Pregnant women of fertile age with cardiac anomaly

Pregnant women of fertile age with cardiac anomaly

Maintaining women of fertile age with heart defects, including pregnant women is the choice and implementation of the best medical method, ensuring the preservation of the life and health of the mother and child.

Indications for hospitalization with indication of the type of hospitalization.

Type of hospitalization: planned, emergency. Indications for planned admission: cardiac anomaly (CA) in pregnant women with maternal risk assessment World Health Organization (WHO) I, WHO II, WHO II-III. The term of inpatient treatment in pregnant women with CA is determined individually. When treating cardiac insufficiency (CI) in a cardiology hospital the treatment duration is set depending on the stage of CI and the effectiveness of therapy. Indications for emergency hospitalization: CA in pregnant women with assessment maternal risk WHO III, WHO IV. CA in pregnant women with maternal evaluation risk WHO III, WHO IV, with the progression of CI up to 30 weeks, pregnancies are sent to cardiological hospitals at the place of residence in emergency order, after 30 weeks to specialized obstetric hospitals. Childbirth and the postpartum period are especially dangerous for women with CA. Postpartum adjustment occurs mainly in the first three days after birth. This period may be complicated by pulmonary edema, increase in right ventricular, left ventricular or total CI due to redistribution of  blood volumes between the great and the small circle of blood circulation, a sharp shift in pressure gradients and uncompensated hypoxemia. Therefore, critical periods are considered 48-72 hours periods after delivery.

Diagnostic criteria

Complaints: pain in the heart, shortness of breath, palpitations, interruptions in work heart, dizziness, fainting, cyanosis, edema.

Anamnesis: diagnosis of CA and features of its course with the previous pregnancy, random finds.

Physical examination: auscultatory pathological heart murmurs, wheezing in the lungs, bulging and throbbing of the neck veins. Symptoms associated with concomitant diseases of the bronchopulmonary system, dysfunction of thyroid, electrolyte disorders, anemia and other pathological conditions.

Laboratory studies: increasing pro-BNP levels.

Instrumental studies: ECG signs, EchoCG signs of CA.

Consultation of narrow specialists: for the purpose of the need for cardiac surgical correction of CA during pregnancy and making a collective decision on the possibility of prolonging pregnancy:

  • arrhythmologist;
  • cardiac surgeon;
  • endocrinologist;
  • ophthalmologist;
  • hematologist;
  • nephrologist.

Objectives of treatment:

Maximum effectiveness for the mother and safety for the fetus.

Improvement of the clinical condition, reduction of symptoms of HF, increase of exercise tolerance.

Treatment tactics

Non-drug treatment (diet, regimen, etc.).

Requirements for dietary purposes and restrictions:

  • a normal balanced diet without restriction of consumption;
  • salt and liquid. In the presence of CI – limitation of daily consumption of salt;
  • weight loss during pregnancy is not recommended with the risk of giving birth to children with low weight and subsequent slowdown in their growth;
  • refusal to smoke and use alcohol.

Requirements for work, rest, rehabilitation:

  • sufficient 8-10 hour night sleep, preferably 1-2 hour day sleep;
  • bed rest and oxygen during dyspnea attacks;
  • in the presence of CA – limitation of physical exertion, sexual rest;
  • moderate aerobic exercise (comfortable but regular motor mode);
  • supercooling and night work are not recommended;
  • individual solution of the residual disability issue according to the patient’s condition;
  • rehabilitation of chronic foci of infection.

Surgical intervention.

With the ineffectiveness of drug treatment for a certain period, with increasing CI:

  • surgical correction of CA, surgical treatment of arrhythmias in
    according to the risk/benefit ratio, both for the mother and fetus;

  • valvuloplasty (balloon or surgical instrumental). If an artificial valve is implanted, the choice of prosthesis is determined on the basis of the planned pregnancy. With inefficiency of surgical anticoagulation and obstruction of blood flow intervention is indicated.

Preventive actions

Starting from the 6th week of gestation, the volume of circulating blood in a pregnant starts to increase. Large loads on the cardiovascular system occur during the 7-8th obstetric month of pregnancy and during childbirth. Therefore, pregnant women should be examined at least three times:

Stage I – in the period of 8 to 10 weeks of pregnancy in order to clarify the diagnosis and address the possibility of prolonging pregnancy.

Stage II – in the period of 28 – 30 weeks of pregnancy to assess the state of the cardiovascular system during the period of maximum physiological loads.

Stage III – in the period of 36 – 38 weeks to prepare and select the method of delivery.

A large role in the favorable outcome of pregnancy for mother and child plays pregravid training of women of fertile age with congenital heart disease, which includes the following activities:

  • treatment of associated diseases – hypertension, diabetes, chronic kidney disease, etc.;
  • avoid taking teratogenic drugs with the onset of pregnancy, medication should be discontinued or revised by a specialist doctor;
  • discussion of anticoagulant therapy in pregnant women with mechanical  prosthetic heart valve;
  • treatment at the dentist is preferably carried out before pregnancy.

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