Maternal cardiac function in normal twin pregnancy: a longitudinal study

Abstract

ABSTRACT

The Effect of Chorionicity on Maternal Cardiac Adaptation to Uncomplicated Twin Pregnancy: A Prospective Longitudinal Study

“…Furthermore, we documented progressive impairment of both systolic and diastolic function from the first to the third trimester, which was associated with a longitudinal increase in SV. These results are consistent with those previously reported in a cohort of uncomplicated twin gestations longitudinally evaluated throughout pregnancy and postpartum; however, in that study cardiac findings were not assessed separately according to chorionicity as the number of MC pregnancies was too small for comparison (6/30); DC pregnancies accounted for 80% (24/30) of the included cases and were assumed to be largely responsible for the observed findings [8].…”

“…More significant changes have been reported in twin compared to singleton pregnancies, including higher maternal cardiac output (CO) and lower total vascular resistance (TVR) across gestation [2][3][4][5][6][7][8]. In a recent study focusing on maternal haemodynamics in uncomplicated twin gestations, significant changes in systolic and diastolic function were documented from the first to third trimester [9].…”

Management of Pregnancy in Patients With Complex Congenital Heart Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association

“…[24][25][26][27][28][29][30][31][32][33] Maternal cardiac output increases 30% to 50% in a singleton pregnancy, with an additional 10% to 20% increment in a twin pregnancy. [34][35][36][37] Maternal posture can significantly affect cardiac output, especially after 20 weeks' gestation when the gravid uterus compresses the vena cava and pelvic veins. 38 Compared with measurements in late pregnancy in the left lateral recumbent position, cardiac output is lowered by ≈14% in the supine position and by ≈30% in lithotomy.…”

“…In the supine position, contractions are associated with an ≈15% rise in cardiac output; in the lateral position, cardiac output rises only ≈8% to 11%. 32,35,63 In the supine position, compression of the inferior vena cava by the gravid uterus reduces venous return and cardiac output, whereas virtual occlusion of the distal aorta and its branches by the uterus results in a greater increase in arterial pressure. 63.64 Lateral recumbency is not associated with impeded venous return or elevations in systemic arterial pressure.…”

“…Third Trimester (28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42) Weeks) The frequency of cardiac evaluation in late pregnancy must be individualized. Once the peak hemodynamic load of pregnancy is reached, normal symptoms of pregnancy (edema, dyspnea on exertion) may worsen, so patients must be monitored closely to distinguish such symptoms and signs of normal pregnancy from those that may reflect hemodynamic compromise.…”