medigraphic.com
Federación Mexicana de Ginecología y Obstetricia, A.C.

2020, Number 05

<< Back Next >>

Ginecol Obstet Mex 2020; 88 (05)

Echocardiographical findings in pregnancy and late postpartum of healthy mexicans women´s

Íñigo-Riesgo CA, Gómez-Vargas JR, Gutiérrez-Fajardo P, Torres-Gómez LG

Language: Spanish
References: 33
Page: 296-305
PDF size: 370.00 Kb.


ABSTRACT

Objective: The aim of this prospective, observational and longitudinal study, was to evaluate and to compare the maternal adaptation through changes on anthropometric and Doppler echocardiographic parameters in Mexican normal pregnancy with single product.
Materials and Methods: Prospective, observational, longitudinal study, from January 2014 to January 2017. Obstetric ecosonograms and echocardiographic Doppler studies were performed on 2nd and 3rd trimester and six months postpartum. Each patient was her own control. The data were analyzed using SPSS Windows 17, ANOVA for compared the 3 groups with P value ‹ 0.05 was considered significant, as well as a non-parametric correlation of Pearson.
Results: There were thirty pregnant with a mean age 22.5 ± 3.1 years-old, between 2nd and 3rd trimester, with obstetrics ultrasound were corroborated gestational age. With transthoracic echocardiography, we found significant changes between 2nd trimester and 6 month post-partum, among the main, the left ventricle (LV) in diastole (cm), 4.5 ± 2.5 versus 4.2 ± 2.3 (p ‹ 0.01), end diastolic left ventricle volume (mL) 93 ± 14.8, vs 78 ± 17.8 (p ‹ 0.05). Stroke volume (mL) 99.5 ± 15.7 vs 86 ± 11.8 (p ‹ 0.01). Systemic vascular resistance (dyne/sec/cm5 ) 870 ± 108 vs 1,262 ± 176 (p ‹ 0.001). From, 2nd and 3rd trimester and postpartum, left atrial diameter (cm), 3.1 ± 4.4, 3.3 ± 4.4, 2.9 ± 4.3 (p ‹ 0.001). Cardiac output (L/m), 6.8 ± 0.4, 7.0 ± 0.4, 4.7 ± 0.4 (p ‹ 0.001).
Conclusion: Pregnancy is a transitory overload condition with important organic and functional effects mainly in the second trimester.


REFERENCES

  1. Walters WA, Lim YL. Changes in the maternal cardiovascular system during human pregnancy. Surg Gynecol Obstet 1970; 10:765-84.

  2. Capeless EL, Clapp JF. When do cardiovascular parameters return to their preconception values? Am J Obstet Gynecol 1991; 165: 883-86. https://doi.org/10.1016/0002- 9378(91)90432-Q

  3. Capeless EL, Clapp JF. Cardiovascular changes in early phase of pregnancy. Am J Obstet Ginecol 1989; 161:1449-53. https://doi.org/10.1016/0002-9378(89)90902-2

  4. Duvekot JJ, Peeters LL. Maternal cardiovascular hemodynamic adaptation to pregnancy. Obstet and Gynecol Surv 1994; 49: S1-S14.

  5. Lee Wesley, et al. Noninvasive maternal stroke volume and cardiac output determinations by pulsed Doppler echocardiography. Am J Obstet Gynecol 1988; 158:505-510. https://doi.org/10.1016/0002-9378(88)90014-2

  6. Pritchard JA, MacDonald PC, Gant NF Williams´ Obstetrics. 17th Ed. New York: Appleton-Century-Crofts, 1985:195.

  7. Dennis AT, et al. Echocardiographic determination of resting haemodynamics and optimal positioning in term pregnant women. Anaesthesia.2018; 73 (11):1345-1352. doi:10.1111/anae.14418

  8. Asín Cardiel E, Ruiz Martínez I. Diagnóstico en Cardiología. Ecocardiografía Modo M, Bidimensional, Contraste y Doppler. Ergometría, ECG dinámica (Holter), Cardiología nuclear. EMALSA, Interamericana McGraw-Hill. Madrid, 1988; 3-245.

  9. Feigenbaum, H. Ecocardiografía. 5ª ed. Buenos Aires: Médica Panamericana, 1994; 132-76.

  10. Bamfo JE, et al. Reference ranges for tissue Doppler measures of maternal systolic and diastolic left ventricular function. Ultrasound Obstet Gynecol 2007; 29: 414-420. doI:10.1002/uog.3966

  11. Desai DK, et al. Echocardiographic assessment of cardiovascular hemodynamics in normal pregnancy. Obstet Gynecol 2004; 104: 20-9. doi: 10.1097/01. AOG.0000128170.1516.1d

  12. Wang Y, Moss J Thisted R. Predictors of Body Surface Area. J. Clin Anesth. 1992; 4: 4-10. https://doi.org/10.1016/0952- 8180(92)90111-D

