Maryland CC Project Lankford – Physiologic Changes of Pregnancy Part I
Mar 27, 2022
Dr. Allison Lankford, an Assistant Professor specializing in Maternal-Fetal Medicine, brings her expertise to discuss the physiologic changes during pregnancy. She presents fascinating case studies, including the complexities of twin pregnancies with maternal heart conditions and the management of severe preeclampsia. Dr. Lankford dives into ultrasound techniques for assessing fetal health, discusses respiratory challenges in COVID cases, and highlights the intricacies of trauma management in pregnant patients. It's a deep dive into the art and science of pregnancy care!
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Cardiomyopathy Complicating Twin Delivery
- Lankford recounts a twin pregnancy patient with familial TTN dilated cardiomyopathy who decompensated and required cesarean delivery under general anesthesia.
- The team placed Swan catheters, used inotropes, prepared for possible VA-ECMO, and managed postpartum hemorrhage with transfusion support.
Optimize Cardiac Index And Inotrope Choice
- Target a cardiac index >2.2 when optimizing pregnant patients with cardiogenic shock, even with twin gestation.
- Prefer shorter-acting titratable inotropes (e.g., epinephrine) over long-acting agents like milrinone during anticipated major hemorrhage or rapid physiologic shifts.
Cardiac Output And Vascular Resistance Shifts
- Pregnancy raises cardiac output 40–50%, mainly via increased stroke volume with modest heart rate rise.
- Systemic vascular resistance falls mid-pregnancy, lowering BP around 26–28 weeks before returning toward baseline by ~32 weeks.