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The functional state of the cardiovascular system during pregnancy and in childbirth. Pregnancy and Cardiovascular Diseases

Heart diseases occupy the first prevalence in all extragenital diseases occurring during pregnancy.
This pathology is given great attention, because Pregnancy due to physiological changes can significantly worsen the course of the disease and lead to serious complications, both for the mother and for the development of the child.

Information The question of the possibility of preservation of pregnancy should be solved jointly with an obstetrician-gynecologist and a cardiologist in the early stages, and ideally during the period of pregnancy planning.

Possible complications of heart disease during pregnancy:

  1. Severe flow;
  2. Chronic hypoxia of the fetus;
  3. Interene fetal death.

It should be remembered that heart diseases are extreme danger not only for a child, but also for the mother and can lead to disability and even a deadly outcome.

The main diseases of the cardiovascular system during pregnancy:

  1. Acquired and congenital heart defects;
  2. Rheumatic disease;
  3. Heart rate disorders;
  4. Operated heart;
  5. Myocardial diseases.

Additionally Treatment of these diseases should be carried out regularly throughout the pregnancy in the prescription of the cardiologist.

A complex of therapeutic measures depends on the type of disease and its gravity. As a rule, prescribe the following groups are predarata:

  1. Antiarrhythmic drugs;
  2. Heart glycosides;
  3. Antiagregants;
  4. Anticoagulants.

Maintaining pregnancy in women with heart disease

At the first appearance of a woman with diseases of the cardiovascular system it is necessary to resolve the possibility of preservation of pregnancy.

Indications for interrupting pregnancy:

  1. Aortic valve failure;
  2. Stenosis of the aortic valve with significant increase in heart and expressed myocardial deficiency;
  3. Mitral valve failure in combination with insufficiency of blood circulation, rhythm disorders or activation of the rheumatic process;
  4. Operated heart (the question of the possibility of pregnancy conservation is solved individually);
  5. Acute rheumatic process or aggravation of the chronic process;
  6. Severe cardiomyopathy;
  7. Severe course of myocarditis;
  8. Cleaning arrhythmia in combination with heart defects;
  9. Pronounced defect of the interventricular partition;
  10. Pronounced stenosis of the pulmonary artery;
  11. Heavy flow with an open arterial protocol.

Summarizing the above data, it can be noted that the question of the interruption of pregnancy is solved on the basis of the severity of vice, circulatory disorders and the activity of the rheumatic process.

Pregnancy must be conducted in the following principles:

  1. Joint observation of the obstetrician-gynecologist, cardiologist, therapist, cardiac surgeon;
  2. Regular heart examination;
  3. Drug treatment, depending on the disease;
  4. Regular ultrasound control of the state of the fetus, cardiographography, dopplerometry;
  5. Planned hospitalization up to 12 weeks (solving the issue of preservation of pregnancy), 28-32 weeks (for prophylactic treatment), 36-37 weeks (resolving the issue of the method of delivery).

Conducting childbirth for diseases of the heart

Important The way of the delivery should be seamless to each woman individually on the basis of the type of disease and the severity of his flow (a doctor's participation of a anesthesiologist-resuscitator is required in the consultation).

Absolute testimony to Cesarean section:

  1. Combination of heart disease with obstetric pathology;
  2. Vices of the aortic valve;
  3. Stenosis of the mitral valve;
  4. Pronounced circulatory disorders;
  5. Coarctation of aorta;
  6. Heavy flickering arrhythmia;
  7. Rheumatic process 2 and 3 degrees;
  8. Myocardial infarction.

In the absence of contraindications, it is possible to independently root separation through natural generic paths.

Features of natural labor:

  1. The position of the woman on the left side (it is strictly eliminated by the position lying on the back);
  2. Maximum childbing anesthesia (optimally epidural anesthesia);
  3. Reduction of the second period of childbirth due to the "shutdown of labor". Curtain the crotch to accelerate the birth of the child, obstetric tongs are imposed in severe cases;
  4. Watching a woman together with a cardiologist and anesthesiologist-resuscitator;
  5. Constant monitoring of the condition of the cardiovascular system of the woman and the state of the fetus;
  6. Optimally maintaining childbirth under hyperbaric oxygenation.

The main place among the somatic pathology in pregnant women occupies diseases of the cardiovascular system. Their share accounts forfishing of all diseases of internal organs. Most often encounteredretail and congenital heart defects, operated heart, hypertensivedisease.

