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vorige hoofdstuk Routine antenatal care, antenatal testing and f...

volgende hoofdstuk Early pregnancy disorders

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2019 | OriginalPaper | Hoofdstuk

17. Maternal adaptations

eerste hoofdstuk lezen

Auteur: Sicco A. Scherjon

Uitgeverij: Bohn Stafleu van Loghum

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Gepubliceerd in: Textbook of Obstetrics and Gynaecology

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Summary

The functional and subjective changes in the mother around her pregnancy are profound and may resemble signs and symptoms of diseases. Equally impressive is the quick return to a pre-pregnancy situation after delivery. These adaptations affect nearly every organ system and are essential for normal maternal pregnancy and normal foetal development. Changes in eating habits are one of the first physiological symptoms of pregnancy. During pregnancy, the maternal body weight increases by on average 12 kg. The importance of the placenta is well recognized. Pregnancy is characterized by a hyperdynamic cardiovascular state. Peripheral insulin resistance becomes more prominent during pregnancy making pregnancy a state of hyperinsulinism with increased glucose levels. Respiration is more efficient during pregnancy, although most pregnant women have a subjective feeling of mild dyspnoea. From early pregnancy onwards there is a substantial increase in renal plasma flow. Nowadays the importance of the human microbiome for normal development of pregnancy is well realized.

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Basal metabolic rate

Amount of energy spent while at rest

Bicornuate uterus

Uterus composed of two ‘horns’, separated by a septum

BMI

Body mass index; kg/m²

Candidiasis

Fungal infection due to any type of Candida (a type of yeast)

Cholecalciferol

Vitamin D₃, made by the skin following UVB light exposure and present in some foods, converted into calciferol (25-hydroxyvitamin D)

Cholestasis

Insufficient flow of bile from the liver to the duodenum due to obstruction or metabolic disturbances of bile formation

Colloid oncotic (or osmotic) pressure

Physiochemical phenomenon caused by differences in protein concentrations (notably albumin) in fluid compartments separated by a semipermeable membrane

Corpus luteum

‘Yellow body’; temporary endocrine structure in the ovaries remaining after ovulation, producing progesterone (and oestradiol and inhibin A)

Decidua

Uterine lining during pregnancy, already formed before pregnancy, under the influence of progesterone

Diabetes insipidus

Condition characterized by increased thirst and large amounts –up to 20 l/day- of diluted urine, probably caused by increased placental production of vasopressinase

Dyspnoea

Shortness of breath

Erythropoietin (EPO, haematopoietin)

Glycoprotein produced by the kidney after cellular hypoxia, stimulating red cell production in the bone marrow

Euthyroid

Normal thyroid function, with normal plasma levels of TSH and T4

Fibrinolysis

Process preventing blood clots from developing by degradation by plasmin of the fibrin mesh

Fundus

Top portion of the uterus, opposite of the cervix

Gingivae

(Gums); mucosal tissue inside the mouth

Haemochorial

Placentation –as in the human- whereby the chorion is in direct contact with maternal blood

Haemodilution

Increased plasma volume leading to a low haematocrit (low concentration of red blood cells) and hyponatraemia

Hyperdynamic circulation

Circulation characterized by high flow and low resistance to flow (relaxation of vessel walls)

Hyperfiltration (glomeruli)

Physiological state during pregnancy were the glomeruli in the kidney produce increased amounts of pro-urine

Hyperinsulinaemia

Excess levels of circulating insulin relative to the level of glucose

Hyperlipidaemia

Elevated levels of any/all lipids or lipoproteins in the blood

Hypothalamus

Brain portion, part of the limbic system, located below the thalamus, linking the nervous system to the endocrine system (regulating metabolic processes) via the pituitary glands

Lactotrophic cells

Cells located in the anterior pituitary producing prolactin, stimulated by thyrotropin-releasing hormone and also regulated by oxytocin

Lung volumes

Volumes of air in the different phases of the respiratory cycle; such as total lung capacity (TLC: 6 litres) and tidal volume (TV: volume of air inhaled in a single breath)

Macrosomic

Indicative of a high prenatal growth rate. Several –sometimes confusing- definitions are used such as large for gestational age (LGA: > P90 or > P97) or a weight > 4 kg or > 4.5 kg

Microbiome

Ecological community of commensal, symbiotic and pathogenic microorganisms, including bacteria, archaea, fungi and viruses, crucial for immunological, hormonal and metabolic homeostasis

Molar pregnancy (hydatidiform mole)

Gestational trophoblastic disease caused by a non-viable fertilized egg not containing the original maternal nucleus (DNA only originates from the sperm cells), resulting in trophoblast overgrowth

Nausea

A non-specific sense of discomfort in the upper stomach with an involuntary urge to vomit

(Maximal) oxygen uptake (VO2)

Maximum rate of oxygen consumption measured during incremental exercise, reflecting cardias fitness

Parasympathetic (nervous) system (PSNS)

Part of the autonomic nervous system, complementary to the sympathetic nervous system (‘fight or flight’), responsible for stimulation of a rest state (‘rest and digest’ and ‘feed and breed’) related to salivation, lacrimation, urination, digestion, defaecation and for sexual arousal

