At heart defects blood circulation. This is particularly dangerous during pregnancy, when the load on the cardiovascular system.
Heart defects are congenital and acquired.
Planning a pregnancy, a woman should identify (or exclude) a congenital heart defect. This will enable the conscious and balanced approach to family planning, and in the case of the possibility of pregnancy and childbirth to prepare for them in advance.
90% of acquired heart defects develop against rheumatism, they can also occur during pregnancy (exacerbation of rheumatic fever in pregnant women is most often seen in the first three and last two months of pregnancy). Fortunately, there is now a wide arsenal of methods of diagnosis and treatment of this disease. Women suffering from rheumatism, especially important to plan a pregnancy. The favorable prognosis of pregnancy is possible if it occurred against the background of an inactive rheumatic process.
With improved methods of diagnosis and treatment of heart disease, many patients with these diseases, especially doomed to sterility, were able to carry and give birth to a child.
How to plan a pregnancy with heart defects
Modern medicine has sufficiently effective methods that allow to calculate the degree of risk associated with pregnancy and childbirth in women with heart defects. With their help doctors help a woman determine the optimum time for conception or decide the fate of an unplanned pregnancy.
The most important method of assessing the state of the cardiovascular system with heart defects is ultrasound of the heart — echocardiography. It is harmless and helps to objectively assess the state of the cavities of the heart valves and orifices. Supporting role in the diagnosis of heart defects play electrocardiography (ECG — a graphical record of the electrical activity of the heart), phonocardiography (PCG — a graphical record of the heart sound phenomena) and Doppler sonography (ultrasound, which allows to evaluate blood flow).
Heart defects in pregnant women from 0.5 to 10% of all heart diseases. Most often, they have found an ASD, or interventricular septum, patent ductus arteriosus. Women with the above defects are usually (with appropriate treatment, compensating defect) tolerate pregnancy and childbirth.
The option to have appeared in many women who have undergone heart surgery. The recovery period after such operation is generally one year. Therefore, it can be a year to plan pregnancy — of course, in the absence of contraindications (adverse result of the operation, the development of diseases that complicate the postoperative rehabilitation and reduce the effect of the operation).
Needless to remind that the possibility of pregnancy and childbirth admissibility should be decided individually before pregnancy, depending on the general condition of women, the nature of the disease, the severity of the operation, etc. After a comprehensive survey of the patient's doctor can give a definite conclusion.
However, even with the stabilization of the women after surgery (or therapeutic) treatment of pregnancy amid growing pressure on the heart increases the risk of recurrence of the underlying disease (previously compensated defect may become decompensated) — this is another argument in favor of the need to consult with a doctor and medical monitoring before and during pregnancy, even if the woman thinks she is healthy and full of energy.
There are severe heart defects with significant impairment of blood circulation (pulmonary artery stenosis, tetralogy of Fallot, coarctation of the aorta, etc.), the presence of which can be developed as a dramatic disruption of the cardiovascular system, in 40-70% of cases, they lead to the death of a pregnant , so when these defects contraindicated in pregnancy.
Such defects can be inherited, and the probability of transmission of the disease the child is determined in each case. (For example, if heart disease is present in two or more family members, the probability of his inheritance increases.)
In general, the prognosis for the mother and the child is worse than the more pronounced impairment of blood circulation and activity of rheumatic process. In severe heart failure and a high degree of activity of rheumatic process of pregnancy is contraindicated. However, the question of the continuation of the pregnancy is solved patient and physician in every case.
Management of Pregnancy
During pregnancy significantly increases the load on the cardiovascular system. By the end of the second trimester blood circulation rate increases by almost 80%. Blood volume also increased (by 30-50% by the eighth month of pregnancy). This is understandable — after a parent joins the circulatory system and blood flow of the fetus.
With this additional load in a third pregnancy with a healthy heart may experience irregular heart rhythm (arrhythmia), and the valves of the heart, that we talk about women with heart defects.
If necessary, medication for heart diseases is carried out throughout the pregnancy. The goal of treatment — normalization of blood circulation and the creation of normal conditions for the development of the fetus. Question regarding drugs and their dosage is decided individually, according to gestational age and the degree of circulatory disorders.
When treatment failure resorting to surgery, preferably 18-26 weeks of gestation.
