From the Research
Normal pulmonary artery catheter values in pregnancy differ from non-pregnant values due to the physiological changes of pregnancy, with central venous pressure (CVP) typically ranging from 3-10 mmHg, pulmonary artery systolic pressure normally 15-30 mmHg, and pulmonary capillary wedge pressure (PCWP) typically measuring 6-12 mmHg 1.
Key Physiological Changes
- Central venous pressure (CVP): 3-10 mmHg
- Pulmonary artery systolic pressure: 15-30 mmHg
- Pulmonary artery diastolic pressure: 8-15 mmHg
- Pulmonary capillary wedge pressure (PCWP): 6-12 mmHg
- Cardiac output: increases by 30-50% during pregnancy, reaching 6-7 L/min by the third trimester
- Systemic vascular resistance: decreases by about 20% during pregnancy
Clinical Implications
These changes reflect the normal cardiovascular adaptations to pregnancy, including increased blood volume, decreased vascular resistance, and increased cardiac output to meet the demands of the growing fetus and placenta. Clinicians should interpret pulmonary artery catheter measurements in pregnant women with these physiological changes in mind, as using non-pregnant reference ranges could lead to misdiagnosis of cardiovascular conditions during pregnancy 2. The use of pulmonary artery catheters in pregnant women with severe pulmonary hypertension can help monitor perinatal pulmonary arterial pressure and guide treatment, potentially improving clinical outcomes and lowering short-term mortality 1. However, the incidence rate of pulmonary artery catheter-related complications is around 7.3%, highlighting the need for careful consideration and management 1.
Management Considerations
- Pulmonary artery catheterization may be beneficial in managing severe preeclampsia and eclampsia, with a subjective evaluation demonstrating its usefulness in determining management in 93% of cases 3.
- The safety and efficacy of pulmonary artery catheterization in pregnant women with pulmonary hypertension should be carefully evaluated, considering the potential benefits and risks 4, 1.
- Multidisciplinary management and continuous epidural anesthesia may be relatively safe approaches for pregnancy termination in patients with severe pulmonary hypertension 4.