Vascular diseases

doi:10.1017/CBO9780511544552.004

3 - Vascular diseases

from Section 1 - Cardiovascular and respiratory disorders

Published online by Cambridge University Press: 19 October 2009

David R. Gambling

Edited by

David R. Gambling ,

M. Joanne Douglas and

Robert S. F. McKay

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David R. Gambling: Affiliation:
Clinical Associate Professor, (non-salaried) Department, Anesthesiology, University of California San Diego, CA USA; Staff Anesthesiologist, Sharp Mary Birch Hospital for Women
David R. Gambling: Affiliation:
University of California, San Diego
M. Joanne Douglas: Affiliation:
University of British Columbia, Vancouver
Robert S. F. McKay: Affiliation:
University of Kansas

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Summary

Introduction

Maternal vascular lesions that become apparent during pregnancy may be present before conception but only become symptomatic as a result of the physiologic changes of pregnancy. Blood vessels are weakened by an increase in blood volume and cardiac output (CO); a decrease in systemic vascular resistance (SVR); and hormonal changes. Hence, aneurysms can expand and rupture, or arteriovenous (AV) malformations can grow and, if present in the pulmonary circulation, can worsen a preexisting shunt. Some of the rare conditions described in this chapter affect blood vessels in discrete areas of the body whereas others affect all blood vessels. Often the disorders described are part of an autoimmune disease process that impacts other organ systems. Many of the vascular disorders are associated with high maternal and neonatal mortality. For example, rupture of an enlarging aneurysm can cause abrupt, catastrophic blood loss and poor peripartum outcomes. Likewise, pulmonary hypertension worsens during pregnancy and is often associated with maternal and/or neonatal death. This chapter discusses the clinical implications for the obstetric anesthesiologist of most vascular lesions seen during pregnancy. Intracranial aneurysms during pregnancy are discussed in Chapter 9.

Primary pulmonary hypertension

Primary pulmonary hypertension is a progressive disease that produces a sustained rise of at least 25 mmHg in mean pulmonary artery pressure and an increase in pulmonary resistance, in the absence of an identified pulmonary or cardiac lesion. This inevitably leads to right ventricular (RV) dilatation and RV hypertrophy progressing to RV failure and death.

Type: Chapter
Information: Obstetric Anesthesia and Uncommon Disorders , pp. 57 - 74

DOI: https://doi.org/10.1017/CBO9780511544552.004 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2008

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