Silent pericardial effusion in late pregnancy.

In order to investigate the hemodynarnic changes which occur during pregnancy, 40 healthy pregnant women (mean age 28 years) were studied at various stages of their gestation by Tm and two-dimensional echocardiography. All pregnancies were uncomplicated and there was one twin gestation. Of 40, 20 women were in late pregnancy (32nd to 38th weeks of pregnancy) and complained with occasional dyspnea and/or palpitations. In all cases, cardiac examination was normal. In 2 of 20, blood pressure was elevated respectively at 150/90 and 160/80 mm Hg; in all cases the electrocardiogram was normal or showed nonspecific ST-T changes. The data concerning myocardial function are discussed elsewhere.’ We want to stress here the fact that surprisingly, in 8 of the 20 women who were in late pregnancy, echocardiograms showed definite signs of pericardial effusion as strictly defined: in these cases a separation between posterior left ventricular epicardium and pericardium continued through the cardiac cycle.2 According to Horowitz’s criteria,’ the effusion was large in one, (Fig 1), moderate in two, and small in four cases. Pericardial effusion was clinically silent as neither precordial pain nor pericardial friction rub was present; it appeared in late pregnancy and, in all cases, did not occur before the 32nd week; it was transient and could no longer be detected two months after delivery. None of the pregnant women presented with eclampsia, recent viral illness or evidence of congestive heart failure. In both women with high blood pressure, pericardial effusion was respectively large and moderate. To our knowledge, pericardial effusion has not been reported so far in the late pregnancy; it is likely to result from water and salt inflation; in the 8 pregnant women who showed a pericardial effusion, the mean weight gain was higher than in the 12 others who were free of any pericardial fluid at the same stage of gestation; however, the difference was not statistically significant, due to the small number of cases of each group. Silent pericardial effusions may at times be present in the late pregnancy; as they cannot be detected by clinical examination and electrocardiogram, echocardiography could afford a safe and reliable approach of their diagnosis.