Maternal hemodynamic effects of uterine contractions by M-mode and pulsed-Doppler echocardiography

Article Abstract:

Many changes in the cardiovascular system occur during a normal pregnancy. These include: increased amount of circulating blood, the blood volume; increased amount of blood pumped out of the heart, the cardiac output; decreased heart rate and increased amount of blood ejected at each heart beat, the stroke volume. These changes are generally well tolerated in healthy normal pregnancies. Women having impaired heart function may not tolerate the blood- and heart-related stresses imposed by pregnancy. Echocardiography, the noninvasive use of sound waves directed at the heart to produce an image revealing the structure and motion of the heart muscle, was used to evaluate cardiovascular function in 19 normal laboring women. A spinal (epidural) anesthetic was used to control the pain of labor and delivery, though it had not been used in previous hemodynamic studies of pregnant women. The effect of uterine contractions on the function of the heart during epidural anesthesia was evaluated. It was found that uterine contractions during labor increased the stroke volume, but not the heart rate, which contributed to an 11 percent increase in the total cardiac output during contractions. Echocardiographic studies on other patient populations are recommended.

Cardiovascular diseases, Testing, Hemodynamics, Pregnancy, Labor (Obstetrics), Cardiovascular diseases in pregnancy

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Doppler assessment of the fetal and uteroplacental circulation during nifedipine therapy for preterm labor

Article Abstract:

Nifedipine is a calcium channel blocking agent which relaxes smooth muscle by preventing calcium from entering the cell. It is used to treat high blood pressure and early or preterm labor. To see how fetal circulation and the flow of blood through the placenta are affected by nifedipine, Doppler ultrasound, the use of high frequency sound to monitor movement, was performed on 11 normal fetuses during early labor. Arteries in the fetal brain, kidney, heart, lungs, and umbilical cord were evaluated. The arteries supplying the uterus were also evaluated. An initial 30 mg dose of nifedipine was followed four hours later by a 20 mg dose to treat preterm labor. Doppler determinations made before and five hours after nifedipine administration revealed no significant difference in the blood flow velocity among any of the blood vessels. Short-term nifedipine administration for the treatment of preterm labor did not produce changes in the blood circulation of the mother or the fetus, as determined by Doppler ultrasonography. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Blood flow, Maternal-fetal exchange, Fetus, Drug therapy, Premature labor, Doppler ultrasonography, Blood circulation, Nifedipine, Laser Doppler blood flowmetry, Laser Doppler flowmetry

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Ultrasonographic guidance for central venous access during pregnancy

Article Abstract:

A 26-year-old-woman pregnant with twins began labor early. She was diagnosed with hypertension, high blood pressure, and was given drug therapy to prevent seizures arising as a complication of high blood pressure. Further examination of the patient revealed lung edema, a swelling in the lung tissue, which was treated with the drug furosemide to reduce fluid retention. A day later the patient had a very low urine output, indicating that she required additional fluids. Fluid replacement via the central venous system, directly into a large vein, was decided upon. Fluids were delivered through the jugular vein, a large vein in the neck. Ultrasonography, the use of high frequency sound to visualize internal structures, was used to ease placement of a pulmonary artery catheter, a small tube placed into the vein. The application of real-time ultrasonography is useful when central venous monitoring is required in pregnant patients.

Care and treatment, Methods, Pregnancy, Complications of, Pregnancy complications, Intravenous catheterization, Prenatal ultrasonography, Ultrasonics in obstetrics

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