Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 7, Number 1, February 2016, pages 25-31

Serial Changes in Pulmonary Hemodynamics During Pregnancy: A Non-Invasive Study Using Doppler Echocardiography

**Table 1.** Age Distribution of Cases Along With Controls
Group	Number of pregnant females (study group)	Number of non-pregnant females (control group)
A (18 - 25 years)	30 (50%)	8 (53.3%)
B (26 - 32 years)	16 (27%)	4 (27%)
C (33 - 40 years)	14 (23.3%)	3 (20%)
Total	60 (100%)	15 (100%)

Table 1. Age Distribution of Cases Along With Controls

Group

Number of pregnant females (study group)

Number of non-pregnant females (control group)

A (18 - 25 years)

30 (50%)

8 (53.3%)

B (26 - 32 years)

16 (27%)

4 (27%)

C (33 - 40 years)

14 (23.3%)

3 (20%)

Total

60 (100%)

15 (100%)

**Table 2.** Distribution of Pregnant Women According to Parity
Group	Total	Number of primigravida women	Number of bigravida	Number of multigravida
A (18 - 25 years)	30	17 (28.3%)	6 (10%)	7 (11.7%)
B (26 - 32 years)	16	4 (6.7%)	9 (15%)	3 (5%)
C (33 - 40 years)	14	1 (1.7%)	11 (18.3%)	2 (3.3%)
Total	60	22 (36.7%)	26 (43.3%)	12 (20%)

Table 2. Distribution of Pregnant Women According to Parity

Group

Total

Number of primigravida women

Number of bigravida

Number of multigravida

A (18 - 25 years)

17 (28.3%)

6 (10%)

7 (11.7%)

B (26 - 32 years)

4 (6.7%)

9 (15%)

3 (5%)

C (33 - 40 years)

1 (1.7%)

11 (18.3%)

2 (3.3%)

Total

22 (36.7%)

26 (43.3%)

12 (20%)

**Table 3.** Clinical Symptomatology of Studied Subjects
Group	Total	Asymptomatic	Lower extremity edema	Chest pain	Palpitation	Exertional dyspnea
Study group	60	22 (36.7%)	28 (46.7%)	4 (6.7%)	24 (40%)	21 (35%)
A (18 - 25 years)	30	4 (6.7%)	1 (20%)	2 (3.3%)	5 (28.3%)	14 (33.3%)
B (26 - 32 years)	16	10 (16.7%)	10 (16.7%)	1 (1.7%)	5 (8.3%)	5 (8.3%)
C (33 - 40 years)	14	8 (13.3%)	6 (10%)	1 (1.7%)	2 (3.3%)	2 (3.3%)
Control group	15	11 (73.3%)	0	1 (6.7%)	2 (13.3%)	1 (6.7%)

Table 3. Clinical Symptomatology of Studied Subjects

Group

Total

Asymptomatic

Lower extremity edema

Chest pain

Syncope

Palpitation

Exertional dyspnea

Study group

22 (36.7%)

28 (46.7%)

4 (6.7%)

24 (40%)

21 (35%)

A (18 - 25 years)

4 (6.7%)

1 (20%)

2 (3.3%)

5 (28.3%)

14 (33.3%)

B (26 - 32 years)

10 (16.7%)

1 (1.7%)

5 (8.3%)

C (33 - 40 years)

8 (13.3%)

6 (10%)

1 (1.7%)

2 (3.3%)

Control group

11 (73.3%)

1 (6.7%)

2 (13.3%)

1 (6.7%)

**Table 4.** Physical Findings of Studied Subjects
Group	Total	Tachycardia	Hypertension (BP > 140/90)	Cardiac enlargement	Parasternal heave	Loud P2	Murmur	Pedal edema
Study group	60	24 (40%)	10 (6.7%)	4 (6%)	3 (5%)	28 (6.7%)	21 (5%)	28 (6.7%)
A (18 - 25 years)	30	17 (28.3%)	1 (1.7%)	0	0	11 (18.3%)	8 (13.3%)	12 (20%)
B (26 - 32 years)	16	5 (8.3%)	2 (2.3%)	1 (1.7%)	1 (1.7%)	8 (13.3%)	6 (10%)	10 (17%)
C (33 - 40 years)	14	2 (2.3%)	7 (11.7%)	3 (5%)	2 (2.3%)	9 (15%)	7 (11.7%)	6 (10%)
Control group	15	4 (27%)	0	0	0	0	1 (6.7%)	0

Table 4. Physical Findings of Studied Subjects

Group

Total

Tachycardia

Hypertension (BP > 140/90)

Raised JVP

Cardiac enlargement

Parasternal heave

Loud P2

Murmur

Pedal edema

Study group

24 (40%)

10 (6.7%)

4 (6%)

3 (5%)

28 (6.7%)

21 (5%)

28 (6.7%)

A (18 - 25 years)

17 (28.3%)

1 (1.7%)

11 (18.3%)

8 (13.3%)

12 (20%)

B (26 - 32 years)

5 (8.3%)

2 (2.3%)

1 (1.7%)

8 (13.3%)

6 (10%)

10 (17%)

C (33 - 40 years)

2 (2.3%)

7 (11.7%)

3 (5%)

2 (2.3%)

9 (15%)

7 (11.7%)

6 (10%)

Control group

4 (27%)

1 (6.7%)

**Table 5.** Complete Hematogram of Studied Subjects
Group	Total	Mean Hb (g%)	Mean PCV (%)	Mean TLC (cells/mm³)	Mean platelet count (lakh/mm³)	Mean MCV (fL)	Mean MCHC (%)
Study group	60	9.6	36	6,880	1.84	82	30.5
A (18 - 25 years)	30	10.1	38	7,100	2.1	80	32.4
B (26 - 32 years)	16	9.1	34	6,550	1.7	86	30.1
C (33 - 40 years)	14	9.2	33	6,600	1.65	84	30.3
Control group	15	12.4	44	6,850	32.2	84	34

Table 5. Complete Hematogram of Studied Subjects

Group

Total

Mean Hb (g%)

Mean PCV (%)

Mean TLC (cells/mm³)

Mean platelet count (lakh/mm³)

Mean MCV (fL)

Mean MCHC (%)

Study group

9.6

6,880

1.84

30.5

A (18 - 25 years)

10.1

7,100

2.1

32.4

B (26 - 32 years)

9.1

6,550

1.7

30.1

C (33 - 40 years)

9.2

6,600

1.65

30.3

Control group

12.4

6,850

32.2

**Table 6.** Major Urinary Laboratory Findings in Studied Cases
Group	Total	Mean specific gravity	Mean proteinuria	Pyuria
Study group	60	1.018	18 (30%)	2 (2.3%)	11 (18.3%)	14 (23.3%)	14 (23.3%)
A	30	1.016	5 (8.3%)	0	3 (5%)	5 (8.3%)	5 (8.3%)
B	16	1.018	7 (11.7%)	1 (1.7%)	4 (6.7%)	5 (8.3%)	4 (6.7%)
C	14	1.018	6 (10%)	1 (1.7%)	4 (6.7%)	4 (6.6%)	5 (8.3%)
Control group	15	1.016	2 (13.3%)	0	2 (13.3%)	0	0

Table 6. Major Urinary Laboratory Findings in Studied Cases

Group

Total

Mean specific gravity

Mean proteinuria

Pyuria

Hematuria

Bacteriuria

Study group

1.018

18 (30%)

2 (2.3%)

11 (18.3%)

14 (23.3%)

1.016

5 (8.3%)

3 (5%)

5 (8.3%)

1.018

7 (11.7%)

1 (1.7%)

4 (6.7%)

5 (8.3%)

4 (6.7%)

