{"id":4701,"date":"2022-08-26T11:29:27","date_gmt":"2022-08-26T08:29:27","guid":{"rendered":"https:\/\/burcaktok.com\/?p=4701"},"modified":"2022-08-26T11:31:12","modified_gmt":"2022-08-26T08:31:12","slug":"pregnancy-and-heart-diseases","status":"publish","type":"post","link":"https:\/\/burcaktok.com\/en\/gebelik-ve-kalp-hastaliklari\/","title":{"rendered":"Pregnancy and Heart Diseases"},"content":{"rendered":"

Kardiyovask\u00fcler sistem hastal\u0131klar\u0131 ve gebelik, anne ve \u00e7ocuk mortalitesi y\u00f6n\u00fcnden, \u00f6nemli bir yer i\u015fgal eder. Eskiye oranla daha etkin tedavi ve daha az gebeli\u011fe son verme zorunlulu\u011funa ra\u011fmen, anne mortalitesi h\u00e2l\u00e2 %3,9 ve \u00e7ocuk mortalitesi %10-50 aras\u0131nda de\u011fi\u015fmektedir. Normal gebelik de\u011fi\u015fmeleri (Kan volum\u00fcn\u00fcn artmas\u0131, vask\u00fcler yata\u011f\u0131n geni\u015flemesi, ekstraselluler \u00f6nemli su retansiyonu gibi), kalbi ge\u00e7ici de olsa, b\u00fcy\u00fck bir y\u00fck alt\u0131na sokmaktad\u0131r. Organik lezyonlu bir kalbin, rezerv g\u00fcc\u00fc daralm\u0131\u015f bulundu\u011fu i\u00e7in, gebeli\u011fin getirdi\u011fi yeni \u015fartlara uyum sa\u011flayamamas\u0131, anne ve \u00e7ocuk i\u00e7in tehlikeli olabilir.\u00a0Pregnancy and Heart Diseases<\/strong>\u00a0The 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.<\/p>\n

\"pregnancyCauses of Pregnancy and Heart Diseases<\/h2>\n

Kalp hastal\u0131klar\u0131 ve gebelik, t\u00fcm gebelerin %2,5-%1-0,5’ini kapsamaktad\u0131r. Bunlar\u0131n % 80-90’\u0131 ge\u00e7irilmi\u015f romatizmaya ba\u011fl\u0131d\u0131r. %3- 3’\u00fc kongenital kalp hastal\u0131\u011f\u0131d\u0131r. Romatizmal vakalar\u0131n %75-80’i mitral stenozu vakalar\u0131d\u0131r.<\/p>\n

Anne mortalitesi: %39, \u00c7ocuk mortalitesi: %10-50’dir.<\/p>\n

Hafif ve kompanse kalp hastalar\u0131nda \u00e7ocuk mortalitesi: %10<\/p>\n

A\u011f\u0131r dekompanse vakalarda :%50<\/p>\n

Do\u011fan \u00e7ocuklar\u0131n dismat\u00fcre ve premat\u00fcrelik oran\u0131 :%50’dir.<\/p>\n

Diagnosis:
\nEarly 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,
\nEdema, tachycardia attacks and pathological strain, if any, should definitely suggest the possibility of heart disease.
\nPregnancy and Heart Diseases<\/strong>\u00a0The 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.<\/p>\n

1. derece: (%49) Semptom vermeyen, \u00e7al\u0131\u015fma g\u00fcc\u00fcn\u00fc k\u0131s\u0131tlamayan organik kalp hastal\u0131\u011f\u0131.
\n2. derece: (%39) Solunum zorlu\u011fu ve \u00e7abuk yorulma, g\u00fcnl\u00fck u\u011fra\u015f\u0131lar\u0131 k\u0131s\u0131tlar, istirahatte veya \u00e7ok hafif i\u015flerde kendilerini iyi hissederler. \u0130\u015f zorla\u015f\u0131nca \u015fik\u00e2yetler ortaya \u00e7\u0131kar.
\nMortality in these two groups is %0.5 \u2013 %1.
\nGrade 3: (% 8) They have difficulty even in light activities. daily work
\nare highly restricted. Mortality %5.
\n4. derece: (% 4) En hafif i\u015fe bile dayanamazlar. \u0130stirahatte bile yetersizlik belirtileri vard\u0131r. Bu grupta mortalite y\u00fcksektir. %22.<\/p>\n

