Table 2.
The physiological changes in pregnancy and their impact on diagnosis
| System | Changes | Impact |
| Cardiovascular | ↓ peripheral vascular resistance | Masking of initial signs of sepsis |
| ↑ heart rate | Increased hypoperfusion | |
| ↓ arterial pressure | ||
| ↑ cardiac output | ||
| Blood | ↑ plasma volume | Greater reduction of oxygen supply to tissues |
| ↑ red cell volume | ||
| Anemia | ||
| Respiratory | ↑ tidal volume | Delayed physiological response to metabolic alkalosis |
| ↓ residual volume | ||
| ↑ minute-ventilation by 30-40% | Impaired oxygenation | |
| ↑ respiratory center simulation → ↑ respiratory rate | ||
| ↓ da PaCO2 | ||
| Renal | Ureteropelvic dilation and ↓ureteral pressure due to smooth muscle relaxation | Delayed identification of renal injury secondary to sepsis |
| Flaccid bladder | Favorable to pyelonephritis | |
| ↑ intravesical pressure due to the pregnant uterus weight | ||
| ↑ vesicoureteral reflux | ||
| ↑ renal plasma flow | ||
| ↑ glomerular filtration rate | ||
| ↓ urea and creatinine average values | ||
| Asymptomatic bacteriuria | ||
| Gastrointestinal | ↓ muscle tone across the digestive tract | ↑ risk of bacterial translocation |
| Delayed gastric emptying | ↑ risk of aspiration pneumonia | |
| Diaphragm elevation by the pregnant womb | ↑ risk of cholestasis, hyperbilirumbinemia and jaundice | |
| Changes in bile composition | ||
| ↑ production of pro-inflammatory cytokines bye Kupffer cells | ||
| Coagulation | ↑ factors VII, VIII, IX, X, XII, Von Willebrand and fibrinogen | ↑ risk of thrombotic events |
| ↓ protein S | ↑ risk of DIC | |
| ↓ fibrinolytic activity | ||
| Genital | ↓ vaginal pH | ↑ risk of chorioamnionitis |
| ↑ glycogen in vaginal epithelium |
PaCO2 - arterial carbon dioxide partial pressure; DIC – disseminated intravascular coagulation.