Circulatory System of Pregnant Women

Physiological Changes in the Cardiac Function of a Pregnant Woman

Several cardiological changes occurring in pregnant women include changes in the cardiac functions that contribute majorly to the so-called new circulatory system. As a result, the mother’s body embraces the child firmly, leading to its development and growth.

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Maternal hemodynamic changes: At the end of the first trimester, there is an increase of
50% rise in the renal plasma flow and glomerular filtration rate due to the vasodilation caused in the kidneys. There is a marked decrease observed in the serum creatinine, uric acid, and urea values.

Cardiac output: The cardiac output rises massively in the mother. Since invasive techniques cannot be undertaken, the mother is often measured on cardiac output by performing echocardiography. The highest rise is seen in the mother in the first trimester, and then it continues to increase in the second trimester. By the 24th week, the cardiac output rises by
45% in a normal pregnancy.

Blood Pressure: The marked decrease is observed in the systolic and diastolic blood pressure, mean arterial pressure, central systolic blood pressure during pregnancy. Blood pressure changes are again markedly increased in the third trimester after the fall in the previous two trimesters.

Heart Rate: Heart rate changes are marked, and striking changes are observed throughout gestation in the heart rate. Almost 10 to 20 beats per minute changes are observed in the heart rate during the entire pregnancy period. There is always a
20−25% increase from the baseline in the heart rate. Although several cardiac parameters undergo a sea change, there is still very little change in the myocardial contractility, left and right ventricular ejection fractions.

Changes in Plasma volume: A profound increase in the plasma volume and total blood volume is observed during pregnancy. Blood volume shows a steep rise in the first trimester and rapidly increases during the entire pregnancy.

Red blood cell mass: Red cell mass and generation of red blood cells (erythropoiesis) are increased during pregnancy. Therefore, the mothers would have changes in the blood flow, and the rise in blood count helps the growth and nourishment of the fetus.

Hormonal Changes observed in a Pregnant Mother

There has always been a strong link between pregnancy and hormonal changes. For example, progesterone and estrogen secretions are responsible for the increased vasodilation of the heart and the surrounding areas.

During pregnancy, the corpus luteum produces a hormone known as relaxin, which circulates in the body during pregnancy leading to changes in the body.

A higher concentration of progesterone and relaxin in the blood lowers the mean systolic blood pressure in the second and third trimesters.

Additionally, the activation of the renin-angiotensin-aldosterone hormone system during pregnancy increasing the plasma volume of the renin-angiotensin-aldosterone levels beginning at 6 to 8 weeks and progressing up to 28-30 weeks. As the estrogens increase, the renin substrate in the body also increases during pregnancy.

Transthoracic Echocardiography and Magnetic Resonance
In typical transthoracic echocardiography, there is a mild dilatation observed in the four chambers of the heart of a pregnant mother with respective changes in the right atrium and ventricle. There is also mitral regurgitation observed alongside tricuspid and pulmonary regurgitations. With the help of magnetic resonance imaging, the mother’s left ventricular volumes can be observed better. All these findings have always indicated a rise in the major volumes of cardiac systems in expecting mothers. Hence, there is a marked change in the circulatory system during pregnancy, and pregnant mothers move towards normalcy only after the gestation period comes to an end.

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