Good work

1. Institute of Health Department of Biomedical Sciences M.
Physiology Unit
Advanced Cardiovascular System Seminar On Cardiovascular Response To
Pregnancy And Fetal Circulation Its Regulation And Related Disorders
By Temam G , may, 2023
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2. AIMS
TO GAIN AN UNDERSTANDING OF THE
PHYSIOLOGICAL CHANGES IN
CARDIOVASCULAR THAT OCCUR DURING
PREGNANCY AND FETAL CERCULATION ITS
REGULATION AND RELATED DISORDERS
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3. Physiological changes during pregnancy
 Circulatory
 Metabolic
 Respiratory
 Digestive
 Thermoregulation
 Urinary
 Skin
 Breasts
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4. Organ Systems
 Cardiovascular system
 Pulmonary system
 Genital tract
 Urinary system
 Endocrine system
 Gastrointestinal Tract
 Skin
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5. Hormones
 OESTROGEN
 Produced in corpus luteum that inhibits further
release of GnRH , LH and FSH. A new corps luteum
develops with each menstrual cycle.
 Produced by placenta after 12 weeks
 Responsible for growth particularly of uterus and
breasts
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6. Progesterone
 Produced in corpus luteum and then the placenta
 Relaxes smooth muscle.
 Inhibits uterine contractions until uterus is prepared
for labour.
 Regulates storage of body fat.
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7. Human Chorionic Gonadotrophic
 HCG is a produced by the placenta after implantion.
 Secreted from trophoblast of the developing embryo.
 Maintains corpus luteum until placenta takes over.
 Used in tests to confirm pregnancy.
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8. Three hormone in pregnancy
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9. Human placental lactogen
Alters maternal metabolism
Diverts glucose to fetus
Mobilises free fatty acids from maternal stores.
Lactogen has a relation ship in association
with a development of gestational DM
complication see pregnancy
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10. Maternal Changes - Anatomical And
Physiological
Cardiovascular changes
increase in SV.
increase in cardiac output.
increase in HR at given work load.
increase in blood volume (mostly during latter half of
pregnancy).
Uterus may compress large blood vessels reducing
venous return.
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11. Cardiovascular system: Anatomic changes
The earliest and most dramatic changes.
Improves fetal oxygenation and nutrition.
 Heart is displaced upward and to the left.
 Increase ventricular muscle mass and sizes increase.
 Pregnancy-associated changes in the cardiac position on a
chest x-ray may be confused with cardiac pathology until
the pregnancy is recognized.
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13. Cardiovascular Changes
INCREASE
• Blood volume
• Cardiac (heart) output
• Stroke volume
• End diastolic volume
• Resting pulse
• 40% of blood plasma
DECREASE
• Hematocrit
• Blood pressure
• Blood supply to uterus
• Cardiac reserve
• Vascular resistance
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14. Cardiovascular System …
 Hemoglobin stays the same (12-16 g/dL) initially.
 May drop down to 10 g/dL and still be normal
physiologic anemia.
 Normal pregnancy Hgb is 10-14 g/dL later in
pregnancy.
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15. Cardiova….
 Decreased Hct (38-47%)
Normal pregnancy Hct is 32-42 later in pregnancy
 Pulse rate may increase 10-15 beats.
 Weight of uterus can cause supine hypotensive
syndrome.
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17. Cardiovascular system functional change
 Marked increase in cardiac output (CO).
 Overall –Increases from 30% to 50%
 Half of the increment occur by 8 weeks of gestation
 Maximum reached between 20 and 24 weeks’ gestation >
maintained until delivery.
Cause by
 Stroke volume
 Heart rate (↑10-15) bpm over the non-pregnant at term)
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19. Cardiovascular system functional change
 Distribution of cardiac output
 First trimester - uterus receives about 2% of the cardiac
output in the first .
 At term –increasing up to 20% at term About one-fifth
of the cardiac output goes through the uterus at term
increasing the risk from postpartum hemorrhage
substantially.
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20. Cardiovascular system functional change
 Systemic vascular resistance decreases during pregnancy
-> decrease arterial blood pressure
Cause by
 Elevated progesterone.
 Increase production of vasodilator substance -> PG, NO,
ANP.(atrial natriuretic peptide)
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21. Cardiovascular system functional change
 Blood pressure decrease ->Lowest at 24 weeks.
 ↓SBP of 5 -10 mm Hg
 ↓DBP of 10 -15 mm Hg
 Gradually returns to non-pregnant values by term.
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23. FETAL CIRCULATION
 The fetal circulation is the circulatory system of a
human fetus, often encompassing the entire
fetoplacental circulation which includes the umbilical
cord and the blood vessels within the placenta that
carry fetal blood.
