1. Adaptación Materna Al Embarazo

8/15/2019 1. Adaptación Materna Al Embarazo

http://slidepdf.com/reader/full/1-adaptacion-materna-al-embarazo 1/93

DRA JENNY CHAVEZ

ESCUELA DE MEDICINA

UES



OBJETIVOS

COMO EL CUERPOMATERNO SUFRE

CAMBIOSFISIOLOGICOS YANATOMICOS COMOCONCECUENCIA DELEMBARAZO,EXPLICADO A TRAVESDEL TIEMPO

CAMBIOS:UTERINOSCERVICALESMAMASCARDIOVASCULARESRENALESPULMONARESDIGESTIVOS

COAGULACIONMETABOLICOS



P/!# !p!"s !&p"/ta#t$s $# ("sa&+!"s 's!"(%)! "s

E( $&+a/a4" $s 's!"(%)! "

S"# adapta !"#$s t$&p"/a($s

S!/3$# pa/a sat!s2a $/ d$&a#das * #$ $s!dad$sd$( 2$t"

E( a&+!$#t$ &at$/#" s$ &"d!' a pa/a da/+!$#$sta/ 2$ta(



UTERO

5t$/" #"

)$sta#t$P$sa 67 )/s0

3"(-&$# 87 &(

Ut$/" )$sta#t$V"(-&$# t"ta( at$/&!#" d$ 9 (ts0

Capa !dad d$ 977a 8777 &a*"/

P$s" 8777 a 8877)/s0



C/$ !&!$#t":

H!p$/t/"'a d$ (as 1(-(as &-s -(a/$s T$ !d" '+/"s" T$ !d" $(;st! "

E2$ t" d$ $st/")$#"s * p/")$st$/"#a

Pa/$d$s -t$/!#as a( !#! !" s"# )/-$sas * a('#a( d$()adas d$ "09 a 807 &s0

D$sp-1s d$ (as 8< s$&a#as =a* $2$ t"&$ ;#! " p"/ $( /$ !&!$#t" d$( 2$t"



DISPOSICION DE FIBRAS MUSCULARESDEL UTERO

80 apa $>t$/#a "# ap- =a: 2"/&a -# a/ "s"+/$ $( 2"#d" * s$ $>t!$#d$ a ("s (!)a&$#t"s0

<0 apa &$d!a : /$d d$#sa d$ '+/as &-s -(a/$sp$/2"/adas p"/ 3as"s sa#)-.#$"s $# t"dasd!/$ !"#$s

?0 apa !#t$/#a : '+/as s!&!(a/$s a $s'#t$/,a(/$d$d"/ d$ ("s "/!' !"s d$ (a t/"&pa d$Fa("p!" * "/!' !" $/3! a( !#t$/#" 0



UTEROForma : @p!/!2"/&$ p/$ "# $p !"#a( @ a87@8<ss$ 3-$(3$ d$ 2"/&a $s21/! a

=asta "3"!d$0 @F"/&a d$ sa " t-+-(a/ a( '#a( d$( $&+a/a4"

D$>t/" /"ta !%#: p"/ $( s!)&"!d$s0

P"s! !%# s-p!#a /$t/" $d$ * s$ ap"*a a:@(a "(-&#a 3$/t$+/a(@Vas"s -t$/!#"s ad*a $#t$s 3$#a a3a !#2$/!"/ *

a"/ta



UTEROContractilidad : 0 (a !#t$#s!dad d$ (as"#t/a !"#$s 3a/!a s$) # $( p$/!"d" d$($&+a/a4":

1er trimestre : "#t/a !%# =asta &&H),!//$)-(a/$s $ !#d"("/as0

2º. Trimestre "#t/a !"#$s B/a>t"# =! s,$sp"/;d! as0

3er. Trimestre "#t/a !"#$s B/a>t"# =! sas" !adas a 2a(s" t/a+a " d$ pa/t"0



UTEROA( a3a#4a/ $( $&+a/a4" (as "#t/a !"#$s:Esp"/;d! as a//.t&! as $ !#2/$ -$#t$s

