Physiologic Adaptation During Pregnancy

  • G. W. Ostheimer
Part of the Developments in Critical Care Medicine and Anesthesiology book series (DCCA, volume 30)


Pregnancy involves major physiologic and anatomic adaptation by all of the maternal organ systems. The anesthesiologist caring for the pregnant patient must understand these physiologic changes in order to provide safe analgesia and anesthesia to the mother and enable safe delivery of the fetus.


Cesarean Delivery Lower Esophageal Sphincter Regional Anesthesia Laryngeal Mask Airway Functional Residual Capacity 
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  1. 1.
    Pernoll ML, Metcalf J, Schlensler TL: Oxygen consumption at rest and during exercise in pregnancy. Respir Physiol 22:285, 1975CrossRefGoogle Scholar
  2. 2.
    Mashini IS, Albazzaz SJ, Fadel HE: Serial noninvasive evaluation of cardiovascular hemodynamics during pregnancy. Am J Obstet Gynecol 156:208, 1987Google Scholar
  3. 3.
    Ueland K: Maternal cardiovascular hemodynamics. VII: Intrapartum blood volume changes. Am J Obstet Gynecol 126:671, 1976PubMedGoogle Scholar
  4. 4.
    Shrier RW, Durr JA: Pregnancy: An overfill or underfill state. Am J Kidney Dis 9:284, 1987Google Scholar
  5. 5.
    Schrier RW: Pathogenesis of sodium and water retention in high-output and low-output cardiac failure, nephrotic syndrome, cirrhosis, and pregnancy. N Eng J Med 319:1127, 1988CrossRefGoogle Scholar
  6. 6.
    Eckstein KL, Marx GF: Aortocaval compression: Incidence and prevention. Anesthesiology 40:381, 1965Google Scholar
  7. 7.
    Enein M, Zina AA, Kassem M et al: Echocardiography of the pericardium in pregnancy. Obstet Gynecol 69:851, 1987PubMedGoogle Scholar
  8. 8.
    Paller MS: Decreased pressor responsiveness in pregnancy: Studies in experimental animals. Am J Kidney Dis 9:308, 1987PubMedGoogle Scholar
  9. 9.
    De Simone CA, Leighton BL, Norris MC et al: The chronotropic effect of isoproterenol is reduced in term pregnant women. Anesthesiology 69:626, 1988CrossRefGoogle Scholar
  10. 10.
    Messih MNA: Epidural space pressures during pregnancy. Anaesthesia 36:775, 1981PubMedCrossRefGoogle Scholar
  11. 11.
    Kirz DS, Dorchester W, Freeman RK: Advanced maternal age; the mature gravida. Am J Obstet Gynecol 152:7, 1985PubMedGoogle Scholar
  12. 12.
    Bletka M, Hlavat JV, Trakova M: Volume of whole blood and absolute amount of serum proteins in the early stages of late toxemia of pregnancy. Am J Obstet Gynecol 106:10, 1970Google Scholar
  13. 13.
    Knuttgen HG, Emerson K: Physiologic response to pregnancy at rest and during exercise. J Appl Physiol 36:549, 1975Google Scholar
  14. 14.
    Gilroy RJ, Mangura BT, Lavietes MH: Rib cage and abdominal volume displacements during breathing in pregnancy. Am Rev Respir Dis 137:668, 1988PubMedGoogle Scholar
  15. 15.
    Prowse CM, Gaenster EA: Respiratory and acid-base changes during pregnancy. Anesthesiology 26:381, 1965PubMedCrossRefGoogle Scholar
  16. 16.
    Tyler JM: The effects of progesterone on the respiration of patients with emphysema and hypercapnea. J Clin Invest 39:34, 1960PubMedCrossRefGoogle Scholar
  17. 17.
    Shankar KB, Moseley H, Vemula V et al: Physiological dead space during general anesthesia for caesarean section. Can J Anaesth 34:373, 1987PubMedCrossRefGoogle Scholar
  18. 18.
    Leontie EA: Respiratory disease in pregnancy. Med Clin North Am 62:111, 1974Google Scholar
  19. 19.
    Bevan DR, Holdcroft A, Loh L et al: Closing volume and pregnancy. Br Med J [Clin Res] 1:13, 1974CrossRefGoogle Scholar
  20. 20.
    Russell GN, Smith CL, Snowdon SL et al: Preoxygenation and the parturient patient. Anaesthesia 42:346, 1987PubMedCrossRefGoogle Scholar
  21. 21.
    Archer GW, Marx GF: Arterial oxygen tension during apnea in parturient women. Br I Anaesth 46:358, 1974CrossRefGoogle Scholar
  22. 22.
    Bhavanishankaat K, Moseley H, Kumar Y et al: Arterial to end-tidal carbon dioxide tension difference during anaesthesia for tubal ligation. Anaesthesia 42:482, 1987CrossRefGoogle Scholar
  23. 23.
    Lind LJ, Smith AM, McIver DK et al: Lower esophageal sphincter pressures in pregnancy. Can Med Assoc J 98:571, 1968PubMedGoogle Scholar
  24. 24.
    Attia RR, Ebeid AM, Fisher JE et al: Maternal, fetal and placental gastrin concentrations. Anaesthesia 37:18, 1982Google Scholar
  25. 25.
    O’Sullivan GM, Sutton AJ, Thompson SA et al: Noninvasive measurement of gastric emptying in obstetric patients. Anesth Analg 66:505, 1987PubMedCrossRefGoogle Scholar
  26. 26.
    O’Brien WF, Saba HI, Knuppel RA et al: Alterations in platelet concentration and aggregation in normal pregnancy and preeclampsia. Am J Obstet Gynecol 155:486, 1986Google Scholar
  27. 27.
    Burrows RF, Kelton JG: Incidentally detected thrombocytopenia in healthy mothers and their infants. N Engl J Med 319:142, 1988PubMedCrossRefGoogle Scholar
  28. 28.
    Davison JM: Overview of kidney function in pregnant women. Am J Kidney Dis 9:248, 1987PubMedGoogle Scholar
  29. 29.
    Bellina JH, Dougherty CM, Mickal A: Ureteral dilation in pregnancy. Am J Obstet Gynecol 108:356, 1970PubMedGoogle Scholar
  30. 30.
    Datta S, Kitzmiller JL, Naulty JS et al: Acid-base status of diabetic mothers and their infants following spinal anesthesia for cesarean section. Anesth Analg 61:662, 1982PubMedCrossRefGoogle Scholar
  31. 31.
    Stewart DE: Psychiatric symptoms following attempted natural childbirth. Can Med Assoc J 127:713, 1982PubMedGoogle Scholar
  32. 32.
    Lee RV, D’Alauro F, White LM et al: Southeast Asian folklore about pregnancy and parturition. Obstet Gynecol 71:643, 1922Google Scholar
  33. 33.
    Senden IP, Wetering VD, Eskes TK et al: Labor pain: A comparison of parturients in a Dutch and American teaching hospital. Obstet Gynecol 71:541, 1988PubMedGoogle Scholar
  34. 34.
    Colman AD: Psychological state during first pregnancy. Am J Orthospychiatry 39:788, 1969CrossRefGoogle Scholar
  35. 35.
    Palahniuk RJ, Shnider SM, Eger EI: Pregnancy decreases the requirement for inhaled anesthetic agents. Anesthesiology 41:82, 1974PubMedCrossRefGoogle Scholar
  36. 36.
    Goland RS, Wordlaw SL, Stark RI et al: Human plasma endorphin during pregnancy, labor and delivery. J Clin Endocrinol Metab 52:74, 1981PubMedCrossRefGoogle Scholar
  37. 37.
    Lyrenas S, Nyberg F, Lindberg BO et al: Cereborspinal fluid activity of dynorphin-converting enzyme at term pregnancy. Obstet Gynecol 72:54, 1988PubMedGoogle Scholar
  38. 38.
    Datta S, Hurley RJ, Naulty IS et al: Plasma and cerebrospinal fluid progesterone concentrations in pregnant and nonpregnant women. Anesth Analg 69:950, 1986Google Scholar
  39. 39.
