How to deal with a heart disease during pregnancy?

Increased occurrences of Heart Disease have been found in pregnant women, this constitutes a substantial amount of high risk pregnancies.

Changes that occur in maternal circulation have the potential to affect both maternal and unborn baby s health. Records show that 4% of pregnancies may have heart issues, with no prior known existence. It is a two-way relation, i.e. the disease can influence pregnancy and vice-versa.

Pregnancy has a profound effect on the mother s body and especially the heart. Most of these changes start in the first three months and peak during the second trimester, and plateau during the third trimester. According to Dr Manjiri Mehta, Consultant Gynecologist, Obstetrician and Laparoscopic Surgeon and Dr Brajesh Kumar Kunwar, Interventional Cardiologist, Hiranandani Hospital, Vashi, some changes that occur in the Heart and related system during pregnancy are:

The pulse rate increases

The cardiac output (blood pumped out by the heart) increases

Certain changes occur in the ECG

A patient s medical history is important to assess the possible risks at hand and should comprise of evidence on the baseline functional status and previous cardiac events as these are strong interpreters of cardiac issues that occur during pregnancy.

Previous cardiac occurrence

Left-sided heart obstruction- valve disease or thickened heart muscles

Low pumping power of heart

Diabetes and high BP during pregnancy

Physiological changes during pregnancy and after delivery

Many of the normal symptoms of pregnancy, such as breathlessness on exertion or lying flat, swelling of the body, and feeling one s own heart beat are also symptoms of associated Heart Disease. Physical signs commonly seen with pregnancy are clearly swollen visible neck veins, extra heart sounds, exaggerated heart sounds and swelling of feet.

Types:

1. Rheumatic Heart Disease: 90% of Heart Disease problems in pregnancy are of this type. Mitral Stenosis (narrowing of Mitral valve) is the most common. In all these types of heart diseases, the risk of heart failure is high, followed by risk of fetal loss. The others that fall in the same group are Aortic Stenosis (narrowing of Aortic Valve) and Mitral Insufficiency (the valve does not close properly when the heart pumps out blood).

2. The second type of heart disease that is seen during pregnancy is the Congenital Type. This can exist already but are asymptomatic and can show symptoms for the first time during pregnancy. A few of them are Atrial Septal Defect (ASD) and Ventricular Septal Defect (VSD), which are septal defects (hole in the heart), Tetralogy of Fallots (rare condition caused by a combination of four heart defects that are present at birth), Pulmonary Hypertension (high blood pressure that affects the arteries in your lungs and the right side of your Heart) and Cyanotic Heart Disease.

Pulmonary Hypertension and Cyanotic Heart

Disease pose the biggest problem during pregnancy and the mortality rate can significantly increase.

3. Cardiac Arrhythmias (problems with rhythmic beating of the heart) are managed more or less in the same way in pregnant and non- pregnant patients.

4. Cardiomyopathies are not common during pregnancy. They are seen towards the last part of pregnancy or early post-partum period. The exact cause of this is not known but these women may be Hypertensive or malnourished during pregnancy.

Management:

Management of these pregnancies is based on a multidisciplinary approach, by both an Obstetrician and Cardiologist who play an important role. For milder heart diseases, frequent consultations with time to time hospital admissions are the accepted methods of management. Women with heart disease are at risk of cardiac complications during pregnancy and delivery. Risk assessment should be performed in these women, and the management of pregnancy and delivery should be planned accordingly.

Basic guidelines to be followed are as follows (All types of heart diseases in pregnancy)

Avoid excess weight gain

Consume low sodium diet

Rest in left lateral position

Get adequate sleep

Strenuous activity and anemia increase the work load on the Heart and also interfere with placental circulation (blood supply to the baby), and are hence best avoided

Labored breathing and difficultly in doing routine work is to be looked for. Especially during labor and immediate post delivery period

Use of Epidural Anesthesia to reduce pain during labor

Prophylactic Antibiotics to reduce chances of infection

Delivery to be done at a Tertiary Care Hospital

Vaginal delivery is advisable unless there is an obstetrical indication

Other routine obstetrical care and fetal monitoring for growth etc. is managed as in any other pregnancy

Electrocardiography or Echocardiogram should be promptly done in case of any doubts

Diagnosis of problem at the earliest

Source: Press release

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