Pregnancy presents increased cardiovascular requirementswoman system. Adaptive changes are caused by coexistence of twoorganisms - Mother and Fetal. Pregnant women have physiologicaltachycardia, more pronounced inIII trimester. At the same time increasesimpact and minute heart volume. By the 28-30th week of pregnancy Cardiacemail increases by almost 30%, mainly due to the participation of heartcuts and increasing impact volume of the heart. On the same time startsit is noticeable to increase the volume of circulating blood. Reduced peripheralthe resistance of blood vessels and blood viscosity facilitate the process of hemocirculation.These changes provide a progressive increase in blood flow in the uterus, placenta, lactic glands and kidneys. As pregnancy progressionthe need of the body of the mother and fetus in oxygen, which in manygOM is provided by hyperfunction of cardiac activity. Compensatethe possibilities of women suffering from diseases of cardiovascular-free systems are limited, therefore, their pregnancy often proceeds complicated and can lead to decompensation of cardiac activity.
A new chain of changes in the cardiovascular system causes childbirth andlerodo period. With each battle, blood from the uterus is pushed out bythe board to the heart, which increases the heart emission by 15-20%, increasesblood pressure and reflex reduces heart rate.In women experiencing pain or fear, there is even more pronouncedincrease cardiac output. Such a heart load can be criticalcreative for women with cardiac pathology.
Immediately after the birth of the fetus, due to the sharp shutdown of the uterine-plazentblood flow and eliminating the grade of the lower hollow vein is observedincreasing the volume of circulating blood, which increases the load onheart, and in sick women can contribute to the occurrence of cardiacinsufficiency.
Acquired heart defects. Acquired heart defects meet6-8% of pregnant women. Most often they have rheumatic origins.Rheumatism refers to toxic-immune diseases. The causative agent isp-hemolytic streptococcus group A. Rheumatism is systemica disease of the connective tissue with the predominant localization of the proofcA in blood circulation bodies. Most often girls and womenof a rough age. Most often, rheumatism affects the mitral valve, less often - aortic, even less often - three-rolled.
Stenosis of an atrioventricular hole ranks first amongrheumatic etiology counters. With pronounced blood flow fromleft atrium in the left ventricle increases pressure in the leftatrium, in the pulmonary veins and capillaries. Changes in cardiovascularthe vascular system during pregnancy, expressed in increasing circulating blood volume, heart rate and heart raterosa, contribute to the development of edema of the lungs. Risk of hypertension, pulmonary edema, pulmonary artery thromboembolism, flickering arrhythmiasthe stenosis of an atrioventricular valve is enhanced with increasing physicalemotional and hemodynamic load in childbirth.
Mitral valve failure in an isolated form meetsrarely, more often it is combined with stenosis of an atrioventricular hole andwith vices of aortic valve. Due to blood regurgitationthe accuracy of the mitral valve is observed filling the left atrium, and then overflow and expansion of the left ventricle. Excessive dilatationthe left ventricle leads to a decrease in the systolic volume and to the dispensing of blood circulation (left-selling deficiency). Such a violation of blood circulation is developing with severe deficiency of mitralclaus. A small degree of insufficiency or combinedmitral vice with a predominance of insufficiency usually have a beneficiaryprica forecast. The mitral valve prolapse is relatively rare.Hemodynamic shifts are mainly due to insufficiencymitral valve.
Aortic stenosis - the stenosis of the mouth of the aorta in pure form is rare. It is usually combined with aortic insufficiency or mitral wallzom. The narrowing of the mouth of the aorta is halved not reflected in the state of the patient. Fora more pronounced aortal stenosis develops the dilatation of the left cavitythe ventricle, it increases pressure, the cardiac release decreases. Firstla arises left-selling, and then the right-hand deficiencyblood circulation.
Effect of pregnancy on rheumatic heart patterns. During pregnancy, and then during a generic act and in the postpartum periodoRDE is possible the development of complications in the form of exacerbation of the rheumatic process, the increase in the insufficiency of blood circulation and the development of acute cardiaccaptivity.
Aggravation of the rheumatic process, due to the peculiarities of immunologisticsthe status and hormonal background in pregnant women, is observed prettyseldom. Critical periods of exacerbation of rheumatism correspond to the first14 weeks And then the 20-32nd weeks of burden. The aggravation of the roar is somewhat morematism occurs in the postpartum period. Currently, all rheumato-logs indicate the predominance of erased forms of the rheumatic process,
Insufficiency of blood circulation in women with acquired heart defects may complicate the course of pregnancy at the endII. trimester, during childbirth and in the first 2 weeks. postpartum period. These periods are considered critical. However, the possibility of developing decompensation of cardiac acts is maintained during the first year of life after delivery. Developmentinsufficiency of blood circulation is associated not only with the character of the vice of thets, but also with the duration of its existence and age of a woman. Factorsleading to the decompensation of cardiac activity are the following:1) the inertial lifestyle of a woman; 2) the development of late gestosis; 3) activation of the rheumatic process; 4) the presence and aggravation of chronicfoci of infection; 5) acute infectious (especially viral) diseases;6) lack of regular observation during pregnancy obstetrician and terasinge cardiologist; 7) lack of sufficient anesthesia and incorrectconducting birth.
Acute heart failure in pregnant women most often developsthe type of left vehicle and manifests itself in the form of cardiac asthma or edemato their. This pathology is characteristic of mitral stenosis due to inconsistencies.blood inflows from the lungs to the heart and its outflow.
Features of the course of pregnancy and childbirth of the priest-matical vices of the heart. Among the obstetric complications inoGG-speakers are often found with heart defects. Especially often gestosiscompletes the lack of aortic valve. Gestoses develop early, inII. the trimester of pregnancy is characterized by latent flow and bad amenable to treatment. Changes in central and peripheral hemodynamics,the activation of the progulant and platelet levels of hemostasis, the deterioration of the rheological properties of blood, observed in gestoses, on the one hand, is increasing the risk of developing thrombotic complications in a small circle of blood circulationon the other, on the other, it increases the risk of premature detachment normallylocated placenta.

In women with diseases of the cardiovascular system, pregnancyit is complicated by the threat of interrupt. The number of spontaneous miscarriages andpremature genera noticeably exceeds the average indicators. Duringthe percentage of anomaly of the contractile activity of the uterus increases the percentage of anomalies: the number of rapid and rapid labor is increasing. Excessive generic dethe activity can cause hemodynamic destabilization. Features of the cutting activities of the uterus in women with heart defects are associated withthey have the content of prostaglandins.

Some pregnant women with acquired heart defects are developinghypochromic iron deficiency anemia that adversely affectsjet Fetal.

The course of pregnancy at heart defects may be complicated by violationthe uterine-placental blood flow leading to hypoxia or the delay of the development of the intrauterine fetus. The frequency and severity of these complications depend onavailability and degree of severity of decompensation of cardiac activity.

Due to stagnation in the royal and placental circle of blood circulation in women withhearts of blood loss in the last and early postpartum periodsoften exceeds the physiological norm.

Diagnosis of acquired heart defects. Clinical observation and all diagnostic measures in pregnant women with heart defects are jointly carried out by a cardiologist-therapist and an obstetrician, in separate casestea attracting a cardiologist surgeon.

More than 75% of women, heart defects are installed beforethe occurrence of pregnancy, which greatly simplifies the actions of the obstetrician and cardialdog. Diagnostics of the acquired heart defects during pregnancyaround on the same signs as outside it. This topic is described in detail intextbooks for internal diseases. Diagnostic difficulties arisingin some cases, due to changes in the cardiovascular systemwomen in connection with pregnancy: the appearance of noise at the top of the heart, the increaseiI. tone, "Lying" Heart with a high standing diaphragm. Therefore, in addition topercussions and auscultation, be sure to use electrocardiography, phonocardigiography, Ultrasonic Scanning, Spirometry, Speed \u200b\u200bDefinitionblood flow and venous pressure.

Clinical diagnosis, in addition to the characteristics of the vice, must containguidance on or lack of activity of the rheumatic processthe degree of insufficiency of blood circulation.

Determination of the activity of the rheumatic process during pregnancypresents certain difficulties, as some clinical recognitionki active form of rheumatism (subfebrile, moderate tachycardia,eSP, leukocytosis, shift of the neutrophilic formula to the left) are observedhealthy pregnant women. Only a complex of clinical and laboratory datahelps diagnose the activation of the rheumatic process. To clinicalsigns include weakness, fatigue, shortness of breath, subfebilitation, tachycoodiya, arrhythmia. Laboratory signs of rheumatism are leukocytosisover 11.0x10 9 / l, ESE more than 35 mm / h, sharply pronounced neutrophil shiftleft, reducing reticulocytes, the titer of antibodies to streptolizin-0 above 1: 800 andto hyaluronidase above 1: 1000, a certain diagnostic value has cardiovascular insufficiency and hypochromic anemia that cannot betreatment. Clinical options for rheumatism have three degreesprocess activity:


I. power - minimal, characterized by weak severityniche symptoms and minimal changes in laboratory indicators;

II degree - moderate for which moderate clinicalmanifestations of rheumatic attack with low fever, without pronouncedexudative inflammation component in affected organs; smallclones of laboratory indicators;

III degree - Maximum, characterized by bright shared and locally
clinical manifestations and pronounced deviations in the laboratory
indicators.

