Transthoracic Echocardiographic Assessment of the Heart in Pregnancy—a position statement on behalf of the British Society of Echocardiography and the United Kingdom Maternal Cardiology Society

Abstract

Pregnancy is a dynamic process associated with profound hormonally mediated haemodynamic changes which result in structural and functional adaptations in the cardiovascular system. An understanding of the myocardial adaptations is important for echocardiographers and clinicians undertaking or interpreting echocardiograms on pregnant and post-partum women. This guideline, on behalf of the British Society of Echocardiography and United Kingdom Maternal Cardiology Society, reviews the expected echocardiographic findings in normal pregnancy and in different cardiac disease states, as well as echocardiographic signs of decompensation. It aims to lay out a structure for echocardiographic scanning and surveillance during and after pregnancy as well as suggesting practical advice on scanning pregnant women.

Multimodality Imaging of Patent Ductus Arteriosus Complicated by Severe Pulmonary Arterial Hypertension in a Pregnant Patient

“…Pressure gradients in healthy pregnant women may be affected by a normal increase in blood flow and volume. 9 Nonetheless, this does not seem to apply to pregnant patients with pathologic hemodynamic derangements such as in our patient in whom the echocardiographic estimation of PASP and mean PA pressure were later confirmed invasively.…”

“…Normal changes in total blood volume and cardiac output seen in pregnancy can lead to increases in all chamber sizes and generally begin at 12 weeks’ gestation, with a return to baseline values within 3 to 6 months postpartum. 9 These increases in chamber size do not constitute dilation, although it should be noted that normative values for chamber sizes in pregnancy are not firmly established. In an observational echocardiographic study including 121 women, LVEF significantly increased in the second trimester compared with in nonpregnant controls (68% vs 63%, P < .03) and normalized in the third trimester.…”

Pregnancy Arrhythmias: Management in the Emergency Department and Critical Care

“…The most important echocardiographic modifications associated with pregnancy are predominantly attributed to pregnancy-induced hypervolemia and encompass the following aspects: (a) left atrial size increases by 0.4-0.5 cm, while the left ventricular diastolic dimension expands by 0.2-0.4 cm; (b) left ventricular mass experiences a rise of 5-10%, resulting in eccentric hypertrophy; (c) ventricular global systolic function shows no significant alteration; however, global longitudinal strain decreases to the lower end of the normal range in the later stages of pregnancy, maintaining stability until term; (d) each valve may exhibit mild regurgitation, especially in the third trimester; (e) small pericardial effusions are prevalent, reported in up to 25-40% of normal pregnancies; (f) slight elevations in pulmonary arterial pressure are observed [28][29][30][31][32].…”

Associations between Maternal Nutritional Status, Hemodynamic Parameters, and Delivery Outcomes in Low-Risk Pregnancies: A Prospective Observational Study

“…Maternal hemodynamic changes are already detectable in the first weeks of pregnancy and include increased heart rate (HR), cardiac output (CO), stroke volume (SV) and Smith–Madigan inotropy index (SMII), as well as decreased mean arterial pressure (MAP) and systemic vascular resistance (SVR). Both systolic blood pressure (SBP) and diastolic blood pressure (DBP) decrease during pregnancy with SBP decreasing slightly less compared to DBP, due to increased arterial compliance [ 1 , 2 ]. In this setting, the Ultrasonic Cardiac Output Monitor (USCOM) plays a pivotal role in investigating maternal hemodynamics in a non-invasive, reproducible, and time-saving way by assessing the flow through the aortic valve with a non-imaging continuous-wave Doppler transducer [ 3 , 4 , 5 , 6 ].…”