Respiratory Physiology in Pregnancy
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چکیده
Pregnancy is a normal but altered physiologic state that results in significant hormonal,mechanical, and circulatory changes. The increases in progesterone and estrogen associated with pregnancy contribute to vascular and central nervous system effects, changes in the balance of bronchoconstrictor and bronchodilator prostanoids, and increases in peptide hormones that alter connective tissue characteristics. The course of pregnancy is accompanied by structural changes to the ribcage and abdominal compartments as a consequence of the hormonal changes and the enlarged uterus. Cardiac output, pulmonary blood flow, and circulating blood volume are all increased due to increased metabolic demands. This increase in blood volume without an increase in red cell mass results in a decreased hemoglobin concentration. There is a reduction in plasma oncotic pressure due to both increased blood volume and a decrease in albumin concentration. The combination of increased pulmonary blood flow, increased pulmonary capillary blood volume, and decreased oncotic pressure all promote the formation of edema in the periphery and in the lung. Given the dramatic physical and hormonal alterations of pregnancy, perhaps the most remarkable aspect of respiratory physiology is the relatively minor impact that pregnancy has on the function of the lung. To be able to accurately identify and diagnose respiratory abnormalities in pregnant patients, the clinician must first understand normal physiologic changes of pregnancy. Over the years, there have been several excellent reviews of the effects of pregnancy on the respiratory system in health and disease (1–6). This chapter provides an updated overview of respiratory physiology in healthy pregnant women (6).
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Respiratory physiology of pregnancy: Physiology masterclass.
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تاریخ انتشار 2009