Profound maternal cardiovascular changes occur during pregnancy in response to altered nutritional requirements, added thermoregulatory needs and changes in the hormonal environment. Since the essential functions of the cardiovascular system occur at the level of the microcirculation, changes in microvascular parameters, such as vascular remodeling in response to altered local demand, are likely to occur in normal pregnancy. Pathophysiological changes are also likely to occur at the microvascular level in pre-eclampsia. The primary objective of this chapter is to consider how changes in the forces that govern both microvascular exchange and the microvascular endothelial barrier contribute to the pathophysiology of the multisystem disorder of pre-eclampsia. In the first part of the chapter, the cardiovascular changes in normal pregnancy that influence forces governing transvascular fluid movement and their effects on microvascular exchange are discussed. Since changes in microvascular permeability are likely to affect plasma volume, a brief discussion of volume homeostasis in pregnancy is included. Primary source references have been provided.

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