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Anatomo-physiological Changes During Labor and After Delivery

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Epidural Labor Analgesia
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Abstract

The major anatomo-physiological changes of the maternal cardiovascular system happen throughout gestation and include an increase of blood volume, cardiac output, maternal heart rate, decrease of arterial blood pressure, and systemic vascular resistance. These changes are almost fully reversed in the weeks and months after delivery. During labor and delivery, there is further adaptation of cardiac output which progressively rises in both stroke volume and heart rate, peaking with contractions.

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References

  1. Ouzounian JG, Elkayam U (2012) Physiologic changes during normal pregnancy and delivery. Cardiol Clin 30:317–329

    Article  PubMed  Google Scholar 

  2. Robson SC, Hunter S, Boys RJ et al (1987) Cardiac output during labour. Br Med J (Clin Res Ed) 295:1169–1172

    Article  CAS  Google Scholar 

  3. Lees MM, Scott DB, Slawson KB et al (1968) Haemodynamic changes during caesarean section. J Obstet Gynaecol Br Commonw 75:546–551

    Article  CAS  PubMed  Google Scholar 

  4. Hendricks CH (1955) The hemodynamic of a uterine contraction. Am J Obstet Gynecol 76:969

    Google Scholar 

  5. Duvekot JJ, Peeters LL (1994) Maternal cardiovascular hemodynamic adaptation to pregnancy. Obstet Gynecol Surv 49(Suppl 12):S1

    Article  CAS  PubMed  Google Scholar 

  6. Ueland K, Hansen JM (1969) Maternal cardiovascular dynamics. Part 3. Labor and delivery under local and caudal analgesia. Am J Obstet Gynecol 103:8–18

    CAS  PubMed  Google Scholar 

  7. Segal S, Csavoy AN, Datta S (1998) The tocolytic effect of catecholamines in the gravid uterus. Anesth Analg 87:864–869

    CAS  PubMed  Google Scholar 

  8. Neumark J, Hammerle AF, Biegelmayer C (1985) Effects of epidural analgesia on plasma catecholamines and cortisol in parturition. Acta Anaesthesiol Scand 29:555–559

    Article  CAS  PubMed  Google Scholar 

  9. Albright GA, Jouppila R, Hollmen AI et al (1981) Epinephrine does not alter human intervilluos blood flow during epidural anesthesia. Anesthesiology 54:131–135

    Article  CAS  PubMed  Google Scholar 

  10. Camann WR, Ostheimer GW (1990) Physiological adaptations during pregnancy. Int Anesthesiol Clin 28:2–10

    Article  CAS  PubMed  Google Scholar 

  11. Capeless EIL, Clapp JR (1991) When do cardiovascular parameters return to their preconception values? Am J Obstet Gynecol 161:883–886

    Article  Google Scholar 

  12. Robson SC, Hunter S, Moore M et al (1987) Haemodynamic changes during the puerperium: a Doppler and M-mode echocardiographic study. Br J Obstet Gynecol 94:1028–1039

    Article  CAS  Google Scholar 

  13. Robson SC, Boys RJ, Hunter S et al (1989) Maternal hemodynamics after normal delivery and delivery complicated by postpartum hemorrhage. Obstet Gynecol 74:234–239

    CAS  PubMed  Google Scholar 

  14. Robson SC, Hunter S, Dunlop W (1987) Left atrial dimensions during early puerperium. Lancet 2:111–112

    Article  CAS  PubMed  Google Scholar 

  15. Williams KP, Wilson S (1999) Evaluation of cerebral perfusion pressure changes in laboring women: effects of epidural anesthesia. Ultrasound Obstet Gynecol 14:393–396

    Article  CAS  PubMed  Google Scholar 

  16. Juppila R, Hollmen A (1976) The effect of segmental epidural analgesia on maternal and foetal acid-base balance, lactate, serum potassium and creatine phosphokinase during labor. Acta Anesthesiol Scand 20:259–268

    Article  Google Scholar 

  17. Reed PN, Colquhoun AD, Hanning CD (1989) Maternal oxygenation during normal labour. Br J Anaesth 62:316

    Article  CAS  PubMed  Google Scholar 

  18. Müller G, Huber JC, Salzer H et al (1984) Maternal hyperventilation as a possible cause of fetal tachycardia sub partu. A clinical and experimental study. Gynecol Obstet Invest 17:270–275

