Pregnancy in Patients With Heart Disease

What are heart disease in pregnant women and why are they important?

The term heart disease refers to any alteration of the heart or cardiovascular system. During pregnancy, blood circulation of women suffers normal changes by the effect of hormones, such as increased blood volume, increased heart rate (heart rate) and changes in blood pressure, among others, so That the heart has to work harder. In normal conditions these changes only cause some discomfort like fatigue, dizziness or swelling; However, if the woman suffers heart disease there can be a serious risk for her and the baby, which can even cause them death.

How frequent and what are the causes of heart disease in pregnant women?

Heart diseases are present in 2-4% of pregnant women but are expected to increase due to a lifestyle unhealthy population and medical advances that make women before dying in childhood, now reaching reproductive age. In addition, they are an important problem because in many countries it is the first cause of nonobstetric maternal death (unrelated to pregnancy itself).

Causes of heart disease in pregnant women include the consequences of rheumatic fever in infancy, congenital heart disease (heart malformations from birth), or heart damage acquired from heart attacks, damage to multiple heart valves, Presence of alterations of the heart rhythm, among others.

Pregnancy in Patients With Heart Disease

 

 

What is the risk of heart disease in pregnancy for the mother and her baby?

Normal changes in the circulatory system that occur during pregnancy mean a challenge for the heart, which may not be supported by pregnant women with heart disease, leading in many cases to heart failure (the heart’s inability to pump blood properly) , Increased risk of pregnancy-related blood pressure changes such as pre-eclampsia, postpartum haemorrhage or even death of the mother. Of course, all this depends on the type of heart disease, its severity, associated diseases and functional status at the time of conception. Thus, those women with milder heart disease and who can perform the activities of daily life without problems will have fewer complications and less risk of dying than those with serious diseases and limitation,

The fetus also has many risks, as about 20% of babies have some type of complication, which as in mothers, may be of different gravity. Baby complications include increased a risk of heart disease congenital, premature birth, low birth weight, brain damage or death, among other fetal damage.

What are the signs and symptoms of heart disease in a pregnant woman?

There are a number of signs and symptoms that are common in pregnancy and are not necessarily a reflection of a heart problem, as they can be found in healthy and stable pregnant women, including decreased exercise capacity, difficulty in Breathing, fainting at times, swelling of the legs or even the presence of blows. That is why detecting heart disease in pregnancy can be difficult, even some tests, such as the electrocardiogram, may have variations from a nonpregnant woman, which can lead to diagnostic difficulties. That is why it is required judicious assistance to prenatal controls, careful medical evaluation and before the presence of doubts, evaluation by a medical group with experience in this type of patients.

Although many signs and symptoms of heart disease may be confused with changes in normal pregnancy, the following warning signs should be kept in mind to consult a group of cardiologists with experience in heart disease during pregnancy:

  • History of heart disease independent of whether or not there are symptoms.
  • Progressive swelling, especially if it starts early in pregnancy.
  • Difficulty breathing fast progress and greatly limits activity.
  • Frequent fainting, occurring with exercise or at rest, or that are of long duration or with incomplete recovery (alterations of movement, inconsistencies, etc.).
  • Blue color on lips or hands.
  • Chest pain.
  • Changes in heart rhythm.
  • The presence of blows heard by the doctor.

How is the follow-up and treatment of pregnant women with heart disease?

The first fundamental aspect in all women is that before pregnancy should have a pre-conception review with an obstetrician-gynecologist to assess if they are able to become pregnant. In patients with known or suspected cardiac disease and who desire pregnancy, they should also be reviewed by cardiology to discuss from the contraceptive to the possibility of pregnancy, either with adjustments to treatment or to establish if pregnancy is definitely contraindicated.

However, if a woman with heart disease did not take precautions in the pre-conception evaluation and is pregnant, proper care of these pregnant women with heart disease requires a multidisciplinary team (different specialties) that includes cardiologists, obstetrician-gynecologists, Anesthesiologists, intensive care specialists, neonatologists and other specialties of support during pregnancy, childbirth and postpartum; Therefore they should have follow-up in hospitals with experience in this type of patients, to try to reduce the risks of the mother and the baby already mentioned previously.

Consultation with an experienced team will help to perform a not only maternal-fetal risk assessment, but also allow for the necessary changes in medications or dosages prior to pregnancy or breastfeeding. It will be defined if special care measures are needed, the level of care required depending on the severity of the illness, and since some of the diseases are curable, the medical team will advise the previous treatment and wait at least one year before becoming pregnant. In this way, proper follow-up during pregnancy will help ensure a successful outcome for both mother and baby.

What is important at the time of delivery in these patients?

Doctor examining a pregnant woman

Unfortunately, many women with heart disease who are pregnant do not make adequate controls and only get evaluated by the cardiologist at the time of delivery, which is not recommended as they may not have enough time to plan properly childbirth. However, in these cases, supervision by a team with experience in pregnant women with cardiopathy is required to define adequate treatments during the labor, delivery and postpartum period, which are critical moments due to the risk of cardiac decompensation.

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As for the idea of the need for caesarean section in all these patients, it is really a myth, since it has been seen that vaginal delivery usually involves a lower rate of complications for both mother and child, and except for some heart diseases Very specific, vaginal delivery will always be the ideal route of birth, unless the obstetrician considers a cesarean section necessary for some noncardiac condition of the mother or for fetal reasons.

Additionally, cardiology checks are required in the postpartum period because in the first few weeks there are significant changes in blood volume that can lead to decompensation and even death.

Where can the controls be performed on pregnant women with heart disease?

As previously mentioned, a medical team with experience in the follow-up and appropriate treatment of these patients is required. The University Hospital San Vicente Foundation, has a clinic of pregnancy and heart disease, with a multidisciplinary group with experience in the management of these patients. For more visit http://healthyfamilyapp.com/.

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