Maternal Cardiac Function in Twin Pregnancy

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.…”

“…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.…”

The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: Heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs

“…During the course of pregnancy, there are a large number of pregnancyinduced hemodynamic changes in the cardiovascular system, which are summarized in Table 5 ( [57][58][59][60][61][62][63][64]. During the peripartum period, further changes are noted as well (65)(66)(67)(68).…”

Pregnancy and cardiovascular risk: A review focused on women with heart disease undergoing fertility treatment

“…7 Kametas and colleagues reported that, compared to women with singleton pregnancies, women with twin pregnancies experienced a maternal cardiac output increase of 20%. 13,14 In addition, there was a significant decrease in total vascular resistance and greater left ventricular (LV) end-diastolic and end-systolic dimensions, LV mass, fractional shortening and ejection fraction. 14 Labour and the postpartum period also pose additional physiological challenges with uterine contractions, expulsive efforts, pain, anxiety, blood loss and the process of uterine involution.…”