  13. Quinones MA, et al. Recommendations for quantification of Doppler echocardiography: a report from the Doppler. Quantifications Task Force of the Nomenclature and Standards Committee of American Society of Echocardiography. J Am Soc Echocardiogr. 2002; 15: 167-84. doi:10.1067/ mje.2002.120202

  14. Ihlen H, et al. Determinations of cardiac output by Doppler echocardiography. Br Heart J 1984; 51:51-54-60.

  15. Adeyeye VO, et al. Echocardiographic Assessment of cardiac changes during normal pregnancy among Nigerians. Clinical Medicine Insights: Cardiology 2016:10; 157-162. doi:10.4137/CMC.S40191

  16. Melchiorre K, et al. Cardiac structure and function in normal pregnancy. Curr Opin Obstet Gynecol 2012; 24: 413-21. doi: 10.1097/GCO.Ob013e328359826f

  17. Valensise H, et al. Maternal cardiac systolic and diastolic function: relationship with uteroplacental resistances. A Doppler and Echocardiographic longitudinal study. Ultrasound Obstet Gynecol 2000; 15:487-97. https://doi. org/10.1046/j.1469-0705.2000.00135.x

  18. Kametas NA, et al. Maternal left ventricular transverse and long-axis systolic function during pregnancy. Ultrasound Obstet Gynecol 2001; 18: 467-74. https://doi. org/10.1046/j.0960-7692.2001.00574.x

  19. Mesa A, et al. Left ventricular diastolic function in normal human pregnancy. Circulation 1999; 99: 511-17. https:// doi.org/10.1161/01.CIR.99.4.511

  20. Mashini IS, et al. Serial noninvasive evaluation of cardiovascular hemodynamics during pregnancy. Am J Obstet Gynecol 1987; 156:1208 -13. https://doi.org/10.1016/0002- 9378(87)90146-3

  21. Savu O, et al. Morphological and functional adaptation of the maternal heart during pregnancy. Circ Cardiovasc Imaging. 2012; 5:289-97. https://doi.org/10.1161/CIRCIMAGING. 111.970012

  22. Mone SM, et al. Control mechanisms for physiological hypertrophy of pregnancy. Circulation. 1996; 94:667-72. https://doi.org/10.1161/01.CIR.94.4.667

  23. Mabie WC, et al. A longitudinal study of cardiac output in normal human pregnancy. Am J Obstet Gynecol 1994; 170: 849-56.

  24. Cornette J, et al. Validation of maternal cardiac output assessed by transthoracic echocardiography against pulmonary artery catheterization in severely ill pregnant women: prospective comparative study and systematic review. Ultrasound in Obstetrics and Gynecology 2016; 49 (1): 317-29. https://doi.org/10.1002/uog.16015

  25. Petersen JW, al. Comparison of multiple non-invasive methods of measuring cardiac output during pregnancy reveals marked heterogeneity in the magnitude of cardiac output change between women. Physiol Rep. 2017; 5 (8). https://doi.org/10.14814/phy2.13223

  26. Bijl RC, et al. Methods and considerations concerning cardiac output measurement in pregnant women: recommendations of the International Working Group on Maternal Hemodynamics. Ultrasound Obstet Gynecol 2019; 54:35-50. https://doi.org/10.1002/uog.20231

  27. Ouzounian JG, Elkayam U. Physiologic changes during normal pregnancy and delivery. Cardiol Clin 30. 2012:317-329. https://doi.org/10.1016/j.ccl.2012.05.004

  28. Bamfo JEAK, et al. Maternal left ventricular diastolic and systolic long-axis function during normal pregnancy. Eur J Echocardiography 2007; 8, 360-68. https://doi. org/10.1016/j.euje.2006.12.004

  29. Fok WY, et al. Left ventricular diastolic function during normal pregnancy: assessment by spectral tissue Doppler imaging. Ultrasound Obstet Gynecol 2006; 28:789-93. https://doi.org/10.1002/uog.3849

  30. Buddeberg BS, et al. Cardiac structure and function in morbidly obese parturients: An echocardiographic study. Anesth Analg. 2019; 129 (2): 444-49. doi:10.1213/ ANE.0000000000003554

  31. Yuan L, et al. Echocardiographic study of cardiac morphological and functional changes before and after parturition in pregnancy-induced hypertension. Echocardiography. 2006; 23:177-82. https://doi.org/10.1111/j.1540- 8175.2006.00203.x

  32. Buddeberg BS, et al. The impact of gestational diabetes on maternal cardiac adaptation to pregnancy. Ultrasound Obstet Gynecol. 2019 Nov 30. https://doi.org/10.1002/uog.21941

  33. Balci A, et al. Associations between cardiovascular parameters and uteroplacental Doppler (blood) flow patterns during pregnancy in women with congenital heart disease: Rationale and desing of the Zwangerschap bij Aangeboren Hartafwijking (ZAHARA) II study. Am Heart J. 2011; 161:269-75. https://doi.org/10.1016/j.ahj.2010.10.024




2020     |     www.medigraphic.com