Table 1
Hemodynamic changes of pregnancy, labor, and delivery and the early postpartum period. CO: cardiac output; HR: heart rate: SVR: systemic vascular resistance
| HEMODYNAMIC CHANGES OF PREGNANCY |
|---|
| Increased heart rate |
| Increased plasma volume |
| Decreased systemic vascular resistance |
| Increased cardiac output |
| Increased hypercoagulable state |
| HEMODYNAMIC CHANGES OF LABOR AND DELIVERY |
| Initial rapid increase in HR, stroke volume, CO |
| Return of blood from placenta to mother with uterine contractions (≤ 500 cc/ contraction), increases preload |
| HEMODYNAMIC CHANGES OF EARLY POSTPARTUM |
| CO peaks, ~80% higher than pre-labor CO |
| Increased preload |
| Normalization of SVR to prepregnancy levels (increased afterload) |
| Hypercoagulable state persists to ~8-12 weeks postpartum |
Table 2
Considerations for valvular lesions during pregnancy, by type. CO: cardiac output: TTE: transthoracic echocardiogram; AV: atrioventricular
| Obstructive Lesions | Severe obstructive lesions are poorly tolerated in pregnancy |
| Aortic stenosis | Risk of decompensated heart failure throughout pregnancy with increased CO and plasma volume |
| Follow with TTE each trimester | |
| Treat based on symptoms: consider AV nodal blocking agents, diuretics | |
| Mitral stenosis | Risk of decompensated heart failure and atrial arrhythmias |
| Follow with TTE each trimester | |
| Treat with AV nodal blocking agents, diuretics, consider anticoagulation for atrial arrhythmias | |
| Pulmonary and tricuspid stenosis | Less common, generally better tolerated than left sided lesions |
| Treat based on symptoms: consider AV nodal blocking agents, diuretics | |
| Regurgitant lesions | Regurgitant lesions are generally better tolerated than obstructive lesions |
| Treat based on symptoms: consider AV nodal blocking agents, diuretics, vasodilators | |
| Prosthetic valves | Mechanical valves: obligate anticoagulation during pregnancy |
| Bioprosthetic valves: valve degeneration may require repeat intervention during pregnancy |