A-&$#ta# d$ !#t$#s!dad =asta 87@89 && H)

C"# -#a 2/$ -$# !a =asta d$ -#a ="/a

B/a>t"# H! s a pa/t!/ d$ (as < SEM 2a(s" t/a+a " d$pa/t" * a( '#a(

O+ $t!3" &ad-/a/ $( -$(("



RIEGO SANGUINEO

UTEROPLACENTARIOD$p$#d$ d$( /!$)" -t$/!#" t"ta( 3!$#$ d$ A0-t$/!#as * O3;/! as0

A-&$#ta d$ 97@ 97 &( &!# a( t$/&!#"

Las venas uterinas : d!st$# !+!(!dad s$ d$+$ aa&+!"s a(" a# - " -t$/!#" p(a $#ta/!"0

E( control del riego uteroplacentario : a-&$#t"p/")/$s!3" d$ (a 3as"d!(ata !%# * /$ !&!$#t""#t!#-" d$ 3as"s p(a $#ta/!"s0



RIEGO SANGUINEO

UTEROPLACENTARIOLA VASODILATACION ES ESTIMULADA POR:

Est!&-(a !%# $st/")$#! aR$2/a ta/!$dad 3as -(a/ a ("s $2$ t"s p/$s"/$s d$(a a#)!"t$#s!#a II 3as"d!(ata !%#

Oxido nítrico : 2a t"/ d$ /$(a a !%# d$/!3ad" d$($#d"t$(!"0 P"t$#t$ 3as"d!(atad"/0



RIEGO SANGUINEOUTEROPLACENTARIO

F(- " t$/"p(a $#ta/!" 97 &( &!# a (as87 s

977@677 a('#a(

C"#s-&" t"ta( d$">!)$#" '#a( d$( $&+a/a4" $s

d$ <7 &( &!#8< &( &!#000002$t"

&( &!#000000000P(a $#ta

&( &!#00000 t$/"



C-$((" -t$/!#"R$t!$#$ $( 2$t" * s$ p/$pa/a pa/a (a d!(ata !%#d-/a#t$ $( pa/t"

Cambios en el estroma :

@/$+(a#d$ !&!$#t"@ !a#"s!s as" !ada a( a-&$#t" d$3as -(a/!dad

* a( $d$&a @ H!p$/p(as!a $ =!p$/t/"'a d$ (as )(;#d-(as

Componentes: &-s -(" (!s" 87 * /$st" d$t$ !d" "#$ t!3" "(;)$#" * a t$/&!#" s-2/$a&+!"s p"/ /$(a>!#a0



C-$((" -t$/!#"Ca&+!"s $# $( $p!t$(!" * )(;#d-(asp/"d- $# p/"(!2$/a !%# #"t"/!a d$ (as)(;#d-(as

E t/"p!%# 's!"(%)! "

Las 1(-(as d$ (a &- "sa p/"d- $# &" "$# "#d- t" $/3! a( /! " $#!#&-#")("+-(!#as * !t" !#as0

E# $( t/a+a " d$ pa/t" $s $>p-(sad"0 Es $(((a&ad" tap%# &- "s"



OVARIOCUERPO LUTEOI&p"/ta#t$ p/"d- !%# P/")$st$/"#a @6sR$a !%# d$s!d-a( as" a d$t/!t"s $#d"&$t/!a($s0

T-&"/$s d$ (a )$sta !%#:

Quiste tecaluteinicos 0 @B$#!)#"s@Est!&-(a !%# 's!"(%)! a $>a)$/ada d$ -# 2"(. -("

as" a p/"d- !%# d$ HCG0@ O as" a EGT

17



VAGINA Y PERINEA-&$#t" d$ 3as -(a/!dad d$ (a p!$(, 3-(3a *&-s -("s d$( p$/!#$0

"#$%&#:A-&$#t" d$ 3as -(a/!dad s!)#" d$ =adK!

