Pregnancy and Heart Diseases

Cardiovascular diseases and pregnancy occupy a significant place in terms of maternal and child mortality. Despite more effective treatments and less need for termination of pregnancy compared to the past, maternal mortality still ranges from %3.9 and child mortality from -50. Normal pregnancy changes (such as increased blood volume, dilation of the vascular bed, and significant extracellular water retention) place a great, albeit temporary, burden on the heart. A heart with organic lesions, having a reduced reserve capacity, may be unable to adapt to the new conditions of pregnancy, which can be dangerous for both mother and child. Pregnancy and Heart Diseases The doctor's responsibility is very heavy: He will decide whether the pregnancy should continue or not. If the pregnancy is to continue, the mother will need to avoid any behavior that may burden the heart.

Causes of Pregnancy and Heart Diseases

Heart disease and pregnancy account for 2.5-10.5% of all pregnant women with altered % values. Of these, 80-90% are due to previous rheumatic diseases, and 3-3% are due to congenital heart disease. Of the rheumatic cases, 75-80% are due to mitral stenosis.

Maternal mortality: , Child mortality: -50.

Child mortality in mild and compensated heart disease:

In severely decompensated cases:

The rate of dysmature and prematurity in newborns is .

Diagnosis:
Early diagnosis is very important. However, even in normal pregnant women, diagnosis is quite difficult, as dyspnea, tachycardia, extrasystole and sulphate can be observed due to the heart being pushed upwards by the diaphragm and changes in circulatory conditions. Air hunger that occurs during daily tasks in the first months of pregnancy,
Edema, tachycardia attacks and pathological strain, if any, should definitely suggest the possibility of heart disease.
Pregnancy and Heart Diseases The functional adequacy of the myocardium is more important than its quality. For this reason, pregnant women are divided into 4 categories according to their complaints. This compartment has practical importance in prognosis and treatment. New York Heart Disease. This recommendation of the Association has been adopted by many clinics.

Grade 1: () Asymptomatic organic heart disease that does not impair work capacity.
Grade 2: () Difficulty breathing and easy fatigue restrict daily activities; they feel well at rest or with very light work. Symptoms appear when work becomes difficult.
Mortality in these two groups is %0.5 – %1.
Grade 3: (% 8) They have difficulty even in light activities. daily work
are highly restricted. Mortality %5.
Grade 4: (% 4) They cannot tolerate even the lightest work. They show signs of weakness even at rest. Mortality is high in this group. .

Pregnancy and birth of pregnant women who are in grades I and II can be completed successfully under prenatal care and heart control.
Pregnant women who are in grade III and IV need to be under frequent control and be hospitalized and monitored. It may be necessary to resort to medical abortion in some of the patients who are at grade IV. Although a classification based solely on subjective complaints has great practical value, it is also important to consider the characteristics of each case listed below:

a) Recent rheumatic infection,
b) Cases with subfebrile and evolutive course,
c) Cases with continuous tachycardia and arrhythmia,
d) Auricular fibrillation,
e) Cases that have just recovered from decompression,
f) Heart patients who cannot rest,
g) Cases whose condition has worsened during previous pregnancies and births should be subject to special evaluation.

In another classification KPregnant Women with Alpine DiseaseThey are divided into two categories: suitable and inappropriate cases.
Suitable cases:
(1) There is no hypertrophy of the heart. There is only diastolic suffle.
(2) Has not yet decompensated.
(3) There is no anomaly in cardiac conductivity.
(4) There are no complications related to other organs. Even in suitable cases.

a- If the rheumatic lesion concerns two valves,
b-If the patient is over 35 years of age,
c-If there are symptoms of preeclampsia,
d- If an intercurrent infection is involved,
Heart failure can begin at any time.

Ineligible cases:
(1) Diastolic strain and associated cardiac hypertrophy,
(2) There is a history of decompensation in a previous pregnancy and outside pregnancy.
(3) Heart rhythm is severely disturbed.
(4) There are additional medical complications.

