A longitudinal study of maternal cardiovascular function from preconception to the postpartum period

Mahendru, A.; Everett, Thomas R.; Wilkinson, Ian B.; Lees, C.; McEniery, Carmel M.

doi:10.1097/hjh.0000000000000090

Cited by 204 publications

(181 citation statements)

References 41 publications

Supporting

Mentioning

151

Contrasting

Unclassified

Order By: Relevance

“…In a longitudinal study of blood pressure at 16 weeks postpartum, both brachial and central SBPs remained lower than preconception values but similar to early pregnancy levels. 3 Although a decrease in blood pressure during pregnancy has been found in most studies 12 ( Figure 2), a recent study challenged this September 16, 2014…”

Section: Blood Pressurementioning

confidence: 94%

“…Arterial pressures decrease to a nadir during the second trimester (dropping 5-10 mm Hg below baseline), but the majority of the decrease occurs early in pregnancy (6-to 8-week gestational age) compared with preconception values. 3 Because many of these changes occur very early in pregnancy, they emphasize the importance of comparing hemodynamic measurements with preconception values rather than early pregnancy values when changes have already occurred. Arterial pressures begin to increase during the third trimester and return close to preconception levels postpartum.…”

Section: Blood Pressurementioning

confidence: 99%

See 1 more Smart Citation

Cardiovascular Physiology of Pregnancy

2014

View full text Add to dashboard Cite

1003P regnancy is a dynamic process associated with significant physiological changes in the cardiovascular system. These changes are mechanisms that the body has adapted to meet the increased metabolic demands of the mother and fetus and to ensure adequate uteroplacental circulation for fetal growth and development. Insufficient hemodynamic changes can result in maternal and fetal morbidity, as seen in preeclampsia and intrauterine growth retardation. In addition, maternal inability to adapt to these physiological changes can expose underlying, previously silent, cardiac pathology, which is why some call pregnancy nature's stress test. Indeed, cardiovascular disease in pregnancy is the leading cause of maternal mortality in North America. 1 We therefore review here the normal cardiovascular physiology of pregnancy to provide clinicians with a basis for understanding how the presence of cardiovascular disease may compromise the mother and fetus and how their decisions about medical care may need adjustment. Maternal Hemodynamic ChangesPregnancy is associated with vasodilation of the systemic vasculature and the maternal kidneys. The systemic vasodilation of pregnancy occurs as early as at 5 weeks and therefore precedes full placentation and the complete development of the uteroplacental circulation.2 In the first trimester, there is a substantial decrease in peripheral vascular resistance, which decreases to a nadir during the middle of the second trimester with a subsequent plateau or slight increase for the remainder of the pregnancy 3 ( Figure 1). The decrease is ≈35% to 40% of baseline. Systemic vascular resistance increases to near-prepregnancy levels postpartum, 4 and by 2 weeks after delivery, maternal hemodynamics have largely returned to nonpregnant levels.5 Increased vascular distensibility, or compliance, has been observed in normal human pregnancy starting in the first trimester.6 Systemic vascular resistance increases to nearprepregnancy levels postpartum. 4 Vasodilation of the kidneys results in a 50% increase in renal plasma flow and glomerular filtration rates by the end of the first trimester. This results in decreases in serum creatinine, urea, and uric acid values. Cardiac OutputCardiac output increases throughout pregnancy.8 Invasive measuring techniques are rarely used during pregnancy, so echocardiography is most commonly used to assess hemodynamics in pregnancy. Cardiac output measurements are usually made with the mother in the left lateral decubitus position to avoid positional variation. The sharpest rise in cardiac output occurs by the beginning of the first trimester, and there is a continued increase into the second trimester.9 After the second trimester, there is debate as to whether cardiac output increases, decreases, or plateaus. By 24 weeks, the increase in cardiac output can be up to 45% in a normal, singleton pregnancy. 10Echocardiography and cardiac magnetic resonance imaging estimates of cardiac output trend similarly in pregnancy. In a comparative study of 34 normal pregna...

