Medical care and pregnancy - Physiological changes

Physiological changes of pregnancy are listed in
Table 9.5, along with possible implications for medical
care in pregnancy. Most changes are somewhat
dependent on gestational age. While the most sensitive
period with respect to congenital malformations
occurs during the first trimester in organogenesis, the
increase in plasma volume, cardiac output, and glomerular
filtration does not begin to manifest significantly
until the second trimester, with peak effect
noted by 30 weeks gestation. In general, the fetus poorly tolerates maternal
hypotension, hypoxemia, hypovolemia, and acidosis.
Thus, while a non-pregnant patient may tolerate
greater physiological stress, for example mild hypoxemia
during an acute asthmatic attack, the pregnant
woman should be treated vigorously for the acute
attack with medication and more liberal use of supplemental
oxygen. More importantly, preventive
measures should be undertaken, whenever possible,
to avoid acute exacerbations of chronic disease, such
as diabetes and asthma.

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