Physiologic and Anatomic Changes during Pregnancy

2019 ◽  
Author(s):  
Abdulaziz Alfadhel ◽  
Elizabeth Young Han ◽  
Dan Drzymalski
Keyword(s):  
Blood Flow ◽  
Cardiac Output ◽  
Minute Ventilation ◽  
Anesthetic Management ◽  
Management Strategies ◽  
Respiratory Alkalosis ◽  
Uterine Blood Flow ◽  
Gestational Thrombocytopenia ◽  
Ventilatory Mechanics ◽  
In Pregnancy

Pregnancy results in physiologic and anatomic changes that allow the mother to adapt to the greater metabolic requirements of pregnancy. These changes include the enlarging uterus, which results in compression of surrounding structures, and increased hormonal production, which exerts its effects on maternal physiology. Cardiac output increases to maintain higher uterine blood flow, and minute ventilation increases, which results in a chronic respiratory alkalosis. Plasma volume increases, which results in physiologic anemia of pregnancy and may contribute to gestational thrombocytopenia. An understanding of these and other changes that occur in pregnancy is important for the anesthesiologist because they have important implications for management of the parturient undergoing an anesthetic procedure. The goal of this chapter is to highlight some of the most salient features of physiologic changes that occur during pregnancy and to begin to offer some basic anesthetic management strategies. This review contains 6 tables, and 36 references. Key Words: airway changes during labor, cardiovascular changes during pregnancy, gastroesophageal reflux disease, gestational thrombocytopenia, hydronephrosis during pregnancy, left uterine displacement, physiologic anemia, ventilatory mechanics

Physiologic and Anatomic Changes during Pregnancy

2019 ◽  
Author(s):  
Abdulaziz Alfadhel ◽  
Elizabeth Young Han ◽  
Dan Drzymalski
Keyword(s):  
Blood Flow ◽  
Cardiac Output ◽  
Minute Ventilation ◽  
Anesthetic Management ◽  
Management Strategies ◽  
Respiratory Alkalosis ◽  
Uterine Blood Flow ◽  
Gestational Thrombocytopenia ◽  
Ventilatory Mechanics ◽  
In Pregnancy

Pregnancy results in physiologic and anatomic changes that allow the mother to adapt to the greater metabolic requirements of pregnancy. These changes include the enlarging uterus, which results in compression of surrounding structures, and increased hormonal production, which exerts its effects on maternal physiology. Cardiac output increases to maintain higher uterine blood flow, and minute ventilation increases, which results in a chronic respiratory alkalosis. Plasma volume increases, which results in physiologic anemia of pregnancy and may contribute to gestational thrombocytopenia. An understanding of these and other changes that occur in pregnancy is important for the anesthesiologist because they have important implications for management of the parturient undergoing an anesthetic procedure. The goal of this chapter is to highlight some of the most salient features of physiologic changes that occur during pregnancy and to begin to offer some basic anesthetic management strategies. This review contains 6 tables, and 36 references. Key Words: airway changes during labor, cardiovascular changes during pregnancy, gastroesophageal reflux disease, gestational thrombocytopenia, hydronephrosis during pregnancy, left uterine displacement, physiologic anemia, ventilatory mechanics

Physiologic and Anatomic Changes during Pregnancy

2019 ◽  
Author(s):  
Abdulaziz Alfadhel ◽  
Elizabeth Young Han ◽  
Dan Drzymalski
Keyword(s):  
Blood Flow ◽  
Cardiac Output ◽  
Minute Ventilation ◽  
Anesthetic Management ◽  
Management Strategies ◽  
Respiratory Alkalosis ◽  
Uterine Blood Flow ◽  
Gestational Thrombocytopenia ◽  
Ventilatory Mechanics ◽  
In Pregnancy

Pregnancy results in physiologic and anatomic changes that allow the mother to adapt to the greater metabolic requirements of pregnancy. These changes include the enlarging uterus, which results in compression of surrounding structures, and increased hormonal production, which exerts its effects on maternal physiology. Cardiac output increases to maintain higher uterine blood flow, and minute ventilation increases, which results in a chronic respiratory alkalosis. Plasma volume increases, which results in physiologic anemia of pregnancy and may contribute to gestational thrombocytopenia. An understanding of these and other changes that occur in pregnancy is important for the anesthesiologist because they have important implications for management of the parturient undergoing an anesthetic procedure. The goal of this chapter is to highlight some of the most salient features of physiologic changes that occur during pregnancy and to begin to offer some basic anesthetic management strategies. This review contains 6 tables, and 36 references. Key Words: airway changes during labor, cardiovascular changes during pregnancy, gastroesophageal reflux disease, gestational thrombocytopenia, hydronephrosis during pregnancy, left uterine displacement, physiologic anemia, ventilatory mechanics

Chest diseases in pregnancy

2020 ◽  
pp. 2613-2618
Author(s):  
Meredith Pugh ◽  
Tina Hartert
Keyword(s):  
Minute Ventilation ◽  
Air Embolism ◽  
Rare Condition ◽  
Respiratory Alkalosis ◽  
Varicella Zoster Virus Infection ◽  
Venous Air Embolism ◽  
Varicella Zoster ◽  
Pregnant State ◽  
Varicella Pneumonia ◽  
In Pregnancy

Respiratory changes in pregnancy include an increase in tidal volume and minute ventilation, leading to a primary respiratory alkalosis. This chapter examines the various chest conditions arising in pregnancy—these include: amniotic fluid embolism—unique to pregnancy; venous air embolism—a rare condition that can occur in pregnancy; venous and pulmonary thromboembolism—pregnancy is a risk factor; pulmonary oedema—this can be caused by heart disease, as in the non-pregnant state, but it can also be associated with pre-eclampsia or HELPP syndrome and be induced by tocolysis; aspiration; varicella pneumonia—a potentially devastating complication of primary varicella-zoster virus infection; and influenza, which is associated with increased maternal morbidity.

