EDEMA IN PREGNANCY
By: Doc Mo
N (of 1354)
Percentage
Hypertension
20
21.5
Pulmonary
20
21.5
Cardiac
11
11.8
Hemorrhage
8.6
CNS
8.6
Sepsis/Infection
6.4
Malignancy
6.4
Pregnancy physiology
Cardiovascular adaptations:
10% by 7th week
Plateau at 50% by 32
weeks
Larger increase in
Blood pressure variability (CO
x SVR)
multiples
Accompanied by RBC
Increased cardiac output (HR
x SV)
mass
SVR variability
Pregnancy physiology
Cardiovascular adaptations:
RBC mass < PV
Better placental
perfusion?
Blood viscocity
Stasis
(CO
x SVR)
Placental thrombosis
Protective during delivery
Pregnancy physiology
Cardiovascular adaptations:
BP = CO x SVR
Influenced by GA &
position
10% by 7th week
(likely due to
progesterone)
SVR variability
to
Pregnancy physiology
Cardiovascular adaptations:
20% in pregnancy
Likely 2 to SVR
Some impact from FT4
other causes
SVR variability
Pregnancy physiology
Cardiovascular adaptations:
CO = HR x SV
Reflects LV capacity
Increases by 10th week
weeks
(4.5 L/min 6.0 L/min)
2 to HR before 20 weeks
2 to SV after 20 weeks
Pregnancy physiology
Cardiovascular adaptations:
Increased plasma volume
Hemodilution
Measure of impedance to
maternal after load
Decreases in 1st/2nd
trimester
(Nadir by 14-24 weeks)
Inversely proportional to
Increased cardiac output (HR
x SV)
CO
SVR variability
Pregnancy physiology
Cardiovascular adaptations (during labor):
CO (35%) & HR (7%) during contractions
SupineLateral position=22%CO & 27%SV
CO during contractions:
17% at less than 3 cm
23% at 4-7 cm
35% at 8 cm or more
(Offset by regional anesthesia)
Pregnancy physiology
Cardiovascular adaptations (post partum):
Impacted by blood loss at delivery
Increased CO (59%) & SV (71%) within 1-3 hours
500 ml
+5.2%
vs. Cesarean
1000 ml
-5.8%
Pregnancy physiology
Pulmonary adaptations:
Mucosal edema
Upper airways
Mechanics of respiration
Physiologic changes
Acid-base changes
Mucosal vascularity
Rhinitis & Epistaxis
Pregnancy physiology
Pulmonary adaptations:
Upper airways
Mechanics of respiration
Physiologic changes
Acid-base changes
8% thoracic
circumference
5 cm elevation of
diaphragm
Increase
15%
50%
76%
in dyspnea
by 10 weeks
by 19 weeks
by 31 weeks
Pregnancy physiology
Pulmonary adaptations:
FEV1
Upper airways
Mechanics of respiration
Physiologic changes
Acid-base changes
Unchanged
FRC
10-25%
TLC
minimally
Minute Vent20-40%
Alveolar Vent
50-75%
Pregnancy physiology
Pulmonary adaptations:
Upper airways
Mechanics of respiration
Physiologic changes
Acid-base changes
Pregnancy=Compensated
respiratory alkalosis
Pregnancy physiology
Other adaptations:
Genitourinary
Gastrointestinal
Hematologic
Endocrine
Immune
Pulmonary-Pulmonary Edema
Causes:
Hydrostatic
Systolic dysfunction
Diastolic dysfunction
Valvular disease
Permeability
Pneumonia
Septic shock
ARDS
Pulmonary-Pulmonary Edema
Treatment (general):
Sit patient upright
Administer oxygen (may use CPAP until diuresis)
Furosemide (aim for 2L diuresis in 3-4 hours)
Morphine (2-5 mg IV)
Treatment (Specific):
Systolic dysfunction (afterload reduction/inotrop/diuretic)
Diastolic dysfunction (anti-HTN)
Management
Acute pulmonary edema requires emergency
management. Furosemide is given in 20 to 40 mg
intravenous doses along with therapy to control
dangerous hypertension.
Ante/post artum? Fetus dead/alive?
cardioactive drugs lower peripheral resistance and
in turn severely diminish uteroplacental circulation.
The cause of cardiogenic failure echocardiography,
Not an indication for emergency cesarean delivery.
Indeed, in most cases, these women are better
served by vaginal delivery.