By Ian M Symonds; Sabaratnam Arulkumaran; E M Symonds
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Extra resources for Essential obstetrics and gynaecology
Adapted from Broughton Pipkin F (2007) Maternal physiology. In: Edmonds DK (ed) Dewhurst’s Textbook of Obstetrics and Gynaecology, 8th edn. ) delivery suggests that this inhibition is mediated through the placenta. There is an increased tendency to clotting in pregnancy and the puerperium. RESPIRATORY FUNCTION The level of the diaphragm rises and the intercostal angle increases from 68° in early pregnancy to 103° in late pregnancy. Although there is upward pressure on the diaphragm in late pregnancy, the costal changes occur well before they could be attributed to pressure from the enlarging uterus.
Eosinophils, basophils and monocytes remain relatively constant during pregnancy, but there is a profound fall in eosinophils during labour and they are virtually absent at delivery. The lymphocyte count remains constant and the numbers of T and B cells do not alter, but lymphocyte function and cell-mediated immunity in particular are depressed, possibly by the increase in concentrations of glycoproteins coating the surface of the lymphocytes, reducing the response to stimuli. There is, however, no evidence of suppression of humoral immunity or the production of immunoglobulins.
Fat is deposited early in pregnancy. It is also used as a source of energy, mainly by the mother from mid to late pregnancy for her high metabolic demands and those of lactation, so that glucose is available for the growing fetus. Total fat accretion is ~2–6 kg, mainly laid down in the second trimester, and is regulated by the hormone leptin. It is deposited mainly over the back, the upper thighs, the buttocks and the abdominal wall. Changes in plasma proteins Maternal total plasma calcium falls, because albumin concentation falls, but unbound ionized calcium is unchanged.
Essential obstetrics and gynaecology by Ian M Symonds; Sabaratnam Arulkumaran; E M Symonds