Pregnancy.pptx changes associated with pregnancy

Pregnancy

1. PREGNANCY Website : www.tamsmed.com

2. INTRODUCTION Two compartment model is the simplest model in pregnant ladies  Mother & Fetus But in practice, many compartments in mother & fetus may present e.g. Placenta, amniotic fluid Website : www.tamsmed.com

3. Fetus  nutrient requiring organism mainly glucose Also amino acids, lactate, fatty acids, ketone bodies Website : www.tamsmed.com

4. METABOLIC CHANGES IN PREGNANCY

5. METABOLIC CHANGES IN PREGNANCY 10-20 % increase in BMR by 3 RD trimester Extra calories required = 300 kcal/day Weight gain = 11 kgs Website : www.tamsmed.com

6. WEIGHT GAIN OF PREGNANCY Due to: 1. Uterus 2. Breast 3. Increase blood volume 4. Increased extravascular extracellular fluid 5. Maternal reserves (increase in cellular w ater, fats & proteins) Website : www.tamsmed.com

7. WEIGHT GAIN OF PREGNANCY Due to: 1. Uterus 2. Breast 3. Increase blood volume 4. Increased extravascular extracellular fluid 5. Maternal reserves (increase in cellular w ater, fats & proteins) Website : www.tamsmed.com

8. PREGNANCY INDUCED HYPERVOLEMIA Functions 1. To meet metabolic demands of large uterus with its greatly hypertrophied vascular system 2. To provide abundant nutrients for placenta & fetus 3. To protect mother & fetus against deleterious effects of impaired venous return in supine & erect positions 4. To safeguard mother against adverse effects of blood loss during parturition Website : www.tamsmed.com

9. INCREASE BLOOD VOLUME More plasma increase RBCs increase Website : www.tamsmed.com

10. PITTING EDEMA OF PREGNANCY Because of 1. Increased venous pressure below the level of uterus because of partial vena cava occlusion 2. Decreased interstitial colloid osmotic pressure Website : www.tamsmed.com

11. CARBOHYDRATE METABOLISM

12. CARBOHYDRATE METABOLISM Pregnancy is characterized by: 1. Mild fasting hypoglycemia 2. Prolonged post prandial hyperglycemia 3. Hyperinsulinemia After meals 4. Greater suppression of glucagon 5. Peripheral insulin resistance 6. Switch in fuels Website : www.tamsmed.com

13. CARBOHYDRATE METABOLISM Pregnancy is characterized by: 1. Mild fasting hypoglycemia 2. Prolonged post prandial hyperglycemia 3. Hyperinsulinemia After meals 4. Greater suppression of glucagon 5. Peripheral insulin resistance 6. Switch in fuels Website : www.tamsmed.com

14. PERIPHERAL INSULIN RESISTANCE To ensure a sustained postprandial supply of glucose to fetus Because of 1. Placental steroids (estrogen & progesterone) 2. Placental lactogen (causes lipolysis with liberation of FFA 3. Placental GH is a major determinant of ins-R after mid pregnancy Website : www.tamsmed.com

15. CARBOHYDRATE METABOLISM Pregnancy is characterized by: 1. Mild fasting hypoglycemia 2. Prolonged post prandial hyperglycemia 3. Hyperinsulinemia After meals 4. Greater suppression of glucagon 5. Peripheral insulin resistance 6. Switch in fuels Website : www.tamsmed.com

16. CARBOHYDRATE METABOLISM Pregnancy is characterized by: 1. Mild fasting hypoglycemia 2. Prolonged post prandial hyperglycemia 3. Hyperinsulinemia After meals 4. Greater suppression of glucagon 5. Peripheral insulin resistance 6. Switch in fuels Website : www.tamsmed.com

17. SWITCH IN FUELS From glucose to lipids Change rapidly from PP state to fasting So plasma glucose Plasma concentration of FFA, TG, cholesterol are higher When fasting prolonged  these alterations are exaggerated & ketonemia rapidly appears Website : www.tamsmed.com

