cardiovascular system prof dk

7/30/2019 Cardiovascular System Prof DK

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Maternal Physiology :

Cardiovascular systemSMF/Dept.Obstetri dan Ginekologi

FK UNAIR - RSUD dr Soetomo

dr. Andita Hapsari


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During pregnancy and the puerperium, the heart and

circulation undergo adaptation.

Changes in cardiac Function The first 8 weeks Increase Cardiac output 5 week

Increases the resting pulse rate 10 beats/min

Plasma volume expansion begins Weeks 10 and 20and preload is increased


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Ventricular performance during pregnancy isinfluenced by :

The decrease in systemic vascular resistance

Changes in pulsatile arterial flow

Allow cardiovascular system to adjust to thephysiological demands of the fetus while

maintaining maternal cardiovascular integrity


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Cardiac sounds during pregnancy

(1) An exaggerated splitting of the first heart

sound with increased loudness of bothcomponents

(2) No definite changes in the aortic and

pulmonary elements of the second sound

(3) A loud, easily heard third sound

(Cutforth and MacDonald (1966))


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The reversible morphological and functional

adaptations

Physiological hypertrophy Never been absolutely proven

Derived with Echocardiographic, have not been verified with MRI

Cardiac plastcity is likely a continuum that encompassesphysiological growth (exercise), as well as pathological

hypertrophy (hypertension) -Hill and Olson, 2008

Serial Echocardiographic examination across pregnancy and

postpartum in 46 healthy women 34% greater left ventricular

muscle mass index during late vs early pregnancySchannwell and

associates, 2002

Any increased mass does not meet criteria for

hypertrophyHibbard and colleagues, 2009


10/25 Cardiac Output

Blood

volume and

basal

metabolicrate

Mean

arterial

pressure and

vascularresistance

Cardiac output at rest,in lateral

recumbent position,beginning in early pregnancy


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In lateral recumbent position

At term : increase 1.2 L/min (almost 20 percent)

a woman was moved from her back onto her left side.

Fetal oxygen saturation : 10 percent higher

a laboring woman is in a lateral recumbent > supine


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Multifetal pregnancies : Singletons

Maternal CO

by another almost 20% (SV 15 % and HR 3.5 %)

Left atrial diameter and left ventricular end-diastolic diameterdue to augmented preload

cardivascular reserve

due to the increased heart rate and inotropic contractility


13/25Hemodynamic Function in Late Pregnancy

Cardiac output Left ventricular function (stroke work index) ~ to the

nonpregnant normal range

Heart rate, stroke volume, and cardiac output

Systemic vascular and pulmonary vascular resistance

Colloid osmotic pressure.

NSC for -Pulmonary capillary wedge pressure

-Central venous pressure

(between late pregnancy and the puerperium)


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Arterial pressure usually decreases to a nadir at 24 to

26 weeks

Diastolic pressure decreases more than systolic

Antecubital venous pressure remains unchanged

Brachial

artery

pressure

cardiovascular system prof dk

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