Abstract
In this paper, we describe a mathematical model of the cardiovascular system in human pregnancy. An automated, closed-loop 1D–0D modelling framework was developed, and we demonstrate its efficacy in (1) reproducing measured multi-variate cardiovascular variables (pulse pressure, total peripheral resistance and cardiac output) and (2) providing automated estimates of variables that have not been measured (uterine arterial and venous blood flow, pulse wave velocity, pulsatility index). This is the first model capable of estimating volumetric blood flow to the uterus via the utero-ovarian communicating arteries. It is also the first model capable of capturing wave propagation phenomena in the utero-ovarian circulation, which are important for the accurate estimation of arterial stiffness in contemporary obstetric practice. The model will provide a basis for future studies aiming to elucidate the physiological mechanisms underlying the dynamic properties (changing shapes) of vascular flow waveforms that are observed with advancing gestation. This in turn will facilitate the development of methods for the earlier detection of pathologies that have an influence on vascular structure and behaviour.
Highlights
The human cardiovascular system undergoes significant physiological and structural adaptations during healthy pregnancy
The cardiac output for the two individuals follows different trends over time; for B, the largest value occurs during the first trimester and shows a large reduction by the third trimester; A follows a more typical behaviour in time, with an increase in cardiac output from trimester 1 to 2 and a reduction during trimester 3
It could be anticipated that physiological adaptation, especially that relate to compliance, would occur more slowly for an older individual, as studies have indicated increased arterial stiffness in older pregnant women (Salmi et al 2010) and in non-pregnant individuals (Lee and Oh 2010)
Summary
The human cardiovascular system undergoes significant physiological and structural adaptations during healthy pregnancy. Cardiac output increases by 30–50% (Meah et al 2016; Soma-Pillay et al 2016) as a result of increases in both stroke volume and heart rate, blood volume increases by up to 40%, vascular compliance is increased, and total peripheral resistance is reduced. These changes maintain a relatively uniform mean arterial blood pressure throughout. The maternal cardiovascular system undergoes several major physical adaptations These include remodelling of the heart and blood vessels, which cause changes in blood flow distribution and flow rates.
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