Elsevier

Obstetrics & Gynecology

Volume 87, Issue 2, February 1996, Pages 310-318
Obstetrics & Gynecology

Review
Cardiac output in normal pregnancy: A critical review

https://doi.org/10.1016/0029-7844(95)00348-7Get rights and content

Objective

To review the literature about the effect of normal pregnancy on cardiac output, with special attention to study design, measurement technique, position of the subject, and parity.

Data Sources

For studies from the period 1955–1987, we examined Cumulated Index Medicus (National Library of Medicine Cataloging in Publication. Chicago: American Medical Association). For studies from 1988 to May 1, 1994, we used Medline on SUver Platter (U.S. National Library of Medicine SUver Platter International, 1994).

Methods of Study Selection

Thirty-three cross-sectional and 19 longitudinal studies on cardiac output measurement in normal pregnancy were retrieved and reviewed. Thirteen longitudinal studies were excluded from analysis because an unvalidated technique was used or because not all subjects were measured at each study interval. The six remaining studies of genuine longitudinal design with at least two measurements throughout pregnancy were used for the definitive analysis. The results of the cross-sectional studies were included only to demonstrate a trend.

Data Extraction and Synthesis

By pooling data from cross-sectional studies, a tendency was shown toward a higher cardiac output in the second trimester compared with the first trimester, and a tendency toward lower cardiac output was found in the third trimester compared with the second trimester. After delivery, cardiac output was lower than at any time during pregnancy. Selected longitudinal studies showed that the rise in cardiac output occurred early in the first trimester, and a further rise occurred during the second trimester. During the third trimester, cardiac output rose, fell, or plateaued, irrespective of the method of measurement applied or conditions during measurement.

Conclusions

Cardiac output during the third trimester was widely divergent among the studies and probably dependent on individual factors. The tendency to report cardiac output as averages negated these inter-individual differences.

References (81)

  • AtkinsAFJ et al.

    A longitudinal study of cardiovascular dynamic changes throughout pregnancy

    Eur J Obstet Reprod Biol

    (1981)
  • HeethaarRM et al.

    Thoracic electrical bioimpedance, suitable for monitoring stroke volume during pregnancy?

    Eur J Obstet Gynecol Reprod Biol

    (1995)
  • RoySB et al.

    Circulatory effects of pregnancy

    Am J Obstet Gynecol

    (1966)
  • RovinskyJJ et al.

    Cardiovascular hemodynamics in pregnancy. II. Cardiac output and left ventricular work in multiple pregnancy

    Am J Obstet Gynecol

    (1966)
  • AdamsJQ

    Cardiovascular physiology in normal pregnancy; studies with the dye-dilution technique

    Am J Obstet Gynecol

    (1954)
  • VorysN et al.

    The cardiac output changes in various positions in pregnancy

    Am J Obstet Gynecol

    (1961)
  • SmithRW

    Cardiovascular alterations in toxemia

    Am J Obstet Gynecol

    (1970)
  • ClarkSL et al.

    Central hemodynamic assessment of normal term pregnancy

    Am J Obstet Gynecol

    (1989)
  • GroenendijkR et al.

    Hemodynamic measurements in preeclampsia: Preliminary observations

    Am J Obstet Gynecol

    (1984)
  • KuzniarJ et al.

    Echocardio-graphic estimation of hemodynamics in hypertensive pregnancy

    Am J Obstet Gynecol

    (1982)
  • VeilleJC et al.

    Cardiac size and function in pregnancy-induced hypertension

    Am J Obstet Gynecol

    (1984)
  • VeilleJ et al.

    Obesity pregnancy and left ventricular func-tioning during the third trimester

    Am J Obstet Gynecol

    (1994)
  • DrosteS et al.

    Maternal and fetal hemodynamic effects of autologous blood donation during pregnancy

    Am J Obstet Gynecol

    (1992)
  • MortonMJ et al.

    Exercise dynamics in late gestation: Effects of physical training

    Am J Obstet Gynecol

    (1985)
  • CapelessEL et al.

    When do cardiovascular parameters return to their preconception values?

    Am J Obstet Gynecol

    (1991)
  • UelandK et al.

    Maternal cardiovascular dynamics. IV. The influence of gestational age on the maternal cardiovascular response to posture and exercise

    Am J Obstet Gynecol

    (1969)
  • VeilleJC et al.

    Maternal cardiovascular adaptations to twin pregnancy

    Am J Obstet Gynecol

    (1985)
  • MashiniIS et al.

    Serial noninvasive evaluation of cardiovascular hemodynamics during pregnancy

    Am J Obstet Gynecol

    (1987)
  • CapelessEL et al.

    Cardiovascular changes in early phase of pregnancy

    Am J Obstet Gynecol

    (1989)
  • McGaugheyHS

    The cause of the blood and vascular alterations of normal pregnancy and pre-eclampsia

    Am J Obstet Gynecol

    (1952)
  • WallenburgHCS

    Hemodynamics in hypertensive pregnancy

  • RossoP et al.

    Maternal hemodynamic adjustments in idiopathic fetal growth retardation

    Gynecol Obstet Invest

    (1993)
  • RubierS et al.

    Systolic time intervals in pregnancy and in the postpartum period

    Am Heart J

    (1973)
  • RubierS et al.

    Cardiac size and performance during pregnancy estimated with echocardiography

    Am J Cardiol

    (1977)
  • SecherNJ et al.

    Measurements of cardiac stroke volume in various body positions in pregnancy and during caesarean section: A comparison between thermodilution and impedance cardiography

    Scand J Clin Lab Invest

    (1979)
  • EasterlingTR et al.

    Measurement of cardiac output during pregnancy: Validation of Doppler technique and clinical observations in preeclampsia

    Obstet Gynecol

    (1987)
  • EasterlingTR et al.

    Measurement of cardiac output in pregnancy by Doppler technique

    Am J Perinatal

    (1990)
  • MilsomI et al.

    Measurement of cardiac stroke volume by impedance cardiography in the last trimester of pregnancy

    Acta Obstet Gynecol Scand

    (1983)
  • MilsomI et al.

    Measurement of cardiac stroke volume during cesarean section: A comparison between impedance cardiography and the dye dilution technique

    Acta Anaesthesiol Scand

    (1983)
  • EasterlingTR et al.

    Measurement of cardiac output in pregnancy by thermodilution and impedance techniques

    Br J Obstet Gynaecol

    (1989)
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