Role of echocardiography for assessment of cardiovascular haemodynamics during pregnancy

Abstract

Background: Pregnancy is associated with volume overload producing significant vascular and hemodynamic adaptations in cardiovascular physiology. Present study was designed to follow up gradual adaptations in cardiovascular hemodynamics during the course of pregnancy using Doppler echocardiography which is reproducible and noninvasive technique. Methods: In present prospective study of 50 women, were divided into 2 groups of 25 each: control group & study group (pregnant patient in I trimester, II trimester & III trimester). They were non-invasively analysed for cardiovascular function and systemic hemodynamics using echocardiography and compared with control group. The data was analysed using ANOVA for comparison within the group and student's t-test for comparison between the groups. p value <0.05 was considered to be significant. Results: Mean age and height in control and study groups were comparable. Weight gain was within the expected range with advancement of pregnancy. Heart rate was increased in I and II trimesters with peak rise in III trimester. The difference between control group and study groups was statistically significant (p < 0.05).Systolic blood pressure was slightly decreased in all the trimesters as compared to control group which was statistically not significant. There was gradual increase in SBP from I to III trimesters. Diastolic blood pressure progressively decreased in I and II trimesters and then increased in III trimester. The difference in DBP between control group and I, II trimesters of pregnancy was significant (p<0.05).Systemic vascular resistance progressively decreased with advancement of pregnancy and difference was statistically significant (p <0.05) . Cardiac output is steadily increased in all trimesters of pregnancy with peak at 36 weeks and was statistically significant (p<0.05). It was due to increase in both heart rate and Stroke volume. Ejection fraction also increased in all trimesters. Conclusions: Present study shows significant functional changes in the cardiovascular dynamics during pregnancy. Doppler echocardiography provides an excellent noninvasive method for the evaluation and serial analysis of hemodynamic changes. These results will help in distinguishing abnormal echocardiographic changes from the normal physiologic changes of pregnancy. Therefore maternal echocardiography should be introduced into the antenatal management protocol, which will help to identify women at high risk to developing cardiovascular complications and there by early intervention.

Dyspnea in pregnancy might be related to the incomplete physiological adaptation of the heart

“…Other major cardiovascular changes associated with a normal pregnancy include increased stroke volume, cardiac output, heart rate, and venous return, as well as a paradoxical fall in systemic vascular resistance and blood pressure. 14 These hemodynamic alterations are mandatory to protect the mother from the consequences of hemorrhage and for the optimal growth of the fetus. 4 The other alteration in the maternal cardiopulmonary system is the effect of pregnancy on pulmonary artery pressure and left ventricular end-diastolic pressure.…”

“…Recently, speckle-tracking echocardiography and evaluation of ventricular strain, particularly GLS and GCS, have provided more comprehensive information regarding ventricular dysfunction in pregnant women with dyspnea and subclinical abnormalities. 14 …”

Assessment of Clinical and Echocardiographic Findings of Pregnant Women with Dyspnea

“…The calculated sample size was 323 by taking 70% prevalence. 15 Inclusion Criteria: Consecutive pregnant females irrespective of trimester were included in the study.…”

Physiological Changes in Cardiovascular System during Normal Pregnancy: A Review

“…15 Increased CO during the last trimester has not been projected sufficiently as a variety of studies are available showing a decrease, no change, or an increase, and have been mostly attributed to subjective adaptations of the mother during pregnancy along with interference by anthropometric variables of the mother and positioning of the body. 13,[16][17][18][19][20][21][22][23][24][25][26] Studies have also shown that this increased CO is likely to be enhanced in subsequent pregnancies. 27 The changes in CO are attributed to either neurohumoral factors such as estrogen and progesterone or placental factors.…”