Chronic heart failure in our country is considered to evaluateusing the classification of N. D. Strazhestko and V.X. Vasilenko:

/ stage -symptoms of circulatory disorders (shortness of breath, heartbeat,fatigue) appear only after exercise;

Pa Stage- shortness of breath and heartbeat become almost constant orappear with very light load; Miogenic symptoms are founddilatation of the heart and stagnation in a small circle of blood circulationleft-deceased failure, in the liver - with deficiency of the rightheart departments;

PB Stage -stagnant phenomena are expressed in small and largecircle circle;

III Stage -irreversible changes in internal organs.

The diagnosis of rhythm disorders and the conductivity of the heart is vitalvalue. If the extra asistol and paroxysmal tachycardia canbe in healthy pregnant women, then the registration of atrial tachycardiawomen with heart disease can be a harbinger of flickering arrhythmia, leading to a rapid increase in heart failure.

Treatment of rheumatic heart defects in pregnant n s. Both diagnostic and therapeutic measures require jointforces of cardiologists and obstetricians. Rational assistance to pregnant with vicehearts consist of the following components: mode, diet, psychoprophylactic preparation for childbirth, oxygen therapy, medication treatment. In modepatients should be provided for sufficient night sleep (8-9 h) and dayholidays in bed (1-2 h). The diet should be easily dismantled, contain vitamines and salts of potassium. Psychoprophylactic preparation for childbirth should be started with early pregnancy terms and to be aimed at eliminatingha before childbirth. Saturation of the body of pregnant oxygen shouldperform any available ways: from oxygen cocktails tooxybatherapy.

Medication therapy pursues many goals: prevention or treatmentrecurrence of rheumatism, prevention of decompensation of cardiac activitythe treatment of chronic and acute cardiovascular failure.

Most clinicians consider it necessary to carry out preventionrheumatism recurrences in critical periods of possible exacerbation of the proofsa: up to 14 weeks, from 20 to 32 weeks. pregnancy and postpartum period. For this purpose, bicillin-1 or bicyllin-5 are used in combination withacetylsalicylic acid. The latter should not be appointed in the first 8 weeks.(teratogenic action) and in the last 2 weeks. pregnancy (the possibility oflonging of pregnancy due to anti-contaminated effect). For the treatment of rheumatism recurrence, penicillin or semi-syntheticanalogues. With severe forms of rheumatism, corticosteroids add(prednisone or dexamethasone).

Cardial therapy with heart defects largely depends on the degree of blood circulation. When compensated vices is recommendedperiodically within 2-3 weeks. applying an infusion from the grass of the horizon, vitamines group B and C, Rutin.

The main drugs in the treatment of heart failureheart glycosides: Stroofantin, Corglikon, Digoxin, ClausenID, Digitoxin. Along with glycosides, diuretics are widely used, whichreduce the amount of fluid in the body, reduce venous pressure andreduce venous stagnation in organs. As diuretics apply furseid, hypothiazide, spironolactone, Eufillin. To improve the function of myofib-rill is recommended for a long time to assign vitamins of the group B, E, C,potassium orotat, riboxin.

Emergency therapeutic assistance is required for pregnant women, women andpupils in the edema of the lungs, which can occur in the mitralnose and deficiency of the aortic valves. Treatment starts with immediateintravenous administration 2-4 ml of 0.25% pipolfen solution, 2 ml 0.5% solutionseduksen and 1 ml of 2% properol solution. At the same time intravenously administered1 ml of 0.05% solution of stanfantine per 10 ml of 20% solution of glucose. At higharterial pressure add gangliplockers such as hasten, benzohexo-pentamine. Under the language can be put a nitroglycerin tablet.

Emergency assistance may be required in violation of the heart rhythm. For the suppression of atrial tachycardia paroxysms use slowintravenous administration of 2 ml of 0.25% verapamil solution, soluble in 8 mlisotonic sodium solution chloride or 5-10 ml of 10% novocain-amide solution with 10 ml of isotonic sodium chloride solution. Ventricular tachycoodiIs are stopped by lidocaine.

The thromboembolism of the pulmonary artery and its branches, which arose in pregnant women with valve vices requires emergency medical events, whichsome should be aimed at eliminating bronchospasm and spasm of the blood circulation vessels, improving the rheological properties of blood,holding the effective treatment of gas exchange and blood circulation. Treatment of startingbased on intravenous administration 2 ml of 0.25% Droperidol solution, 1-2 ml0.005% fentanyl solution and 1-2 ml of 1% diploma solution; then intravenbut 400 ml of REOPOLIGLUKIN is dripping, with an increase in blood pressure, adding 10 ml of 2.4% of the euphilline solution. In the futurethrombolytic therapy is connected by streptocinase, urchinase or fibrilnolizin. At the time of intensive therapy, cardiac glycosides are introduced intravenously. Simultaneously with medication therapy is carried outinhalation of oxygen through a mask or nasal catheters, with increasingrespiratory failure passes to IVL.

Patients with heart defects inthe course of pregnancy must be placed in a hospital at least 3 times. Firstthe hospitalization is carried out on time 8-12 weeks. in the prenatal separation of a specialized maternity hospital or in the therapeutic department of multipro-film hospital. The second time, pregnant is hospitalized in the prenatal deputyon the period of 28-32 weeks, the third hospitalization is carried out for 3 weeks. beforechildbirth.

The first hospitalization is resolved by the issue of saving or interruption.pregnancy, for this purpose, attracting all the necessary diagnostic methods, determine the degree of risk of adverse outcome of pregnancy. L. V. Va-nina (1961) offered to distinguish 4 degrees of risk:

I. power - Pregnancy at heart vice without signsinsufficiency and exacerbation of the rheumatic process;

II degree - Pregnancy at heart pattern with initial symptomsheart failure (shortness of breath, cyanosis), if there are minimalsigns of exacerbation of the rheumatic process (IA. degree in Nesterov);

III degree - Pregnancy with decompensated heart disease withsigns of the prevalence of the right-hand deficiencies, ifmoderate signs of activation of rheumatism (PA), with the appearance of flexorsarrhythmia or pulmonary hypertension;

IV degree - Pregnancy with decomposed heart defectwith signs of left ventricular or total failure, withmaximum signs of aggravation of the rheumatic process (Sha)tsative arrhythmia and thromboembolic manifestations of pulmonary hyper-tENSION.

Continued pregnancy is permissible only whenI and II risk degrees.
The second mandatory hospitalization is carried out in the period of the largesthemodynamic loads on the heart. At this time, pregnant women needcardiac therapy and other medical and preventive measuresriyati.

The third mandatory hospitalization is necessary for pregnantnoah to childbirth, cardiac therapy and development planchildbirth.

