Physiologic respiratory changes and dyspnea during pregnancy
- Steven E Weinberger, MD
Steven E Weinberger, MD
- Adjunct Professor of Medicine
- University of Pennsylvania School of Medicine
- Executive Vice President and CEO Emeritus
- American College of Physicians
- Section Editors
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
- Peter J Barnes, DM, DSc, FRCP, FRS
Peter J Barnes, DM, DSc, FRCP, FRS
- Editor-in-Chief — Pulmonary and Critical Care Medicine
- Section Editor — Asthma
- Professor of Medicine
- National Heart and Lung Institute, Imperial College, London
Dyspnea, or breathing discomfort, is common during pregnancy. Dyspnea during pregnancy can represent either underlying or new cardiac or pulmonary disease, or, more commonly, be a result of the pregnancy itself.
PHYSIOLOGICAL CHANGES IN PREGNANCY POTENTIALLY AFFECTING RESPIRATION
Distinguishing physiologic dyspnea of pregnancy from other causes requires an understanding of both the cardiopulmonary changes that occur during normal pregnancy and the syndrome of dyspnea during normal pregnancy [1-4]. Both cardiovascular and respiratory changes accompany normal pregnancy.
Cardiovascular changes — The most striking cardiovascular changes during pregnancy are increases in blood volume and cardiac output [5-7].
●Blood volume – Blood volume starts to rise during the first trimester and eventually reaches a maximum that is 40 to 50 percent above the baseline, nonpregnant blood volume. Because plasma volume increases more than red cell mass, the hematocrit generally falls, resulting in the physiologic "anemia of pregnancy" (figure 1). (See "Hematologic changes in pregnancy".)
●Cardiac output – Cardiac output also starts to rise in the first trimester, reaching a peak at 20 to 32 weeks of gestation that is 30 to 50 percent above baseline (figure 2) [7,8]. Although the increase in cardiac output is initially due to a rise in stroke volume, the increase is maintained later in pregnancy by an increase in heart rate, as stroke volume falls during the third trimester. Decreases in systemic vascular resistance and pulmonary vascular resistance accompany the increase in cardiac output . Blood pressure during pregnancy is often notable for a rise in pulse pressure due to an unchanged systolic pressure accompanied by a decrease in diastolic pressure. (See "Maternal cardiovascular and hemodynamic adaptations to pregnancy".)
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- PHYSIOLOGICAL CHANGES IN PREGNANCY POTENTIALLY AFFECTING RESPIRATION
- Cardiovascular changes
- Respiratory changes
- Dyspnea of pregnancy
- EVALUATION OF PREGNANT WOMEN WITH DYSPNEA
- Initial evaluation
- - History and physical examination
- Does the patient have underlying pulmonary or cardiac disease?
- Is dyspnea of acute or gradual onset?
- Is cough present?
- Is the chest clear on auscultation?
- Are other symptoms present?
- Is onset early in gestation or near term?
- Additional clues
- - Laboratory and imaging tests
- Additional testing
- Indications for prompt referral
- WOMEN WITH RESPIRATORY INSUFFICIENCY
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS