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Hemodynamic Changes in Pregnancy

Hemodynamic Changes in Pregnancy: Pathogenesis & clinical findings Hormonal & physical changes in the body occur during pregnancy ↑ Estrogen & progesterone levels activate the renin-angiotensin-aldosterone system** to ↑ aldosterone levels Aldosterone promotes sodium & water retention to ↑ blood volume Estrogen ↑ peripheral vasodilation which ↓ vascular resistance Baroreceptors detect a ↓ in blood pressure & send sympathetic signals to the heart to ↑ cardiac output Blood pressure ↓ between 0-24 weeks gestation Estrogen, progesterone, & relaxin circulate systemically & ↓ systemic vascular resistance ↑ Estrogen stimulates liver to ↑ fibrinogen production & clotting factors I, II, VII, VIII, IX & XII Estrogen inhibits hepatic production of antithrombotic factor S & antithrombin to ↓ fibrinolysis Blood becomes hypercoagulable & ↑ risk of thrombus (clot) formation ↑ Risk of disseminated intravascular coagulation** Thrombus forms in deep vein of leg, calf, or pelvis ↑ Plasma volume ↑ Hydrostatic pressure in peripheral vessels pushes fluid into extravascular spaces ↑ Water in vessels ↓ red blood cell (RBC) concentration (↓ hematocrit) ↑ Risk of blood loss during Peripheral edema ↑ Blood flow to uterus delivery Mild tachycardia to supply fetus with oxygen & nutrients Anemia early in pregnancy (first trimester) Kidneys detect ↓ oxygen levels from ↓ hematocrit & upregulate erythropoietin production Erythropoietin stimulates ↑ RBC production in bone marrow Gestational hypertension (new onset hypertension after 20 weeks gestation) ↑ Hematocrit later in pregnancy Deep vein thrombosis** Authors: Orly Aziza Alam Randhawa Reviewers: Riya Prajapati Michelle J. Chen Jessica Revington Rachel Wang* * MD at time of publication ** See corresponding Calgary Guide slide Legend: Pathophysiology Mechanism ↑ Risk of developing preeclampsia** Sign/Symptom/Lab Finding Complications Pale or Cold Dizziness clammy skin Fatigue ↑ Risk of shock ↑ Risk of organ damage ↑ Risk of syncope Published Aug 25, 2025 on www.thecalgaryguide.com Thrombus travels through venous circulation to the heart & into the pulmonary arteries Pulmonary embolism