Procoagulants

Inactive coagulation protein (such as prothrombin, factor Xa), activated during the clotting process, producing serine protease or a co-factor resulting in the formation of a fibrin clot

Ptyalism

Increased production of saliva

Pyrosis

Burning sensation in the chest (oesophagus) due to gastric reflux

Shear stress

A force generated by blood on endothelial cells, deforming these cells in the direction of the flow, eliciting cytoskeletal remodelling and the release of e.g. NO (and eNOS), prostacyclin and ICAM-1

Semi-allograft

Foetal-placental unit: a ‘transplant’ where half of the genes come from another individual

Somatotropic cells

Cells constituting 20 % of the anterior pituitary cells, releasing growth hormone (GH) in response to GNRH and inhibited by GH inhibiting hormone (somatostatin) coming from the hypothalamus

Syncytiotrophoblast

Epithelial outer layer (syncytium: fused cytotrophoblast cells) of the trophoblast covering of (embryonic) villi

Trophoblast

Outer layer of the blastocyst (originally to trophectoderm), forming two layers around the core of the placental villi: an inner core of cytotrophoblast (mononuclear) and an outer core of syncytiotrophoblast (multinucleated)

Ureterocalyceal dilatation

Increase in ureter and kidney calyces diameter most prominent on the right side

Uterus myomatosus (uterine fibroids)

Uterine leiomyomas or fibroids are benign smooth muscle tumours of the uterus

(Arginine) vasopressin (AVP or ADH)

Antidiuretic hormone (ADH), in structure resembling oxytocin, produced by the hypothalamus, released in the bloodstream via the posterior pituitary, stimulating water reabsorption and constricting arterioles (increasing blood pressure)

Chu DM, Ma J, Prince AL, Antony KM, Seferovic MD, Aagaard KM. Maturation of the infant microbiome community structure and function across multiple body sites and in relation to mode of delivery. Nat Med. 2017;23:314–26. CrossRef

Lipinski P, Stys A, Starzynski RR. Molecular insights into the regulation of iron metabolism during the prenatal and early postnatal periods. Cell Mol Life Sci. 2013;70:23. CrossRef

LoMauro A, Alverti A. Respiratory physiology of pregnancy. Breathe 2015;11:297–301. CrossRef

Lowensohn RI, Stadler DD, Naze C. Current concepts of maternal nutrition. Obstet Gynecol Survey 2016;71:413–26. CrossRef

Muktabhant B, Lawrie TA, Lumbiganon P, Laopaiboon M. Diet or exercise, or both for preventing excessive weight gain in pregnancy. Cochrane Database Syst Rev. 2015, Issue 6. Art. No. CD007145.

Poston L, Caleyachetty R, Cnattingius S, Corvalan C, Uauy R, Herring S, Gillman MW. Preconceptional and maternal obesity: epidemiology and health consequences. Lancet Diabetes Endocrinol. 2016;4:1025–36. CrossRef

Uchikova EH, Ledjev II. Changes in haemostasis during normal pregnancy. Eur J Obstet Gynecol Reprod Biol. 2005;119:185–8. CrossRef

Vinayagam D, Thilaganathan B, Stirrup O, Mantovani E, Khalil A. Maternal Hemodynamics in Normal Pregnancies: Reference ranges and the Role of Maternal Characteristics.Ultrasound Obstet Gynecol. 2017 Apr 24. https://doi.org/10.1002/uog.17504. CrossRef

Wagner CL, Hollis BW, Kotsa K, Fakhoury H, Karras SN. Vitamin D administration during pregnancy as prevention for pregnancy, neonatal and postnatal complications. Rev Endocr Metab Disord. 2017;18:307–22. https://doi.org/10.1007/s11154-017-9414-3. CrossRefPubMed

10.

Yalamanchi S, Cooper DS. Thyroid disorders in pregnancy. Curr Opin Obstet Gynecol. 2015;27:406–15. CrossRef

Titel

Maternal adaptations

Boek

Textbook of Obstetrics and Gynaecology

Print ISBN: 978-90-368-2130-8

Elektronisch ISBN: 978-90-368-2131-5

https://doi.org/10.1007/978-90-368-2131-5

DOI

https://doi.org/10.1007/978-90-368-2131-5_17

Auteur:

Sicco A. Scherjon

Uitgeverij

Bohn Stafleu van Loghum

Volgnummer

Hoofdstuknummer

Extra’s

Textbook of Obstetrics and Gynaecology H17 Maternal adaptations

Bohn Stafleu van Loghum

Deel dit onderdeel of sectie (kopieer de link)

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Summary

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Met onderstaand(e) abonnement(en) heeft u direct toegang:

BSL Academy Geneeskunde Radboud 2018-2019

BSL - Textbook of Obstetrics and Gynaecology

BSL Academy Geneeskunde UMC Utrecht 2019-2020

BSL Academy Geneeskunde Radboud Universiteit 2019-2020

BSL Academy Geneeskunde UMC Groningen 2019-2022

Extra’s