Assessment of left ventricular structural and functional indices by echocardiography in relation to the haemoglobin levels in second trimester of pregnancy.

ABSTRACT

Background & objectives: Pregnancy is characterized by profound changes in functions of virtually every regulatory system in human body. Blood volume increases progressively from 6 – 8 weeks of gestation & reaches a maximum at approximately 32 to 34 weeks. The increase in plasma volume (40-50%) is relatively greater than that of RBC mass (20 -30%) resulting in hemodilution & decrease in haemoglobin concentration. Thus during pregnancy the mother is under risk of developing nutritional deficiency anaemia. Hence it is decided to determine the impact of altered haemoglobin levels in second trimester of pregnancy on left ventricular hemodynamic functions in present study. Method: In present study subjects were females in the age group of 20 – 30 years with the singleton midterm pregnancy (20 -28 weeks) attending antenatal clinics of New Civil Hospital, Surat whereas the control group comprised of purposive sample (33 healthy subjects) from those attending other outpatient department in reference to comparable age, height & accessibility. Pulse and Blood Pressure was measured by standard techniques and capillary blood was collected for Hb% estimation by cynmethhemoglobin method. Finally, Echocardiography was recorded using MEGAS CVX & MEGAS GPX equipped with ADV4 software from ESAOTE s.p.a Firenze, Italy and the frequency used for Doppler echocardiography was 2.0 -2.5 – 3.3 -5.0 MHZ & sweep time was 2 – 12 seconds. Results: The observations suggest volume overload during pregnancy is a risk factor for left ventricular contractility functions. Interpretation & conclusion: Increased values of stroke volume, cardiac output & cardiac index interpret the result of inability to compensate pressure overload or elevated venous return. Left ventricular diastolic dysfunction in the form of relaxation abnormalities is one of the first changes with left ventricular hypertrophy. The reduction of haemoglobin in second trimester; significantly and negatively correlates with the left ventricular cardiac function. The significant increase in CO and CI reflects a hyperkinetic heart in pregnancy. The increase in percent ejection fraction and percent fractional shortening in the study population can be best explained by Frank- Starling’s law governing the heart.