A-&$#ta s$ /$ !"#$s +(a# a, $sp$sa

A-&$#ta (a t"+a !((-s



PIEL YPIGMENTACIONE# (t!&"s &$s$s apa/$ $# 2/a# as /" as $# p!$( d$

a+d"&$#: $st/.as )$sta !"#a($s $# &-(t.pa/as s$3-$(3$# p(at$adas0

D!astas!s d$ & s -("s /$ t"s a+d"&!#a($s

@PIGMENTACION :as" !ada a PROGESTERONAE# (.#$a &$d!a s$ 2"/&a (.#$a a(+a pa/d" "+s -/" 0

C("as&a " &$(as&a $# a/a * -$(("

A-&$#ta (a p!)&$#ta !%# $# a/$"(a * p!$( )$#!ta(0



C#'(%O)

"#)C* #+,):A/a as 3as -(a/$s " t$(a#)!$ tas!as$# a/a , -$((", +/a4"s * t%/a>

a#t$/!"/

E/!t$&a pa(&a/

As" !ad"s a ("s $st/%)$#"s



MAMAS 1er mes : P/-/!t" * t$#s!%# $ =!p$/s$#s!+!(!dad a(!#! !" d$( $&+a/a4" 0

-2do mes : @a-&$#ta $( 3"(-&$# * 3$#as +a " (ap!$(

@P$4%# s$ a)/a#da, $/1 t!(, $st/.as

@ =!p$/t/"'a $ =!p$/p(as!a@ apa/! !%# d$ /$d 3$#"sa "(at$/a(0 @t-+1/ -("s d$ M"#t)"&$/* @s-$($ =a+$/ a("st/"



CAMBIOSCARDIOVASCULARES



CAMBIOS CARDIOVASCULARES9 s$& a-&$#ta $( $asto Cardiaco :80A-&$#t" 2/$ -$# !a a/d!a a

<0D!s&!#- !%# d$ R$s!st$# !a 3as -(a/p$/!21/! a

87@<7 s$& a-&$#t" d$( volumenplasm tico p"/ aumento de precarga.



CAMBIOS CARDIOVASCULARES/isminu0e el desempe oventricular:

80D!s&!#- !%# RVP

<0Ca&+!"s $# - " a/t$/!a( p-(s;t!(?0A-&$#ta (a apa !dad 3as -(a/



Est" a-&$#ta (a d!st$# !+!(!dad d$("s 3as"s0

P$/&!t$ a( apa/at" a/d!"3as -(a/a -sta/s$ a (as d$&a#das's!"(%)! as d$( 2$t" &a#t$#!$#d" (a!#t$)/!dad a/d!"3as -(a/ &at$/#a 0



CAMBIOS CARDIOVASCULARES0

CORAZONA-&$#ta (a 2/$ -$# !a d$ p-(s" 87(at &!#

E( d!a2/a)&a s$ $($3ap/")/$s!3a&$#t$ d$sp(a4a#d" $("/a4%# a (a !4 -!$/da * a//!+a0

La p-#ta d$( "/a4%# =a !a a2-$/a 0



GASTO CARDIACOLa presi n arterial 0 +" $st;# d!s&!#-!das

E( volumen sanguíneo * (a tasa metab lica+asa( a-&$#tad"s0

E( $asto Cardiaco a-&$#tad" a-&$#ta &as$# d$ +!t" d"/sa( s-p!#"

A( t$/&!#" a-&$#ta 8<77 &( &!# $# <7

32



FUNCION HEMODINAMICA $# $&+a/a4" a3a#4ad"/isminu0e :

RVPRV P-(&"#a/ La P/$s!%# "("!d"s&"t! a

&o se modi4ca:

P/$s!%# p-(&"#a/P/$s!%# 3$#"sa $#t/a(



PRESION ARTERIALD!s&!#-*$ p" " d-/a#t$ $( $&+a/a4" $#9@87 &&H) d$sd$ (a s$&a#a 8< a (a < ,

pa/a (-$)" /$sta+($ $/s$ a ("s #!3$($sp/$3!"s $# (a s$& ? MIGRACION DEL

TROFOBLASTO

E( /!$)" sa#)-.#$" $# $>t/$&!dad$sp1(3! as s$ /$ta/da



PRESION ARTERIALEsta# a&!$#t" sa#)-.#$" $# $>t/$&!dad$sp1(3! as * 3$#a a3a !#2$/!"/ * 3$#asp1(3! as:

EDEMA DE MIEMBROS INFERIORES

VARICES EN PIES VULVA Y HEMORROIDES TROMBOSIS VENOSA PROFUNDA



SISTEMA RENINA@ANGIOTENSINA@

ALDOSTERONAC"#t/"( /$#a( d$ TA a t/a31s d$( $ -!(!+/!"d$ sa($s * a)-a

La /$#!#a s$ p/"d- $ $# /! %# &at$/#" * (a-#!dad -t$/"p(a$#ta/!a

E# =!)ad" &at$/#" * 2$ta( s$ p/"d- $ $(a#)!"t$#s!#")$#" s-st/at" d$ /$#!#a



SISTEMA RENINA@ANGIOTENSINA@

ALDOSTERONAE( a-&$#t" d$ a#)!"t$#s!#a s$ as" !a a(a-&$#t" d$ $st/")$#"s

E( a-&$#t" a (a /$2/a ta/!$dad a a#)!"t$#s!#aII$s "#s$ -$# !a d$ (a /$2/a ta/!$dad d$ ("s3as"s a (a a#)!"t$#s!#a II

E( p$pt!d" #at/!-/$t! " s$ /$tad" $# ("sa/d!"&!" !t"s ta&+!$# /$)-(a $( 3"(sa#)-!#$"



PROSTAGLANDINAS)u producci n se asocia al control de:80 T"#" 3as -(a/<0 T$#s!%# a/t$/!a(?0E -!(!+/!" d$( s"d!"0C"a)-(a !%#90Fa t"/ pa/t! !pa#t$ $# (a /$s!st$# !a a a#)!"t$#s!#a

S!#t$t!4ada $# &$d-(a /$#a( '#a( $&+a/a4"

La p/!# !pa( $s (a PROSTACICLINA PGI<vasodilatador



R$#a($sCambios anat micos:ongitud del ri n

incrementa de 1 a 1.5 cms

elvis renal se dilata 6astacapacidad de 78 ml

os ur9teres se dilatan porarriba del estrec6osuperior mas el der. Que eli!;.



#dem s se alargan se amplían 0se vuelven mas curvos lo ;ueaumenta la estasis urinaria<legando 6asta 288 ml residuales=

Otros >actores:

%ncremento del in>undíbulopelviano/extro rotaci n del ?tero



F-# !%# /$#a(Tasa de 4ltraci n glomerular 0 el @uAo renalplasm tico incrementa 6asta el 58B

#umenta la depuraci n de creatinina end gena

$lucosuria transitoriaroteinuria transitoria es de 288 388mgD2E 6

+enina angiotensinogeno angiotensina %% "#)O +,)O+

#ngiotensina %% estimula aldosterona 0 con la#/ >omentan la retenci n de agua 0 sodio



FUNCION RENALLas !2/as d$ /$at!#!#a s1/! a * #!t/%)$#"d$ -/$a d$ /$ $#

La $> /$ !%# d$ p/"t$.#as, a&!#"; !d"s *)(- "sa a-&$#ta

La "s&"(a/!dad s$/! a d$ /$ $



VEJIGA,levaci n trígono vesical

presi n intrauretral <continencia=

capacidad vesical

a0 re@uAo vesico ureteral

%ncontinencia urinaria

'a0or incidencia de in>ecci n47



PULMONE( d!a2/a)&a s$ $($3a as! &s0

E( ;#)-(" s-+ "sta( s$ a&p(!a a(a&p(!a/s$ $( $( d!;&$t/" t/a#s3$/sa(d$ (a a a t"/; ! a < &s0

La !/ -#2$/$# !a t"/; ! a a-&$#ta &s0



PULMONCapa !dad p-(&"#a/ t"ta( d!s&!#-*$$#t/$ a 9

Capa !dad 2-# !"#a( /$s!d-a(, 3"(-&$#/$s!d-a( * 3"(-&$# $sp!/at"/!" d$/$s$/3a, d!s&!#-*$ $# -# <7

