ORIGINAL ARTICLE

Pericardial effusion in normal pregnant women

HASSANS.O. AEDULJABBAR,
KHALIDM.H. MARZOUKI,
TARIFH. ZAWAWIAND AHMEDS. KHAN
From the Departments of ObstetricstGynecology and Internal Medicine, King Abdulaziz University, College of
Medicine, Jeddah, Saudi Arabia

Acra Obstet Gynecol Scand 1991; 70: 291-294

Fifty-two normally pregnant women underwent echocardiography to examine their per-

icardium in the first, second and third trimester. Pericardial effusion was noted in 15.3%
of the women ( n = 8 ) in the first trimester, 19.2% (n=10) in the second trimester and
44.2% (n=23) in the third trimester of pregnancy. Pericardial effusion during pregnancy
was found to be completely resolved in all patients who underwent an echocardiogram 6
weeks post delivery (n=11). There was no statistically significant difference in age,
hemoglobin, total protein, albumin/globulin ratio or mean blood pressure during preg-
nancy between those who developed pericardial effusion and those who did not. The
frequency of occurrence of pericardial effusion in primigravidas at 69.2% (9/13) was
higher than that in multigravidas, with a ratio of 35.9% (14/39), the difference being
statistically significant (p < 0.025). The frequency of occurrence of pericardial effusion in
patients who gained more than 12 kg during pregnancy at 67.7% (11117) was higher than
in patients who gained less than 12 kg, with a ratio of 34.3% (12135), the difference being
statistically significant (p < 0.02s).

Key words: echocardiography; pericardial effusion; pregnancy

Submitted July 19, 1990

Accepted January 18, I991

Ever since Elder (1) first recognized that pericardial
effusion could be detected by diagnostic ultrasound,
many investigators have refined this technique,
thereby establishing the role of echocardiography as
being of paramount significance in diagnosing per-
icardial effusions (2-11).
Pregnancy, a normal physiological event in fe-
males, imposes by various mechanisms, an increase
in the functional load on the heart and circulation. A
few studies have looked into the effect on the per-
icardium, resulting in the development of pericardial
effusion during normal pregnancy (12, 13, 14). How-
ever, these studies have focused their attention on
the last trimester of pregnancy, thus not answering
the question: when d o these women begin t o devel-
o p pericardial effusion during the course of preg-
nancy? In order to elucidate this, we report in this
study on 57 normally pregnant women who were
evaluated by echocardiography throughout their
course of pregnancy at King Abdulaziz University
Hospital, Jeddah, Saudi Arabia.
Material and methods
Fifty-seven pregnant women in their first trimester
of pregnancy were randomly selected from the au-
thors' antenatal clinic at King Abdulaziz University
Hospital, Jeddah, Saudi Arabia. Each subject had a
singleton pregnancy. These females were then exam-
ined by two physicians and those found to be clin-
ically normal were included in the study. The se-
lected subjects then had blood tests performed,
which included hemoglobin level, total serum pro-
teins, albumin/globulin ratio, renal function test,
free T,, TSH and autoantibody profile. E C G was

19' Actn Obsret Gynecol Scand 70 (1991)

292 H . S . 0. Abduljabbar et al.

Table 1. Comparison between various factors and occurrence of pericardial effusion

