Role of echocardiography for assessment of cardiovascular haemodynamics during pregnancy

Sonali S. Somani, Sunandini R, Shashikant G. Somani


Background: Pregnancy is associated with volume overload producing significant vascular and hemodynamic adaptations in cardiovascular physiology. Present study was designed to follow up gradual adaptations in cardiovascular hemodynamics during the course of pregnancy using Doppler echocardiography which is reproducible and noninvasive technique.

Methods: In present prospective study of 50 women, were divided into 2 groups of 25 each: control group & study group (pregnant patient in I trimester, II trimester & III trimester). They were non-invasively analysed for cardiovascular function and systemic hemodynamics using echocardiography and compared with control group. The data was analysed using ANOVA for comparison within the group and student’s t- test for comparison between the groups. p value <0.05 was considered to be significant.

Results: Mean age and height in control and study groups were comparable. Weight gain was within the expected range with advancement of pregnancy. Heart rate was increased in I and II trimesters with peak rise in III trimester. The difference between control group and study groups was statistically significant (p < 0.05).Systolic blood pressure was slightly decreased in all the trimesters as compared to control group which was statistically not significant. There was gradual increase in SBP from I to III trimesters. Diastolic blood pressure progressively decreased in I and II trimesters and then increased in III trimester. The difference in DBP between control group and I, II trimesters of pregnancy was significant (p<0.05).Systemic vascular resistance progressively decreased with advancement of pregnancy and difference was statistically significant (p <0.05) . Cardiac output is steadily increased in all trimesters of pregnancy with peak at 36 weeks and was statistically significant (p<0.05). It was due to increase in both heart rate and Stroke volume. Ejection fraction also increased in all trimesters.

Conclusions: Present study shows significant functional changes in the cardiovascular dynamics during pregnancy. Doppler echocardiography provides an excellent noninvasive method for the evaluation and serial analysis of hemodynamic changes. These results will help in distinguishing abnormal echocardiographic changes from the normal physiologic changes of pregnancy. Therefore maternal echocardiography should be introduced into the antenatal management protocol, which will help to identify women at high risk to developing cardiovascular complications and there by early intervention.



Pregnancy, Echocardiography, Hemodynamics

Full Text:



Schrier RW. Pathogenesis of sodium and water retention in high output and low output cardiac failure, nephrotic syndrome and pregnancy. N Engl J Med. 1989;319:1127-34.

Presbitero P, Boccuzzi GG, Groot CJM, Roos-Hesselink JW. ESC textbook of cardiovascular medicine. Oxford: Oxford University Press. 2009.

Siu SC, Sermer M, Colman JM, Alvarez AN, Mercier LA, Morton BC et al. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation. 2001;104:515–21.

Vered Z, Poler SM, Gibson P, Wlody D, Wrez J. Noninvasive Detection of the morphologic and hemodynamic changes during normal pregnancy. Clin Cardiol. 1991;14:327-34.

Robson SC, Hunter S, Boys RJ and Dunlop W. Serial study of factors influencing changes in cardiac output during human pregnancy. Am J Physiol. 1989;256:1060-5.

Sahn DJ, DeMaria A, Kisslo J, Weyman A. Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation. 1978;58:1072-83.

Van Oppen AC, Stigter RH, Bruinse HW. Cardiac output in normal pregnancy: A critical review. Obstet Gynecol. 1996;87:310-8.

Desai DK, Moodley J, Naidoo DP. Echocardiographic assessment of cardiovascular hemodynamics in normal pregnancy. Obstetrics & Gynecology. 2004;104(1):20-9.

Mabie VC, DiSessa TG, Crocker LG, Sibai BM, Arheart KLA. Longitudinal study of cardiac output in normal pregnancy. Am J Obstet Gynecol. 1994; 170(3):849-56.

Wilson M, Mongauti AA, Zervondeki I, Letcher RL, Romney BM, Von Oeyon P et al. Blood pressure, the rennin-aldosterone system and sex steroids throughout normal pregnancy. Am J Med. 1980;68(1):97 –107.

Bharshankar JR, Kakade CT , Bharshankar RNS, Kale AH . Hemodynamic changes in normal Indian primigravida: Serial evaluation by echocardiography. Int J Biol Med Res. 2012; 3(1):1289-93.

Bene RD, Barletta G, Mello G, Lazzeri C, Mecacci F, Parretti E et al. Cardiovascular function in pregnancy: effects of posture. British Journal of Obstetrics and Gynaecology. 2001;108:344-52.

Cong J, Fan T, Yang X, Squires JW, Cheng G, Zhang L et al. Structural and functional changes in maternal left ventricle during pregnancy: a three-dimensional speckle-tracking echocardiography study. Cardiovascular Ultrasound .2015;13:6.

Tso G, Lee J, Lui G, Trivedi H, Cohen M, Bernstein P et al. Range of echocardiographic parameters during normal pregnancy. Montefiore Medical Center, Bronx, NY, JACC . 2012;59(13):534-47.

Hankins GD, Clark SL, UCI Kan E, Van Hook JW. Maternal oxygen transport variables during the third trimester of normal pregnancy. Amj Obstet Gynaecol. 1999;180:406-9.

Simmons LA, Gillin AG, Jeremy RW. Structural and functional changes in left ventricle during normotensive and preeclamptic pregnancy. Am J Physiol. 2002;283:1627-33.

Schannwell CM, Zimmerman T, Schneppenheim M, plehn G. Left ventricular hypertrophy and diastolic dysfunction in healthy pregnant women. Cardiology.2002;97:73-8.

Weiner CP, Lizasoain I, Baylis SA, Knowles RG, Charles IG. Induction of calcium dependent nitric oxide synthases by sex hormone. Proc Natl Acad Sci. 1994;91:5212-6.

Cunningham FG, Leveno KJ, Bloom SL et al. In Maternal Physiology. Williams Obstetrics 22nd edn. Mc Graw-Hill. 2005;129:135-6.

Poppas A, Shroff SG, Korcarz CE, Hibbard JU. Serial assessment of cardiovascular system in normal pregnancy. Circulation. 1997;95:2407-15.

Carbillon L, Uzan M, Uzan S. Pregnancy, vascular tone and maternal hemodynamics: A crucial adaptation. Obstet Gynecol Surv. 2000;55:574-81.

Savu O, Jurcuţ R, Giuşcă S, van Mieghem T, Gussi I, Popescu BA et al. Morphological and functional adaptation of the maternal heart during pregnancy, Circ Cardiovasc Imaging. 2012;5(3):289-97.

Duvekot JJ, Cheriex EC, Pieters FAA, Paul MPCA, Louis PLH. Early pregnancy changes in volume homeostasis develop as a consequence of preceding changes in maternal hemodynamic. Am Obstet Gynecol. 1993;169(6):1382-92.

Gilson GJ, Samaan S, Crawford MH, Qualls CR, Curete LG. Changes in hemodynamics, ventricular remodelling and ventricular contractility during normal pregnancy: A longitudinal study. Obstet Gynecol. 1997;89 (6):957-62.