MATERNAL PHYSIOLOGY

PATRICK DUFF, M.D.

UNIVERSITY OF FLORIDA
 MATERNAL PHYSIOLOGY
OVERVIEW

 Placenta
 Hormone production
 Mechanisms of placental transfer
 Changes in uterus
 Cardiopulmonary changes
 Hematologic changes
 Alterations in GI function
 Renal function changes
PLACENTAL HORMONE PRODUCTION
HORMONE PRODUCTION BY THE
PLACENTA

HORMONE FUNCTION
Human placental Antagonizes insulin 
lactogen (HPL) spares glucose for use by
fetus
Enhances lipolysis
provides alternate fuel
source for mother
Human chorionic Stimulates corpus luteum
gonadotropin (hCG) to secrete estradiol and
progesterone
MECHANISMS OF PLACENTAL
TRANSFER

MECHANISM EXAMPLES
Simple diffusion Water, oxygen,
carbon dioxide
Facilitated diffusion Glucose
Active transport Amino acids, iron
Pinocytosis Drugs,
immunoglobulins
 CHANGES IN UTERUS

 Uterine blood flow Status % of C.O.

increases significantly Perfusing
 Uterine blood flow Uterus
may approach 500 –
Non- <1%
750 cc/ minute
pregnant
 Hemorrhage is key
cause of maternal Pregnant 15-20%
death
DISTRIBUTION OF UTERINE BLOOD FLOW
DURING PREGNANCY

Myomet
Endomet
Placenta
 CARDIOVASCULAR CHANGES
DURING PREGNANCY

CARDIAC PERCENT
FUNCTION INCREASE IN
PREGNANCY
Heart rate 5-15%
Stroke volume 25-30%
Cardiac output 35-50%
 CHANGES IN CARDIAC OUTPUT
DURING LABOR

STAGE OF LABOR ADDITIONAL

PERCENT
INCREASE IN
CARDIAC OUTPUT
Early first 15-20%
Late first 30-35%
Second 35-40%
DANGEROUS CARDIAC DISEASES IN
PREGNANCY
 Stenotic valve
lesions
 Ischemic heart
disease
 Marfan syndrome
 Eisenmenger’s
syndrome
 Primary pulmonary
hypertension
PULMONARY FUNCTION ALTERATIONS
IN PREGNANCY
 PULMONARY FUNCTON
ALTERATIONS IN PREGNANCY

PULMONARY CHANGE
VOLUME
Inspiratory reserve No change
volume
Tidal volume Increased
Expiratory reserve Decreased
volume
Residual volume Decreased
 PULMONARY FUNCTION
ALTERATIONS IN PREGNANCY

PULMONARY CHANGE
CAPACITY
Inspiratory capacity (IRV Increased
+ TV)
Vital capacity (IRV + TV + Unchanged
ERV)
Functional residual Decreased
capacity (ERV + RV)
Total lung capacity Decreased
(IRV+TV+ERV+RV)
ALTERATIONS IN ARTERIAL BLOOD
GASES
 Increased pH
 Decreased pCO2
 Decreased HCO3
 PARTIALLY
COMPENSATED
RESPIRATORY
ALKALOSIS
HEMATOLOGIC ALTERATIONS IN
PREGNANCY

COMPONENT PERCENT
CHANGE
Blood volume 30-50%
Plasma volume 50%
Red cell number 30%
PRINCIPAL CAUSES OF ANEMIA IN
PREGNANCY

ETIOLOGY KEY DIAGNOSTIC

TEST(S)
Iron deficiency RBC indices, serum
ferritin
Hemodilution RBC indices
Folate deficiency RBC indices, serum
folate
B 12 deficiency RBC indices, serum
folate
Hemoglobinopathy Hgb electrophoresis
PERIPHERAL BLOOD SMEARS
HEMATOLOGIC ALTERATIONS IN
PREGNANCY

CELL LINE CHANGE

White blood cells Slight increase
Platelets* Unchanged to slight
decease

* Most common causes of thrombocytopenia –

pre-eclampsia and gestational thrombocytopenia
 COAGULATION CHANGES IN
PREGNANCY

Enhanced hepatic synthesis of I, II,

VII, VIII, IX, and X
Placenta  III (tissue
thromboplastin)
Platelets  aggregate more
readily
VIRCHOW’S TRIAD THROMBOSIS

Venous stasis
Alteration in
venous wall
Hyper-
coagulable state
GASTROINTESTINAL ALTERATIONS
IN PREGNANCY

ALTERATION CLINICAL
CONSEQUENCE
Delayed gastric emptying GERD
(gastroparesis) Early satiety
Biliary duct stasis Cholelithiasis
pancreatitis
Change in location of Delay in diagnosis
appendix
CHANGE IN ANATOMIC LOCATION
OF APPENDIX IN PREGNANCY
GASTROINTESTINAL ALTERATIONS
IN PREGNANCY

ALTERATION CONSEQUENCE
Increased intra- Hiatal hernia
abdominal pressure
Delayed colonic Constipation
empyting
RENAL FUNCTION ALTERATIONS IN
PREGNANCY

Renal blood flow increases 30 – 40

% above pre-pregnancy levels
GFR ( creatinine clearance)
increases
Serum BUN, creatinine, and uric
acid decrease
FREQUENCY OF UTIs IN PREGNANCY

TYPE OF FREQUENCY
INFECTION
Asymptomatic 5-10%
bacteriuria
Acute cystitis 2-3%
Pyelonephritis 1-2%
MICROBIOLOGY OF UTIs IN
PREGNANCY

E.coli
Kleb
Proteus
Gram+
 INCREASED RISK OF PYELONEPHRITIS IN
PREGNANCY
 Progesterone inhibits
ureteral peristalsis
 Mechanical
compression of ureter
by gravid uterus
 Complications of
pyelonephritis
 Preterm labor
 Sepsis and ARDS
 INCREASED RISK OF
NEPHROLITHIASIS
 Increased
concentration of
calcium in the urine
 Urinary stasis
 Most common stones
 Calcium oxalate
 Struvite
 MATERNAL PHYSIOLOGY
SUMMARY

ORGAN SYSTEM KEY TEACHING POINTS

Cardiac Danger of stenotic lesions
and pulmonary
hypertension
Pulmonary VC – unchanged
FRC – decreased
ABGs – compensated
respiratory alkalosis
 MATERNAL PHYSIOLOGY
SUMMARY
ORGAN SYSTEM KEY TEACHING POINTS
Hematologic Increased frequency of
anemia, DVT, PE
GI Increased frequency of
GERD, gall bladder
disease, and constipation

Renal Increased RBF and GFR

Increased risk of
ascending UTI
Increased risk of
nephrolithiasis