La apa !dad !#sp!/at"/!a a-&$#ta $#t/$-# 9@87



PULMON/isnea 4siol gica: a-&$#t" d$( 3"(-&$# d$ 3$#t!(a !%# p-(&"#a/

d!s&!#-*$ P "< sa#)-.#$a

H!p$/ 3$#t!(a !%# p-(&"#a/:

A( a-&$#ta/ (a FC /$sp!/at"/!a: "#s$ -$#t$d!s&!#- !%# d$ (a CO< a(3$"(a/ d$+!d" a( $2$ t"d$ p/")$st$/"#a0 $2$ t" $# $#t/"/$sp!/at"/!"



PULMON#lcalosis respiratoria :d!s&!#-*$ $( +! a/+"#at"

a-&$#ta PH sa#)-.#$"

D$s3.a -/3a d$ d!s" !a !%# d$ ">!)$#" a !4 0

Y a-&$#ta (a a'#!dad d$ =$&")("+!#a&at$/#a p"/ ">!)$#"



APARATO DIGESTIVOA-&$#ta# #a-s$as * 3%&!t"s

C"#)$st!%# d$ (a &- "sa "/a( * #asa(

S$#sa !"#$s "("/"sas * d$ d$)-sta !%# p" ""&-#$s

G!#)!3!t!s "#)$st!3a * pt!a(!s&"

M"t!(!dad * t"#" )ast/"!#t$st!#a( d!s&!#-!da, p"/a-&$#t" d$ P/")$st$/"#a



APARATO DIGESTIVOVa !a&!$#t" );st/! " $ !#t$st!#a(d!s&!#-!d"

R$ - " )ast/"$s"2a)! " a-&$#ta: p!/"s!s

E( t$/" d$sp(a4a $( $st"&a)" $ !#t$st!#"s

La =$&"//"!d$s : $st/$ !&!$#t" * a-&$#t"d$ p/$s!%# d$ 3$#as



V$s. -(a +!(!a/a contractilidsd de vesicula disminu0e

#umenta el vol. +esidual 0 estasis biliar

(ilis mas densa: aumenta saturaci n de colesterol

C lculos como consecuencia de la estasis biliar

+etenci n de sales biliares : CO ,)T#)%) %&T+# , #T%C# G +*+%TO $+#"%/%CO

#CC%O& O+'O&# ,)T+O$,&%C# :in6iben transporteintraductal de sales biliares



H.)ad"N" =a* a&+!"s &"/2"(%)! "s

La a t!3!dad 2"s2atasa a( a(!#a p-$d$ d-p(! a/s$

Ha* d!s&!#- !%# (!)$/a d$ (a a(+ &!#a * )("+-(!#asp(as&;t! as

A-&$#t" d$ a()-#as $#4!&as

E# as"s /a/"s p-$d$ p/"d- !/s$ "($stas!s!#t/a=$pat! a CLINICA



COAGULACIONLa cascada de coagulaci n esta activada :80A-&$#t" d$ t"d"s ("s 2a t"/$s d$ "a)-(a !%#

<0A-&$#t" d$ (as !2/as d$ "&p($ "s d$ '+/!#%)$#"d$ a(t" p$s" &"($ -(a/0

Fa t"/ VIII

A-&$#ta# $# &$#"/ )/ad" VII,IX,X,XII

T"d"s ("s 2a t"/$s s$ !# /$&$#ta# a $> $p !%# d$ XI* XIII



C"a)-(a !%# @ ESTADO DEHIPERCOAGULABILIDAD

Fibrinogeno a-&$#ta d$ 809@ 09)/ ( =asta )/0 (

P-$d$ (($)a/ a 3a("/$s d$ 388 a 788M) dL

"# "&!ta#t$ "# ("s 3a("/$s d$

P(as&!#")$#"A t!3!dad '+/!#"(!t! a d!s&!#-!da d-/a#t$ $($&+a/a4" * $( pa/t"



PLA UETAS,stan ligeramente disminuidas

Ci>ras promedio de 213 888Dul < normal258 888=

#nc6o 0 volumen aumentado

a disminuci n de su concentraci n asoc a6emodiluci n por ma0or consumo de pla;uetas

