Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-848d4c4894-4rdrl Total loading time: 0 Render date: 2024-07-03T05:48:29.214Z Has data issue: false hasContentIssue false

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
Get access

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Risberg, A. Hormones and fluid balance during pregnancy, labor and post partum. Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine 2009; 478.Google Scholar
Wilson, M, Morganti, AA, Zervoudakis, I, Letcher, RL, Romney, BM, Von Oeyon, P, et al. Blood pressure, the renin-aldosterone system and sex steroids throughout normal pregnancy. Am J Med. 1980;68:97–104.Google Scholar
Bernstein, IM, Ziegler, W, Badger, GJ. Plasma volume expansion in early pregnancy. Obstet Gynecol. 2001;97:669–72.Google Scholar
Katz, R, Karliner, JS, Resnik, R. Effects of a natural volume overload state (pregnancy) on left ventricular performance in normal human subjects. Circulation. 1978;58:434–41.CrossRefGoogle ScholarPubMed
Sciscione, A, Ivester, T, Largoza, M, et al. Acute pulmonary oedema in pregnancy. Obstet Gynecol. 2003;101:511–15.Google Scholar
Dennis, AT, Solnordal, CB. Acute pulmonary oedema in pregnant women. Anaesthesia 2012;67:646–59.CrossRefGoogle ScholarPubMed
Thornton, CE, von Dadelszen, P, Makris, A, Tooher, JM, Ogle, RF, Hennessy, A. Acute pulmonary oedema as a complication of hypotension during pregnancy. Hypertens Pregnancy. 2011;30:169–79.Google Scholar
Tomlinson, M, Cotton, D. Fluid management in the complicated obstetric patient. The Global Library of Women’s Medicine. 2008; DOI: 10.3843/GLOWM.10192.Google Scholar
Engelhardt, T, MacLennan, FM. Fluid management in pre-eclampsia. Int J Obstet Anesth. 1999;8:253–9.CrossRefGoogle ScholarPubMed
Mackenzie, MJ, Woolnough, MJ, Barrett, N, Johnson, MR, Yentis, SM. Normal urine output after elective caesarean section: an observational study. Int J Obstet Anesth. 2010;19:379–83.Google Scholar
Park, GE, Hauch, ME, Curlin, F, Datta, S, Bader, AM. The effects of varying volumes of crystalloid administration before caesarean delivery on maternal haemodynamics and colloid oncotic pressure. Anesth Analg. 1996;83:299–303.Google Scholar
ASA Task Force on Obstetric Anesthesia. Practice guidelines for obstetric anesthesia: an updated report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia. Anesthesiology. 2007;106:843–63.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×