In modern obstetrics, the testimony for the operation of Cesareanwomen with acquired heart defects are clearly defined. Cesareanthe cross section is carried out in the following cases: 1) with active rheumatic pro-cesse; 2) with a sharply pronounced pounding of the heart with severe failureleft ventricle and the absence of effect from active drug therapy;3) with a combination of heart defect with obstetric pathology requiring surgerycapless delivery.

Conducting labor through natural generics requires compliance with the followingrules. It is necessary to periodically use cardiac means andoxygen inhalation; carry out adequate anesthesia; with the necessarysTI carry out the regulation of generic activities, not allowing protracted, by-trive or rapid labor; produce an early opening of the fruit bubble; shock the expulsion period; carry out the prevention of bleeding inin the early postpartum period. Imposing obstetric forcepers ofringing the expulsion period in women with mitral stenosis, with deficiencyblood circulation, with endocarditis, with decompensation phenomena at previouschildbirth. In other casesII. the period is shortened as a result of executionperineotomy.

Pedaries with heart disease do not bear the restructuring of hemodynamicsafter turning off the uterine-placental circle of blood circulation, soimmediately after the end of the birth, cardiotonic means are introduced, and whenmitral and aortic insufficiency is put on the stomach.

The principles of postpartum period are the same as during pregnantsTI. Baby feeding with breasts is contraindicated with the active form of rheumtsism and with increasing decompensation phenomena.

Pregnancy and congenital heart defects. There are about 50 timespersonal forms of abnormalities of the cardiovascular system, of which15 forms belong to variants of defects with which sick womenmach to reproductive age. During pregnancy congenital vicescentral Asia is much less frequently acquired. In recent years, the number of their non-how much increased, however, the frequency does not exceed 5% of all viceshearts in pregnant women.

Among the most common congenital defects, 3 groups are distinguished:

1) vices accompanied by reset blood from left to right (defect inter-atrial partition, open arterial duct, interventory defectsome partition);

2) vices at which blood reset on the right left (tetradFallo, transposition of trunk vessels);

3) vices under which there is an obstacle to blood flow (stenosis of the pulmonaryarteries, stenosis of the mouth of aorta, coarctation of aorta).

Due to the wide variety of forms of congenital defects are not essentialit is the point of view on the possibility of predicting the effect of pregnancy onfunctioning of the cardiovascular system and, therefore, healthwomen. To each case of pregnancy, such patients need strictlyan individual approach after a thorough examination in specializedin hospital and joint maintenance with therapists, cardiac surgeons andobstetrics. The forecast is determined not only by the form of vice, but also the presence orthe lack of insufficiency of blood circulation, the presence or absence of an increase in pressure in the pulmonary artery, the presence or absence of hypoxemia.These factors are the reason for the unsatisfactory course of pregnancy andadverse outcomes for mother and fetus.

Most often pregnant women meet blood discharge vices from left to right.Well tolerate pregnancy patients with muscle defectdepartment of the interventricular partition, with a small defect of interpresentationpartitions and partial obliteration of open arterial duct.If the disease is accompanied by the insufficiency of blood circulation of anydegree of severity, pulmonary hypertension or blood discharge on the rightin, pregnancy must be interrupted.

Pregnant after the timely operational correction of congenital in the eats of this group well coped with the load and safely give birthhealthy children.

Congenital vices with discharge of blood right left("Blue") are the mostheavy. Tetrad Fallo and the transposition of large vessels arekazan to interrupt pregnancy.

Congenital blocks with an obstaclein the absence of insufficientheart activity and blood circulation do not serve an obstacle topregnancy. If the stenosis of the pulmonary artery is isolated, then, as a rule, pregnancy ends safely for the mother andfetal. When coarctating aorta pregnancy is allowed only with moderatea narrowing and arterial pressure not exceeding 160/90 mm Hg. Art. However, in this case, due to the danger of the discharge of the modified wall of the aortafinish cesarean section.

Watching pregnant women with congenital heart defects and maintenancelabor is carried out according to the principles developed for patients with acquiringthin heart defects.

Pregnancy and operated heart. In recent decades, thanksof the success of cardiac surgery, a group of women appeared in obstetric practicemoved the operational correction of heart defects. Most frequent operationsthey are mitral commissurotomy and the replacement of defective heartvalves with artificial prostheses or biological grafts.Operational treatment of defects so much improves health carethe number of women that the possibility of tooling pregnancy appears. Od-nako pregnancy and childbirth in such patients are a big risk, notalways justified.

For patients who have undergone successful commissionurbation, can be resolvedpregnancy no earlier than a year after the operation after the disappearance of allsigns of heart failure. It is impossible to delay the time of the offensivepregnancy due to the threat of development of restenosis. Contraindicated pregnancyin women of this group in the following cases: Bacterial endocarditis,activation of the rheumatic process, restenosis, traumatic lack of a mitral valve, excessive expansion of an atrioventricular hole. If there are no contraindications, then making pregnancy and childbirththe principles are common to all cardiac patients.

It is extremely difficult to resolve the issue of admissibility of pregnancy in womenwith prosthetized heart valves. Despite the fact that patients with mechanicalanticoagulants constantly get anticoagulants, they persistdanger of the development of thromboembolic complications, including thrombosisvalve. This danger increases during pregnancy due to physiological hypervolemia and hypercoagulation. Pregnancy can be resolveda year after surgery with full adaptation of the body to new conditionshemodynamics. Patients need careful monitoring of the cardiac surgery onall over pregnancy, so all 3 hospitalization implementedaccording to the plan, should be carried out in a specialized obstetric hospital.Like all cardiac patients, they are carried out by complex therapy, including antipers, desensitizing agents, heart glycosisdy, oxygenoraterapy, vitamins. In addition, pregnant women with mechanicalvalve prostheses are obtained by anticoagulant therapy. As anthicoagulant is used phenylin. INI. trimester due to possible teratogenphenylin action is replaced with heparin. For the prevention of hemorrhagicphenylin fetal complications are canceled for 3 weeks. to expected delivery,replacing it with heparin again. Birth is carried out carefully through natural rodoways without imposing obstetric forceps and cut perineum. Cesarean section is produced only when heart failure or strict obstetric testimony. In the postpartum period continue the cardialtean and anticoagulant therapy.

Once again it should be emphasized that the prevention of complications of the mother and theyes, during pregnancy and childbirth, with all types of heart defects, it consists inas follows: early and accurate diagnosis of vice, timely solutionmillet about the possibility of pregnancy preservation, careful observation of the therapist, Cardiologist and obstetrician with planned hospitalization in the hospital in critical periods.

Pregnancy with hypertension.The most space-transoms of diseases of the cardiovascular system include hyperto-niche disease, essential arterial hypertension. Arterial hyphenation is observed in 5-15% of pregnant women. From this number, in 70% of cases, late hundreds are revealed, in 15-25% - hypertensive disease, 2-5% - secondary hypertension associated with diseases of the kidneys, endocrine pato logic, heart disease and large vessels, etc.
Classification. To date, there is no uniform classfiking hypertension. In our country, a classification was adopted, according to which 3 stages of the disease distinguish (Table 16).
According to the classification of WHO, refined in recent years, it is customary to distinguish the following degrees of arterial hypertension (Table 17).