show abstract

Section: Blood Pressurementioning

confidence: 94%

Section: Blood Pressurementioning

confidence: 99%

Cardiovascular Physiology of Pregnancy

2014

View full text Add to dashboard Cite

show abstract

“…5 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 There was a significant direct correlation between heart rate and BMI of 0.097 (p<0.001). 169…”

mentioning

confidence: 85%

Maternal heart rate during the first 48 h postpartum: a retrospective cross sectional study

Samways

Vause

Kontopantelis

et al. 2016

European Journal of Obstetrics & Gynecology and Reproductiv

View full text Add to dashboard Cite

Throughout pregnancy and the puerperium significant cardiovascular changes occur. Maternal heart 70 rate increases by approximately 20% from the pre-conception baseline to the third trimester of 71 pregnancy (1, 2), with a further increase during labour (3). Whilst these changes are well 72 understood, the changes in the postpartum period are less well defined. Studies show maternal 73 heart rate returns to baseline weeks to months post-delivery (4-7), yet the early postpartum period 74 remains poorly described. Knowledge of what constitutes normal during this period is clinically 75 pertinent to facilitate identification of sick women, and avoid inappropriate investigation of healthy 76 women. In some cases the cause of postpartum tachycardia is evident (haemorrhage, sepsis) (8)(9)(10)(11)(12). 77In other cases it is less obvious and should prompt further investigation for causes such as occult 78 bleeding, cardiac pathology or pulmonary embolism (3,(13)(14)(15). 79Modified Early Obstetric Warning Scores (MEOWS) are widely used. The parameters used vary (16, 80 17) and have often been developed from a non-pregnant population. Data derived from a 81 postpartum population would improve the pre-existing MEOWS scores validity; providing a platform 82 for further investigation into the relationship between postpartum heart rate and negative 83 outcomes and ultimately the creation of a postpartum specific clinical assessment tool. 84Study Aims 85 1. Describe the distribution of heart rate in the first 48 hours postpartum (at 6, 12, 24 and 48 86 hours post-delivery), in women with no evidence of sepsis, haemorrhage or anaemia. 87 2. Investigate the relationship between postpartum heart rate and other maternal factors 88(maternal BMI at booking, maternal age, method of delivery, puerperal blood loss, discharge 89 haemoglobin and length of hospital stay). 90 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 3 Gynaecologists' guidelines for major postpartum haemorrhage (19)) or whose discharge 111 haemoglobin was < 100 g/l (British Society of Haematology guidelines on maternal and postpartum 112 anaemia (20)). 113 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 4 Materials and Methods 91 Study Design Statistical Analyses 114Statistical analyses were performed using IBM® SPSS® Statistics 22 (The International Business 115 Machines Corporation®, New York, NY, USA). 116Central tendency for heart rate at each time period postpartum (6, 12, 24 and 48 hours) was 117 calculated using the mea μ . Spread as calculated usi g standard deviation (SD) and suggested 118 normal range upper thresholds were calculated using the me...

show abstract

“…1 Overall comparison. 2 Comparison between simple and no CHD. Comparison between complex and simple.…”

Section: Specific Results In Paper I: Women With Chdmentioning

confidence: 99%

“…The lowest blood pressure occurs in the second trimester, i.e. 5-10/10-15 mmHg below baseline, but the change starts as early as the sixth to eighth week of gestation [2][3][4] .…”

Section: Hemodynamic Changesmentioning

confidence: 99%

Cardiac disease in pregnancy and consequences for reproductive outcomes, comorbidity and survival

Kernell¹

View full text Add to dashboard Cite

show abstract

A longitudinal study of maternal cardiovascular function from preconception to the postpartum period

Cited by 204 publications

References 41 publications

Cardiovascular Physiology of Pregnancy

Cardiovascular Physiology of Pregnancy

Maternal heart rate during the first 48 h postpartum: a retrospective cross sectional study

Cardiac disease in pregnancy and consequences for reproductive outcomes, comorbidity and survival

Contact Info

Product

Resources

About