Skip to main content

Cardiorespiratory Physiology and Pathophysiology in Pregnancy

  • Conference paper
  • 131 Accesses

Part of the book series: Yearbook of Intensive Care and Emergency Medicine ((YEARBOOK,volume 1997))

Abstract

The pregnant state induces profound changes in the mother, resulting in significant alterations in normal physiology. Critical illness in pregnancy provides a unique challenge for the intensivist, in view of this altered maternal physiology, the presence of a fetus, and the occurrence of various diseases specific to pregnancy. The wellbeing of the fetus must be considered, both in terms of its own physiological requirements and its susceptibility to pharmacological and other hazards. Pregnancy-specific diseases such as preeclampsia are associated with characteristic physiological changes, and an understanding of these is essential for appropriate management. This chapter reviews some of the physiological changes occurring during pregnancy that are relevant to critical care management.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Ueland K (1976) Maternal cardiovascular dynamics. VII. Intrapartum blood volume changes. Am J Obstet Gynecol 126: 671–677

    PubMed  CAS  Google Scholar 

  2. Pritchard JA, Baldwin RM, Dickey JC, Wiggins KM (1962) Blood volume changes in pregnancy and the puerperium. Am J Obstet Gynecol 84: 1271–1281

    Google Scholar 

  3. Duvekot JJ, Peeters LLH (1994) Maternal cardiovascular hemodynamic adaptation to pregnancy. Obstet Gynecol Survey 49: S1 - S14

    Article  CAS  Google Scholar 

  4. Robson SC, Hunter S, Boys Richard J, Dunlop W (1989) Serial study of factors influencing changes in cardiac output during human pregnancy. Am J Physiol 256: H1060 - H1065

    PubMed  CAS  Google Scholar 

  5. Dian P, Maltau JM, Noddeland H, Fadnes HO (1985) Oedema-preventing mechanisms in subcutaneous tissue of normal pregnant women. Br J Obstet Gynaecol 92: 1113–1119

    Article  Google Scholar 

  6. Cotton DB, Gonik B, Spillman T, Dorman KF (1984) Intrapartum to postpartum changes in colloid osmotic pressure. Am J Obstet Gynecol 149: 174–177

    PubMed  CAS  Google Scholar 

  7. Kinsella SM, Lohmann G (1994) Supine hypotensive syndrome. Obstet Gynecol 83: 774–788

    PubMed  CAS  Google Scholar 

  8. Lee W, Rokey R, Miller J, Cotton DB (1989) Maternal hemodynamic effects of uterine contractions by M-mode and pulsed-Doppler echocardiography. Am J Obstet Gynecol 161: 974–977

    PubMed  CAS  Google Scholar 

  9. Robson SC, Dunlop W, Hunter S (1987) Haemodynamic changes during the early puerperium. Br Med J 294: 1065

    Article  CAS  Google Scholar 

  10. Robson SC, Hunter S, Moore M, Dunlop W (1987) Haemodynamic changes during the puerperium: a Doppler and M-mode echocardiographic study. Br J Obstet Gynaecol 94: 1028–1039

    Article  PubMed  CAS  Google Scholar 

  11. Nolan TE, Wakefield ML, Devoe LD (1992) Invasive hemodynamic monitoring in obstetrics. A critical review of its indications, benefits, complications, and alternatives. Chest 101: 1429–1433

    Article  PubMed  CAS  Google Scholar 

  12. Clark SL, Horenstein JM, Phelan JP, Montag TW, Paul RH (1985) Experience with the pulmonary artery catheter in obstetrics and gynecology. Am J Obstet Gynecol 152: 374–378

    PubMed  CAS  Google Scholar 

  13. Clark SL, Cotton DB, Lee W, et al (1989) Central hemodynamic assessment of normal term pregnancy. Am J Obstet Gynecol 161: 1439–1442

    PubMed  CAS  Google Scholar 

  14. Gallery EDM, Hunyor SM, Gyory AZ (1979) Plasma volume contraction: A significant factor in both pregnancy-associated hypertension (pre-eclampsia) and chronic hypertension in pregnancy. Q J Med 48: 593–602

    PubMed  CAS  Google Scholar 

  15. Benedetti TJ, Carlson RW (1979) Studies of colloid osmotic pressure in pregnancy-induced hypertension. Am J Obstet Gynecol 135: 308–311

    PubMed  CAS  Google Scholar 

  16. Groenendijk R, Trimbos JBMJ, Wallenburg HCS (1984) Hemodynamic measurements in pre-eclampsia: Preliminary observations. Am J Obstet Gynecol 150: 232–236

    PubMed  CAS  Google Scholar 

  17. Belfort MA, Anthony J, Kirshon B (1991) Respiratory function in severe gestational proteinuric hypertension: The effects of rapid volume expansion and subsequent vasodilatation with verapamil. Br J Obstet Gynaecol 98: 964–972

    Article  PubMed  CAS  Google Scholar 

  18. Kirshon B, Moise KJ, Cotton DB, et al (1988) Role of volume expansion in severe pre-eclampsia. Surg Gynecol Obstet 167: 367–371

    PubMed  CAS  Google Scholar 

  19. Mabie WC, Ratts TE, Sibai BM (1989). The central hemodynamics of severe pre-eclampsia. Am J Obstet Gynecol 161: 1443–1448

    PubMed  CAS  Google Scholar 

  20. Lang RM, Pridjian G, Feldman T, Newmann A, Lindheimer M, Borow KM (1991) Left ventricular mechanics in pre-eclampsia. Am Heart J 121: 1768–1775

    Article  PubMed  CAS  Google Scholar 

  21. Belfort MA, Anthony J, Saade R, et al (1993) The oxygen consumption/oxygen delivery curve in severe pre-eclampsia: Evidence for a fixed oxygen extraction state. Am J Obstet Gynecol 169: 1448–1455

    PubMed  CAS  Google Scholar 

  22. Sibai BM, Mabie BC, Harvey CJ, Gonzalez AR (1987) Pulmonary edema in severe pre-eclampsiaeclampsia: Analysis of thirty-seven consecutive cases. Am J Obstet Gynecol 156: 1174–1179

    PubMed  CAS  Google Scholar 

  23. Mabie WC, Ratts TE, Ramanathan KB, Sibai BM (1988) Circulatory congestion in obese hypertensive women: A subset of pulmonary edema in pregnancy. Obstet Gynecol 72: 553–558

    PubMed  CAS  Google Scholar 

  24. Blanchard K, Dandavino A, Nuwayhia B, Brinkman CR, Assali NS (1978) Systemic and uterine hemodynamic responses to dopamine in pregnant and non-pregnant ewes. Am J Obstet Gynecol 130: 669–673

    PubMed  CAS  Google Scholar 

  25. Fishburne JI, Meis PJ, Urban RB, et al (1980) Vascular and uterine responses to dobutamine and dopamine in the gravid ewe. Am J Obstet Gynecol 137: 944–952

    PubMed  CAS  Google Scholar 

  26. Greiss FC, Crandell DL (1965) Therapy for hypotension induced by spinal anesthesia during pregnancy. Observations on gravid ewes. JAMA 191: 793–796

    CAS  Google Scholar 

  27. Rosenfeld CR, Barton MD, Meschia G (1976) Effects of epinephrine on distribution of blood flow in the pregnant ewe. Am J Obstet Gynecol 124: 156–163

    PubMed  CAS  Google Scholar 

  28. James FM, Greiss FC, Kemp RA (1970) An evaluation of vasopressor therapy for maternal hypotension during spinal anesthesia. Anesthesiology 33: 25–34

    Article  PubMed  Google Scholar 

  29. Shnider SM, de Lorimier AA, Holl JW, Chapter FK, Morishima HO (1968) Vasopressors in obstetrics. 1. Correction of fetal acidosis with ephedrine during spinal hypotension. Am J Obstet Gynecol 102: 911–919

    PubMed  CAS  Google Scholar 

  30. Clark RB, Brunner JA (1980) Dopamine for the treatment of spinal hypotension during cesarean section. Anesthesiology 53: 514–517

    Article  PubMed  CAS  Google Scholar 

  31. Moran DH, Perillo M, LaPorta RF, Bader AM, Datta S (1991) Phenylephrine in the prevention of hypotension following spinal anesthesia for cesarean delivery. J Clin Anesth 3: 301–305

    Article  PubMed  CAS  Google Scholar 

  32. Contreras G, Gutierrez M, Beroiza T, et al (1991) Ventilatory drive and respiratory muscle function in pregnancy. Am Rev Respir Dis 144: 837–841