Table 1

Classification of hypertensive disease used in Russia


There is an increase in blood pressure, but there are no changes in heartbut-vascular system due to arterial hypertension(no left ventricular hypertrophy according to ECG, changeseye DNA vessels).
There is an increase in blood pressure, combined with changescardiovascular system due to arterialhypertension (left ventricular hypertrophy according to ECG, angiospatia retina) and ischemic heart disease (angina)or brain (dynamic violation of cerebral circulation),but the function of the internal organs is not violated.

Previously increased blood pressure may decrease due todevelopment of heart attack or stroke. There is a significant violationheart function (heart failure), and / or brain (strokes),and / or kidney (chronic renal failure).

Table 17.

Classification of the degree of arterial hypertension (WHO, 1999)



Clinical picture and diagnostics. Clinical manifestationshypertensive disease during pregnancy is the same character as not in pregnant women. They depend on the stage of the disease. However, it followsmnage about some decline in blood pressure in the first half of pregnancy, characteristicfor hemodynamics of healthy pregnant women. This ability applies andfor pregnant women with hypertension.

The main diagnostic difficulties that the doctor can meet are determined by the following circumstances. Many pregnant women (especiallyyoung) are not suspected of changes in hell. Specialist examining the Bere-it is difficult to estimate the degree of depressor influence of pregnancy onclaus forms of hypertension. Often developing in the turnspregnancy OGG-Gesstosis makes it difficult to diagnose hypertension.

The diagnosis helps the intersectant anamnesis, including families. It is necessary to establish the presence of an increase in the blood pressure on the nearest relatives. It is necessary to establish whether it was not necessary to increase hell, for examplein case of workshops at school and at work. Important may have

0 the course of previous pregnancies and childbirth. Finding out the complaints of the patient,
blows to pay attention to headaches, bleeding from the nose, pain in the
hearts and others.

Conducting an objective examination, it is necessary to measure blood pressure on both RU-kats, repeating the measurement 5 minutes after a decrease in emotional voltage in women. ECG recording, the research of the Eye DNA is required for thiscategories of pregnant women.

With I. the stages of hypertension Most patients are not experiencedsignificant physical limitations. In the history of them you can meetguidelines for periodic headaches, noise in ears, sleep disorders, episo-wild nose bleeding. On ECG, you can detect signs of hyper-functions of the left ventricle. There are no changes in the eye bottom. Functionscheck are not violated.

With hypertensionII. stages are noted permanent headspain, shortness of breath during exercise. For this stage of the disease,we are hypertensive crises. Signs of hypertrophy ofvodoko. On the eye day can be determined by the narrowing of the arteriesand arterioles, moderate thickening of their walls, compressed veins by compacted artriodes. Urine tests unchanged.

Clinical observations indicate that pregnancy with hy-pertonic diseaseIII stages are practically not found in connection withthe woman's ability to conceive women's ability to conceive.

Differential diagnosis of initial stages of hypertensive diseaseand OGG-gestosis, as a rule, does not cause serious difficulties, since

1 and II. the stages of the disease are missing changes in the urine, there are no swelling,
hypoproteinemia is not detected, there is no reduction in daily diurea.

Treatment. Therapy of hypertensive disease should be started with the creation forsick state of psycho-emotional peace and confidence in the effectiveness of the therapy and the prosperous outcome of pregnancy. Need toattention on strict performance of the day (work, rest, sleep) and. Food should be an easy-to-wear, rich in proteins and vitamins.

Medical treatment is carried out using a complex of preparationstov, acting on various illnesses of the pathogenesis of the disease. Applythe following hypotensive drugs: Diuretics (dichlotiazide, spironolactone, Furosemid, Brinaldix); Preparations acting on different levels of sympathytickening system, including A- and P-adrenoreceptors (anaprilin, clofelin,tildoff); Vasodilators and calcium antagonists (Apresin, Verapamil,fE NITIDIN); Antispasmodics (dibazole, papaverine, but-shpa, eufillin).

Along with medication therapy, physiotherapeuticprocedures: Electrosna sessions, Industothermia Stop and Hearts region, diather-mija of the aircraft region. The beneficial action has hyperbaricskye oxygenation.

Maintain pregnancy and childbirth. Hypertensive diseaseit makes an adverse effect on the course and outcome of pregnancy. SA-ME frequent complication is the development of OGG-gestosis. Gestosis manifests itselfearly, from the 28-32nd week, it takes hard, poorly amenable to therapy, oftenrepeated with subsequent pregnancies.

With hypertensive Mother's disease suffers from fruit. An increase in the peripheral resistance of the vessels against the background of vasoconstriction, sodium delay, followed, and liquids in the interstitial spaces, the amplification of the permeability of the adexact membranes lead to disruption of the function of the placenta. With hypertensivediseases significantly reduced uterine-placental blood flow. These changesthey lead to hypoxia, hypotrophy and even the death of the fetus. Antenatal deaththe fetus may come as a result of detachment of a normally located placeyou, which is a frequent complication of hypertension.

Birth with hypertension is often acquired by fast, rapidthere is a course or protracted, which is equally adversely affected by the fruit.

To determine the tactics of pregnant, suffering from hypertensivethe disease most important is the assessment of the severity of the disease and identifyingpossible complications. For this purpose, the first hospitalization is necessary.patient in early terms, pregnancy (up to 12 weeks). ForI. stages hypertensionthe disease pregnancy continues with regular observation of therapytom and obstetrician. If installedII. stage of the disease, then pregnancyit can be saved in the absence of related activitiescardiovascular system, kidneys, etc.;III stage serves as a testimony forinterruption of pregnancy.

The second hospitalization is necessary during the greatest load ondove-vascular system, i.e. at 28-32 weeks. In the prenatal department is carried outcareful examination of the patient and correction of conducting therapy. Thirdplanned hospitalization should be carried out in 2-3 weeks. before the estimatedgiving birth to preparing a woman to the delivery.

As a rule, childbirth occur through natural generic paths. WhereinI. the period of childbirth is carried out with adequate anesthesia in continuinghypotensive therapy and early amniotomy. In the period of expulsion of hypertensiontherapy is enhanced with gangliplockers up to controlmy hypo-, or rather, normal. Depending on the state of the feminine andfetal II. the period is reduced by producing perineotomy or the impulse of obstess-kich forceps. INIII preventive measures are carried out by the period of childbirth forreduction of blood loss; With the last fertime, 1 ml of methyl ergometrine is introduced.Throughout the generic act periodically carry out preventionfetal hypoxia.

