Cardiac structure and function in normal pregnancy

Melchiorre, K.; Sharma, Rajan; Thilaganathan, B.

doi:10.1097/gco.0b013e328359826f

Cited by 112 publications

(106 citation statements)

References 56 publications

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“…1 The findings on cardiac function are in agreement with those of Mone et al who also showed a preservation of contractile function throughout pregnancy with a decrease in function near term.…”

Section: Comparison With Previous Studiessupporting

confidence: 82%

“…Functional changes of the heart in pregnancy have been widely investigated during the last few decades with relatively inconsistent results. [1][2][3][4][5][6] Some studies demonstrated an enhancement of cardiac function in pregnancy, whereas others showed depressed cardiac function, and a few, unchanged functional status. [1][2][3][4][5][6] The most likely reason for these conflicting results is that complex data on maternal cardiac function has not been interpreted in the context of heart geometry, loading conditions, and maternal anthropometric factors, which are all modified from as early as the time of conception 7 and continue to change continuously throughout pregnancy.…”

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confidence: 99%

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Maternal Cardiovascular Function in Normal Pregnancy

et al. 2016

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Abstract-The aim of this study was to investigate cardiac functional status in pregnancy using a comprehensive approach taking into account the simultaneous changes in loading and geometry, as well as maternal age and anthropometric indices. This was a prospective cross-sectional study of 559 nulliparous pregnant women assessed at 4 time points during pregnancy and at 1 year postpartum. All women underwent conventional echocardiography and tissue Doppler velocities and strain rate analysis at multiple cardiac sites. Mean arterial pressure and total vascular resistance index significantly decreased (both P<0.001) during the first 2 trimesters of pregnancy and increased thereafter. Stroke volume index and cardiac index showed the opposite trend compared with mean arterial pressure and total vascular resistance index (both P<0.05). Myocardial and ventricular function were significantly enhanced in the first 2 trimesters but progressively declined thereafter. By the end of pregnancy, significant chamber diastolic dysfunction and impaired myocardial relaxation was evident in 17.9% and 28.4% of women, respectively, whereas myocardial contractility was preserved. There was full recovery of cardiac function at 1 year postpartum. Cardiovascular changes during pregnancy are thought to represent a physiological adaptation to volume overload. The findings of a drop in stroke volume index, impaired myocardial relaxation with diastolic dysfunction, and a tendency toward eccentric remodeling in a significant proportion of cases at term are suggestive of cardiovascular maladaptation to the volume-overloaded state in some apparently normal pregnancies. These unexpected cardiovascular findings have important implications for the management of both normal and pathological pregnancy states. Melchiorre et al Cardiac Function and Geometry in Pregnancy 755changes in maternal loading conditions, cardiac geometry, as well as age and anthropometric indices. MethodsThis was a prospective cross-sectional study performed over a 5-year period from June 2008 to February 2013. Healthy nulliparous women with singleton viable pregnancy were recruited consecutively from the routine antenatal clinic at St George's Hospital, University of London. The local institutional review committee approved the study, and all participants provided written informed consent. Women who subsequently developed adverse maternal complications, such as diabetes mellitus, preeclampsia, peripartum cardiomyopathy, pregnancy complication, or any other medical comorbidity, were excluded from the analysis. Women were recruited at 4 time points during pregnancy (11-14, 20-23, 28-32, and 37-39 weeks' gestation) and at 1 year postpartum after pregnancy care in our institution. A group of 50 nonpregnant healthy volunteer nulliparous women matched for age was also assessed to derive baseline echocardiographic values. All groups were matched for ethnicity and maternal age. To ensure that we recruited optimally healthy women, we also excluded women with a prepregnancy body mass...

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Section: Comparison With Previous Studiessupporting

confidence: 82%

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confidence: 99%

Maternal Cardiovascular Function in Normal Pregnancy

et al. 2016

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“…The major hemodynamic changes induced by pregnancy include an increase in cardiac output between 30 and 40% (as a result of increased stroke volume and to a lesser extent increased maternal heart rate 15-20 bpm) [5], plasma volume expansion is 10-15% at 6-12 weeks of gestation, and at the term, is 30-50% higher than non-pregnant women, increase in red cell volume [6] (a greater increase in intravascular volume than red cell mass, that results in the dilutional or physiologic anemia of pregnancy), reductions in systemic vascular resistance and systemic blood pressure [7].…”

Section: Changes Physiologic In the Mothermentioning

confidence: 99%

“…O pregnancy ≥ 24 weeks, AU at 4 cm above the navel: possible hemodynamic compromise exerted by the uterus, cesarean section perimortem is indicated during cardiopulmonary arrest to benefit the mother as well as the fetus. Consider not closing the abdominal incision if cesarean section was necessary, to bind blood vessels as well as reduce the possibility of an abdominal compartment syndrome [2,3,[6][7][8][9][10].…”

Section: Cesarean Perimortemmentioning

confidence: 99%

Resuscitation of Obstetric Patient

Molano-Franco¹,

Maya²

2017

Resuscitation Aspects

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The number of cases of pregnant patients with cardiorespiratory arrest requiring resuscitation has increased worldwide, secondary to the main number of patients with high-risk pregnancies associated with chronic, especially cardiopulmonary, pathologies. The knowledge of the resuscitation algorithms by the health personnel responsible for the care of pregnant patients is mandatory, because due to different physiological and anatomical changes, there are particularities in the management and use of medications. In addition, a detailed description of the steps included in the resuscitation is necessary, where assessment of the airway, ventilation, circulation, and defibrillation determines a step in resuscitation. One of the determining and exclusive events in this type of patients is cesarea perimortem. That is why it includes a concrete description of the time and the indications for its realization. Finally, a list of medicines most used in resuscitation in pregnancy, with its dosage and safety range, is mentioned. The pregnant patient poses a challenge to resuscitation teams. This review refers to the recommendations for establishing "obstetric blue code" protocols at the institutional level.

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“…This is associated with significant cardiovascular and obstetric complications and drives poor outcomes in high risk groups. (3,4) Maternal cardiac disease in pregnancy is not infrequently complicated by heart failure, arrhythmias and stroke while these babies are at increased risk of low birth weight, prematurity and death. (5)(6)(7) It is therefore not surprising to find that maternal cardiac disease is the leading cause of maternal mortality in many first world countries.…”

Section: Introductionmentioning

confidence: 99%

Patient profi le of a tertiary obstetric-cardiac clinic

Merwe

Hall

Herbst

et al. 2017

SAHJ

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relatively fixed combination of factors, can often surprise one. Gestational age at presentation, the unique combination of maternal functional status at a given gestation coupled with the severity of cardiac disease and the known natural course Results: There were 231 women, rheumatic heart disease (n=79; 34.2%) was the predominant cardiac disease followed by congenital heart disease (n=78; 33.8%), medical conditions (n=38; 16.4%) and previous peripartum cardiomyopathy (n=9; 3.9%). Eighty-two women (35.5%) were perceived to be extremely high risk and their entire pregnancies were managed in the Obstetric-Cardiac clinic. The most common RHD lesion was mitral regurgitation (34.2%) and mixed mitral valve disease (24.1%). The most frequent CHD was ventricular septal defects (n=27; 35%). Conclusions: The cardiac disease profi le of patients seen at this obstetric-cardiac clinic in a South African tertiary hospital refl ects a transition from the disease profi le of a typical developing country (high burden of rheumatic heart disease) to the disease profi le seen in a more developed country (high burden of congenital heart disease). This could indicate improved quality of socio-economic development and the health care system. The increasing complexity of cardiac pathology that has to be dealt with in pregnant patients presenting to a tertiary hospital requires close collaboration between the obstetrician, cardiologist, cardiac surgeon and anesthetist caring for these patients. A dedicated obstetric-cardiac clinic is a good model to utilise in a tertiary hospital when aiming to optimise the care of patients with cardiac disease in pregnancy.

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Cardiac structure and function in normal pregnancy

Cited by 112 publications

References 56 publications

Maternal Cardiovascular Function in Normal Pregnancy

Maternal Cardiovascular Function in Normal Pregnancy

Resuscitation of Obstetric Patient

Patient profi le of a tertiary obstetric-cardiac clinic

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