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24. Umbilical Cord
 Placenta - Site where exchange of gases, nutrients
and waste take places with maternal circulation.
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25. Umbilical (conti.)
2umbilical arteries: return non-oxygenated blood, fecal
waste, CO2 to placenta.
 1umbilical vein: brings oxygenated blood and nutrients
to the fetus.
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26. Three shunts are present in fetal life
1. Ductus venosus: carries oxygenated blood from umbilical
vein to inferior vena cava bypassing fetal liver.
2. Ductus arteriosus: carries oxygenated blood from
pulmonary artery to aorta bypassing fetal lung.
3. Foramen ovale: connects the right and left. It pushes blood
from right atrium to the left atrium bypassing the
pulmonary circulation.
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29. pathway
Oxygenated blood from the placenta
through umbilical vein
fetus
liver
Receives deoxygenated blood from the portal vein
through ductusvenosus
Inferior vena cava
Right atrium of heart
through foramen ovale
Left atrium of the heart
Left ventricle of the heart.
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30. During ventricular systole
During ventricular systole
Left ventricular blood Right ventricular blood
pumped with < O2 content
Ascending aorta and distributed is discharged
by their branches to the heart, Pulmonary arteries
head ,neck ,brain ,arms. Ducts arteriosus
Descending aorta
Hypo gastric arteries
Umbilical arteries
Placenta
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31. Cardiac Output
During fetal life
Cardiac Output 350ml per kg per min
Following birth
500ml per min
Heart Rate 120-140per min
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32. At Birth
 As the baby is born, the cardiovascular system undergoes
a quick, drastic change.
 With its first breath, the baby's pulmonary vascular
resistance substantially drops, which is in response to the
oxygen now present in the lungs and the physical act of
breathing.
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33. At Birth
 With the clamping of the umbilical cord after birth,
the systemic vascular resistance increases helping the
blood flow towards the lungs.
 The ductus arteriosus has a left-to-right flow within
10 minutes. The smooth muscle in the ductus
arteriosus responds to the oxygen by increasing
calcium channel activity causing constriction and
ultimately closure of the shunt.
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34. At Birth
 The increased systemic resistance also raises the pressure
in the left atrium to be higher than the right atrium, and
this causes the foramen ovale to close.
 The ductus arteriosus becomes the ligamentum arteriosum,
 The foramen ovale becomes the fossa ovalis.
 The umbilical vein becomes the ligamentum teres(round
ligament).
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35. Changes in the Fetal Circulation
after birth
Shunt Functional
closure
Anatomical
closure
Remnant
Ductus
arteriosus
10 –96 hrs
after birth
2 –3 wks
after birth
Ligamentum
arteriosum
Formamen
ovale
Within several
mins after birth
One year
after birth
Fossa ovalis
Ductus
venosus
Within several
mins after birth
3 –7 days
after birth
Ligamentum
venosum
Umbilical arteries →Umbilical ligaments
Umbilical vein →Ligamentum teres
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36. Fetal Vs Infant Circulation
Fetal Infant
Low pressure system
 Right to left shunting
 Lungs non-functional
 Increased pulmonary
resistance
 Decreased systemic
resistance
High pressure system
Left to right blood flow
Lungs functional
Decreased pulmonary
resistance
Increased systemic
resistance
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39. summary
 The fetal circulatory system provides the fetus with
nutrients and oxygen, while also removing waste
products and carbon dioxide from fetal circulation.
 The umbilical cord develops from the placenta and is
attached to the fetus. Oxygenated blood from the mother
in the placenta flows through the umbilical vein and into
the inferior vena cava (IVC), bypassing the liver via the
ductus venosus.
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40. Summary ( conti…)
 From the IVC, oxygenated blood travels to the right
atrium of the heart. There is greater pressure in the right
atrium compared to the left atrium in fetal circulation;
therefore most of the blood is shunted from the right
atrium to the left atrium through an opening called the
foramen ovale.
 Once in the left atrium, blood travels through the left
ventricle into the aorta and the systemic circulation.
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41. Summary ( conti…)
 The deoxygenated blood travels back to the placenta
via the umbilical arteries to be oxygenated by the
mother.
 Additionally, some oxygenated blood in the right
atrium can also enter the right ventricle and then the
pulmonary artery.
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42. Summary ( conti…)
 Because there is high resistance to blood flow in the
lungs, the blood is shunted from the pulmonary
artery into the aorta via the ductus arteriosus, hence
bypassing the lungs.
 Blood then enters the systemic circulation, and the
deoxygenated blood is recycled back to the mother
via the umbilical arteries.
