HEMODYNAMIC

CHANGE IN
PREGNANCY
BY
JEMA MARANDRA EMKAMAS
 INTRODUCTION
Physiological and anatomical alterations develop in
many organ systems during the course of pregnancy
and delivery.
During pregnancy and the puerperium, the heart
and circulation undergo remarkable physiological
adaptations.
Changes in cardiac function become apparent during
the first 8 weeks of pregnancy .
the cardiovascular system demonstrates changes
thatoptimize oxygen and nutrient delivery to the
growing fetus. Cardiac output has been
CARDIOVASCULAR CHANGE
HEART
RENIN, ANGIOTENSIN II
The renin-angiotensin-aldosterone blood
pressure control via sodium and water
balance.
All components of this system (in
normal pregnancy)
Renin produced by both the maternal
kidney and the placenta
Angiotensinogen produced by both
maternal and fetal liver.
Estrogen stimulated renin and
angiotensin production
BLOOD VOLUME
PREGNANCY BLOOD VOLUME
begins to increase during the first trimester
The function of Pregnancyhypervolemia
meets the metabolic demands of the enlarged
uterus and its greatly hypertrophied vascular system
provides abundant nutrients and elements to
support the rapidly growing placenta and fetus.
protects the mother, and in turn the fetus, against
the deleterious effects of impaired venous return in
the supine and erect positions
safeguards the mother during the parturition from
blood loss.
Angiotensin I

R
E
N prorenin
I
N

Induction of Natrium +
Angiotensin II aldosteron water
secretion resistance

Water
reabsorbtion,
blood water
volume ekscretion
ENDOTHELIN
Endothelins stimulate secretion of
ANP(atrial natriuretic peptide ) ,
aldosterone, and Nitric Oxide
endothelin receptors in pregnant and
nonpregnant myometrium.
Endothelins also have been identified in the
amnion, amnionic fluid, decidua, and
placenta
NITRIC OXIDE
potent vasodilator
released by endothelial cells, and
may have important implications for
modifying vascular resistance during
pregnancy.
PROSTAGLANDIN
have a central role in control of vascular
tone, blood pressure, and sodium balance.
increased markedly during late pregnancy
regulates blood pressure
CARDIAC OUTPUT
normal pregnancy :
mean arterial pressure
and vascular resistance
decrease, while CARDIAC
blood volume and basal OUTPUT
metabolic rate
increase.
 -ANP : of blood vessels
BP : CO muscle relaxation
-Nitric oxide : vasodilator
SVR -prostaglandin

SV HR

KONTRACTILITY
PRELOAD AFTERELOAD

VOL ANGIOTEN
PLASMA SIN
CIRCULATION
venous blood flow in the legs is retarded
during pregnancy.
Caused by during latter pregnancy is
attributable to occlusion of the pelvic veins
and inferior vena cava by the enlarged
uterus.
Supine uterus compressed vena
systemdisturb vena backflow CO
decreased hemodynamic disturbances
FETO-MATERNAL CIRCULATION