Alterations in physiology and anatomy during pregnancy

Tan, Eng Kien; Tan, Eng Loy

doi:10.1016/j.bpobgyn.2013.08.001

Cited by 366 publications

(269 citation statements)

References 83 publications

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“…Although these particular patients were in critical condition upon presentation, we note that early signs of hemorrhage may be difficult to detect. Since plasma volume is 30% higher in pregnant women, onset of clinical signs after aneurysm rupture may be delayed (49). Importantly, compensatory mechanisms after major hemorrhage may decrease blood flow to the placenta in an attempt to maintain adequate perfusion pressure in the mother, and fetal distress may be an early sign of blood loss in the mother (9).…”

Section: Maternal Outcomementioning

confidence: 99%

The management of intracranial aneurysms during pregnancy: a systematic review

Barbarite

Hussain

Dellarole

et al. 2015

Turkish Neurosurgery

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It has been estimated that 1.8% of women of childbearing age (16 to 44 years) develop intracranial aneurysms, however the incidence of unruptured intracranial aneurysms during pregnancy is not well established in the literature (25). Rupture of intracranial aneurysms occurs in the range of 1 to 10 per 100,000 pregnancies (1, 33). Case fatality from subarachnoid hemorrhage during pregnancy is reported as high as 83%, but outcomes have improved with better medical care (10, 12). Cerebrovascular management of aneurysms during pregnancy is complicated by the nature of maternal hemodynamics and their intimate relationship to the developing child. Given the dependence of the fetus on its mother, and the importance of a stable environment during fetal development, risk reduction from an intracranial aneurysm must clearly focus on both the mother and the child (39,40,42). Whether these aneurysms █ INTRODUCTIONAlthough intracranial aneurysms are uncommon during pregnancy, normal hemodynamic changes in pregnant women may increase vascular stress and the risk of aneurysm formation, progression and rupture (35,44,47). Systemically, maternal adaptations to pregnancy include increases in cardiac output (CO) and plasma volume (PV), and a redistribution of the CO between various organs (43). Cerebrovascular changes are thought to result from hormones that increase during pregnancy, such as estrogen, progesterone, and vascular endothelial growth factor (36). Other reported factors that may potentiate aneurysm progression during pregnancy include high levels of relaxin and increased wall tension from intraparenchymal artery hypoplasia (6, 51).Hemodynamic changes during pregnancy may favor the formation and rupture of intracranial aneurysms. Despite this risk, guidelines for managing intracranial aneurysms during pregnancy have not been clearly defined. The objective of this review is to describe the treatment options for pregnant women with intracranial aneurysms, and to report the maternal and fetal outcomes associated with different treatment strategies. A search of the literature was conducted using the PubMed database for the period January 1991 through June 2015. Aneurysm characteristics and management, pregnancy management, and maternal and fetal outcomes were evaluated. The most recent search was performed in June 2015. In total, 50 aneurysms (44 patients) were evaluated. Rupture was confirmed upon imaging in 36 aneurysms (72%), and most aneurysms ruptured during the third trimester (77.8%). Coil embolization was associated with a lower complication rate than clipping in patients with ruptured aneurysms (9.5% vs 23.1%). For patients with unruptured aneurysms, surgical management was associated with 31.9% fewer complications compared to no treatment. Most patients underwent Cesarean delivery (84%), and a combined neurosurgical-obstetrical procedure was used for 8 patients with ruptured aneurysms near term. Adverse outcomes were reported in 11.9% of children. Treatment of intracranial aneurysms during pregnancy is sa...

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Section: Maternal Outcomementioning

confidence: 99%

The management of intracranial aneurysms during pregnancy: a systematic review

Barbarite

Hussain

Dellarole

et al. 2015

Turkish Neurosurgery

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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%

“…Left lateral uterine displacement is necessary in the pregnant patient with fundal height at or above the umbilicus, to minimize aortocaval compression, to optimize venous return, and to generate adequate stroke volume during cardiopulmonary resuscitation [6].…”

Section: Changes Physiologic In the Mothermentioning

confidence: 99%

“…During pregnancy, the anatomy of the upper respiratory airway undergoes numerous changes; upper airway, the pharynx and larynx edema occur as a result of hormonal effects and may reduce visualization during laryngoscopy and therefore, intubation in a pregnant woman can be difficult, and smaller endotracheal tubes may be needed [6,8].…”

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%

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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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Ozone Exposure During Pregnancy and Risk of Gestational Hypertension or Preeclampsia in China

et al. 2023

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ImportanceAlthough certain air pollutants have been associated with adverse obstetric outcomes, evidence regarding the association of ozone (O3) exposure with the risk of hypertensive disorders in pregnancy (HDP) is limited and inconsistent.ObjectivesTo evaluate the association between gestational O3 exposure and HDP (ie, gestational hypertension and preeclampsia) risk, and to explore the window of susceptibility for O3 exposure during pregnancy.Design, Setting, and ParticipantsThis cohort study recruited pregnant patients from the Obstetrics and Gynecology Hospital of Fudan University in Shanghai, China, from March 2017 to December 2018. Participants were older than 18 years, had no infectious diseases or chronic noncommunicable diseases before pregnancy, were Shanghai residents with intent to participate in the study, and had plans to give birth in Shanghai. Gestational hypertension and preeclampsia were diagnosed according to the diagnostic criteria of the Chinese Society of Obstetrics and Gynecology during the study period. Data on residential addresses, demographic characteristics, and household living environments were collected from participants through a questionnaire survey. Data were analyzed from December 10, 2021, to May 10, 2022.ExposuresA high temporospatial resolution model was applied to predict individual levels of daily O3 exposure during pregnancy.Main Outcomes and MeasuresThe outcomes were gestational hypertension and preeclampsia, and data on these diagnoses were extracted from the hospital’s information system. A logistic regression model was used to estimate the associations between O3 exposure and risk of gestational hypertension or preeclampsia. Exposure-response associations were confirmed by restricted cubic spline functions. Distributed lag models were used to identify the O3 exposure window of susceptibility.ResultsAmong the 7841 participants (all females; mean [SD] age, 30.4 [3.8] years), 255 (3.2%) had gestational hypertension and 406 (5.2%) had preeclampsia. Pregnant individuals with HDP had considerably higher prepregnancy body mass indexes and lower educational levels. The mean (SD) O3 exposure levels were 97.66 (25.71) μg/m3 in the first trimester and 106.13 (22.13) μg/m3 in the second trimester. Each 10-μg/m3 increment of O3 exposure during the first trimester was associated with higher gestational hypertension risk (relative risk, 1.28; 95% CI, 1.04-1.57). However, gestational O3 exposure was not associated with the risk of preeclampsia. The restricted cubic spline function analysis revealed an exposure-response association between O3 exposure and risk of gestational hypertension.Conclusions and RelevanceResults of this study showed an association between increased gestational hypertension risk and O3 exposure during the first trimester. Furthermore, gestational weeks 1 to 9 were identified as the window of susceptibility for O3 exposure and elevated gestational hypertension risk. Sustainable O3 control is needed to reduce the disease burden of gestational hypertension.

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Alterations in physiology and anatomy during pregnancy

Cited by 366 publications

References 83 publications

The management of intracranial aneurysms during pregnancy: a systematic review

The management of intracranial aneurysms during pregnancy: a systematic review

Resuscitation of Obstetric Patient

Ozone Exposure During Pregnancy and Risk of Gestational Hypertension or Preeclampsia in China

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