18. FAT METABOLISM

19. FAT METABOLISM Hyperlipidemic state (lipid , lipoprotein, apolipoprotein) Increase lipolysis & decrease lipoprotein lipase After delivery, lipid, lipoprotein and apolipoprotein decrease Lactation speeds these changes Website : www.tamsmed.com

20. LEPTIN Peptide hormone secreted by adipose tissue in pregnancy (peak in 2 nd trimester) Produced by placenta ROLE in :  Regulation of increased maternal energy demands  Regulate fetal growth  Role in fetal macrosomia & growth restriction Website : www.tamsmed.com

21. GHRELIN Hormone secreted by adipose tissue in pregnancy (peak in mid pregnancy & then decrease) Produced by placenta Role in  Fetal growth & cell proliferation  Regulate growth hormone secretion Website : www.tamsmed.com

22. PROTEIN METABOLISM

23. PROTEIN METABOLISM Positive nitrogen balance Amino acid concentration are higher in fetal rather than maternal compartment Regulated by placenta :  Placenta concentrates aa in fetal circ.  It is involved in prot synth, oxidation and transamination Website : www.tamsmed.com

24. PROTEIN METABOLISM In pregnancy, though there is increased production on proteins, decrease in amount of proteins occur due to hemo- dilution LT hypo albuminemia Due to decrease in protein binding, increase in free drug concentration leads to increased therapeutic effect. Website : www.tamsmed.com

25. PROTEIN METABOLISM Concentrations of lipoproteins and fat increase in pregnancy which leads to increased binding of fat with protein Therefore, availability of protein further decreases for the drugs to get binding. Serum albumin become normal after 5-7 wks after parturition. Website : www.tamsmed.com

26. FASTING Glucose Amino acids Insulin Glucagon Lactogen Website : www.tamsmed.com

27. FED STATE Glucose Amino acids Insulin Website : www.tamsmed.com

28. ELECTROLYTE & MINERAL METABOLISM

29. ELECTROLYTE & MINERAL METABOLISM Na & K retained But serum Na & K slightly (expanded plasma volume) Total serum Ca (decreased albumin) Serum ionized Ca = unchanged Both total & ionized Mg Serum phosphate = unchanged Website : www.tamsmed.com

30. IRON METABOLISM Early pregnancy in serum Fe & ferritin : 1. Minimal iron demands 2. Amenorrhoea Requirement is large after mid-pregnancy Website : www.tamsmed.com

31. HB & HAEMATOCRIT slightly If Hb at term is < 11 mg %, it is because of iron deficiency anemia , and not because of hypervolemia of pregnancy Website : www.tamsmed.com

32. IMMUNOLOGICAL FUNCTIONS Suppression of Th 1 & Tc 1 IL-2, interferon Ύ, TNF-β Upregulation of Th2 cells IL-4,6,13 Website : www.tamsmed.com

33. LEUKOCYTES Chemotaxis & adherence functions are depressed Distribution of cell type is altered:  Granulocyte & CD-8 T-lymphocytes  Monocytes & CD-4 T lymphocytes Website : www.tamsmed.com

34. INFLAMMATORY MARKERS Leukocye alkaline phosphatase CRP ESR Complement C-3 & C-4 Website : www.tamsmed.com

35. COAGULATION & FIBRINOLYSIS All clotting factors except 11, 13 HMW fibrinogen complexes Website : www.tamsmed.com

36. PLATELETS Decreased slightly One study found that in mid-pregnancy thromboxane A2 is increased , which induces platelet aggregation Website : www.tamsmed.com

37. REGULATORY PROTEINS 1. Activated protein C 2. Free protein S 3. Protein Z 4. Antithrombin = unchanged Website : www.tamsmed.com

38. SUMMARY

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41. THE PHYSIOLOGICAL CHANGES DURING PREGNANCY IS LONGER (1DAY TO 10 MONTHS) BU T RETURN IS VERY QUICK (5-7 WKS AFTER PARTURITION)

42. THANKS … Website : www.tamsmed.com