    Article  PubMed  Google Scholar 

  19. Tomimatsu T, Kakigano A, Mimura K et al (2013) Maternal carbon dioxide level during labor and its possible effect on fetal cerebral oxygenation: mini review. J Obstet Gynecol Res 39:1–6

    Article  Google Scholar 

  20. Tomimatsu T, Kakigano A, Mimura K et al (2012) Maternal hyperventilation during labor revisited: its effect on fetal oxygenation. Reprod Sci 19:1169–1174

    Article  PubMed  Google Scholar 

  21. Palahniuk RJ, Shnider SM, Eger EI II (1974) Pregnancy decreases the requirement for inhaled anesthetic agent. Anesthesiology 41:82

    Article  CAS  PubMed  Google Scholar 

  22. Datta S, Hurley RJ, Naulty JS et al (1986) Plasma and cerebrospinal fluid progesterone concentrations in pregnant and non-pregnant women. Anesth Analg 65:950

    Article  CAS  PubMed  Google Scholar 

  23. Butterworth JF IV, Walker FO, Lysak SZ (1990) Pregnancy increases median nerve susceptibility to lidocaine. Anesthesiology 72:962

    Article  PubMed  Google Scholar 

  24. Gin T, Chan MT (1994) Decreased minimum alveolar concentration of isoflurane in pregnant humans. Anesthesiology 81:829

    Article  CAS  PubMed  Google Scholar 

  25. Chan MT, Gin T (1995) Postpartum changes in the minimum alveolar concentration of isoflurane. Anesthesiology 82:1360

    Article  CAS  PubMed  Google Scholar 

  26. Wadhwa PD, Porto M, Garite TJ et al (1998) Maternal corticotropin-releasing hormone levels in the early third trimester predict length of gestation in human pregnancy. Am J Obstet Gynecol 179:1079–1085

    Article  CAS  PubMed  Google Scholar 

  27. Reis FM, Fadalti M, Florio P et al (1999) Putative role of placental corticotropin-releasing factor in the mechanisms of human parturition. J Soc Gynecol Investig 6:109–119

    Article  CAS  PubMed  Google Scholar 

  28. Florio P, Cobellis L, Woodman J et al (2002) Levels of maternal plasma corticotropin-releasing factor and urocortin during labor. J Soc Gynecol Investig 9:233–237

    Article  CAS  PubMed  Google Scholar 

  29. Torricelli M, Ignacchiti E, Giovannelli A et al (2006) Maternal plasma corticotrophin-releasing factor and urocortin levels in post-term pregnancies. Eur J Endocrinol 154:281–285

    Article  CAS  PubMed  Google Scholar 

  30. Juppila R, Hollmen A, Juppila P et al (1976) The effect of segmental epidural analgesia on maternal ACTH, cortisol and TSH during labour. Ann Clin Res 8:378–384

    Google Scholar 

  31. Westgren M, Lindahl SG, Norden NE (1986) Maternal and fetal endocrine stress response at vaginal delivery with and without an epidural block. J Perinat Med 14:235–241

    Article  CAS  PubMed  Google Scholar 

  32. Juppila R (1976) The effect of segmental epidural analgesia on maternal growth hormone, insulin, glucose and free fatty acids. Ann Chir Gynaecol 65:398–404

    Google Scholar 

  33. Juppila R, Juppila P, Moilanen K et al (1980) The effect of segmental epidural analgesia on maternal prolactin during labour. Br J Obstet Gynaecol 87:234–238

    Article  Google Scholar 

  34. Vasicka A, Kumaresan P, Han GS et al (1978) Plasma oxytocin in initiation of labor. Am J Obstet Gynecol 130:263–273

    CAS  PubMed  Google Scholar 

  35. Goodlin RC, Chapin JW (1982) Determinants of maternal temperature during labor. Am J Obstet Gynecol 143:97–103

    CAS  PubMed  Google Scholar 

  36. Benerjee S, Cashman P, Yentis SM et al (2004) Maternal temperature monitoring during labor: concordance and variability among monitoring sites. Obstet Gynecol 103:287–293

    Article  Google Scholar 

  37. Gerbasi FR, Bottoms S, Farag A et al (1990) Changes in hemostasis activity during delivery and the immediate postpartum period. Am J Obstet Gynecol 162:1158–1163

