Pulmonary function during pregnancy in normal women and in patients with cardiopulmonary disease

Abstract

Pulmonary function studies were carried out during pregnancy in 8 normal women, in 8 patients with valvular (either mitral or aortic) heart disease, and in 8 patients with chronic pulmonary disease (either emphysema or sarcoidosis). In healthy pregnant women, changes in lung volumes and maximal expiratory flow rates were not significant. Diffusing capacity tended to decrease associated with unchanged pulmonary capillary blood volume. In patients with valvular heart disease, ventilation and oxygen consumption increased toward the term. The patients with mitral valve lesions showed a significant decrease in diffusing capacity with an increase in pulmonary capillary blood volume. In patients wth emphysema, characteristic changes were increasing obstructive functional abnormalities associated with an increase in pulmonary diffusing capacity and pulmonary capillary blood volume. None of these patients, however, had clinical evidence of deterioration of their disease. Patients with sarcoidosis had no appreciable alteration in pulmonary function tests.The influence of various factors, such as increased ovarian hormones, ventilation-perfusion relationships, intra-abdominal distension, and cardiac haemodynamics, are discussed in relation to the change in pulmonary diffusing capacity and pulmonary capillary blood volume. From the standpoint of pulmonary function studies we think that patients with mitral heart disease and those with pulmonary emphysema tolerate pregnancy less favourably than normal subjects and patients with sarcoidosis.The influence of pregnancy on pulmonary function has been reported by many workers. While some investigators found that pregnancy has little effect on overall respiratory function, others felt that such factors as the gradual abdominal distension, the enlarged breasts, and the inherent circulatory changes do indeed affect the respiratory physiology in the pregnant woman. In the chronically ill patient, it is even more difficult to overlook the progression of respiratory symptoms and the diminution of cardiac reserve during the second half of pregnancy and during the early post-partum period. Part of the problem becomes evident when one notes that there have been only a few reports of serial pulmonary function studies in normal pregnant women as well as in pregnant patients with cardiopulmonary disease. This paper reports the studies of pulmonary function in 8 normal women and 16 patients with various cardiopulmonary diseases during each of the three trimesters of pregnancy and 10 weeks after delivery. Special attention is focused on changes in pulmonary diffusing capacity and pulmonary capillary blood volume. METHODS OF STUDYIn eight normal women and 16 patients, pulmonary function tests were studied during the first (10th week), the second (24th week), and the third (36th week) trimesters of pregn.ancy and 10 weeks after delivery. The data obtained 10 weeks after delivery were considered as the control values. In all patients radiographs of the chest with shielded abdomen, and electrocard...

Respiratory function in singleton and twin pregnancy

“…These results are consistent with the majority of previous studies 2,3,10,11 , although only findings from singleton pregnancies were reported. In contrast, Milne et al 13 found the pulmonary diffusing capacity decreased to a low at 24 weeks of gestation, but their sample included smokers and smoking reduces the pulmonary diffusing capacity.…”

Spirometric Evaluation of Antenatal Women and Their Outcome at a Tertiary Care Centre

“…Changes in lung capacities during pregnancy may also be attributed to various factors like exercise, increase in body weight, changes in chest wall, position and movement of diaphragm, mobility of thoracic cage, change in intraabdominal and intra-pleural pressures, changes in accessory muscles of respiration and mechanical effect of enlarging breasts. 3,14 The results of Monga et al, 15 Girija P et al, 10 Mokkapatti et al 4 agree with the result of present study of decrease in FVC during pregnancy, whereas the results of Gazioglu et al 16 M J Berry et al, 17 T K Das et al 12 show an FVC to be relatively constant during pregnancy. But the results of Anita Teli et al 18 Grindheim et al 19 and Surekha De et al 9 are at variance from those of present study showing increase in forced vital capacity.…”

An update on contraindications for lung function testing

“…A lax cervix leading to third trimester abortion is treated with a Shirodka suture where ‘bearing down’ may not a good idea in these patients. There are a variety of studies of lung function in human pregnancy, including spirometry,53 lung volumes,53 54 airway resistance,55 maximum mouth pressures,56 gas transfer54 57–59 or maximum oxygen uptake60 during swimming and cycling in the third trimester. Most find normal values and report no complications in women.…”