1.018

6 (10%)

1 (1.7%)

4 (6.7%)

4 (6.6%)

5 (8.3%)

Control group

1.016

2 (13.3%)

**Table 7.** Major Laboratory Assessment in Liver Function Tests in Studied Cases
Group	Total	Mean total bilirubin (mg%)	Mean SGPT (U/mL)	Mean SGOT (U/mL)	Mean ALP (U/mL)	Mean total albumin
Study group	60	0.9	36	38	64	3.7
A	30	0.9	37	40	70	3.84
B	16	1.0	34	36	62	3.7
C	14	1.2	33	38	60	3.58
Control group	15	1.1	36	34	68	3.8

Table 7. Major Laboratory Assessment in Liver Function Tests in Studied Cases

Group

Total

Mean total bilirubin (mg%)

Mean SGPT (U/mL)

Mean SGOT (U/mL)

Mean ALP (U/mL)

Mean total albumin

Study group

0.9

3.7

0.9

3.84

1.0

3.7

1.2

3.58

Control group

1.1

3.8

**Table 8.** Relevant ECG Findings in Studied Subjects
Group	Total	Sinus tachycardia	Right axis deviation	Right ventricular enlargement	Right bundle branch block	ST-T changes	Ventricular ectopics
Study group	60	24 (40%)	8 (12.3%)	5 (8.3%)	1 (1.7%)	4 (6.7%)	2 (2.3%)
A	30	17 (28.3%)	3 (5%)	0	0	0	1 (1.7%)
B	16	5 (8.3%)	2 (2.3%)	2 (2.3%)	0	1 (1.7%)	0
C	14	2 (2.3%)	3 (5%)	3 (5%)	1 (1.7%)	3 (5%)	1 (1.7%)
Control group	15	4 (26.7%)	0	0	0	0	0

Table 8. Relevant ECG Findings in Studied Subjects

Group

Total

Sinus tachycardia

Right axis deviation

Right ventricular enlargement

Right bundle branch block

ST-T changes

Ventricular ectopics

Study group

24 (40%)

8 (12.3%)

5 (8.3%)

1 (1.7%)

4 (6.7%)

2 (2.3%)

17 (28.3%)

3 (5%)

1 (1.7%)

5 (8.3%)

2 (2.3%)

1 (1.7%)

2 (2.3%)

3 (5%)

1 (1.7%)

3 (5%)

1 (1.7%)

Control group

4 (26.7%)

**Table 9.** Echocardiographic Pulmonary Hemodynamic Assessment During First Trimester
Age group (years)	Total	RVID (cm)	PADP (mm Hg)	TRVel (m/s)	PASP (mm Hg)	TVI_RVOT (cm)	PVCSA (cm²)	PBF (L/min)	PVR_ECHO (Woods Unit)
Minor intergroup differences in pulmonary artery systolic pressure, pulmonary artery diastolic pressure, and pulmonary vascular resistance were not found to be statistically significant (P > 0.05).
Study group
A (18 - 25)	30	2.9	10.2	2.13	18.4	20.1	3.6	5.2	1.24
B (26 - 32)	16	2.99	9.8	2.3	20.1	20.2	3.6	5.2	1.26
C (33 - 40)	14	2.98	11.2	2.2	20	20.1	3.6	5.2	1.27
Total	60	2.96	10.7	2.2	19.4	20.1	3.58	5.20	1.25
Control group
A (18 - 25)	8	2.81	9.9	2.10	17.7	19.8	3.55	5.2	1.22
B (26 - 32)	4	2.87	9.8	2.24	19.8	20.2	3.55	5.11	1.3
C (33 - 40)	3	2.8	10.3	2.20	19.3	20.1	3.57	4.98	1.26
Total	15	2.83	10	2.17	18.8	20	3.56	5.16	1.24

Table 9. Echocardiographic Pulmonary Hemodynamic Assessment During First Trimester

Age group (years)

Total

RVID (cm)

PADP (mm Hg)

TRVel (m/s)

PASP (mm Hg)

TVI_RVOT (cm)

PVCSA (cm²)

PBF (L/min)

PVR_ECHO (Woods Unit)

Minor intergroup differences in pulmonary artery systolic pressure, pulmonary artery diastolic pressure, and pulmonary vascular resistance were not found to be statistically significant (P > 0.05).