Prevention of complications of pregnancy and childbirth. Pro- filactic measures are reduced to regular and more observationpregnant in women's consultation. Maintaining a patient must exerciseshared midwife and therapist. Should strictly adhere to the rule of threehospitalization of pregnant woman even with good health and effectthe tivtivity of outpatient hypotensive therapy. Absolutely shown the hospitallake in the case of joining late gestosis, even flowing in easyform.

With physiologically occurring pregnancy and especially in childbirth, such conditions of blood circulation arise, in which the load on the cardiovascular system is significantly increased.

Pregnancy and childbirth presented to the function of the heart, significant requirements in connection with the increase in blood mass and the total weight of the pregnant, the emergence of a new link in a large circulation circle (uterine-placental blood circulation), a change in all types of metabolism, the functions of the endocrine apparatus, the central nervous system.

In the second half and especially by the end of pregnancy, considerable importance is also acquired by mechanical factors, to a certain extent imperative normal operation of the cardiovascular system, mainly high standing diaphragms, which achieves the greatest degree to the 36th week of pregnancy. High standing diaphragms, according to V. V. Sykova, lowers its work. As an additional blood circulation engine, reduces the life capacity of the lungs, makes it difficult for the pulmonary blood circulation and entails a heart offset; In this case, the heart is not so much risen as it approaches the chest and at the same time somewhat turns around its axis. The change in the position of the heart is accompanied by relative "twisting" vessels bringing and carrying blood, which also causes the difficulty of pulmonary blood circulation.

The main changes in hemodynamics during pregnancy are reduced to an increase in the mass of circulating blood (volume of plasma and red blood cells), minute and shock volumes, the number of heart rate, blood flow velocity.

An increase in the mass of circulating blood occurs gradually. In this case, the volume of circulating blood in 28-32 weeks of pregnancy increases by about 30-40%, in the first trimester of pregnancy 5-5.3 liters, in the third - 6.0-6.5 liters. The number of circulating blood increases mainly due to fluid (plasma), which causes a decrease in the specific gravity of the blood and the emergence of "Pregnant's Sheets". While the number of circulating blood during pregnancy increases by 30%, the hemoglobin content increases by only 15%; Hematocrit decreases.

With an increase in the period of pregnancy, a minute amount of blood increases - from 5.5 liters at the beginning of pregnancy to 6.4-7 liters of 28-32 weeks.

The increase in the minute volume of blood is due to an increase in the mainly shock volume and to a lesser extent - the participation of heart abbreviations. In this case, the systolic volume increases by 25-50%, reaching 70-80 ml against 60-65 ml in non-embled. The speed of blood flow in pregnant women, equal to the "Hand - Ear" section of 10 s at the beginning of pregnancy, somewhat increases towards it (11-13 s). The pulse frequency in healthy pregnant women even in peace increases. At the same time, tachycardia is observed more than 50% of pregnant women.

Speaking of blood pressure level during pregnancy and in childbirth, women with a healthy cardiovascular system must be remembered by two circumstances:

  • you need to know the dynamics of blood pressure before pregnancy and from the very beginning it. The degree of excitability of the vasomotor apparatus in different women is different, and in changes in blood pressure, and the functional state of the body, its nervous system, due to both exogenous and endogenous factors, plays a major role in the vessel tone;
  • in the absence of pathological shifts in the state of the cardiovascular system, blood pressure during pregnancy and even changes relatively slightly.

In the first half of pregnancy, systolic, diastolic and pulse pressure is somewhat reduced, and from 6-7 months there is a tendency to increase it (especially diastolic). Many authors talk about the wave-like rise of maximum blood pressure, starting from about the 6th month of pregnancy, but it remains within the physiological norm.

Next, it is necessary to emphasize that if women with normal initial blood pressure of 110-10 / 70-80 mm RT. Art. It is noted in the second half of pregnancy over 130-135 / 80-90 mm RT. Art., It should be regarded as a signal of a possible occurrence of the pathological condition of the vascular system on the soil.

It should be remembered that there are often sharp oscillations in hemodynamics, which is often observed on changes in blood pressure levels.

After opening the fruit bubble, blood pressure is usually reduced, sometimes quite sharply. Therefore, V. V. Stroganov recommends as a preventive treatment of eclampsia, an early opening of the fruit bubble as a preventive treatment.

In the second and third periods of childbirth there are quick and sharp change of lifting and falling blood pressure. The venous pressure in the upper limbs (in the vein of the elbow bend) does not significantly change significantly, while in the femoral veins it is noticeably rising.

When assessing the condition of the cardiovascular system, pregnant women should also take into account the indicators of gas exchange. As the pregnancy develops, the life capacity of the lungs (jerking) is reduced, the maximum lung ventilation and the saturation of arterial blood oxygen is reduced, the amount of non-oxidized exchange products is growing (the content of lactic acid increases). At the same time, the minute respiratory volume (mod) increases, increases the efficiency of using inhaled air oxygen. In the body of pregnant women, the reserve of oxygen is significantly reduced and regulatory capabilities are extremely tense. Particularly significant circulatory and respiratory changes occur in childbirth. The increase in the pulse, the increase in the shock and minute volumes, blood pressure, oxygen consumption by tissues, an increase in the concentration of dairy and pyruogradic acids, etc.

Research ADAMS and Alexander showed strengthening of the heart during bouts by 20%, and after the death of the last - by 18%. During the generic act, the work of the heart increases by 5%! and more compared with the state of peace (V. X. Vasilenko). All of the above factors are the cause of the emergence and development of the symptom complex of complaints and clinical manifestations, which, with undoubted, indicates some changes and known tensions in the functions of the cardiovascular system in pregnant women. However, these changes in the organism of healthy pregnant women are physiological. The degree of severity depends on the general state of the body of a pregnant woman, the ability to quickly and fully adapt to the new, unusual conditions of the external and internal environment, from the diseases transferred in the past. In determining these abilities of the body, a large role belongs to the central nervous system. The symptom complex of functional changes arising from most pregnant women may be different, from the barely noticeable, almost no complaints of phenomena, up to standing on the verges with significant impaired functions of the cardiovascular system.

The most frequent complaints, especially in the second half of pregnancy, which are often healthy pregnant, are: shortness of breath, heartbeat, general weakness, sometimes dizziness. The pulse frequency reaches 90-100 ° C / min, even more increasing in the process of childbirth, especially in the period of expulsion of the fetus. Immediately after the end of the birth, most often in the first hours of the postpartum period, if there were no significant blood loss in childly, bradycardia is observed with a slowdown of the pulse up to 60-70 UD / min.

Tachycardia in pregnant women - One of the usual heart reactions. In the overwhelming majority of cases, tachycardia in pregnant women with a healthy cardiovascular system is a temporary phenomenon. It relaxes and disappears as a woman's body adapting to new external and inner stimuli.

Tachycardia in childbirth can achieve a significant extent, especially in the period of expulsion of the fetus. The reasons for its following:

  • great physical tension;
  • sharply pronounced negative emotions (pain, fear);
  • relative oxygen fasting amplified by the end of labor.