    Article  CAS  PubMed  Google Scholar 

  38. Hellgren M, Blomback M (1981) Studies on blood coagulation and fibrinolysis in pregnancy, during delivery and in the puerperium. I. Normal condition. Gynecol Obstet Invest 12:141–154

    Article  CAS  PubMed  Google Scholar 

  39. SharmaSK PJ, Wiley J (1997) Thromboelastographic changes in healthy parturients and postpartum women. Anesth Analg 85:94

    Google Scholar 

  40. Dahlman T, Hellgren M, Blomback M (1985) Changes in blood coagulation and fibrinolysis in the normal puerperium. Gynecol Obstet Invest 20:37–44

    Article  CAS  PubMed  Google Scholar 

  41. Holdsworthh JD (1979) Relationship between stomach contents and analgesia in labor. Br J Anaesth 50:1145–1148

    Article  Google Scholar 

  42. Bataille A, Rousset J, Marret E et al (2014) Ultrasonographic evaluation of gastric content during labor under epidural analgesia: prospective comfort study. Br J Anaesth 112:703–707

    Article  CAS  PubMed  Google Scholar 

  43. Pritchard JA (1961) Plasma cholinesterase activity in normal pregnancy and eclamptogenic toxemia. Am J Obstet Gynecol 82:132

    Google Scholar 

  44. Shnider Sol M (1965) Serum cholinesterase activity during pregnancy, labor and puerperium. Anesthesiology 26:335–339

    Article  Google Scholar 

  45. Navratil E (1939) Effect of birth on serum cholinesterase. Arch Gynak 168:178

    Article  CAS  Google Scholar 

  46. Picolli R, Longo G (1947) Serum cholinesterase in obstetrics; values during parturition and puerperium. Boll Soc Ital Biol Sper 23:486

    Google Scholar 

  47. Stefanelli S, Petronio G (1948) Relationships between serum cholinesterase activity and blood acetylcholine in labor and childbed. The influence of some substances (histamine, pituitrin, folliculin) on cholinesterase activity. Boll Soc Ital Biol Sper 24:644

    CAS  Google Scholar 

  48. Hodges RJH, Bennet JR, Turnstall ME et al (1959) Effects of oxytocin on the response to suxamethonium. Br Med J 1:413

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  49. Cohen SE (1982) Who is the pregnant patient different? Semin Anesth 1:3

    Google Scholar 

  50. Pilkington S, Carli F, Dakin MJ (1995) Increase of Mallampati score during pregnancy. Br J Anaesth 74:638–642

    Article  CAS  PubMed  Google Scholar 

  51. Farcon EL, Kim MH, Marx GF (1995) Changing Mallampati score during labor. Can J Anaesth 74:638–642

    Google Scholar 

  52. Heller PJ, Scheider EP, Marx GF (1983) Pharyngolaryngeal edema as a presenting symptom in preeclampsia. Obstet Gynecol 62:523–524

    CAS  PubMed  Google Scholar 

  53. Juppila R, Juppila P, Hollmen A (1980) Laringeal o edema as an obstetrics anaesthesia complication. Acta Anaesthesiol Scand 24:97–98

    Article  Google Scholar 

  54. Ekmann DM, Glassemberg R, Gavriely N (1996) Acoustic reflectometry and endotracheal intubation. Anesth Analg 83:1084–1089

    Google Scholar 

  55. D’Urso AD, Rubinstein I, Lawson VG et al (1988) Comparison of glottidis areas measured by acoustic reflections versus computerized tomography. J Appl Physiol 64:367–370

    Google Scholar 

  56. Ochroch EA, Eckmann DM (2002) Clinical application of acoustic reflectometry in predicting difficult airway. Anesth Analg 95:645–649

    PubMed  Google Scholar 

  57. Rocke DA, Murray WB, Rput CC et al (1992) Relative risk analysis of factors associated with difficult intubation in obstetric anesthesia. Anesthesiology 77:67–73

    Article  CAS  PubMed  Google Scholar 

  58. Hood D, Dewan D (1993) Anesthesia and obstetric outcome in morbidity obese parturients. Anesthesiology 79:1210–1218

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Raffaella Parpaglioni .

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Parpaglioni, R. (2015). Anatomo-physiological Changes During Labor and After Delivery. In: Capogna, G. (eds) Epidural Labor Analgesia. Springer, Cham. https://doi.org/10.1007/978-3-319-13890-9_2

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  • DOI: https://doi.org/10.1007/978-3-319-13890-9_2

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