Heart Disease in Pregnancy

Heart Disease During Pregnancy

• Learning Outcomes: By the end of the session, students should be able to recognize symptoms and signs of heart disease during pregnancy, manage pregnancies complicated by heart disease, and identify factors contributing to heart failure.

History of Heart Disease in Pregnancy

• Symptoms/Signs: Breathlessness, change in heart rate/rhythm, increased tiredness, and reduced exercise tolerance.

Examination for Heart Disease in Pregnancy

• Physical Examination: Pulse, blood pressure (BP), jugular venous pulse (JVP), heart sounds, ankle and sacral edema, and basal crepitation.

Management of Heart Disease During Pregnancy

• Joint Clinic Management: Patients should be managed in a joint clinic setting.
• Reducing Physical Activity: Patients should be advised to reduce physical activity.
• Anticoagulants: Heparin is used for congenital heart disease and valve replacement.
• Fetal Risk Counseling: Counseling about potential fetal risks during pregnancy is essential.

Fetal Risks in Pregnancy with Heart Disease

• Congenital Heart Disease: Maternal cyanosis can lead to fetal hypoxia.
• Iatrogenic Prematurity: Potential for prematurity.
• Fetal Growth Restriction (FGR): Pregnancy complication.
• Drug Effects: Potential drug-induced teratogenicity, growth restriction, or foetal loss.

Labour & Delivery Management

• Spontaneous Onset: Favored approach for labor initiation.
• Pain Management: Analgesia as needed.
• Fluid Balance: Maintaining proper fluid levels is important.
• Oxytocin: Judicious use of oxytocin.
• Elective Forceps: Elective forceps might be necessary.
• Antibiotics: Prophylactic use of antibiotics as needed.
• Cesarean Section: Only if medically indicated.
• Ergometrine: Contraindicated during labor.

Predisposing Factors for Heart Failure During Pregnancy

• Respiratory Infection: Infection of the respiratory system can be a risk factor.
• Urinary Tract Infection (UTI): Urinary tract infections are to be considered as a risk factor as well.
• Anemia: Low blood count can increase the risk.
• Steroid Use: Use of steroid medications.
• Tocolytics: Drugs used to stop preterm labor.
• Multiple Gestations: Pregnancies with more than one fetus.
• Hypertension: High blood pressure.
• Arrhythmias: Irregular heartbeats.
• Pain-Related Stress: Stress related to pain.
• Fluid Overload: Excess fluid in the body.

Contraindications for Pregnancy with Heart Disease

• Pulmonary Hypertension: Pregnancy is contraindicated in cases of pulmonary hypertension.
• Aortic Root Diameter: Greater than 4.5 cm.
• Severe Aortic/Mitral Stenosis: Pregnancy should not be considered in such cases.
• Cardiomyopathy: Patients with ejection fraction below 30.
• Coarctation of the Aorta: Pregnancy contraindication.