Study group

A (18 - 25)

2.9

10.2

2.13

18.4

20.1

3.6

5.2

1.24

B (26 - 32)

2.99

9.8

2.3

20.1

20.2

3.6

5.2

1.26

C (33 - 40)

2.98

11.2

2.2

20.1

3.6

5.2

1.27

Total

2.96

10.7

2.2

19.4

20.1

3.58

5.20

1.25

Control group

A (18 - 25)

2.81

9.9

2.10

17.7

19.8

3.55

5.2

1.22

B (26 - 32)

2.87

9.8

2.24

19.8

20.2

3.55

5.11

1.3

C (33 - 40)

2.8

10.3

2.20

19.3

20.1

3.57

4.98

1.26

Total

2.83

2.17

18.8

3.56

5.16

1.24

**Table 10.** Echocardiographic Pulmonary Hemodynamic Assessment During Second Trimester
Age group (years)	Total	RVID (cm)	PADP (mm Hg)	TRVel (m/s)	PASP (mm Hg)	TVI_RVOT (cm)	PVCSA (cm²)	PBF (L/min)	PVR_ECHO (Woods unit)
No significant changes in pulmonary artery systolic pressures compared to first trimester were observed (P > 0.05).
Study group
A (18 - 25)	30	2.92	10.4	2.20	192	24.7	3.56	6.73	1.04
B (26 - 32)	16	2.9	10	2.24	20.2	24.4	3.47	6.68	1.09
C (33 - 40)	14	3.10	10.9	2.26	20	24.36	3.57	6.65	1.08
Total	60	2.95	10.4	2.23	19.7	24.52	3.57	6.70	1.06
Control group
A (18 - 25)	8	2.80	10.3	1.94	16.7	20.7	3.49	5.22	1.20
B (26 - 32)	4	2.84	9.9	2.2	19.4	20.9	3.52	5.23	1.28
C (33 - 40)	3	2.8	10.2	2.4	23.4	20.8	3.53	5.19	1.30
Total	15	2.8	10.2	2.16	19.1	20.7	3.52	5.22	1.22

Table 10. Echocardiographic Pulmonary Hemodynamic Assessment During Second Trimester

Age group (years)

Total

RVID (cm)

PADP (mm Hg)

TRVel (m/s)

PASP (mm Hg)

TVI_RVOT (cm)

PVCSA (cm²)

PBF (L/min)

PVR_ECHO (Woods unit)

No significant changes in pulmonary artery systolic pressures compared to first trimester were observed (P > 0.05).

Study group

A (18 - 25)

2.92

10.4

2.20

192

24.7

3.56

6.73

1.04

B (26 - 32)

2.9

2.24

20.2

24.4

3.47

6.68

1.09

C (33 - 40)

3.10

10.9

2.26

24.36

3.57

6.65

1.08

Total

2.95

10.4

2.23

19.7

24.52

3.57

6.70

1.06

Control group

A (18 - 25)

2.80

10.3

1.94

16.7

20.7

3.49

5.22

1.20

B (26 - 32)

2.84

9.9

2.2

19.4

20.9

3.52

5.23

1.28

C (33 - 40)