Relative hypoxemia Along with the mechanical factors that make the normal operation of the cardiovascular apparatus and reduced gear, causes the occurrence of shortness of breath, for which many women are more complaining of in the second half of pregnancy. A shortness of breath in healthy pregnant women can be due to disruption of metabolism with a pronounced shift towards acidosis and relative hypoxemia. Since in the second half of pregnancy acts, in addition, the mechanical factor, then the shortness of pregnant women should be attributed to the mixed form. During the battles and especially the fertilizer, blood saturation is significantly reduced, because in the process of childbirth, respiratory delay, intense muscular work and significant exhaustion of the oxygen reserve are combined. All this is one of the prerequisites for the appearance of shortness of breath in pregnant women and women in labor.

However, the adaptive mechanisms of the body allow the overwhelming majority of women well to adapt to the inevitable functional changes, coming during pregnancy, and serious violations in the activity of the cardiovascular system usually does not occur.

Pregnant women have a slight increase in the heart due to some hypertrophy and expanding the left ventricle. It depends on a number of interrelated causes: a) an increase in the total mass of blood, b) some difficulty promotion of gradually increasing blood mass. However, minor hypertrophy and the expansion of the heart develop slowly and gradually, and the heart has time to adapt to increased requirements filed to the cardiovascular system.

During pregnancy, the health of the heart increases, which, according to the literature, increases by an average of 50% compared with the period before pregnancy.

A significant increase in pregnancy in the absence of a valve vice or inflammatory process in myocardium indicates a decrease in the heart rate.

Auscultative, as many authors indicate, in some pregnant women (about 30%), especially in the second half of pregnancy, the mild-blowing systolic noise in the top of the heart and the pulmonary artery is determined. These noise can be served with a completely healthy cardiovascular system and are purely functional character. Thus, systolic noise on the pulmonary artery depends on the temporary relative narrowing of it as a result of some inflection due to the high standing of the diaphragm changing the normal arrangement of the heart and large vessels. Systolic noise at the top of the heart indicates a small functional deficiency of the mitral valve. These noise are shortly after childbirth disappear, which confirms their functional origin.

The features of blood circulation during pregnancy, mainly in the second half of it, determine the emergence of a number of clinical symptoms, causing diagnostic difficulties (displacement of the boundaries of the heart, the appearance of noise, accent Tone on the pulmonary artery, extrasystole). It is not easy to decide whether they are manifestation of organic heart diseases or caused by physiological changes due to pregnancy.

To estimate the functional state of the cardiovascular system in pregnant women, electrocardiography (ECG), vector vigorography (VKG), balleriography and phonocardiography (BKG and FKG) are particularly important. ECG changes in pregnant women are reduced to the appearance of the left type, negative teeth of T in III, the increase in the systolic indicator, an increase in the CRST segment and the teeth T in I and III leads. With increasing the term of pregnancy, certain changes in FKG are noted, due to the difficulty of pulmonary circulation and the increase in pressure in the small circle circle. They are reduced to an increase in the distance q (r) of the ECG to the I Tone FKG (C 0.035 to 0.05 (C), a change in tone 2 due to the increase in the amplitude of the second component part of it, an increase in the distance T ECG - II tone FKG (from 0.03 to 0.05 C), the emergence of additional sound phenomena - systolic noise, an increase in the amplitude of the second tone on the pulmonary artery, splitting and splitting it.

During pregnancy, the vector virtogram is also changed - the QRS loop area by the end of the pregnancy increases by more than 40%.

Very substantially varies during pregnancy and scum. In the second half of pregnancy, the wave k is increasing and deepened, which is due to the increase in blood flow in the downward aorta, large blood flow of a small pelvis and abdominal vessels, an increase in pressure in them, and, consequently, a corresponding increase in peripheral resistance.

The amplitude of the respiratory fluctuations Ij increases with the rise of the pregnancy, the ballistocardiographic index (BI) decreases, the respiratory index (RI) increases, changes in the I degree according to Brown and violation of the relationship ratios of ballergartiograms - JK / IJ, KL / IJ, KL / JK.

Changes in BKG in healthy women are the result of the overflow of the pelvis vessels, the increase in the venous inflow to the right heart, changes in the anatomical axis of the heart due to the horizontal position.

With the physiological course of pregnancy, there are noticeable changes in the vascular permeability associated with a violation of the functional state of vascular membranes and a change in capillary blood circulation.

With capillaryroscopic studies, an increase in the number of capillary loops is detected, the expansion of them, mainly the venous part, the presence of a more muddy background, pericapillary edema, slowing down the blood current.

In recent years, it has been proved that an increase in the minute volume (and the change in other hemodynamic parameters) occurs since the beginning of pregnancy, increasingly until 28-32nd of the week, after which it gradually decreases.

As is known, the main burden on the cardiovascular system is observed immediately after the expulsion of the fetus against the background of relative rest. Due to the sudden lowering of intra-abdominal pressure, immediate restructuring of the entire blood circulation should occur. At this moment, the vessels of the abdominal cavity are quickly overwhelmed with blood. It happens like bleeding in the abdominal vessels. The influx of blood to the heart is reduced, and the heart works participated, but with a significant decrease in systolic volume - "half empty" (M. M. Salgannik, etc.). Meanwhile, the enhanced heart work at this moment is also required because in the period of expulsion, especially by the end of it, the guinea necessarily arises the state of relative hypoxia; To eliminate her heart must be strenuously, with a voltage to work.

Healthy organism, a healthy cardiovascular system has the ability to easily and quickly adapt to often significant and sudden changes in hemodynamics In connection with which the healthy girlfriend, as a rule, quickly occurs the necessary coordination in the circulatory system. However, with certain defects in the work of the heart, most often in the third period of birth can be a functional failure of it. It is possible to provide and prevent the occurrence of insufficiency of blood circulation and must, for which it is necessary to study the condition of the cardiovascular system of each pregnant woman in advance and know, under what pathological changes in this system are dangerous violations in childbirth.

In cases of unclear diagnosis, pregnant should be able to send to the hospital (at the beginning of pregnancy - to therapeutic, in the third trimester - c) for an in-depth clinical examination, observation and treatment.

Cardiovascular diseases in pregnant women occupy the first place among the entire pathology. The frequency of detection of heart disease they range from 0.4 to 4.7%. Recently, there has been an increase in the number of pregnant and feminines suffering from cardiovascular diseases, which is explained by a number of reasons: early diagnosis of heart disease, expanding the testimony to preserve pregnancy, an increase in the group of women operated on the heart, and the number of seriously ill women who are either themselves, Or with the permission of doctors decide to preserve pregnancy, being confident in the success of medical science.

