Navigating women with congenital heart disease during pregnancy: Management strategies and future directions

Table 1 Physiological changes during pregnancy and delivery

Changes	Variables	First trimester	Second trimester	Third trimester	Delivery
Hemodynamic	CO	Small increase	Moderate increase	Moderate increase	Significant increase
	SVR	Mild decrease	Moderate decrease	Moderate decrease	-
	PVR	Mild decrease	Mild decrease	Mild decrease	Mild increase
	HR	Small increase	Moderate increase	Significant increase	Very significant increase
	BP	Mild decrease	Mild decrease	No change	Mild increase
WBC	WBC count	-	-	-	High
RBC	RBC mass	Small increase	Moderate increase	Moderate increase	-
Blood volume	Plasma volume	Moderate increase	Moderate increase	Very significant increase	Extremely significant increase
Remodeling in heart	LV mass	Small increase	Small increase	Small increase	-
	Chamber sizes	-	-	4-chamber enlargement	-
Aorta	Distensibility	Increase	-	-	-
Respiratory minute ventilation	O2 saturation1	Small increase	Moderate increase	Moderate increase	-
Cardiac biomarkers	BNP	No change	-	-	Mild increase
	cTn	No change	-	-	-
	CK-MB	Increase	-	-	-
	D-dimer	Small increase	Moderate increase	Significant increase	-
ECG changes	P wave	Small increase	Plateau	-	-
	Q wave	-	-	Prominent Q wave in inferior and anterolateral leads	-
	QTc	-	-	Mild increase	-
	ST changes	-	-	-	ST depression after cesarean section delivery
Arrhythmia	APC	Common	-	-	-
	PVC	Common	-	-	-

¹O2 saturation < 95% is abnormal during pregnancy and needs investigation.

CO: Cardiac output; SVR: Systemic vascular resistance; PVR: Pulmonary vascular resistance; HR: Heart rate; BP: Blood pressure; WBC: White blood cells; RBC: Red blood cells; LV: Left ventricle; BNP: Brain natriuretic peptide; CK-MB: Creatine kinase-isoenzyme MB; ECG: Electrocardiography; cTn: Cardiac troponin; APC: Atrial premature contraction; PVC: Premature ventricular contraction.