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Upcoming pregnancy and heart defects: everything an expectant mother needs to know. Pregnancy and heart defects

These are congenital or acquired anatomical abnormalities of the heart valves, openings, intracardial septa, aorta and pulmonary artery, the course of which can be complicated during gestation or worsen its prognosis. Manifested by weakness, fatigue, drowsiness, heaviness in the legs, shortness of breath, palpitations, peripheral edema, dry cough. Diagnosed by echocardiography, ECG, phonocardiography. For treatment, antibiotics, glycosides, diuretics, peripheral vasodilators, β-blockers, antithrombotic agents are used. Operations are performed in exceptional cases according to indications.

ICD-10

Q20-Q28 Congenital anomalies [malformations] of the circulatory system

General information

Heart disease affects 3 to 4.7% of adult women. According to observational data in the field of obstetrics, acquired structural anomalies are detected in 75-90% of pregnant women with anatomical heart defects, congenital - in 7-8.5%, conditions after operations (mitral or mitral-aortic commissurotomy, valve replacement) - in 1 1.5%. The structure of acquired defects is dominated by rheumatic (85-89%), among which the combined mitral make up 40-70%, mitral stenosis - 20%, mitral insufficiency - 15%, aortic - 8-10%. The relevance of timely detection of a heart anomaly in a pregnant woman, the choice of a rational pregnancy management scheme and a method of delivery is due to a significant risk of decompensation of the disease during gestation, a high probability of both maternal and perinatal mortality.

Causes

Anomalies in the structure of the valve apparatus, septa, openings and outgoing great vessels usually occur long before the onset of gestation. However, changes in hemodynamics characteristic of the period of pregnancy can manifest cardiological disease or aggravate its clinical picture. The most common causes of heart defects found in pregnant women are:

  • Inflammation of the endocardium and myocardium... In 80-85% of cases, anomalies in the structure of the heart develop as a result of rheumatic lesions. Less commonly, they become the result of infective endocarditis of another genesis, syphilis, specific inflammatory changes in diffuse connective tissue diseases (scleroderma, systemic lupus erythematosus, rheumatoid arthritis).
  • Birth defects... Up to 7.3-8.0% of cardiac defects are dysembryogenetic or inherited in an autosomal recessive, autosomal dominant pattern. More often than others, pregnant women show signs of an open aortic duct, atrial and interventricular septal defects, pulmonary artery stenosis, coarctation of the aorta, and transposition of great vessels.

In some patients, secondary functional valve failure occurs against the background of cardiac diseases, which are accompanied by overload of the ventricles or expansion of the fibrous ring of the valve structures (hypertension, symptomatic arterial hypertension, dilated cardiomyopathy, cardiosclerosis, myocardial infarction).

Pathogenesis

The mechanism of development of pathological manifestations in heart defects in pregnant women depends on the characteristics of a particular anomaly, however, in the gestational period, a number of general load and adaptive hemodynamic factors arise that affect the course of cardiovascular disease. From 10 to 32 weeks, the volume of blood circulating in the vascular bed increases by 30-35%, which, combined with an increase in hydrostatic capillary pressure, leads to an increase in the amount of extracellular fluid by 5-6 liters. At the same time, the work of the left ventricle increases, which is accompanied by an increase in stroke and minute volumes by 35-50%, an increase in systolic and pulse pressure, and a decrease in diastolic pressure on the arms. At the end of the second or third trimesters, physiological tachycardia occurs up to 85-90 heart contractions per minute.

An increase in the load on the myocardium leads to an increase in the mass of the left ventricle by 8-10% with hypertrophy and dilatation of the cardiac cavities, the appearance of physiological arrhythmias against the background of disturbances in myocardial excitability and conduction. The formation of the uteroplacental system increases the capacity of the vascular system of the pregnant woman. The growing uterus compresses the inferior vena cava, displaces the diaphragm and heart upward, reshapes the chest, and restricts lung excursion. This, as well as the transposition of the great vessels and the more transverse position of the heart, increases the load on the myocardium. Lack of adaptive mechanisms in pregnant women with organic heart defects is manifested by the development and progression of circulatory disorders, the occurrence of heart failure. In addition, in some patients, the rheumatic process is aggravated, which intensifies morphological changes in the heart.

