te w hic h o c cu rs
du e to the effec t o f es tro g en
 H emo dilu t io n p r o tec ts ag a ins t blo o d lo s s (RBC lo s s ) du ring deliver y.

NOTE:
 H emo dilu t io n du ring p reg na nc y c a us es p hys io lo g ic a l a nemia – H b c o nc
fa lls
 Bu t a s the a bs o lu te RBC ma s s inc rea s es , the o xyg en c a rrying
c a pa c ity o f the blo o d inc rea s es

1
 E s tro g en, p rog es tero ne, nitric o xide , rela xin
↓
C a u s es va s o dila ta tio n in p erip hera l / s ys temic veno u s c irc u la tio n
↓
Dec rea s ed s ys te mic v es ic u la r res is ta nc e.

3 . T h u s , BP fa lls in p reg na nc y
Fa l l in DBP is mo re tha n fa ll in SBP
Alo ng w ith s ys temic va s c u la r res is ta nc e, the p u lmo na ry va s cu la r res is ta nc e a nd
c u ta neo u s va s c u la r res is ta nc e a ls o dec rea s ed. T hu s , mo re blo o d is g o ing to th e
lu ng s , brea s ts , u teru s a nd inc rea s ed blo o d fl o w in c u ta neo u s c irc u la tio n w hic h
lea ds to
 P a lma r erythema
 Sp ider a ng io ma s

RE L AX IN → a ho rmo ne s ec reted by

 C o rp u s lu teu m
 P la c enta
 Dec idu a

RO L E O F RE L AX IN

1 . Remo d eling o f rep ro du c tive tra c t

2. Rena l h emo d yna mic c ha ng es
3 . V a s o dila tio n (rela xed rena l ves s els ) Rela xin do es no t c a u s e p erip hera l j o int la xity

WAT E R RE T E NT IO N :

 Wa ter retentio n is mo re tha n sa lt retentio n

 O c c u rs du e to direc t a c tio n o f es tro g en o n k idneys
 Du e to inc rea s e in thirs t; there is dec rea s ed thres ho l d o f p la s ma os mo la lity
f o r feeling thirs ty i. e. res etting o f o s mo tic thres ho ld fo r thirs t o c c u rs
 Dec rea s ed p la s ma os mo la lity by 1 0m o s m/k g

2
  S a lt retentio n mea ns inc rea s ed retentio n o f s o diu m a nd p o tas s iu m a lo ng w ith
w a ter
 Amo u nt o f wa ter retentio n :
o T o ta l a mo u nt → 6. 5 liters
o Fetu s , AF, p la c enta → 3 . 5 L
o Brea s ts , u teru s , blo o d vo lu me → 3 L
o M o s t o f this w a ter is in intra va sc u la r co mp onent w hic h is the p a rt o f
extra c ellu la r c o mp o nent

H E M AT O L O G IC AL CH AN G E S

 Inc rea s ed blo o d vo lu me (3 0 - 40%)

 Inc rea s ed p la s ma vo lu me (40 - 5 0%)
 Inc rea s ed RBC ma s s (20 - 3 0%)
 Bec a u s e o f thes e hema to log ic a l c ha ng es hemo dilu tio n o c c u rs w hic h
dec rea s es the blo o d vis c o s it y
 Inc rea s e in p la s ma vo lu me s ta rts by 1 0 w eek s
 Inc rea s e in RBC ma s s s ta rts by 8 w eek s (this inc rea s e is a bo u t 45 0ml)
 Bec a u s e o f inc rea s e in RBC mas s , the iro n req u irement inc rea s es in
p reg na nc y
o T o ta l iro n req u irement in p reg na nc y → 1 000mg
o Fetu s a nd p la c enta →3 00mg
o RBC ma s s → 5 00mg
o O blig a te lo s s → 200mg
 In 1 s t ha lf o f p reg na nc y → o nly 3 - 4 mg /da y o f iro n is req u ired w hic h needs
to be a bs o rbed. In 2 n d ha lf o f p reg na nc y → 6- 7 mg /da y is req u ired
 Des p ite inc rea s e in RBC ma s s & beca u s e o f hemo dilu tio n the
o H b c o u nt dec rea s es
o H ema to c rit / P C V dec rea s es
o P la telet c o u nt dec rea s es (nea r to no rma l)
o P la s ma p ro tein c o nc entra tio n d ec rea s es

3
 P hys io lo g ic a l a nemia s ta rts a t 7 - 8 w eek s bu t rea c hes ma x by 3 2 w eek s
bec a u s e the p la s ma vo lu me is a ls o ma x a t 3 2 w eek s
o Seru m iro n c o nc entra tio n ↓
o Seru m ferritin ↓
o T IBC ↑
o Seru m tra ns ferrin rec ep to r ↑
o M C H C rema ins s a me
 O ther hema to lo g ic a l c ha ng es →
I. T L C ↑ (neu tro p hillia )
II. T o ta l p ro tein a mo u nt ↑
III. All c lo tting fa c to rs a re inc rea s ed exc ep t fac to r 1 1 a nd 1 3
IV. Fibrino g en ↑ by 5 0%
V. ↑E SR