Cardiac disease in pregnancy | Dr Andrew Deaner, Consultant Cardiologist
How to manage cardiac disease during pregnancy?
Cardiac disease is a serious problem these days especially when people have adopted reckless habit of consuming the unhealthy variation of food items. It is really important to check out the options that will help you get the best remedy of the heart problem. The researchers have found out cardiac disease as a major problem for pregnant women. This can lead to complication of health of both the baby and the mother. There are ways through which you can easily manage the heart problem during pregnancy.
Pregnancy has a significant need the cardiovascular system. There are several physiological changes in the cardiovascular system during pregnancy. If the pregnant lady has someone suffering from heart disease in his or her family, it will be due to hereditary. Therefore it is necessary that a pregnant woman with cardiac disease need specialist and management before, during and after the delivery. The impact of the changes to a pregnant woman with cardiac problem will vary, depending on the type and seriousness of the disease.
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propercounselling must be given to all women in the reproductive age who have congenital or acquired cardiac problem to make a choice of pregnancy. After pregnancy, the woman must be kept under a multi-disciplinary team of doctors and investigations must beunder takenfrom time to time. This team should consist of obstetricians, cardiologists, andanaesthetists. Proper arrangements must be made at the nearby local hospitals. The main aim of management is to take care of the current condition by medicines, monitor the condition fordeterioratin to minimizechancesof overloading the cardiovascular system delivery and later period. Labor should be induced beforehand to avoid running after the onset of labor.
Mode of delivery
Most women with heart disease prefervaginal deliveryunless there specific obstetric indications or deterioration in cardiac problems demanding early delivery. Vaginal delivery can be easily performed by inducing labor, giving low dose of regional analgesia for relief of pain, and assisting in delivery with instruments like forceps to avoid the mother’s effort of pushing.
In the post-partum period or the time after delivery high-level care and observation is required in the hospital for at least two weeks. It has recently been found that chest infections or other problems occur anytime from 1 month of pre delivery to 5 months after delivery.
Specific high-risk conditions
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Myocardial infarction was a leading cause of cardiac death of women in the last few years. A low threshold for diagnosis of myocardial infarction and acute coronary syndrome in women with risk factors must be tackled in the form of coronary angiography, emergency coronary intervention, andthrombolysis.Thrombolysisat the time of delivery carries a significant risk of hemorrhage. The first choice for treatment of acute coronary syndrome in pregnant women is percutaneous coronary intervention.
Aortic dissection is a particular risk in women with Marfan’s syndrome; the risk is thought to be highest near full-term or immediately after delivery. Women suffering from Marfan’s syndrome must be managed with pre pregnancy counseling. If there is risk of aortic dissection, the replacement of aortic root replacement must be conducted before pregnancy.
Valvular heart disease
The valvular condition which carries the highest risk pregnancy is mitral stenosis. This rheumatic heart disease is common in less developed countries. Pregnant women suffering from mitral stenosis should be managed in tertiary centers with experts in the field. The greatest risk in this pulmonary edema at the time of delivery. The management of other valvular conditions in pregnancy will be governed by the severity of the condition.
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Pulmonary arterial hypertension carries a very high risk during pregnancy and the mortality rate is up to 50%. This condition must be discussed before conception. If pregnancy has to be continued, proper arrangements must be made to handle her condition by a multi specialist team.
Peripartum cardiomyopathy is defined as the presence of heart failure without any other obvious cause in a pregnant woman occurring anytime from 1 month pre-delivery up to 5 months after delivery
There is a misconception in the society that a woman living with heart problems should not get pregnant. But modern medical practitioners ensure that heart disease can be safely managed during pregnancy. It is necessary to evaluate the heart condition of the woman and to determine if pregnancy is a good idea. There are very rare cases when pregnancy is at risk with heart problems. Some experts say that the hormonal changes during pregnancy helps the problematic heartto workbetter. But it is advisable that women with high risk of heart condition must take expert counselling before conceiving and arrange for multi-disciplinary specialist care to have a healthy pregnancy anda deliver a healthychild.
Ways to manage cardiac disease during pregnancy
Avoid fat during pregnancy
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When you are pregnant, it is important to take care of your diet schedule. You need to stay fit along with your baby inside your womb. Some people have an opinion that, feeding people with fat during pregnancy can keep both the mother and baby healthy. But, this is totally a wrong fact. You need to have a perfect diet chart for the women who are pregnant without saturated fat.
Early diagnosis of cardiac problem
The cardiac problem should be diagnosed at the initial stage. You actually need to have your heart check up when you are pregnant. Once you get the early diagnosis, treating the problem will be easy. Management of cardiac problem will be quite easy if you can plan it in advanced.
Levels of care
It is important to find out whether the women will be recurring the obstetric care and cardio logical treatment during pregnancy. There are three levels of care in which the level 1 is known for all those who are suffering from highly risky stage of cardio logical problem. For all such patients’ exclusive care must be provided within the specialty clinic. Then comes the level 2 treatment, here it focuses about the lesion on moderately complex patient. Here the ailment can be done with good collaboration among the obstetric service provider and the specialists dealing with it. The level 3 is very minor case where the pregnant lady with cardiac disorder will be treated right at home. In some cases treatment can be done in the regional hospitals.
Video: Congenital Heart Disease and Pregnancy | Cincinnati Children's
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