Throughout the pregnancy is carried out periodically ehokardiotokografiya (ultrasound of the fetal heart). Using the Doppler explore utero-placental and fetal (fruity) blood flow to avoid hypoxia (oxygen starvation) of the fruit.
Naturally, constantly monitor the state of the mother's heart (his methods have been described in the previous section).
Often, even with initially compensated malformation during pregnancy complications are possible, so every pregnant, suffering from heart disease, should be at least three times during a pregnancy to be tested in the cardiology hospital.
The first time — on term up to 12 weeks of pregnancy, when, after thorough cardiac and, if necessary, rheumatological, survey question solved the possibility of maintaining pregnancy.
The second time — in the period 28 to 32 week, when the load on the heart of a woman is particularly large and very important to carry out preventive treatment. After all, a big load onheart at this time can lead to:
- Chronic heart failure is characterized by fatigue, edema, shortness of breath, enlargement of the liver;
- heart rhythm disturbances (arrhythmias);
- congestive heart failure and extreme poverty — pulmonary edema and thromboembolic events (ie, blockage of arteries lung clots) in the systemic circulation and the pulmonary artery (these states represent a direct threat to human life, they should be removed immediately in the intensive care unit).
These complications can occur not only during pregnancy but also in labor, and in the early postpartum period.
For the child, such violations maternal circulation are fraught with a lack of oxygen (hypoxia). If you do not take timely measures, there may be a delay in fetal development, lack of body mass (wasting) of the fruit.
The third is hospitalized 2 weeks before giving birth. At this time, a repeated cardiac evaluation and produced a birth plan, being prepared for them.
The question of the mode of delivery is solved individually, depending on how much offset defect in time delivery. This may be through natural childbirth ways to shut down or turn off without any attempts (see below) or cesarean section.
Often, a few weeks before giving birth increases the load on the heart is so worsens the condition of the pregnant woman, that may require early delivery. Best of all, if it happens in 37-38 weeks.
Birth plan drawn up jointly an obstetrician, a cardiologist and intensive care. At
tempts — a period of expulsion — is a particularly difficult time for the heart of women in labor, so this try to shorten the time of delivery, making dissection of the perineum (perineotomy or episiotomy), and stenosis of the mitral valve opening, any degree of heart failure, complications associated with the violation of the heart the circulatory system in the previous birth, — imposing weekend forceps.
Caesarean section is conducted in the following cases:
- vice combination with obstetric complications (narrow pelvis, malposition in the uterus, placenta previa);
- mitral insufficiency with significant circulatory disorders (pronounced regurgitation — reverse reflux of blood from the ventricle into the atrium);
- Mitral valve stenosis is not amenable to surgical correction;
- vices of the aortic valve with impaired circulation.
After the birth
Immediately after birth the placenta and the blood rushes to the internal organs, especially the organs of the abdominal cavity. Circulating blood volume in the vessels of the heart is decreased. Therefore, immediately after giving birth, women are imposing that support the work of the heart (cardiotonic).
From maternity women with heart defects are issued not earlier than two weeks after the birth, and only under the supervision of a cardiologist in the community.
If a woman after childbirth should take the medication about heart disease, breast-feeding is ruled out, since many of these drugs get into the milk. If after giving birth defect of the heart is compensated and no treatment is required, a woman can breastfeed.
Women suffering from rheumatism, should be especially careful to monitor their health in the first year after birth, when, according to statistics, frequently observed exacerbation of the disease.
Advice to women suffering from heart diseases
Remember that the main cause of adverse pregnancy and birth outcomes in women with heart defects, which, in principle, pregnancy is not contraindicated, is insufficient or irregular inspection at the antenatal clinic, the lack of integrated management of pregnancy obstetrician and a cardiologist and, consequently, the lack of efficacy of therapeutic interventions and errors in the conduct of childbirth and the postpartum period.
- try to avoid unplanned pregnancy;
- consult with the attending cardiologist you before pregnancy, find out whether you are able to bear a child and by what method of delivery you should be prepared;
- if you suffer from a congenital heart defect, certainly (preferably before pregnancy) consult with a geneticist;
- Find out what mode you should follow to avoid compromising themselves and the unborn baby, how to eat, what kind of treatment and physical exercises could help you carry and give birth to a child;
- assigned to you do not miss prenatal visits and receptions with a cardiologist, just go through all the prescribed examinations;
- do not give up on hospitalization and medication — because of how effectively supports the work of your heart, is not only your health but also the health and life of your baby.