Factor No pericardial Pericardial

effusion effusion
~~~~ ~ ~

Mean age (years) 25.16 f 6 27.0 f 1

Mean blood pressure (mmHg) 116/79+ 11.4/3.6 i i 7 n s f 11.2/3.5
Hemoglobin (gm/l) 113k5 114_+4
Total protein (gm/l) 68.9 f 5.3 69.7 f 7.6
Albumin/Globulin ratio 1.2 k 0.3 1.3 f 0.4
1st trimester (n=52) 44 8 (15.3%)
2nd trimester (n=52) 42 10 (19.2%)
3rd trimester (n=52) 29 23 (44.2%)
Six weeks postpartum ( n = l l ) 11 0 (O"/O)

also performed in all subjects. Upon review of their
investigations, if found normal, these pregnant
women then underwent echocardiography in their
first, second and third trimester of pregnancy and in
the sixth week following delivery. Two-dimensional
and M-mode echocardiograms were performed by a
consultant cardiologist, using a 3.5 MHz transducer
on a General Electric R T 3000 machine. Presence of
pericardial effusion was established according to on
the criteria of Horowitz et aI.(lS) Any subject devel-
oping hypertension, gestational diabetes or who had
had upper respiratory tract infection within one
month prior to the echocardiogram was performed,
was excluded from the study.
The subjects were divided into two groups accord-
ing to their gravidity, the primigravida group and the
multigravida group. They were also divided into two
additional groups according to the net weight gain
during pregnancy, subjects who gained less than 12
kg and those who gained more than 12 kg. The
frequency of occurrence of pericardial effusion was
recorded in each group.
Data were collected and statistically analysed us-
ing SPSS/PC package, more specifically, the chi
square test.
Results
Fifty-seven subjects entered the study, two of whom
were excluded due to presence of signs of valvular
Table 11. Frequency of occurrence of pericardial effusion in
primigravida and multigravida subjects
Total no. of Pericardial N o pericardial
patients effusion effusion
Primigravida 13 9 (69.2%) 4 (30.8%)
Multigravida 39 14 (35.9%) 25 (64.1%)
x2=4.392; df=l, p<0.025.
heart disease. Another 3 patients were lost during
follow-up. Fiftytwo patients fulfilled our criteria and
underwent uneventful pregnancies. None of our fe-
male subjects developed any complications to render
them unsuitable for this study. All subjects had a
normal renal function test, free thyroxine, TSH,
ECG and a negative autoantibody profile. Pericar-
dial effusion was found to appear in 15.3% of those
in the first trimester, 19.2% of those in the second
trimester and 44.2% in the third trimester of preg-
nancy. The extent of pericardial effusion in our
group of patients was calculated according to the
method described by Horowitz et al. (lS), the results
of which revealed that all patients in our study group
who developed pericardial effusion in the first and
second trimester of pregnancy were found to have
mild pericardial effusion (0.3-0.5 cm). Nineteen o u t
of 23 women continued to have mild pericardial
effusion in their third trimester of pregnancy, o f
whom 4 accumulated more pericardial fluid and
were upgraded as having moderate pericardial effu-
sion (0.54.8 cm). None of our patients had per-
icardial tamponade. No significant E C G changes
were noted in these subjects and none of them devel-
oped clinically audible pericardial rub.
We did not find any statistically significant differ-
ence in age, hemoglobin, total protein, albumin/
globulin ratio or mean blood pressure during preg-
nancy between those who developed pericardial ef-
fusion during pregnancy and those who did not. The
results of these two groups are summarized in
Table I .
Table I1 shows the frequency of occurrence of
pericardial effusion in primigravidas and in multigra-
vidas, and on comparing the two frequencies it was
found more commonly in the primigravidas than in
multigravidas, which was statistically significant
(x=4.392; d f = l ; p<0.025).
Table 111 shows the frequency of occurrence of
pericardial effusion in those subjects who gained
more than 12 kg during pregnancy and those who

Arla Obstet Gynecol &and 70 (1991)


Table 111. Frequency of occurrence of pericardial effusion in subjects who gained > 12 kg and those who gained < 12 kg
Total no. of
patients
Subjects gained < 12 kg 35
Subjects gained > 12 kg 17
x2=4.292; d f = l , p<0.025.
gained less than 12 kg, and on comparing the two
frequencies, pericardial effusion was more com-
monly found in those subjects who gained more than
12 kg, which was statistically significant (x2=4.292;
d f = l ; p<0.025).
Discussion
Hemodynamic changes and their effects o n females
during pregnancy have not received the attention
they deserve. Pregnancy increases the total body
fluid volume and imposes an increase in the work
load of the heart (16).
Our finding of a 44.2% prevalence of pericardial
effusion is similar to the one by Enein et a1 (12), who
found 42.9%, and Haiat e t al (13), who found 8 out
of 20 pregnant women (40%) in their third trimester
of pregnancy to have pericardial effusion. It is in-
teresting to note from our study, however, that per-
icardial effusion may develop very early in preg-
nancy. Unfortunately, not all the subjects in this
study attended to have an echocardiogram per-
formed in the sixth week after delivery, but none of
the 11 subjects who had pericardial effusion during
pregnancy and who had an echocardiogram per-
formed in the sixth week after delivery showed any
evidence of pericardial effusion.
There was no correlation between the presence of
pericardial effusion and the subject's age, blood
pressure, hemoglobin level, total protein on albu-
mdglobulin ratio. There was, however, a statisti-
cally significant difference in the frequency of occur-
rence of the pericardial effusion in the primigravidas
when compared with multigravidas, which could be
explained by the physiological adaptation of the
multigravida to the increase in the total body fluid.
Subjects who gained more than 12 kg during preg-
nancy (which is the average weight gain during nor-
mal pregnancy), ran an increased risk of developing
pericardial effusion, which may be due to the in-
crease in fluid retention, contributing t o both phe-
nomena.
Pericardial effusion in normal pregnancy 293
Pericardial No pericardial
effusion effusion
12 (34.3%) 23 (65.7%)
11 (67.7%) 6 (35.3%)
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Address for correspondence:

Hassan S . 0. Abduljabbar, M.D.
Department of Obstetrics and Gynecology
King Abdulaziz University Hospital
P . 0 . Box 6615
Jeddah 21452
Saudi Arabia

A d a O h w 3 Gyrrecol S a n d 70 ( I Y Y I )