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Chapter 33 - Fluid Overload and Underload

from Section 6 - Anaesthetic Emergencies During Pregnancy

Published online by Cambridge University Press:  06 May 2021

By
Renate Wendler
Edited by
Edwin Chandraharan  and
Sir Sabaratnam Arulkumaran
Edwin Chandraharan
Affiliation:
St George's University of London
Sir Sabaratnam Arulkumaran
Affiliation:
St George's University of London
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Summary

The maternal body accumulates water in pregnancy. Total body water can increase by up to 8 L. Oestrogens increase plasma renin activity with enhanced renal sodium absorption and water retention (renin–angiotensin–aldosterone system). Plasma osmolality decreases by about 10 milliosmol/kg below non-pregnant levels [1, 2]. These changes promote sufficient placental perfusion as the plasma volume rises steadily throughout the first two trimesters and plateaus at around 32 weeks. Reduced maternal plasma volume is associated with abnormal pregnancy outcome [3].

The normal human heart is able to tolerate recurrent episodes of pregnancy-related volume overload without compromising normal function [4]. Disturbances in the cardiovascular system and the regulation of fluid balance can lead to changes in blood pressure and to hypotension or hypertension. Imbalance in salt and fluid regulation is common and can cause oedema in later stages of pregnancy.

Type
Chapter
Information
Obstetric and Intrapartum Emergencies
A Practical Guide to Management
 , pp. 239 - 244
Publisher: Cambridge University Press
Print publication year: 2021

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References

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