Uterine artery pseudoaneurysm and embolisation during pregnancy

2020 ◽  
Vol 13 (5) ◽  
pp. e234058
Author(s):  
Jared T Roeckner ◽  
Adetola F Louis-Jacques ◽  
Bruce R Zwiebel ◽  
Judette M Louis
Keyword(s):  
Blood Flow ◽  
Uterine Artery ◽  
Thrombin Injection ◽  
Uterine Blood Flow ◽  
Coil Embolisation ◽  
Artery Pseudoaneurysm ◽  
Healthy Young Woman ◽  
Dangerous Condition ◽  
Uterine Artery Pseudoaneurysm ◽  
In Pregnancy

Uterine artery pseudoaneurysm in pregnancy is a dangerous condition as rupture can be catastrophic due to the large volume of uterine blood flow. We present a case of a healthy, young woman with a desired pregnancy at 15 weeks of gestation incidentally discovered to have a pseudoaneurysm of the uterine artery during a routine prenatal ultrasound. She underwent initial thrombin injection followed by endovascular coil embolisation of the left uterine artery and carried the pregnancy to term without further complications.

Tracheal blood flow during spontaneous and mechanical ventilation of dry gases in sheep

1990 ◽  
Vol 69 (3) ◽  
pp. 1117-1122 ◽  
Author(s):  
D. A. White ◽  
G. H. Parsons
Keyword(s):  
Mechanical Ventilation ◽  
Blood Flow ◽  
Cardiac Output ◽  
Left Atrial ◽  
Bronchial Artery ◽  
Minute Ventilation ◽  
Fold Increase ◽  
Artery Blood Flow ◽  
The Common ◽  
Spontaneously Breathing

Tracheal blood flow increases greater than twofold in response to eucapnic hyperventilation of dry gas in anesthetized sheep. To determine whether this occurs at normal minute ventilation, we studied sheep in which tracheal blood flow was measured in response to humid and dry gas ventilation while 1) awake and spontaneously breathing and 2) anesthetized and intubated during isocapnic mechanical ventilation. In additional sheep, three tracheal mucosal temperatures were measured during humid and dry gas mechanical ventilation to measure airway tissue cooling. Tracheal blood flow was determined by use of a left atrial injection of 15-microns-diam radiolabeled microspheres. Previously implanted flow probes on the pulmonary artery and the common bronchial artery allowed continuous recording of cardiac output and bronchial blood flow. Tracheal blood flow in awake spontaneously breathing sheep was 10.8 +/- 5.6 (SD) ml.min-1.100 g wet wt-1 while humid gas was breathed, and it was unchanged with dry gas. In contrast, isocapnic ventilation of intubated animals with dry gas resulted in a 10-fold increase in blood flow to the most proximal two-ring tracheal segment compared with that seen while humid gases were spontaneously ventilated [101 +/- 75 vs. 11 +/- 6 (SD) ml.min-1.100 g-1, P less than 0.05]. Despite a 10-fold increase in proximal tracheal blood flow, there was no response in distal tracheal and bronchial blood flow, as indicated by no change in the common bronchial artery blood flow.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of hyperthermia on uterine blood flow and shunting through uterine arteriovenous anastomoses in the late-pregnant ewe

1999 ◽  
Vol 11 (5) ◽  
pp. 201 ◽  
Author(s):  
Suzanne L. Miller ◽  
Graham Jenkin ◽  
David W. Walker
Keyword(s):  
Blood Flow ◽  
Experimental Period ◽  
Respiratory Alkalosis ◽  
Uterine Horn ◽  
Arteriovenous Anastomoses ◽  
Uterine Blood Flow ◽  
Ambient Conditions ◽  
Total Blood ◽  
Uterine Arteries ◽  
Pregnant Sheep

The effect of maternal hyperthermia on uterine blood flow (UBF) through the two main uterine arteries and on the proportion of UBF shunted through uterine arteriovenous anastomoses (AVAs) was investigated. Eight late-pregnant ewes were exposed to normothermic (22–23˚C) or hyperthermic (approx-imately 39˚C) ambient conditions for 8 h. UBF was measured in the left and right uterine arteries using flow probes and microspheres were injected into the uterine artery before, during and after the experimental period. The distribution of microspheres between the uterus and lungs was determined to calculate changes in capillary and AVA blood flows. Hyperthermia produced a significant (P<0.05) increase in maternal core temperature (+1.5˚C), increase in maternal blood pH (+0.21; P<0.05) and decrease in maternal pCO 2 (–16.2 mmHg; P<0.05). Blood flow to the uterine horn ipsilateral to the corpus luteum (CL) remained unchanged during hyperthermia, whereas total UBF and blood flow to the contralateral uterine horn were significantly decreased (P<0.05), by 23.1% and 20.8%, respectively, of pre-heat control values. The proportion of UBF shunted through uterine AVAs during hyperthermia was not significantly different from values observed in normothermic ewes (21.9 0.7%). Mild to moderate hyperthermia in late-pregnant sheep induces respiratory alkalosis and decreases total blood flow to the uterus, brought about by a decrease in blood flow to the uterine horn contralateral, but not ipsilateral to the CL. Heat treatment does not alter the proportion of UBF traversing uterine AVAs.

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