Trombocitopenia : debaAo de 2.5 del percentil



PLA UETAS< &!tad $( t/"&+">a#" !#d- $:

80a)/$)a !%# p(a -$ta/!a<0a-&$#t" p/")/$s!3"



CAMBIOS

HEMATOLOGICOS VOLUMEN SANGUINEOA-&$#ta 7@ 9 p"/ = ipervolemia !#d- $:

a -+/!/ (as d$&a#das d$ t$/" /$ !d" s!st$&a3as -(a/

+ p/"t$)$/ a &ad/$ * 2$t" "#t/a a(t$/a !%# d$(/$t"/#" 3$#"s" $# p"s! !%# s-p!#a * $/$ ta

p/"t$)$/ a &ad/$ d$ $2$ t"s ad3$/s"s d$ (ap$/d!da sa#)-.#$a as" !ada a( pa/t"



E( 3"(-&$# sa#)-.#$"

a-&$#ta pa/a :80 -$ $( t$/" -$#ta "# &as sa#)/$

<0 Sat!s2a $ #$ $s!dad$s &$ta+%(! as d$( 2$t"

?0 S$ $($3$ $( /!$)" sa#)-.#$" a "t/"s t$ !d"s

0 D!s!pa !%# d$( a("/ &at$/#"

90 C"&p$#sa p$/d!da sa#)-.#$a d-/a#t$ $( pa/t"



VOLUMEN SANGUINEOC"&!$#4a a a-&$#ta/ a 8< s$& * $s &- =" &a*"/ $# $(< 0 T/!&$st/$ &as ($#t" $# ?$/ t/!&$st/$0

S- $>pa#s!%# s$ as" !a a a-&$#t" $( p(as&a *$/!t/" !t"s

H!p$/p(as!a &"d$/ada d$ s$/!$ $/!t/"!d$ d$ &$d-(a %s$a

A-&$#ta !2/a d$ /$t! -(" !t"s , as" !ad" a (a &a*"/"# $#t/a !%# d$ $/!t/"p"*$t!#a p(as&;t! a0



CONCENTRACION DE

HEMOGLOBINA@HEMATOCRITO0D!s&!#-!da p"/ (a 3!s "s!dad d$ sa#)/$ t"ta(

A t$/&!#" s- "# $#t/a !%# $s 8<09 )/ 877&(

d$+a " d$ 88 )/ 877 &( as" !ad" ad$' !$# !a d$ =!$//"

@@



HIERRORE UERIMIENTOS?77 a 2$t" * p(a $#ta<77 s$ p!$/d$# $# 3.as d$ $> /$ !%#

I# /$&$#t" p/"&$d!" d$ 3"(-&$# t"ta( d$ $/!t/" !t"s!/ -(a#t$s $s 97 &(

L"s /$ -$/!&!$#t"s a-&$#ta# (a < 0 M!tad * $s d$ @6 &) d.a

s- "# $#t/a !%# d!s&!#-*$



E/!t/" !t"sMasa $/!t/" !ta/!a !# /$&$#ta 97&(

H$&at" /!t" d!s&!#-*$ a( '#a( d$( s$)-#d"t/!&$st/$, $sta+!(!4;#d"s$ $/ a d$( t$/&!#"

A-&$#ta (a #$ $s!dad d$( =!$//"

N$ $s!dad d$ =!$//" @6 &) d!a

#&,'%# F%)%O O$%C# /, ,'(#+#HO



FUNCION INMUNITARIA Y

LEUCOCITARIAS-p/$s!%# d$ 2-# !%# !#&-#!ta/!a =-&"/a($s * &$d!adas p"/$(-(as

F!#a(!dad d$ a $pta/ $( !# $/t" 2$ta( s$&! a($/)$#! " $>t/a "0

'ecanismo de supresi n d$ 1(-(as T a->!(!a/$s * T!t"t">! as , d!s&!#-*$#:

@ !#t$/($- !#as @ !#t$/2$/"# @ 2a t"/ d$ #$ /"s!s t-&"/a( @ 2-# !%# d$ -!&!"ta>!s * ad=$/$# !a d$ p"(!&"/2"#- ($a/$s0

E( &" " $/3! a( "#t!$#$ I#&-#")("+-(!#a A * G,$ !#t$/($- !#a8B



LEUCOCITOSE# $( ?$/ T s$ a(t$/a# : )/a#-(" !t"s *(!#2" !t"s T $( CD a-&$#tad" *d!s&!#-*$# (!#2" !t"s T CD * &"#" !t"s0@

'#+C#/O+,) /, %&F #'#C%O& :E# /$sp-$sta a t/a-&a " !# a&a !%# s$

a-&$#ta# (a 2"s2atasa a( a(!#a * p/"t$.#a C/$a t!3a * 3$(" !dad d$$/!t/"s$d!&$#ta !"#



CAMBIOS METABOLICOSEL a-&$#t" d$ p$s" a( '#a( d$( $&+a/a4" d$+$ s$/ d$12.5Ig 0 Y s$ d!st/!+-*$ $#:

Jtero : 2$t", p(a $#ta * (! -!d" a&#!%t! "

'amas

)angre

L! -!d" $>t/a $(-(a/ * $>t/a3as -(a/, 3"(-&$# sa#)-.#$"

+eservas maternas : )/asa, a)-a $(-(a/ * p/"t$.#as #-$3as0



Ca&+!"s &$ta+%(! "s,l metabolismo aumenta debido a:

/emandas del >eto

#umenta >unci n tiroidea

#umenta T)



D!st/!+- !%# d$ (a )a#a# !a d$ p$s"

a (as 7 s$&0eso >etal 2$t" ?0? )

p(a $#ta 677)/

LA 77)/

total E.K Lg.

eso materno t$/" 77)/

&a&as 77)/

sa#)/$ 80< )

)/asa "/p"/a( 90< ) total M.M Lg.

Total combinado: 12.5 Lg.



METABOLISMO DEL AGUA# +,T,&C%O& /, #$*# ,) ',/%#/# :D!s&!#- !%# d$ (a "s&"(a/!dad p(as&;t! a /$a -st$d$ -&+/a( "s&%t! " , s$d, s$ /$ !%# d$ 3as"p/$s!#a0

A( t$/&!#" p"/ $( "#t$#!d" d$ a)-a d$ ?09 Lts0 2$t",p(a $#ta * LA

A-&$#t" d$( 3"(-&$# sa#)-.#$" &at$/#", t$/" *&a&as $# ?07 Lts0

P/"&$d!" d$ a)-a a '# d$ $&+a/a4" d$ 09 Lts0

$ ( d$ ) ( (



A-&$#t" t"ta( d$ a)-a a( '#a(d$( $&+a/a4"

6 (!t/"s $# t"ta( 90 (!t/"s p(a $#ta 2$t" LA t$/", &a&as, p(as&a 80< (!t/"s: (! -!d" =!st! "

908L a)-a $>t/a $(-(a/80 L a)-a !#t/a $(-(a/



METABOLISMOCARBOHIDRATOS)e caracteri!a por:80 H!p")(! $&!a ($3$ $# a*-#"<0 H!p$/)(! $&!a p"sp/a#d!a( $?0 H!p$/!#s-(!#$&!a

+esistencia peri>9rica a la insulina:

a R$sp-$sta !#s-(.#! a a (a )(- "sa+ S$p/$s!%# d$ (a s$ /$ !%# d$ )(- a)%#R$d- !%# d$ (a !# "/p"/a !%# p$/!21/! a d$ )(- "sa



La =!p$/)(! $&!a $ =!p$/!#s-(!#$&!ap"st$/!"/ a (a !#)$sta s$ da p"/s-p/$s!%# d$( )(- a)"# -$ p/"&-$3$(a /$s!st$# !a p$/!21/! a a(a !#s-(!#a

P/"+a+($&$#t$ &$d!ada p"/Est/")$#s0 * P/")$st$/"#a As$)-/a#-# ap"/t$ "#t!#-" d$ )(- "sa a( 2$t"0



