NPhysiological changes in pregnancy

S These can be described as follows:

e * Circulatory system: a gradual and progressive increase in cardiac output, with an y increase of 40% by the third trimester. An increase in blood volume by about

ยง' one-third is related to a disproportionate increase in plasma volume as com-

y pared with red cell volume, resulting in the physiological anaemia of pregnancy.

A reduction in systemic and pulmonary vascular resistances counterbalances the increased volume load. Systolic arterial blood pressure is unaltered, while diastolic blood pressure falls in the first two trimesters, returning to non-pregnant levels in the third trimester. The cardiovascular stress of pregnancy is maximal at labour, during delivery, and in the immediate post-partum period.

* Respiratory system: an increase in respiratory rate, associated with reduction in paCO2 and in buffering capacity, leads to increased minute ventilation. There is also a reduction in functional residual capacity. Splinting of the diaphragm reduces lung volumes.

* A hypercoagulable state in the blood is the result of increased plasma concentrations of clotting factors, fibrinogen and fibrin degradation products.

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