    Article  PubMed  CAS  Google Scholar 

  33. Baldwin GR, Moorthi DS, Whelton JA, MacDonnell KF (1977) New lung function and pregnancy. Am J Obstet Gynecol 127: 235–239

    PubMed  CAS  Google Scholar 

  34. Marx GF, Murthy PK, Orkin LR (1970) Static compliance before and after vaginal delivery. Br J Anaesth 42: 1100–1104

    Article  PubMed  CAS  Google Scholar 

  35. Rees GB, Pipkin FB, Symonds EM, Patrick JM (1990) A longitudinal study of respiratory changes in normal human pregnancy with cross-sectional data on subjects with pregnancy-induced hypertension. Am J Obstet Gynecol 162: 826–830

    PubMed  CAS  Google Scholar 

  36. Lucius H, Gahlenbeck H, Kleine HO, Fabel H, Bartels H (1970) Respiratory functions, buffer system, and electrolyte concentrations of blood during human pregnancy. Respir Physiol 9: 311–317

    Article  PubMed  CAS  Google Scholar 

  37. Templeton A, Kelman GR (1976) Maternal blood-gases, (PAO2-Pa02), physiological shunt and VD/VT in normal pregnancy. Br J Anaesth 48: 1001–1003

    Article  PubMed  CAS  Google Scholar 

  38. Archer GW, Marx GF (1974) Arterial oxygen tension during apnoea in parturient women. Br J Anaesth 46: 358–360

    Article  PubMed  Google Scholar 

  39. Levinson G, Shnider SM, deLorimier AA, Steffenson JL (1974) Effects of maternal hyperventilation on uterine blood flow and fetal oxygenation and acid-base status. Anesthesiology 40: 340–347

    Article  PubMed  CAS  Google Scholar 

  40. Moya F, Morishima HO, James LS (1965) Influence of maternal hyperventilation on the newborn infant. Am J Obstet Gynecol 91: 76–84

    PubMed  CAS  Google Scholar 

  41. Cook PT (1984) The influence on foetal outcome of maternal carbon dioxide tension at caesarean section under general anaesthesia. Anaesth Intens Care 12: 296–302

    CAS  Google Scholar 

  42. Ivankovic AD, Elam JO, Huffman J (1970) Effect of maternal hypercarbia on the newborn infant. Am J Obstet Gynecol 107: 939–946

    PubMed  CAS  Google Scholar 

  43. Clark RB, Stephens SR, Greifenstein FE (1971) Fetal and maternal effects of bicarbonate administration during labor. Anesth Analg 50: 713–718

    Article  PubMed  CAS  Google Scholar 

  44. Assali NS (1989) Dynamics of the utero-placental circulation in health and disease. Am J Perinatol 6: 105–109

    Article  PubMed  CAS  Google Scholar 

  45. Buss DD, Bisgard GE, Rawlings CA, Rankin JHG (1975) Utero-placental blood flow during alkalosis in the sheep. Am J Physiol 228: 1497–1500

    PubMed  CAS  Google Scholar 

  46. Polvi HJ, Pirhonen JP, Erkkola RV (1995) The hemodynamic effects of maternal hypo-and hyperoxygenation in healthy term pregnancies. Obstet Gynecol 86: 795–799

    Article  PubMed  CAS  Google Scholar 

  47. Meschia G (1979) Supply of oxygen to the fetus. J Reprod Med 23: 160–165

    PubMed  CAS  Google Scholar 

  48. Peeters LH, Sheldon RE, Jones MD, Makowski EL, Meschia G (1979) Blood flow to fetal organs as a function of arterial oxygen content. Am J Obstet Gynecol 135: 637–646

    PubMed  CAS  Google Scholar 

  49. Lapinsky SE, Kruczinski K, Slutsky AS (1995) Critical care in the pregnant patient. Am J Respir Crit Care Med 152: 427–455

    PubMed  CAS  Google Scholar 

Download references

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 1997 Springer-Verlag Berlin Heidelberg

About this paper

Cite this paper

Lapinsky, S.E. (1997). Cardiorespiratory Physiology and Pathophysiology in Pregnancy. In: Vincent, JL. (eds) Yearbook of Intensive Care and Emergency Medicine 1997. Yearbook of Intensive Care and Emergency Medicine, vol 1997. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-13450-4_27

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-13450-4_27

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-13452-8

  • Online ISBN: 978-3-662-13450-4

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics