By Kevin P. Hanretty MD FRCOG
A transparent, very visible textbook of obstetrics for clinical scholars and midwives, that comes with historical past anatomy and body structure in addition to a transparent account of normal obstetric perform. Focuses exclusively on obstetric perform rather than OB/GYN so the topic might be coated intimately and illustrates each thought with transparent line drawings.
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The amounts produced during pregnancy are much increased. It promotes the retention of sodium and water. Renin. Plasma renin activity is five to ten times that in the non-pregnant state. Likewise angiotensinogen levels are increased although in normal pregnancy women show a reduced sensitivity to the hypertensive effects of angiotensin. 35 FETAL AND MATERNAL PHYSIOLOGY ENDOCRINE CHANGES IN PREGNANCY Human chorionic gonadotrophin (HCG) is produced by the trophoblast and peak levels are reached before 16 weeks of gestation.
17 FETAL AND MATERNAL PHYSIOLOGY FETAL HAEMATOLOGY The fetus is hypoxic relative to the maternal oxygen state yet does not become acidotic. There are three factors accounting for this: fetal haemoglobin concentration is high, around 180 g/1, the cardiac output is greater, and finally, the oxygen affinity of fetal haemoglobin is greater. Fetal haemoglobin is comprised of two a and two y chains. The presence of y chains increases oxygen affinity beyond that of adult haemoglobin so that for a given oxygen tension in the blood a greater percentage oxygen saturation is obtained.
A modest amount is stored in the breast. h Three points may be made in relation to fat metabolism. 1. The total metabolism and demand for energy are increased in pregnancy. 2. Glycogen stores are diminished and therefore energy obtained directly from carbohydrate will be reduced. 3. Although blood fat is greatly increased only a moderate amount is laid down in fat stores. 24 FETAL AND MATERNAL PHYSIOLOGY RESPIRATORY CHANGES Physical changes in the respiratory system begin early in pregnancy and are responsible for the improvements in gaseous exchange.