Treatment And Management Of Heart Disease During Pregnancy
“The high risk group should avoid pregnancy or will have to undergo medical termination of pregnancy (MTP) before eight weeks”
The cardiovascular changes during pregnancy are increased blood volume by 40 per cent, increased stroke volume by 40 per cent, increased cardiac output and increased heart rate. There is decreased systemic vascular resistance by 20 per cent and decreased pulmonary vascular resistance. Also, there is increased tendency for blood clotting and blood vessel damage.
Diseases in pregnancy affect two lives. So, more awareness and management is required and the best option is to identify any disorders beforehand through treatments like prenatal check up and counselling, as pregnancy is contraindicated or poorly tolerated in certain conditions.
The high risk group should avoid pregnancy or will have to undergo medical termination of pregnancy (MTP) before eight weeks with curette suction and evacuation with proper care.Cardiac medications like ACEI, ARB, amiodarone and statins are absolutely contraindicated during pregnancy and medications like diuretics, beta-blockers should be used cautiously.
If a patient becomes symptomatic with heart disease, definitive treatment procedure like PBMV (balloon valvotomy) for mitral stenosis, balloon dilatation for coarctation can be done during the second trimester by shielding the foetus from radiation.
Symptomatic patients with heart diseases have to be admitted by the 36th week and carefully monitored till one week postpartum, under institutional care. Asymptomatic or minimally symptomatic patients can be admitted before estimated due date (EDO) and carefully monitored.
Monitoring And Management In Different Stages
During the first stage of labour close monitoring, antibiotic prophylaxis for high risk endocarditis patients and oxytocin drip to increase uterine contraction can be given.
Second stage of labour needs assistance either with forceps, suctionpump and episiotomy. With each uterine contraction about 500 ml of blood enters into maternal arculation, so careful haemodynamic monitoring has to be done. For pulmonary oedema and lung signs, diuretics like Lasix can be given. During the third stage and immediate postpartum minimize postpartum haemorrhage or volume or blood has to be replaced, if more than 300 ml is lost.
Immediate postpartum up to 24-72 hours are the most dangerous periods, as there is fluid shift from uterus, placenta, preload and after load increases. These fluid shifts cause sudden volume changes in maternal circulation and cause sudden haemodynamic burden in cardiac patients resulting in serious complications like pulmonary oedema, cardiac failure, cardiac arrest and even sudden death.
So, apart from taking care of the new born baby, the mother needs full and careful monitoring and management so that the mother recovers quickly to take care of the child.
Awareness and proper management is the key for successful management of a pregnant woman and child, during pregnancy and postpartum.