    Datta S, Lambert DH, Gregus J et al: Differential sensitivities of mammalian nerve fibers during pregnancy. Anesth Analg 62:1070, 1983PubMedCrossRefGoogle Scholar
  40. 40.
    Flanagan HL, Datta S, Lambert DH et al: Effect of pregnancy on bupivacaine-induced conduction blockade in the isolated rabbit vagus nerve. Anesth Analg 66:123, 1987PubMedCrossRefGoogle Scholar
  41. 41.
    Kemp BE, Niall HD: Relaxin. Vitam Horm 41:79, 1985CrossRefGoogle Scholar
  42. 42.
    Berg G, Hammar M, Moller J et al: Low back pain during pregnancy. Obstet Gynecol 71:71, 1988PubMedGoogle Scholar
  43. 43.
    Moran JJ: Stress fractures in pregnancy. Am J Obstet Gynecol 158:1274, 1988PubMedGoogle Scholar
  44. 44.
    Diczfalusy E, Troen P: Endocrine functions of the human placenta. Vitam Horm 19:229, 1961CrossRefGoogle Scholar
  45. 45.
    Datta S, Briwa J: Modified laryngoscope for endotracheal intubation of obese partients. Anesth Analg 60:120, 1981PubMedCrossRefGoogle Scholar
  46. 46.
    Weinreb RN, Lu A, Key T: Maternal ocular adaptations during pregnancy. Obstet Gynecol Sury 42:471, 1987CrossRefGoogle Scholar
  47. 47.
    Weinreb RN, Lu A, Besson C: Corneal thickness in pregnancy. Am J Opthalmol 105:258, 1988Google Scholar
  48. 48.
    Jones CM, Greiss FC: The effect of labor on maternal and fetal circulating catecholamines. Am J Obstet Gynecol 194:149, 1982Google Scholar
  49. 49.
    Huch A, Huch R, Lindmark G et al: Transcutaneous oxygen measurements in labor. J Obstet Gynaecol Br Commonw 81:608, 1974PubMedCrossRefGoogle Scholar
  50. 50.
    Moya F, Morishima HO, Shnider SM et al: Influence of maternal hyperventilation on the newborn infant. Am J Obstet Gynecol 90:76, 1965Google Scholar
  51. 51.
    Zador G, Willeck-Lund G, Nillson BA: Acid-base changes associated with labor. Acta Obstet Gynecol Scand (suppl) 34:41, 1974CrossRefGoogle Scholar
  52. 52.
    Lederman RP, McCann DS, Work B: Endogenous plasma epinephrine and norepinephrine in last trimester pregnancy and labor. Am J Obstet Gynecol 129:5, 1977PubMedGoogle Scholar
  53. 53.
    Maltau JM, Eielsen OV, Stotcke KT: Effect of stress during labor on the concentration of cortisol and esteriol in maternal plasma. Am J Obstet Gynecol 134:681, 1979PubMedGoogle Scholar
  54. 54.
    Cugell DW: Pulmonary function in pregnancy. I. Serial observations in normal women. Am Rev Tuberc 67:568–1953PubMedGoogle Scholar
  55. 55.
    James CF, Gibbs CP, Banner TE: Postparum perioperative risk of pulmonary aspiration. Abstracts of scientific papers. Society for Obstetric Anesthesia and Perinatology. Vancouver, Canada, May, 1983Google Scholar
  56. 56.
    Skaredoff MN, Ostheimer GW: Physiological changes during pregnancy; effects of major regional anesthesia. Reg Anesth 6:28, 1981Google Scholar
  57. 57.
    Shnider S, Levinson G: Anesthesia for obstetrics. 2nd edition. Baltimore, Williams & Wilkins, 1987Google Scholar
  58. 58.
    Gibbs CP: Gastric aspiration: prevention and treatment. Clin Anesthesiol 4:47–52, 1986Google Scholar
  59. 59.
    Turnbull AC, Tindall VR, Robson G et al: Report on confidential enquiries into maternal deaths in England and Wales 1979–1981. London, Her Majesty’s Stationary Office, 1986, pp 85–87Google Scholar
  60. 60.
    Brock-Utne JG, Downing JW, Seedat F: Laryngeal oedema associated with preeclampsic toxemia. Anaesth 32:556–558, 1977CrossRefGoogle Scholar
  61. 61.
