임신 중 해부학적 및 생리학적 변화

 

체중 10-12 kg 증가,

비만 과체중과 관계 없이 LGA 거대아 출산 가능

 

복부, 유방, 둔부 엉덩이

 

칼슘 감소

relaxin, smphysis pubis / sacroiliac joint 이완

 

손과 손가락이 커지는, acromegaloid changes 말단 비대 

 

유추전만증 lordosis 

kyphosis 로 균형 

 

색소 침착 linea nigra, chloasma, mask of pregnancy

spider nevi, palmar erythema, 에스트로겐

 

striae gravidarum, 릴락신 에스트로겐 코르티솔

복직근 이개 diastasis recti

 

감각 예민, montgomery's tubercules 발달

clostrum 출산 전 프로게스테론과 에스트로겐으로 억제

 

 

 

생리학적 변화

 

심박출량 30-50% stroke volume 증가

HR 증가

BP 정상 또는 감소 1기에는 약간 감소, 후기에는 정상

혈장량 40-50% 증가, dilutionla anemia

 

호흡기계 변화

 

 

blood 

interstitial fluid volume 

bone marrow hyperplastic, leukocytosis normal 

se.protein concentration lower 5.5-6.0

colloid osmotic pressure decreased

albumin/globulin ration reduced. 

 

se. lipids up 46$

fibrinogen up 

urea and creatinine down, 

AFP peak 13 주

screening at 16 주 for NTD

 

 

 

Heart rotate anteriorly / upwrad

enlarged on X-ray

soft systolyic murmur,

pulse rate up, 

extrasystoles common

 

BP arterial BP does not increased. 

venous pressure normal 

 

vena cava syndrome in late pregnancy. 

 

capillary permeability remains unchanged. 

 

hyperventilation,

vital capacity unchanged

 

pain in the legs during night, 

CO2, maternal / fetal circulation down. 

 

ureter / renal pelvis dilatation

hydronephrosis -> pronounced on right, 

 

RPF increase, GF increase FF up 

 

 

Hormone up 

ACTH, ADH, aldosterone, cortisone, GH, TH 

 

amino aicd in urine : histidine, 

urea / uric acid / creatinine lowered

iodied clearance increased / plasma inorganic iodine leve reduced

 

bladder pulled up as uterus enlarged. 

at the vesicle neck and hyperemia of the trigone - frequence of urination

vascularity increase

varicosity and hemorrhage

 

bladder tone decrease

overdistention of bladder

 

RAAS

renin increased, angiotensinogen, relative resistance to angiotnesin (in preeclampsia it is lost)

aldosterone for salt and water retention

 

 

alkaline pH hyperptyalism, 

Gums bleed easily

gastric activity reduced. 

gastric motility reduced

 

progesterone - atony

muscle cell 

 

constipation - special diet recommend

 

hiatal hernia : pushed and hormonal 

 

cecum and appendix upward. 

 

gallbladder 

emptying time increased, 

cholinesterase, reduced. 

biliary calculi, relative biliary stasis 

calculous disease 

 

 

no morphological changes in liver, 

 

thyroid gland 

enlarged : diffuse hyperplasia, follicle formation, vascularity 

 

BMR increased, increase oxygen demand

 

estrogen increase response of pituitary thyroid-stimulating hormone (TSH) to TRH 

increase in TBG level

 

radioactive iodine,