Cardiovascular and

Respiration function in
pregnancy
Presented by Dr Omoregie O.B
Senior Registrar Obs&Gyn

Tuesday, October 14, 2008 1

 Cardiovascular function in
pregnancy
• Early pregnancy is xterised by peripheral
vasodilatation, the exact reason for the above is
unknown, however, vasoactive factors such as
nitric oxide derived from the endothelium has
been implicated.
• Pregnancy is a high metabolic state, with
increased heat production – increased
peripheral vasodilatation may be necessary to
control core temp (get rid of excess heat).

Tuesday, October 14, 2008 2

CO = HR x stroke volume

• Initially there is significant increase in HR

(noticeable from 5 wk gestation), with no
change in the stroke volume, until later in
pregnancy when the plasma volume has
increased due basically to increased
sodium retention.

Tuesday, October 14, 2008 3

 Changes in CVS in pregnancy
• HR progressively increases until the 3rd trimester
when the rate are 10-15 beats per minute higher
than the rate in the non- pregnant state (10-20%).
• The stroke volume progressively increases from
an average of below 5L/min in the non-pregnant
state to approximately 7L/min at about 20th wk of
pregnancy, with less dramatic changes thereafter
as the pregnancy progresses to term (30-50%).
• Decreased total peripheral resistance (35%).
• The SBP is relatively unchanged throughout preg.
Tuesday, October 14, 2008 4
 CVS changes (contd)
• The decrease in DBP is more marked in
early pregnancy such that there is a wide
pulse pressure, however, the DBP
increases in later pregnancy to levels
equal to those found in non-pregnant
state.
• Mean arterial pressure decreases (10%)
MAP = 1/3 pulse pressure + DBP

Tuesday, October 14, 2008 5

Changes in cardiac output in labour
Stages of labour % increase in cardiac
output
Latent phase 17

Active phase 23

Late 1st stage/2nd stage 34

Tuesday, October 14, 2008 6

 Normal changes in heart sounds
during pregnancy
• Increased loudness of the 1st and 2nd heart
sounds
• Splitting of the 1st heart sound.
• Loud 3rd heart sound by 20th wk gestation
• > 95% develop systolic murmur which disappear
after delivery.
• 20% have a transient diastolic murmur.
• 10% develop continuous murmur due to
increases blood flow in the breast.
• < 5% will have a 4th heart sound.
Tuesday, October 14, 2008 7
 Heart sounds
• 1st HS occurs with ventricular systole, due mainly
to the closure of the mitral valve.
• 2nd HS signifies the beginning of diastole and its
due to the closure of the aortic valve mainly.
• 3rd HS occurs in early diastole and it correspond
with the end of the first phase of rapid ventricular
filling.
• 4th HS occurs in late diastole due to increase
ventricular filling following atrial contraction
(systole) and related to reduced ventricular
compliance.

Tuesday, October 14, 2008 8

 Respiratory system in pregnancy
• Increased pulmonary blood flow occur due to the
increased cardiac output in pregnancy.

Blood gas and acid-base changes in preg

• decrease Pco2 (15-20%).
• Slight increase Po2

Both changes facilitate exchange of gases

between fetus and mother.
Tuesday, October 14, 2008 9
• The significant decrease in Pco2
predisposes pregnant women to respiratory
alkalosis, this however, is prevented by the
acid-base buffer system principally the
bicarbonate buffer system within the
erythrocyte – an enzyme carbonic anhydrase
converts carbonic acid to bicarbonate,
thereby releasing hydrogen ions to restore
pH. The resultant bicarbonate is excreted in
the kidney.
• In pregnancy the pH alters very little, while
bicarbonate excretion increases.
Tuesday, October 14, 2008 10
 The oxygen availability to maternal
tissues and placenta is increased
• In pregnancy there is increased 2,3-DPG
concentration in maternal RBC.
• 2,3-DPG preferentially binds to deoxygenated Hb
thereby enhancing the release of oxygen from the
RBC at relatively lower levels of Hb saturation (i.e
shifting the oxygen Hb dissociation curve to the
right) this enhances maternal tissue oxygenation.
• 2,3-DPG binds to the β-chain, hence only to adult
haemoglobin.
• In the fetus the oxygen Hb dissociation curve is
shifted to the left, relative to the maternal state,
thus facilitating the transfer of oxygen from mother
to fetus.
Tuesday, October 14, 2008 11
 Ventilatory changes in pregnancy
• The rib cage is displaced upward by the
pregnant uterus, with resultant increase in the
transverse diameter – it improves air flow along
the bronchial tree.
• Women with respiratory problems tend to
deteriorate less in pregnancy, than those with
other chronic disorder.
• Tidal volume increases (the volume of air that is
inspired or expired in a single breath during
regular breathing) – hence the lungs functions
more efficiently for gas transfer.
Tuesday, October 14, 2008 12
 Ventilatory changes (contd)
• The vital capacity decreases (VC is the maximum
volume of air exhaled from the point of maximum
inspiration).
VC = TV + IRV + ERV
• The functional residual capacity decreases. (FRC
is the volume of air in the lungs at tidal volume
end-expiratory position).
• FRC = RV + ERV
• The ventilatory changes do not adversely affect
the interpretation of forced expiratory volume in
one second (FEV1) and peak expiratory flow rate.
• Therefore, such test of ventilation could be used
for the management of pregnant asthmatics or
those with other obstructive pulmonary disorders.
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