Classification

Depending on the origin, heart defects detected in pregnant women are congenital and acquired. Taking into account the localization, isolated mitral, aortic, tricuspid anomalies, damage to the pulmonary artery valves, defects of the intracardiac septa, combined and combined lesions are distinguished. By the nature of the pathological changes, stenosis (narrowing), insufficiency (expansion), abnormal openings, and transposition of vessels are distinguished.

The severity of heart failure has a great prognostic value in the systematization of defects: at I (latent) stage, its signs appear only during physical exertion, with IIA, moderately pronounced symptoms at rest are noted, aggravated by movement, with IIB, significant hemodynamic disturbances are determined at rest, for III (dystrophic) are characterized by organ metabolic disorders. Based on this criterion, four degrees of risk of complications in pregnant women with heart defects are distinguished:

  • Idegree... There is no risk. There are no signs of heart failure, the pressure in the pulmonary artery is normal, and the rheumatic process is inactive. The parts of the heart and the thickness of the myocardium are not changed. The likelihood of a complicated course of gestation does not differ from the indicators in the general population. Pregnancy is not contraindicated.
  • IIdegree... Moderately increased risk. There are latent heart failure and I degree of activity of rheumatism, a moderate increase in pressure in the pulmonary artery system. The parts of the heart are slightly or moderately thickened and dilated. Pregnancy is allowed, but the patient's condition may worsen.
  • IIIdegree... High risk of obstetric and cardiac complications. Heart failure IIA stage, rheumatism of II-III degree of activity, pulmonary hypertension, rhythm disturbances are determined. The parts of the heart are hypertrophied and enlarged. For most patients, gestation is recommended to be interrupted before 12 weeks.
  • IVdegree... Extremely high risk of maternal mortality due to cardiac and obstetric complications. Heart failure IIB-III grade, significant pulmonary hypertension, severe systolic dysfunction of the left ventricle, cyanosis are diagnosed. Pregnancy is usually terminated regardless of the timing.

Symptoms of heart defects in pregnant women

Clinical signs depend on the type of anatomical defects, the duration of the disease and the functional viability of the myocardium. Patients with cardiac defects complain of increased fatigue, drowsiness, a feeling of weakness in the muscles, heaviness in the legs. During exertion, shortness of breath, interruptions, palpitations are observed. In patients with severe circulatory insufficiency, the listed symptoms are also noted at rest. The appearance of pallor or cyanoticity of the skin, edema in the area of ​​the feet, ankle joints, lower legs, the onset of attacks of cardiac asthma with dry cough or coughing up a small amount of mucous sputum, sometimes containing blood streaks, is possible.

Complications

Defects with significant decompensation of the heart function are the leading cause of maternal mortality, which can reach 150-200 cases per 100 thousand live births, and rank second in terms of perinatal mortality (12-29%). The main obstetric complications with anomalies in the structure of the heart are spontaneous abortions, premature birth, early toxicosis, gestosis, HELLP syndrome, discoordination and weakness of labor, coagulopathic bleeding in the postpartum period. Almost every fifth pregnant woman has an untimely discharge of amniotic fluid.

In every second case of pregnancy (except for patients at risk of I degree), there are signs of developmental delay and fetal hypoxia caused by chronic placental insufficiency. Women with congenital heart anomalies are more likely to have children with the same cardiac pathology. With heart defects, the likelihood of developing clinically significant arrhythmias requiring special therapy, cardiovascular complications (thromboembolism, myocardial infarction, stroke), and endocarditis increases.

Diagnostics

Since congenital and acquired heart defects can occur subclinically, in 27% of cases they are first diagnosed during pregnancy. In addition to traditional physical examinations (percussion and auscultation of the heart), when making a diagnosis, modern instrumental methods are used to visualize anatomical defects and assess the functional capabilities of the cardiovascular system. The most informative for the diagnosis of heart defects in pregnant women are:

  • Echocardiography... The combined use of various ultrasound techniques (one-dimensional and two-dimensional echocardiography), Doppler scanning makes it possible to examine the state of the valve apparatus, assess the thickness of the heart walls and the volume of cavities, perform phase analysis and assess contractility. Using this method, defects of large vessels (thoracic aorta, etc.) are also determined.
  • Electrocardiography... ECG is used to screen for violations of the frequency and regularity of the heart rhythm, changes in conduction, to identify possible acute and chronic myocardial damage that complicate the clinical picture and worsen the prognosis of pregnancy with heart disease. According to the indications, the study is supplemented with daily ECG monitoring and phonocardiography.