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44. Heart disease during pregnancy
Introduction
 Heart disease in pregnancy is very rare but
potentially serious and complicates approximately
1% of all pregnancies. The incidence of rheumatic
heart disease and undiagnosed or uncorrected
congenital heart disease is higher in developing
countries.
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45. Intro (conti.)
 If the heart is already compromised by an existing
anomaly, this can result in a poor outcome for both
fetus and mother.
 The onset of pregnancy marks the beginning of
progressive and profound changes in the physiology
of the cardiovascular system.
 Pregnancy in a patient with existing heart disease
should be a carefully planned
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46. Cardiovascular Changes in Pregnancy
 Most pregnant women develop fatigue , shortness of breath,
Decreased exercise capacity , palpitations .
 Some times peripheral edema , jugular venous distension ,
audible systolic flow murmur .
 This is explained by : changes occurring during 1st 5 -8
weeks of pregnancy and reach the peak by the end of 2nd
trimester.
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47. Cardiovascular Changes…
These changes includes :
 Increased Blood Volume by 20 – 50 % during
pregnancy and reach the peak at 32 week remained at
high level to delivery occur .
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49. Increased in Heart Rate
 Increased in Heart Rate 10-15 b/min.
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50. Blood pressure
 systolic Decrease by 5 –10 mm/Hg diastolic
decreased by 10 –15 mm/Hg Due to vasodilatation
caused by :- Placenta acts as arterio –venous shunt
thus decrease peripheral resistance.
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51. Increased liability of varicose vein due to :
I. Pressure of gravid uterus on pelvic veins .
ii. Relaxation of smooth muscle fibers in the blood
vessel wall by progesterone .
iii. Increase in the blood volume .
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52. Increase in the blood volume . Pressure of gravid uterus on pelvic veins .
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55. Aortic and Mitral regurgitation
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56. Diagnosis of Cardiac Disease
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57. Diagnosis of Cardiac Disease
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58. Investigations
 Full Cardiovascular Examination includes Blood tests
CBC.
 Enzyme study (Troponin I)
 Echocardiogram :cardiac status and structural anomalies
 ECG
 CXR ( Chest X ray ) : Assess cardiac size & Outline
 Other Imaging : CT Scan , MRI of the Chest
 Angiography
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59. Management Of Cardiac Failure In
Pregnancy
 Propped up position
 O2 administration
 Monitoring with ECG & pulse oxymetry
 Given diuretic
 Mechanical ventilation
 Injection morphine
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61. Decrease and control the risk
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63. Improve cholesterol levels
 Bad cholesterol affects body and changes the heart
functionality.
 Improve the cholesterol levels and destroy the bad
cholesterol from body.
 This will reduce obesity and improve health.
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64. Control high blood pressure
High blood pressure will result in various cardiac disease in
pregnancy and if not treated properly it may lead to
abnormalities to the baby.
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65. Follow a heart-healthy Diet
 Never skip any of the meals. Follow a healthy diet
which helps in providing rich amount of proteins,
minerals, nutrients and other healthy components to
the body.
 Always consult doctor during pregnancy period to
know the foods to avoid and foods to be taken more
to protect baby from any sort of abnormalities and
diseases.
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66. healthy Diet
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67. Control Diabetics
 Diabetics has the major impact of both body and heart
during pregnancy.
 Few pregnant women may affect with diabetics during
pregnancy and cure by themselves after the delivery of
the baby with the proper treatment and medication.
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68. Manage stress
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69. Manage stress
 Stress may cause many internal body and mental tensions
and changes to the person.
 This may lead to depression and can cause various heart
diseases.
 Stress management is the priority of every pregnancy
woman.
 Unnecessary tensions should be avoided and always be
happy and peaceful.
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70. Exercise
 There are special exercises, yoga, and meditation for
pregnancy women.
 No woman should follow normal exercises or yoga process
during pregnancy time as they may lead to abortions.
 Always do this process in the guidance of experienced
professional.
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71. Water
 As we all know about water and its essentials.
 Always prefer to drink warm water during pregnancy and
prefer water instead of cool drinks or other drinks.
 Never drink bottled water or chill water.
 Maintain a separate water bottle with warm water and carry
where ever you go.
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72. Heart disease in pregnancy guidelines
 Treat the diseases you already have whether it is related
to heart or any other disease.
 Test for birth defects and genetic conditions.
 Check and control pregnancy related complication if
had in past.
 Make pregnant woman stress free and always keep
your body and mind in relaxed state.
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73. Heart disease in pregnancy guidelines
 Monthly consultations are must and medication should be
taken in time.
 Never change multiple doctors during pregnancy follow
only one clinic and doctor till the end.
 Adopt for pregnancy yoga and exercise which helps in ease
delivery
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