    Jouppila R, Joupilla P, Hollmen A: Laryngeal oedema as an obstetric anesthesia complication. Acta Anaesthesiol Scand 24:97–98, 1980PubMedCrossRefGoogle Scholar
  62. 62.
    Mallampati SR, Gatt SP, Gugino LD et al: A clinical sign to predict difficult intubation: A prospective study. Can Anaes Soc J 32:429–434, 1985CrossRefGoogle Scholar
  63. 63.
    Latto IP: Management of difficult intubation. In Latto IP, Rosen M, eds. Difficulties in traceheal intubation. London: Balliere Tindall, 99–141, 1985Google Scholar
  64. 64.
    Gold MI, Buechel DR: A method of blind nasal intubation for the conscious patient. Anesth Analg 39:257–263, 1960PubMedCrossRefGoogle Scholar
  65. 65.
    Fox DJ, Castro T, Rastrelli AJ: Comparison of intubation techniques in the awake patient: The Flexi-lum surgical light (lightwand) versus blind nasal approach. Anesthesiology 66:69–71, 1987PubMedCrossRefGoogle Scholar
  66. 66.
    Ellis DG, Jakymec A, Kaplan RM et al: Guided orotracheal intubation in the operating room using a lighted stylet: A comparison with direct laryngoscopic technique. Anesthesiology 64:823–826, 1986PubMedCrossRefGoogle Scholar
  67. 67.
    Ovasappian A, Yelich S, Dykes MHM et al: Fiberoptic nasotracheal intubation—incidence and causes of failure. Anesth Analg 62:692–695, 1983Google Scholar
  68. 68.
    Dhara SS: Guided blind endotracheal intubation. Anaesth 35:81, 1980CrossRefGoogle Scholar
  69. 69.
    Malan TP, Johnson MD: The difficult airway in obstetric anesthesia: Techniques for airway management and the role of regional anesthesia. J Clin Anesth 1:104–110, 1988PubMedCrossRefGoogle Scholar
  70. 70.
    Scott DB: Endotracheal intubation: Friend or foe? Br Med J 292:157, 1986CrossRefGoogle Scholar
  71. 71.
    Benumof JL, Scheller MS: The importance of transtracheal jet ventilation in the management of the difficult airway. Anesthesiology 71:769–778,1989PubMedCrossRefGoogle Scholar
  72. 72.
    Brain AIJ: Use of the laryngeal mask in obstetric anesthesia. In Van Zundert A, Ostheimer GW, eds. Pain relief and anesthesia in obstetrics. London, Churchill-Livingstone, 1994Google Scholar
  73. 73.
    Chadwick IS, Vohra A: Anaesthesia for cesarean section using the laryngeal airway. Anaesthesia 44:261–262, 989Google Scholar
  74. 74.
    McClune S, Moore J: Laryngeal mask airway for caesarean section. Anaesth 46:227–228, 1990CrossRefGoogle Scholar
  75. 75.
    Heath ML: Endotracheal intubation through the laryngeal mask—helpful when laryngoscopy is difficult or dangerous. Eur I Anaesth 4:41–45, 1991Google Scholar
  76. 76.
    Zakowski MI, Ramanathan S: CPR in pregnancy. Cur Rev Clin Anesth (review) 10:106–111, 1990Google Scholar
  77. 77.
    Rees GAD, Willis BA.: Resuscitation in late pregnancy. Anaesth 43:347–349, 1988CrossRefGoogle Scholar
  78. 78.
    Oates S, Williams GL, Rees GAD: Cardiopulmonary resuscitation in late pregnancy. Br Med J 297:404–405, 1988CrossRefGoogle Scholar
  79. 79.
    Marx G.: Cardiopulmonary resuscitation of late pregnant women. Anesthesiology 56:156, 1982PubMedCrossRefGoogle Scholar
  80. 80.
    O’Connor RL, Sevarino FB: Cardiopulmonary arrest in the pregnant patient: A report of a successful resuscitation. I Clin Anesth 6:66–68, 1994CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 1995

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  • G. W. Ostheimer

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