Due to the possible damaging effects on the fetus, it is not recommended for pregnant women with anatomical heart defects to carry out X-ray studies and MRI. As an exception, in preparation for cardiac interventions, probing of the heart cavities is permissible. To assess the state of the electrolyte balance and the coagulation system, the determination of the concentration of potassium and sodium in the blood serum, a coagulogram is shown. Differential diagnosis is carried out with functional heart murmurs with anemia, vascular dystonia, coronary artery disease with the development of aneurysm, hypertension in pregnant women, myocarditis, toxic cardiomyopathies, myocardial dystrophy, cardiomegaly. In addition to the obstetrician-gynecologist, a cardiologist is involved in accompanying the pregnant woman. If necessary, the patient is examined by a cardiac surgeon, rheumatologist, infectious disease specialist, neuropathologist, hematologist.

Treatment of heart defects in pregnant women

With cardiac defects, there are three critical periods of gestation, during which planned hospitalization is recommended. At 10-12 weeks, an exacerbation of rheumatism is possible due to a physiological decrease in immunity and a decrease in the secretion of corticosteroids. It is during this period that a decision is made about the possibility of prolonging the pregnancy. At 26-32 weeks, the patient's cardiovascular system experiences the greatest stress, which requires additional correction of therapy. 2-3 weeks before delivery, the development or aggravation of heart failure is possible under the influence of overload hemodynamic factors, which should be taken into account when choosing a method of delivery.

The main therapeutic tasks are the prevention of obstetric complications, relief of exacerbations and relapses in patients with rheumatism, prevention of rhythm and conduction disorders. Adequate medical treatment is preferred for the management of most pregnant women with heart defects, including those with heart failure. Medicines for pharmacotherapy are selected individually by the cardiologist. Usually, pregnant women are prescribed:

  • Antibacterial therapy... 10-14-day prophylactic courses of semisynthetic penicillins are indicated for women with rheumatic defects from risk groups I and II. Antibiotics are used according to indications, taking into account the activity of the rheumatic process and, if necessary, supplemented with glucocorticoids.
  • Thiazide and loop diuretics... Provide a decrease in the volume of circulating blood with insufficient contractile activity of the ventricles. In case of left ventricular failure, drugs are combined with drugs that reduce blood flow to the heart chambers, and peripheral vasodilators.
  • Cardiac glycosides... In the absence of pulmonary hypertension, such medications support cardiac output and adequate perfusion of various organs and systems, including the placental complex. With the help of glycosides, tachysystolic atrial fibrillation can also be stopped.
  • Nitrates... Due to the deposition of blood in the veins of the systemic circulation, the agents of this group reduce the preload on the heart, which makes it possible to reduce the signs of venous pulmonary hypertension and blood stagnation in the small circle. The disadvantage of using nitrates is a possible decrease in cardiac output.
  • β-blockers... Drugs that reduce the strength of myocardial contractions are recommended for pregnant women with sinus tachycardia, in which the pressure in the left atrial cavity increases, blood stagnation occurs in the pulmonary circulation. Can be used for tachysystolic atrial fibrillation.
  • Anticoagulants... Taking into account the duration of pregnancy and the results of thromboelastogram, women with heart defects are prescribed low molecular weight heparins, antiplatelet agents in combination with peripheral vasodilators that improve capillary blood flow. During childbirth, heparin is discontinued.

If indicated, minimally invasive operations (endovascular balloon dilatation of aortic stenosis, etc.) and closed mitral commissurotomy are performed. Open surgical interventions for valve replacement with the shutdown of natural blood circulation are carried out only if the woman's life is threatened and the percutaneous correction of the anomaly is impossible.

In the presence of a heart defect, programmed natural childbirth in the daytime with the introduction of a hormonal-energy complex for the prevention of abnormal labor and maximum progressive pain relief using mask anesthesia and epidural analgesia is preferable. For gentle delivery, amniotomy is used. In childbirth, it is permissible to prescribe uterotonics, antispasmodics, antihypoxants. Attempts during the period of expulsion are turned off with high activity of rheumatism, combined and concomitant defects, stenosis, circulatory disorders.

If an active rheumatic process is detected, signs of circulatory disorders, the development of late gestosis, placental insufficiency with chronic hypoxia or delayed fetal development, delivery is performed ahead of schedule at 34-37 weeks. Absolute indications for caesarean section are therapeutically resistant progressive heart failure, grade III rheumatic heart disease, aortic aneurysm, coarctation of the aorta with severe hypertension, complete violation of atrioventricular conduction, use of an artificial pacemaker, subacute course of septic endocarditis, heart defects with predominantly load on the heart , concomitant obstetric pathology (large fetus, narrow pelvis, incorrect position of the child).

Forecast and prevention

The outcome of pregnancy and childbirth with heart defects depends on the variant of the anatomical defect, the presence of circulatory disorders, the activity of rheumatism (with anomalies of rheumatic origin). Combined and combined types of defects, a single ventricle, coarctation of the aorta, severe aortic stenosis, a combination of anatomical abnormalities with bacterial endocarditis, tachyarrhythmia, pulmonary hypertension of 2-3 degrees, Eisenmenger syndrome, Marfan syndrome with an increase in the diameter of the aortic root more than 4 , 5 cm, antecedent postpartum cardiomyopathy. The prognosis also worsens with pronounced degrees of narrowing (insufficiency) of the heart valves and as the age of the pregnant woman increases - after 30 years, the likelihood of developing circulatory failure doubles.

In other cases, when planning pregnancy, it is necessary to take into account the recommendations of a cardiologist, at the pregravid stage, to compensate for the defect as much as possible and stop rheumatic fever, and, if indicated, perform an operation to correct the defect before conception. Pregnant women are shown early registration in the antenatal clinic, diet therapy with sufficient intake of protein, trace elements and vitamins, limiting the amount of liquid and sodium chloride. Dosed physical activity, normalization of work and rest, prophylactic use of herbal preparations with a sedative effect are recommended.

Any defect of the heart in one way or another disrupts blood circulation, but it can become especially dangerous during pregnancy, when the load on the heart of the expectant mother increases. The prevalence of heart disease among pregnant women is about 1–7%, the overwhelming majority of which is in the “operated heart”.

How acquired heart defects affect pregnancy will be discussed in this article.

Pregnancy: why heart disease is dangerous

During pregnancy, the load on a woman's heart increases sharply - complications of heart disease may develop.

During pregnancy, even in a perfectly healthy woman from 3-4 months, the load on the heart increases significantly, reaching a maximum before childbirth and returning to normal by the end of the second week after delivery. Even a healthy heart does not always withstand such loads and malfunctions, manifested by the appearance of single and.

An "operated heart" or "heart with a defect" during pregnancy is less able to withstand the increased load on it, so the following complications are possible:

  1. In a pregnant woman:
  • fainting due to low blood pressure;
  • tachycardia, arrhythmias;
  • an increase in shortness of breath,;
  • thromboembolism.
  1. In the fetus:
  • an increase in hypoxia;
  • signs of delayed neuropsychic development due to hypoxia;
  • the threat of premature birth.

The nature of the complications depends on the type of defect and its severity.

What to do before pregnancy

If a woman has an acquired defect or an operated heart and wants to become pregnant, then she must first consult with a gynecologist and cardiologist (rheumatologist). As a rule, a woman will be asked to undergo an in-depth medical examination, including a blood test for acute-phase reactions ("rheumatic tests"), an ECHO-cardiogram (ultrasound of the heart with a Doppler attachment), and an ECG.

Usually the doctor is guided by the following classification of risk assessment:

  1. I degree... The risk is not increased and pregnancy is permitted. There are no signs, the stage of rheumatism is inactive, the pressure in the pulmonary artery is normal. Chronic heart failure of functional class (FC) I (normal physical activity is not limited, shortness of breath and discomfort only with increased exertion).
  2. II degree... Pregnancy is allowed, however, during the carrying of a child, there may be complications and deterioration of the woman's well-being. Stage I cardiovascular insufficiency, activity of rheumatism 0-I, moderate increase in pressure in the pulmonary artery. Chronic heart failure FC II (habitual exercise may be accompanied by shortness of breath, fatigue, palpitations).
  3. III degree... Due to the increased risk of developing cardiological and obstetric complications, pregnancy is contraindicated, except in cases where the nature of the disease allows for surgical treatment of acquired heart disease. Heart failure II A, activity of rheumatism II – III, Chronic heart failure FC III (at rest there are no signs of heart failure, shortness of breath appears with slight exertion).
  4. IV degree... Pregnancy is completely contraindicated due to the high mortality rate, although motherhood is possible (for example, surrogacy, adoption of a child, etc.). Cardiovascular failure IIB - III, FC IV (shortness of breath, weakness, tachycardia are noted at rest, aggravated by exertion).

If the heart defect can be corrected by surgery, it is best done before pregnancy. Also, even before the onset of pregnancy, it is necessary to ensure that rheumatism goes into an inactive phase and does not worsen throughout the year.

What obstetricians-gynecologists recommend for pregnant women with heart defects


A woman with a heart defect 3 times during pregnancy with a therapeutic and prophylactic purpose should be hospitalized on a planned basis.
  1. Continue to take antirheumatic and cardiac medications... Rheumatism worsens during the first trimester of pregnancy and can complicate its course. For this reason, women continue to take antirheumatic drugs during pregnancy. Cardiac drugs are necessary to maintain adequate cardiac activity and prevent serious complications: pulmonary edema, thromboembolism. What medicines and in what dosages to drink, the doctor decides individually in each case.
  2. Heart surgery at 18–26 weeks of gestation... It is carried out in cases where there is a threat of complications associated with the progression of heart failure, and drug treatment is ineffective.
  3. Planned hospitalization in a hospital:
  • The first time - up to 12 weeks of pregnancy, in order to conduct a thorough rheumatological and cardiological examination and decide on the possibility of carrying a child.
  • The second time is 28–32 weeks of pregnancy, during this period the load on the woman’s circulatory system increases significantly, so it is necessary to carry out preventive treatment. It is during this period that the risk of pulmonary edema, thromboembolism in a pregnant woman, and fetal hypoxia increases.
  • The third time - 2 weeks before the expected birth for a second examination and determination of the tactics of the delivery.
  1. Diet. .

What can be done at home

At first, do not panic. Stress, negative emotions are unlikely to be able to relieve a pregnant woman of heart disease or rheumatism, but to cause a worsening of the condition - please. Focus on the positive aspects of your life and try to remember that all difficulties experienced during pregnancy are temporary.

Secondly, be collected. Talk to your doctor about possible complications during pregnancy and ask him questions about how to prepare for difficult times in life. For example, always carry your doctor's recommended emergency medications to take if your condition worsens, and a telephone to call the emergency team.

Thirdly, teach your loved ones what to do with you if your condition worsens. Prepare a bag of personal belongings in advance in case of hospitalization. Share what helps you cope with the deterioration (for example, lying with the head up, turning on a ventilator, taking a diuretic, etc.) and ask others to help you with this.

Fourthly, ask your gynecologist about how you can determine by fetal movement whether the baby is experiencing oxygen deprivation or is all right. Ask your doctor what to do if you notice your child is uncomfortable.

Fifth, are taking medications prescribed by your doctor. Avoid drugs that are contraindicated during pregnancy, have side effects on the fetus, or have not yet been studied.

At sixth, follow the diet, because extra pounds is an additional burden on the heart.

Seventh, live as physically active as your heart allows. Daily walks, light gymnastics help to improve the blood circulation of the fetus. However, in case of heart defects or after cardiological surgery, it is imperative to discuss with the cardiologist what kind of physical activity is acceptable for you and will not harm you.

Childbirth with heart defects

The question of how to give birth, doctors decide in each case individually, taking into account the degree of compensation of the defect, its type, etc. The most commonly used are 2 delivery options:

  1. Routine labor with shortening or extinguishing of the persistent period... To shorten the persistent period, they resort to dissecting the perineum (episiotomy, perineotomy), and to turn off the attempts, special obstetric forceps are applied to the baby's head and removed from the birth canal.
  2. Cesarean section... It can be performed under general anesthesia, as well as with epidural anesthesia (“back injection”).

After childbirth

After the baby is born, the volume of circulating blood decreases, so the woman is injected with cardiotonics, which will support the work of the heart. Blood circulation is normalized within 2 weeks after childbirth, then the patient is discharged from the hospital. Be prepared for the fact that rheumatism may worsen over the next year.

Heart abnormalities may not be detected until pregnancy. The increased load on blood circulation causes decompensation of defects and is considered an indication for the termination of bearing a child in severe cases. Therefore, all women planning a pregnancy need to undergo a cardiological examination to exclude the likelihood of this pathology.

Read in this article

Heart defects and their characteristics in the mother

In women during pregnancy, there is a change in the systemic blood flow due to the addition of another circle - the uteroplacental one. This increases body weight and blood volume. In the presence of heart problems, including not previously detected anomalies in the development of blood vessels and valve apparatus, structural parts of the myocardium, there may be a sharp deterioration in the condition.

According to the mechanism of development, all defects can be divided into congenital and those arising in the period after birth (acquired).

The formation of intrauterine pathologies occurs in several ways:

  • discharge of blood into the left half of the heart (venous blood goes to arterial) - displacement of vessels (transposition), fusion, they are called "blue" because of cyanosis of the skin;
  • "Pale" defects occur during the transition of arterial blood to venous, these include, open Botallov duct;
  • an obstacle to the movement of blood - stenosis of the main vessels and.

The mitral and aortic valves of the heart are affected in about 70% of all acquired heart defects. There is a narrowing of the holes to which they are attached, insufficient overlapping with shortened flaps or sagging (prolapse) of the valve. There is simultaneous stenosis and insufficiency of the mitral or aortic valve, as well as their combination with damage to other structures of the heart.

As a rule, such diseases are associated with rheumatism, less often they form against the background of infectious processes, trauma or autoimmune diseases.

Any heart defect can have a compensated course. This occurs when the heart is coping with the stress by hypertrophy of the myocardium or vasoconstriction to protect against overflow. A feature of anomalies in the structure of the heart during pregnancy is the frequent decompensation of the state or the manifestation of previously hidden defects. In severe cases, this can threaten the death of the mother and is an indication for termination of pregnancy.

Symptoms for which congenital and acquired defects can be suspected

Children's congenital heart defects, the classification of which includes the division into blue, white and others, are not so rare. The reasons are different, the signs should be known to all future and present parents. What is the diagnosis of valvular and heart defects?
  • A rather unpleasant phenomenon is the identification of cardiomyopathy in pregnant women. It can be dilated, dyshormonal, etc. The complexity of the condition forces doctors in some cases to go for an early delivery.
  • A rather severe defect of the common arterial trunk is detected even in the fetus. However, due to the old equipment, it can be found already in the newborn. It is divided into types of VPS. The reasons can be both hereditary and in the lifestyle of the parents.
  • In modern diagnostic centers, it is possible to determine a heart defect by ultrasound. In the fetus, it is visible from 10-11 weeks. Signs of congenital are also determined using additional examination methods. Errors in determining the structure are not excluded.

    • Pregnancy is a unique state of the female body, the very time when she “lives for two” and “thinks for two”.

    Heart defects are now far from uncommon, but this is not always a contraindication to carrying pregnancy and independent childbirth. The increase in the frequency of heart defects in recent years is associated not so much with the deteriorating health of the population as with the improvement of diagnostic capabilities. In addition, to date, technologies have been developed for many corrective cardiac surgery operations, many of which are performed in childhood. Therefore, now a pregnant woman with a corrected heart defect is a common situation. In our article, we will tell you how to correctly approach pregnancy, what are the features during gestation and childbirth, as well as the effect of a woman's illness on the health of her unborn child.

    Heart disease is a persistent anatomical and functional change in the structure of the structures of the heart and the main (large, main) vessels. Heart defects are divided into congenital and acquired:

    Fetal hypoxia is a state of oxygen starvation of the fetus, under the influence of which various consequences develop. Fetal hypoxia is generally acute and chronic. In the case of cardiac pathology, there is chronic fetal hypoxia, which develops gradually, but can decompensate and lead to serious consequences.

    The consequences of chronic fetal hypoxia are:

    Antenal fetal death due to decompensation of chronic hypoxia.

    Does a child who is born need some kind of examination and treatment?

    Children born to mothers with heart defects are assessed according to the general rules. If the child's condition is satisfactory, then he can be in a joint stay with the mother until the moment of discharge.

    Forecast

    With a compensated condition, the prognosis for the mother and the fetus is relatively favorable, with severe heart failure, there is a danger to the life of the mother. In any case, you should listen to the recommendations of the attending obstetrician - gynecologist and consulting cardiologist.

    Pregnancy in women with heart disease is not uncommon. The guarantee of a successful course and completion of pregnancy in a reasonable approach, planning and adherence to medical recommendations. Take care of yourself and be healthy!

    Having a child is a natural desire for a woman. The moments that darken the joy of motherhood and put the health of the woman and the unborn baby at risk are primary and secondary pathologies of the cardiac and vascular system. One of them is heart disease.

    At the present stage, medicine is armed with rather effective methods that allow calculating and reducing the effect of pathology during pregnancy and childbirth.

    Views

    Heart defects are distinguished according to their origin. They are either primary, arising from disorders of intrauterine development, and (secondary), as a result of a disease or injury.

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    • Health to you and your loved ones!

    Primary heart defects are very rare compared to acquired heart defects. Congenital anomalies account for 2% of all heart ailments.

    Primary Congenital (primary) defects are divided into three groups:
    • defects with an existing obstacle to the movement of blood;
    • pathology of the atrial and interventricular septum - the presence of holes in it, through which the wrong movement of blood is carried out, as well as an open arterial duct, which normally overgrows in a newborn;
    • heart defects arising from the transfer of great vessels.

    Heart defects caused by an obstacle to the movement of blood, if there is no history of insufficient blood circulation, are not a recommendation for early termination of pregnancy. This is due to the fact that the main load on the heart and vascular system falls on the moment of delivery. Childbirth with this pathology is carried out by cesarean section.

    In expectant mothers, defects of the second group are more often diagnosed - with a blood dump from right to left. In the case of a combination of such a disease with circulatory failure, the heart, working at the limit of its capabilities, cannot cope with the increased load while waiting for the child and there is a need to end the pregnancy.

    Heaviness in the chest, palpitations, shortness of breath and fatigue are symptoms of insufficient circulation. The rapid progression of heart failure, combined with the inability to provide qualified medical care, leads to thromboembolism and pulmonary edema.

    Congenital heart defects and pregnancy can be quite compatible and result in a healthy baby being born without harm to the mother's health. Pregnancy and childbirth are going well.

    The exception is the pathologies belonging to the third group. Transfer of great vessels - defects with blood discharge from left to right, the most severe and serve as a reason for termination of pregnancy.
    Secondary
    • The occurrence of secondary heart defects is provoked by rheumatism, sepsis or atherosclerosis. During these diseases, the inner lining of the heart and the myocardium become inflamed. Almost 90% of secondary heart defects are provoked by rheumatism.
    • Rheumatism is a disease caused by streptococcus. A microorganism that causes the common sore throat, which women often suffer from. In most cases, heart valves are affected, which leads to malfunctions, myocardial congestion and circulatory failure.
    • Quite often, combined defects are diagnosed when two heart valves and combined defects are affected, in the case of stenosis and insufficiency in one valve.
    • Acquired heart defects and pregnancy are now less and less diagnosed. This is partly due to the successful treatment of rheumatism and the good prevention of rheumatic malformations. Also, more and more expectant mothers are operated before pregnancy.

    The course of pregnancy with heart disease

    What will be the waiting period for a child in a woman with a heart defect depends on the stage of development of the disease, its severity, activity (exacerbation) of rheumatism and the degree of circulatory disorders.

    Whether it is worth keeping the pregnancy is determined collectively by the obstetrician and cardiologist subjectively in each case. The onset of pregnancy after undergoing heart surgery requires a consultation with a cardiologist. Sometimes after corrective surgery there is a relapse of the disease.

    Blood clots are likely to occur after heart valve replacement while the baby is waiting. For this reason, expectant mothers are constantly receiving treatment aimed at reducing blood clotting.

    Heart defects caused by the transposition of the great vessels (movement of the main vessels) is an ailment with already formed circulatory failure. For this reason, such a disease is a contraindication to pregnancy.

    The best option would be a detailed examination of the woman before pregnancy. An accurate diagnosis and timely treatment will minimize the risks while waiting for the child.

    Features of conducting a future mother in an antenatal clinic

    Managing women with a history of heart disease while waiting for a child is a complex task that requires the combined efforts of a therapist, gynecologist and cardiologist.

    The special condition of a woman implies more complicated requirements for the heart and blood vessels. By the sixth month of pregnancy, the blood circulation rate increases by 80%, the blood volume by 50%.

    High blood pressure, edema, protein in the urine, which are poorly treated, are the most frequently reported complications during pregnancy in women with heart disease. Also, the danger is the threat of spontaneous abortion. Impaired circulation can lead to oxygen starvation of the fetus and intrauterine growth retardation.

    An expectant mother with a heart defect is hospitalized at least three times while waiting for the child:

    When alarms appear in the form of tachycardia, anemia, edema, exacerbation of rheumatism, a woman is sent to a hospital regardless of the gestational age.

    A woman with a heart defect, while carrying a baby, first of all needs to take care of rest and high-quality and long-lasting sleep. It is recommended to sleep ten to twelve hours a day. A nap will be very beneficial during this period.

    Walking in the fresh air, physiotherapy exercises, morning exercises, consisting of simple exercises, will have a positive effect on the body of a pregnant woman and the health of the unborn child. Physical activity should give joy, and not cause overstrain and fatigue.

    The diet should be as varied as possible with an increased amount of protein. Doctors recommend taking special vitamin and mineral complexes. Sessions are often prescribed in a pressure chamber, where oxygen-saturated air is supplied.

    The best solution is to go to a medical clinic that specializes in heart ailments. In this case, it is highly likely that experienced professionals will provide qualified assistance, which will insure the pregnant woman from troubles while waiting for the baby and during childbirth.

    Childbirth

    The issue of giving birth to a woman with a heart defect is decided jointly by an obstetrician-gynecologist, resuscitator and cardiologist. Childbirth with heart defects requires increased attention of doctors, therefore, an individual approach to the woman in labor is used, taking into account the current situation.

    As a rule, natural childbirth is preferred. As a prophylaxis, treatment is carried out aimed at preventing heart failure, arrhythmias, thromboembolism, and at supporting the heart. Childbirth is anesthetized to avoid additional stress on the heart and blood vessels caused by fear and pain.

    The period of pushing is reduced by dissecting the perineum. In case of impaired blood circulation, forceps are used.

    Caesarean section reduces the number of deaths among women in labor with heart disease, since this method of delivery reduces the load on the heart and vascular system.

    Caesarean section is shown:

    • with exacerbation of rheumatism;
    • in case of an unfavorable combination of gynecological anomalies and heart diseases;
    • with heart disease with pronounced left ventricular failure, when there is no result of drug treatment.

    In order to prevent the deterioration of health immediately after childbirth, a woman is injected with drugs that help to normalize the functioning of the heart.

    Postpartum period

    For five days after giving birth, the woman is shown bed rest. This will help prevent blood clots, heart failure, and bleeding.

    On the seventh - eleventh day after childbirth, a study is carried out for exacerbation of rheumatism. Rheumatism is controlled for a year after the birth of the child.

    Typically, women with heart disease are discharged from the hospital fourteen days after giving birth. Further, the patients are monitored by a cardiologist at the place of residence.

    Breastfeeding is possible if the mother does not need to take medication.

    The newborn must be examined for heart disease due to the increased likelihood of its occurrence.