Cardiac disease in pregnancy

Cardiac disease in pregnancy

Cardiac diseases are common and they are a leading cause of maternal mortality.

Many cardiac diseases go undiagnosed throughout life and first manifest during pregnancy due to increased cardiac workload.

Having a cardiac disease warrants intensive monitoring throughout pregnancy to ensure maternal and fetal wellbeing and to avoid morbidity and mortality.

What are the hemodynamic changes that happen during pregnancy and affect cardiac function?

** increased plasma volume

** increased cardiac output

** increased heart rate

These changes can make underlying heart disease symptomatic or worse.

What are the types of heart diseases?

** congenital: the lady is born with it

** valvular heart disease

** cardiomyopathy: problems with the heart muscle itself

** coronary artery disease

** arrythmias: problems with heart electricity

** increased pressure in pulmonary blood vessels

What are the symptoms of cardiac disease in pregnancy?

** shortness of breath

** chest pain

** exertional dyspnea

** palpitations

** bilateral lower limb swelling

** shortness of breath that awakens the lady t night

**dizziness and loss of consciousness

** fatigue and malaise

What are the investigations that are done to assess the heart?

** auscultation using stethoscope

** ECG

**echocardiography

** stress test (walking on treadmill with ECG electrodes on)

what are the complications of cardiac disease in pregnancy?

** infective endocarditis, thus the lady must be covered with appropriate antibiotics

** heart failure

** thrombotic events

** problems with fetal growth leading to preterm birth

** maternal death

Who should care for a pregnant lady with cardiac disease?

It should be conjoined between the obstetrician and the cardiologist

How to care for pregnant ladies with cardiac disease?

** avoid anemia

** correct thyroid dysfunction

** control hypertension and diabetes (if they exist)

** manage fluid balance in cases with advanced cardiac disease

** avoid intrapartum excessive blood loss or fluid overload

** give adequate intrapartum analgesia (can go for epidural but must avoid hypotension)

** serial monitoring of fetal growth throughout pregnancy

** regular follow-ups with the cardiologist

** give anticoagulant if indicated by certain scores

** go for vaginal delivery unless cesarean section is indicated for obstetric reasons

** use instrumental delivery (vacuum or forceps) to shorten the second stage of labor in cases of maternal exhaustion or advanced cardiac disease

Dr Najeeb Layyous  F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist