Respiratory physiology in pregnancy and assessment of pulmonary function

Best Pract Res Clin Obstet Gynaecol. 2022 Dec;85(Pt A):3-16. doi: 10.1016/j.bpobgyn.2022.05.007. Epub 2022 Jun 27.


A progressive chest wall adaptation occurs during pregnancy driven by the hormones and the expanding uterus. The effect of the former is more prevalent in the first weeks of pregnancy, while the latter is more evident in the last trimester. The combination of the hormonal-induced joint loosening together with the progressively enlarging uterus produces changes in the whole chest wall geometry, with the thoracic alterations being the most fundamental. The ribcage changes in size, but not in volume, secondary to an upward bucket handle shift centred in the xiphoidal process so that the lung is not restricted. A virtuous cycle of stretching and muscle conditioning seems to be established between the enlarging uterus, the diaphragm, and the abdominal muscles to prepare these muscles for the expulsive phase. From the respiratory point of view, the supine position seems to hinder the action of the abdominal muscles during forced expiration at the end of pregnancy.

Keywords: Positioning; Pregnancy; Respiratory muscles; Respiratory physiology.

Publication types

  • Review

MeSH terms

  • Diaphragm / physiology
  • Female
  • Humans
  • Lung
  • Pregnancy
  • Respiratory Muscles* / physiology
  • Respiratory Physiological Phenomena
  • Thoracic Wall* / physiology