A patient who experienced decompensation in previous pregnancies should expect a deficiency in her current pregnancy. These patients can be managed with close monitoring and care. In cases where atrial fibrillation is common and often accompanied by congestive heart disease, embolisms and sudden deaths can occur. A woman who has had rheumatic fever may only be allowed to become pregnant after a one-year interval. In pulmonary hypertension, the prognosis is bleak; pregnancy should be avoided. Pregnant women with congenital heart disease, particularly those with pulmonary stenosis and aortic stenosis, can manage pregnancy and delivery under controlled conditions. In these cases, decompensation occurs at a level, and child mortality is between -20.

In patients with Cyanose, if the hematocrit is above 60, the child mortality rate is high. Normal progress can be expected below 50. However, the rate of premature birth (Prematurity), underweight (Small for date) and Dysmature children is high. Pregnancy and Heart Diseases It should not be forgotten that heart failure may occur at any time. The most common failure is seen in the 6th, 7th and 8th months. In addition, a febrile illness, severe anemia and pregnancy toxicosis are also factors that can lead to heart failure.

Rheumatic pregnancy and heart disease (): Aortic stenosis is also present in -15 cases. Pregnant women with mitral stenosis constitute first and second-degree patients in . Those in groups III and IV in are high-risk heart patients. Mortality is high in this category. In cases of mitral stenosis, there are risks of pulmonary edema and right heart failure due to increased pulmonary pressure. This risk is most common in the 6th-8th months and also during labor pains. Kalpine diseases It needs to be closely monitored by a specialist.

The leading signs of danger are increased dyspnea, tachycardia, crackles in the lung bases and then pulmonary edema. It is useful to keep suspicious cases under observation in a clinic in the last months.

Mitral regurgitation: Mitral regurgitation alone is the most benign cases. With stenosis, the situation can become serious at any time. In these cases, medical interruption should be made from the very beginning.

Aortic stenosis (): Pregnancy and childbirth proceed without complications. The prognosis is poor if there is a myocardial lesion in the left heart. The regurgitation is severe.

Aortic insufficiency: Tolerance is good. However, in decompensated cases, pregnancy should be terminated on time.

Endocarditis: In a treated case, pregnancy cannot be allowed until at least 6 months have passed. Recurrence is not expected during pregnancy. Since bacterial flare-ups may occur after tooth extraction, treatment should be carried out under antibiotic pressure. Monitoring and delivery of a pregnant woman with endocarditis, rheumatic heart disease
It should be done according to the principles of the diseases. Deconpensation is 6 times more common than other heart diseases. For septicemia proliphylaxis, delivery should be concluded under high-dose antibiotic pressure. And the pressure is continued throughout the first week of postpartum.

Congenital pregnancy and heart diseases: (%1-3) (Septum defects, pulmonary stenosis, open ductus arteriosus, coarctation aortae, aortic stenosis).

They fall into groups I and II, gmidwifery and birth It goes smoothly. Death rarely occurs. Congenital heart diseases are divided into two groups: cyanotic and non-cyanotic. In aortic isthmus stenoses that cause cyanosis, mortality is %7. Aortic rupture, brain hemorrhage, and decompensation may occur. In these cases, the sectio indication should be broad. However, the prognosis is quite good in cases with atrial defect, open ductus Botalli, and ventricular septum defect.

Pregnancy passes without any problems, but the biggest danger can occur during and immediately after birth: sudden changes in hemodynamic conditions (arterial and venous left-right shunt) also change the direction of the shunt. This leads to inadequacy. With the excess venous blood mass flowing to the right heart, the pressure increases and begins to mix with arterial blood. The danger of shunt is also greater in sectio.

Vacuum or forceps should be preferred for exit. Pregnancy is very rare in blue disease, which does not give a chance to survive until birth. Patients with tetralogy of Fallot also have difficulty reaching childbearing age. Mother-child mortality is high in these. They should not be allowed to become pregnant. Sectio can be lethal.

Coronary disease: Even though pregnancy is rare, it is dangerous. 7.-8. It should be kept under very strict control during the months and after birth. (Cardiac arrest, severe failure, myocardial infarction).