During pregnancy, the cardiovascular system of healthy women undergoes significant changes. Increases (up to 80%) minute volume of the heart, especially on the 26-28th weeks, with a gradual decline in childbirth. By 30-50% increases the volume of circulating blood, reaching a maximum by the 30-36th week. 5-6 l increases the volume of extracellular fluid. An additional load on the cardiovascular system is created, and, as a result, the systolic noise over the pulmonary artery and the top of the heart is listened to 30% of healthy pregnant women, 2nd tone over the pulmonary artery increases, the excitability and conductivity of the heart muscle are disturbed, arrhythmias occur.

Among the diseases of the heart, complicating pregnancy, most often found:

  • acquired and congenital heart defects;
  • anomaly of the development of main vessels;
  • myocardial diseases;
  • operated heart;

A developing pregnancy worsens the course of cardiovascular diseases and can lead to the development of extreme states that require emergency measures not only from obstetric, but also from the therapist, cardiologist, surgeon.

Each pregnant, suffering from a disease of the cardiovascular system, should be hospitalized at least 3 times per pregnancy.

The first hospitalization is desirable to 12 weeks (in a specialized hospital for a thorough cardiological and rheumatological examination). In some cases, the interruption of pregnancy may be shown after cardiac and antipership therapy.

The second hospitalization should be carried out during the greatest hemodynamic load on the heart (28-32th week).

The third mandatory hospitalization should be 2 weeks before delivery for examination and preparation for childbirth, generating a planning plan.

Birth for a term is permissible in cases where hemodynamic indicators were able to significantly improve the hemodynamic parameters with a prosperous state of the fetus. In connection with the deterioration of the state of a pregnant woman often arises about the early delivery. The best result gives a genersion of 37-38 weeks. The plan of the delivery is drawn up consultatively with the participation of obstetric, cardiologist and resuscitator. The choice of the method is strictly individual for each patient, depending on the obstetric situation, but the period of expulsion to all women in labor should be shortened. Indications for cesarean sections are strictly limited.

After the birth of the fetus and the emergence of the last to prevent the deterioration of the state, it is necessary immediately after the birth of a child to introduce cardiotonic products. Pedaries with heart disease can be discharged from the race at home not earlier than 2 weeks after delivery in a satisfactory condition under the supervision of the cardiologist at the place of residence.

Is pregnancy possible for diseases of the cardiovascular system possible. It is possible only before that it is necessary to consult with the doctor, especially if you suffer rheumatism with rheumatic heart disease, he must give you permission to plan pregnancy. In cases where you have good health, and you are taking place, while shortness of breath and reinforced heartbeat rarely occur only during physical exertion, you will not have problems with hatching and the birth of a healthy child.

If you are constantly, even when calm, shortness of breath appears and it starts to increase when you quickly start moving, perform a light job. It is better not to risk pregnancy, it is very dangerous for both you and a child. Even the interruption of pregnancy in this case is a dangerous procedure.

With the development of pregnancy on the cardiovascular system, a woman comes a lot of loads, because all systems are doubly working, because the woman should provide a full-fledged life. A pregnant woman increases its body weight, blood is also increasing in volume, and the uterus that grows, begins to push up a diaphragm, due to this, changes in the heart position. The body begin to occur in a hormonal background. Such changes in the body of the woman are very much loaded with a cardiovascular system, when the term begins to increase, the loads become even more.

When generic activity, the cardiovascular system is very overwhelmed, especially when the second period fence comes. Also, after childbirth, the cardiovascular system will have tolerate the load. Because, with a quick emptying of the uterus, blood begins to redistribute, because of this, changes in hormones again occur.

What is the danger of the disease of the cardiovascular system for pregnant women?

Women are beginning to emerge complications of various nature during pregnancy, in labor and postpartum period, here it is threatened, both the life of a woman and a child. It is very dangerous that the fruit is lack of blood circulation for the first time month, especially this problem occurs in the second half and during childbirth.

Whether pregnancy is possible in women with rheumatism

Rheumatism is a toxic-immune disease that affects joints and heart valves. Rheumatism appears due to in-hemolytic streptococcus, most often the women suffer in young age.

During pregnancy, the rheumatic process begins to exacerbate. Especially for the first time months then at childbirth. What complications arise in pregnant women with rheumatism?

1. Often the pregnancy is prematurely interrupted.

2. Toxicosis continues and in later lines.

3. The fetus lacks oxygen (hypoxia).

4. The royal and placental blood flow is disturbed.

Pregnancy at heart vice

Women who have heart disease require urgent hospitalization, according to the testimony, be sure to three times for pregnancy:

1. In 12 weeks, the pregnant woman should fully undergo a cardiological examination and here will already be a question to leave a child or will be better to interrupt pregnancy.

2. At 32 weeks, a woman must check the heart test, if necessary, then heart therapy, because it is during this period that the greatest loads on the heart occur.

3. The last test of the heart must be two weeks before
childbirth to prepare well for them.

A pregnant woman with cardiovascular problems should remember that the entire outcome depends on its behavior, especially from her lifestyle. If a woman gets the necessary drugs that support and facilitate the work of the heart, keeps the regime, listening to the recommendations of the doctor, the pregnancy will end safely and the woman will be able to give birth without any problems.

What if a woman is contraindicated pregnant?

First you need to cure a vice, possibly with the help of a surgical method, often it helps a woman will return to a full-fledged life. But still such a woman is in the risk group, therefore it will be necessary through the cardiac surgeon throughout the pregnancy.

Whether pregnancy is possible with hypertension

Up to 15% of pregnant women suffer from hypertension, elevated arterial pressure. Often women and do not know that they have increased pressure. For the first time months most often it is reduced or normalized, it will complicate the task.

Hypertension is dangerous in that up to 70% complicated by toxicosis in late lines. In childbirth, hypertensive encephalopathy may appear, with the disease, headache appears and vision is very violated. Very dangerous complications are considered to peel the retina and hemorrhage into the brain.

How to warn hypertension in pregnant women? Constantly and carefully observe the doctor, weekly. If the pressure is increased urgently go to the hospital in the maternity department.

Hypertension can also have its own stages of development, it is precisely whether it is possible to preserve pregnancy:

1 Stage - Pregnancy is possible, tooling and childbirth are successful.

Stage 2 - Pregnancy is allowed only if the woman did not experience the crises of hypertension and the liver, and kidneys work fully.

2 V and 3 stage pregnancy is completely prohibited.

Pregnant women who suffer from hypertension, for three weeks go to the maternity hospital, they should be provided both physical peace and emotional.

So, pregnancy with cardiovascular diseases is possible, but here you need to be very careful. Before planning, the cardiac surgeon was necessarily examined if the necessary course of treatment was necessary. If you suddenly have a serious illness and you do not need to enter and give birth to a child, because it threatens both your health and a child, it is best to think about other ways. Do not risk. It is very important for pregnant women who suffer from cardiovascular diseases to keep control of their health care, to undergo the necessary course of treatment and not forget about preventive methods.