Hematologic Hypercoagulable state ↑ clotting factors result of venous stasis secondary to uterine pressure on great veins of lower extremity Anemia ↑ plasma volume by 50% RBC mass only ↑ by 30% Result is a dilutional gap of 15-20% Leukocytosis result of granulocyte demargination no absolute increase in WBC number Slight thrombocytopenia (still wnl) Cardiac Cardiac output ↑ by 50% result of ↑ heart rate and ↑ stroke volume recall that CO = HR x SV ↑ flow changes ↑ S2 split with inspiration distended neck veins systolic ejection murmor diastolic murmor is NOT a normal finding during pregnancy S3 gallop BP ↓ in first 24 weeks with gradual return to normal ↓ peripheral vascular resistance due to progesterone mediated smooth muscle relaxation Dramatic shifts in cardiac physiology result in high pregnancy mortality in mothers with cyanotic heart disease can result in Eisenmenger's syndrome Pulmonary Mucosal hyperemia nasal stuffiness increased nasal secretions ↑ /= Respiratory rate driven by progesterone stimulation of respiratory drive centers results in chronic respiratory alkalosis with renal compensation Vital capacity, inspiratory reserve do not change PFTs that ↓ total lung capacity (TLC) result of diaphragm elevation by expanding uterus functional residual capacity (FRC) residual volume (RV) PFTs that ↑ tidal volume minute ventilation leads to respiratory alkalosis ↑ PO2, ↓ CO2 allows fetal PCO2 to remain near 40 mmHg GI ↑ Progesterone leads to ↓ GI motility ↓ lower esophageal tone, leading to GERD ↑ Risk of cholelithiasis ↓ GI tract motility Hemorrhoids due to constipation increased venous pressure uterus compressing inferior vena cava Renal ↑ Progesterone leads to ↓ bladder tone urinary stasis predisposes to UTI / pyelonephritis ↑ GFR ↑ glucose excretion thus urine dipstick positive and NOT useful in managing diabetes NO significant ↑ in protein loss serum creatinine and BUN ↓ Endocrine ↑ Pituitary gland size and vascularity ↑ susceptibility to Sheehan's syndrome ↓ Fasting glucose ↑ Post-prandial glucose fetus produces own insulin at weeks 9-12 ↑ Thyroid binding globulin (TBG) due to ↑ estrogen leading to ↑ total T3 and T4 free T3 and T4 remain same (pregnant women are euthyroid) ↑ Cortisol and cortisol binding protein Skin Normal skin changes during pregnancy mimic liver disease due to ↑ estrogen can see spider angiomas can see palmar erythema Hyperpigmentation due to ↑ melanocyte stimulating hormone affects umbilicus perineum face linea nigra