Rhythm disorders: In a normal pregnant woman, the pulse may be above 100. Differentiate from sinus tachycardia
It is difficult. However, this type of tachycardia can be a harbinger of impending heart failure. If tachycardia starts suddenly, causes such as embolism, infection, and bleeding should be investigated. Sinus bradycardia is benign. Partial or complete block is serious. The underlying disease determines the prognosis. is a subsequently occurring condition. pregnancy and heart diseases It is related to . It causes mortality up to . The prognosis is better in congenital cases. In all rhythm disorders, treatment should be directed at the underlying disease. Insufficiency and embolism worsen the prognosis.

Kyphoskolyos: During pregnancy, the chest cavity becomes completely narrow. The heart is forced into an extremely horizontal position. Vital capacity decreases. There is a danger of right heart failure. It should not be left to persistent pain. Anesthesia can be dangerous. Often sectio is mandatory. Attention should be paid to blood loss (Hypovolemic collapse).

TREATMENT OF PREGNANTS WITH HEART DISEASE

The following two complications are expected at any time during pregnancy, birth and puerperium.
1- Pulmonary edema (Mitral stenosis -90): (Paroxysmal dyspnea + cough + foamy sputum + sometimes hemoptysis) manifests with wet rales in the lungs, bronchospasm, and tachycardia. It occurs with excitement, movement, intercourse, lying down, and sleep. It is a very serious complication.

11-Congestive heart failure: Dyspnea increases, neck veins fill, liver enlarges, edema begins in the feet. Myocardial lesions are together. There is cardiac hypertrophy and atrial fibrillation. Myocardium has failed.

Pregnancy and Heart Diseases Treatment: It is the same as other heart diseases.

• After physical exertion, long rest is necessary.
•  It is important to protect yourself from infections. Anemia should be prevented, attention should be paid to nutrition, gaining excess weight may be dangerous. Also, pay attention to salt and water.- 28.-32. Pregnancy weeks are a critical period. It requires rest and close observation.
•  III. In this group of pregnant women, physical activity should be minimal and they should be checked in the clinic in the last two months.
• Starting from the 36th week, III. and IV. This group of patients must be admitted to the clinic. Pregnancy toxicosis If present (), a low-calorie, high-protein and vitamin-rich, salt-free diet is followed (for weight and blood pressure).
• Pregnant women with heart disease should be monitored and treated by a cardiologist. If anemia is present, the increased oxygen demand causes the heart to increase minute volume and experience tachycardia. Hemoglobin levels should not fall below (100 ml/1 1/7 gr). In postpartum women, a high dose of antibiotics should be used to prevent the exacerbation of rheumatic infections.
• In mitral stenosis, if there is an indication, the operation is carried out on the 4th-7th day. It is done in months.

Birth follow-up: In case of decompensation, no intervention should be made for birth. However, the conservative attitude is abandoned in the following two cases:
a) Paroxysmal dyspnea during pregnancy: pulmonary edema may begin at any time. Hemoptysis may become severe. It may be necessary to terminate the pregnancy immediately or even have an emergency valvulotomy operation.

b) If there is insufficiency and toxicosis and it gets worse, the pregnancy is terminated immediately with abdominal hysterectomy. In others, birth should be as vaginal as possible.
– The third period should not last more than 1 hour and should be assisted with forceps or vacuum.
– Help should be given with a mask against cyanosis. Antibiotic pressure should be started against exacerbation of endocarditis. Analgesics and remedial agents should be minimized. The risk of infection, anesthesia, blood loss and embolism is high in Sectio.

During childbirth: There is a danger of decompensation and pulmonary edema due to increased blood volume. Rest under medical supervision is a must. It is true that heart patients can have more successful births with antenatal control and care, and new treatment opportunities. Risk, gmidwifery and Heart Diseases depends on the situation.

III.-IV. If patients in this group cannot be corrected with treatment, they should terminate the pregnancy. A pregnant woman seen in the last three months should be advised not to become pregnant again. If the birth is compromised, the tubes must be tied. The successful contributions of heart surgeries are a fact.

Today, to a pregnant woman with severe mitral stenosis:
(1) The chance of pregnancy and birth can be given with heart surgery.
(2) Or the pregnancy is terminated first. Then heart surgery is performed.
(3) Or the pregnancy continues under strict control.
There is a constant fear of hypoxia leaving sequelae in the child. Open heart operations have eliminated these drawbacks (mental retardation, defects). Pregnancy should be allowed again 3 years after heart surgery.