Hemodynamic findings

Normal pregnancy is characterized by a rise in cardiac output and a fall in systemic vascular resistance. Mean blood pressure gradually falls by 10 to 20 per cent, reaching a nadir by 16 to 22 weeks, and then rises to reach levels by term similar to, or even above, prepregnancy values. Pulmonary vascular resistance, central venous pressure, and pulmonary artery wedge pressure are unchanged.

The cardiovascular hemodynamic profile in pre-eclampsia has been reported to vary from a high-output low-resistance state to a low-output high-resistance state. This may reflect disease duration and severity, therapy, and measurement methods. Severe untreated disease appears to be characterized by intravascular volume depletion with low to normal cardiac output, low pulmonary artery wedge pressure, and high systemic vascular resistance. In pre-eclampsia, central venous pressure and pulmonary artery wedge pressure are poorly correlated, possibly reflecting differences in the preload of the right and left sides of the heart ( Cotton 1988).

Low plasma colloid osmotic pressure, increased pulmonary capillary permeability, and iatrogenic fluid overload predispose women with pre-eclampsia to pulmonary edema. Left ventricular dysfunction may contribute in women with pre-existing chronic hypertension.

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