METABOLISMOCARBOHIDRATOSE( actogeno placentario a-&$#ta a t!3!dad d$H0 /$ !&!$#t":

80a-&$#t" d$ (!p"(!s!s

<0 (!+$/a !%# d$ ; !d"s )/as"s?0 2a !(!ta (a /$s!st$# !a a (a !#s-(!#a0

E# a*-#" (a "# $#t/a !%# d$ a 0 G/as"s, t/!)(! $/!d"s

* "($st$/"( $s &a*"/0

E( a&+!" $#$/)1t! " d$ )(- "sa a (!p!d"s !#d- !d" p"/$( $&+a/a4" INANICION ACELERADA0



METABOLISMO DEGRASASA-&$#t" d$ "# $#t/a !%# d$ (.p!d"s:

(!p"p/"t$!#as * ap"(!p"p/"t$!#as

A(&a $#a&!$#t" d$ )/asas $# &!tad$&+a/a4"

A( '#a( (as /$s$/3as $#$/)1t! as d$ /$ $# p/"t$)$# d$ !#a#! !%# p/"("#)ada



METABOLISMO DE

ELECTROLITOSS$ /$t!$#$ 8777 M$ d$ s"d!" * ?77 M$d$ p"tas!"

A-&$#ta s- $> /$ !%# p"/ a-&$#t" d$ s-/$a+s"/ !%# t!s-(a/

S- "# $#t/a !%# s1/! a a-&$#ta p"/ (a$>pa#s!%# d$( 3"(-&$# p(as&;t! "0



METABOLISMO DE ELECTROLITOSD!s&!#-*$ $( a( !" d!s&!#- !%# d$a(+-&!#a

E( 2$t" a-&$#ta s- d$&a#da d$ a( !"&at$/#"

E( &a)#$s!" s1/! " d!s&!#-*$ d$p/$s!%#



SISTEMA ENDOCRINOO+'O&# /, C+,C%'%,&TO:S$ /$tada $# 8$/ T0 p"/ =!p%'s!s

< &!tad d$ $&+a/a4" a+-#da#t$ $# !/ -(a !%#2$ta( s$ /$tada $# p(a $#ta

S$ =a as" !ad" $( /$ !&!$#t" 2$ta(

/$(a !"#ada "# $( !#! !" d$ t/a+a " d$( pa/t"



SISTEMA ENDOCRINO+O #CT%&#:C!2/as a-&$#ta#

Est!&-(" as" !ad" a $st/%)$#"s

P/!# !pa( 2-# !%# $s as$)-/a/ (a (a ta# !a



SISTEMA ENDOCRINO GLANDULA TIROIDES'O/%F%C#C%O&,):

I#d- $ !# /$&$#t" $# !2/as d$ t!/">!#a

S$ p/"d- $# 2a t"/$s $st!&-(a#t$s d$ t!/"!d$sp(a $#ta

M$#"/ d!sp"#!+!(!dad d$ *"d"

La t!/"!d$s p/$s$#ta /$ !&!$#t" &"d$/ad" p"/=!p$/p(as!a )(a#d-(a/ * a-&$#t" d$3as -(a/!dad



GLANDULASSUPRARRENALESCO+T%)O : # /O)T,+O&#

Concentraci n s9rica

aumentada

Tasa de depuraci nmetab lica menor

,n etapas tempranas la#CT< adenocorticotropica=disminu0e muc6o 0aumenta al 4nal.

)ecreci n aumentada

rotecci n contrae>ecto natriuretico.



SISTEMA

MUSCULOES UELETICOL"/d"s!s p/")/$s!3a

A/t! -(a !"#$s sa /"!(!a as, sa /" " !)$as *p +! as "# &a*"/ &"3!(!dad0

A-&$#ta (a (a>!t-d a/t! -(a/

H-$s"s * (!)a&$#t"s p1(3! "s s$ /$(a a#

P/!# !pa(&$#t$ s.#'s!s d$( p-+!s



G/a !as



GRACIAS YBENDICIONES

1. Adaptación Materna Al Embarazo

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