2.8

10.2

2.4

23.4

20.8

3.53

5.19

1.30

Total

2.8

10.2

2.16

19.1

20.7

3.52

5.22

1.22

**Table 11.** Echocardiographic Pulmonary Hemodynamic Assessment During Third Trimester
Age group (years)	Total	RVID (cm)	PADP (mm Hg)	TRVel (m/s)	PASP (mm Hg)	TVI_RVOT (cm)	PVCSA (cm²)	PBF (L/min)	PVR_ECHO (Woods Unit)
No significant changes in pulmonary artery systolic pressures compared to first and second trimesters were observed (P > 0.05).
Study group
A (18 - 25)	30	2.93	10.4	2.23	19.3	25.7	3.48	7.54	1.103
B (26 - 32)	15	2.92	10.4	2.26	20.2	25.4	3.57	7.58	1.04
C (33 - 40)	11	3.13	10.9	2.27	20.1	25.36	3.52	7.53	1.07
Total	56	2.94	10.5	2.24	19.8	25.45	3.52	7.5	1.04
Control group
A (18 - 25)	8	2.59	10	2.30	20.5	20.5	3.5	5.3	1.27
B (26 - 32)	4	2.71	10.2	2.33	22.4	20.7	3.51	5.1	1.28
C (33 - 40)	3	2.78	9.8	2.32	22	20.6	3.5	5.4	1.32
Total	15	2.67	10.1	2.3	21.2	20.5	3.5	5.3	1.28

Table 11. Echocardiographic Pulmonary Hemodynamic Assessment During Third Trimester

Age group (years)

Total

RVID (cm)

PADP (mm Hg)

TRVel (m/s)

PASP (mm Hg)

TVI_RVOT (cm)

PVCSA (cm²)

PBF (L/min)

PVR_ECHO (Woods Unit)

No significant changes in pulmonary artery systolic pressures compared to first and second trimesters were observed (P > 0.05).

Study group

A (18 - 25)

2.93

10.4

2.23

19.3

25.7

3.48

7.54

1.103

B (26 - 32)

2.92

10.4

2.26

20.2

25.4

3.57

7.58

1.04

C (33 - 40)

3.13

10.9

2.27

20.1

25.36

3.52

7.53

1.07

Total

2.94

10.5

2.24

19.8

25.45

3.52

7.5

1.04

Control group

A (18 - 25)

2.59

2.30

20.5

3.5

5.3

1.27

B (26 - 32)

2.71

10.2

2.33

22.4

20.7

3.51

5.1

1.28

C (33 - 40)

2.78

9.8

2.32

20.6

3.5

5.4

1.32

Total

2.67

10.1

2.3

21.2

20.5

3.5

5.3

1.28

**Table 12.** Echocardiographic Pulmonary Hemodynamic Assessment During Puerperium
Age group (years)	Total	RVID (cm)	PADP (mm Hg)	TRVel (m/s)	PASP (mm Hg)	TVIRVOT (cm)	PVCSA (cm2)	PBF (L/min)	PVRECHO (Woods Unit)
Study group
A (18 - 25)	30	2.83	9.9	2.15	17.9	20.1	3.58	5.27	1.20
B (26 - 32)	15	2.93	10.0	2.29	20.9	20.2	3.57	5.30	1.18
C (33 - 40)	11	2.92	10.6	2.25	20.8	20.1	3.57	5.41	1.20
Total	56	2.89	10.1	2.22	19.8	20.2	3.58	5.30	1.20

Table 12. Echocardiographic Pulmonary Hemodynamic Assessment During Puerperium

Age group (years)

Total

RVID (cm)

PADP (mm Hg)

TRVel (m/s)

PASP (mm Hg)

TVIRVOT (cm)

PVCSA (cm2)

PBF (L/min)

PVRECHO (Woods Unit)

Study group

A (18 - 25)

2.83

9.9

2.15

17.9

20.1

3.58

5.27

1.20

B (26 - 32)

2.93

10.0

2.29

20.9

20.2

3.57

5.30

1.18

C (33 - 40)

2.92

10.6

2.25

20.8

20.1

3.57

5.41

1.20

Total

2.89

10.1

2.22

19.8

20.2

3.58

5.30

1.20