Pregnancy and birth of pregnant women who are in grades I and II can be completed successfully under prenatal care and heart control.
\nPregnant 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:<\/p>\n

a) Recent rheumatic infection,
\nb) Cases with subfebrile and evolutive course,
\nc) Cases with continuous tachycardia and arrhythmia,
\nd) Auricular fibrillation,
\ne) Cases that have just recovered from decompression,
\nf) Heart patients who cannot rest,
\ng) Cases whose condition has worsened during previous pregnancies and births should be subject to special evaluation.<\/p>\n

\"pregnancyIn another classification K<\/strong>Pregnant Women with Alpine Disease<\/strong>They are divided into two categories: suitable and inappropriate cases.
\nSuitable cases:
\n(1) There is no hypertrophy of the heart. There is only diastolic suffle.
\n(2) Has not yet decompensated.
\n(3) There is no anomaly in cardiac conductivity.
\n(4) There are no complications related to other organs. Even in suitable cases.<\/p>\n

a- If the rheumatic lesion concerns two valves,
\nb-If the patient is over 35 years of age,
\nc-If there are symptoms of preeclampsia,
\nd- If an intercurrent infection is involved,
\nHeart failure can begin at any time.<\/p>\n

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

\u00d6nceki gebeliklerinde dekompanse olan bir hastan\u0131n, \u015fimdiki gebeli\u011finde %75 oran\u0131nda yetersizlik beklenmelidir. Bu tip hastalar s\u0131k\u0131 kontrol alt\u0131nda ve bak\u0131mla idare edilebilir. Atrial fibrilasyon s\u0131k g\u00f6r\u00fclen ve konjestif kalp hastal\u0131\u011f\u0131 ile beraber bulunan vakalarda emboli ve ani \u00f6l\u00fcmler g\u00f6r\u00fclebilir. Romatizma ge\u00e7irmi\u015f bir kad\u0131na,, ancak bir senelik ara verdikten sonra, gebe kalmas\u0131na izin verilebilir. Pulmoner hipertansiyonda, prognoz karanl\u0131kt\u0131r. Gebe kalmalar\u0131na izin verilmemelidir. Konjenital kalp hastalar\u0131ndan, pulmoner stenozlu ve aorta stenozlu gebeler, kontrol alt\u0131nda gebelik ve do\u011fumu atlatabilirler. Bu vakalarda dekompanse olu\u015f %15, \u00e7ocuk \u00f6l\u00fcm\u00fc %10-20 aras\u0131ndad\u0131r.<\/p>\n

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.\u00a0Pregnancy and Heart Diseases <\/strong>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.<\/p>\n

Romatizmaya ba\u011fl\u0131\u00a0gebelik ve\u00a0kalp hastal\u0131klar\u0131 (%90): %10-15’inde aorta stenozu da beraberdir. Mitral stenozlu gebelerin %90’\u0131 birinci ve ikinci dereceye giren hastalar\u0131 olu\u015ftururlar. %10’u III. ve IV. gruptakiler, y\u00fcks\u00fck rizikolu kalp hastalar\u0131d\u0131r. Mortalite bu kategoride y\u00fcksektir. Mitral stenozlu vakalarda, pulmoner bas\u0131n\u00e7 fazlal\u0131\u011f\u0131n\u0131n neden oldu\u011fu, akci\u011fer \u00f6demi ve sa\u011f kalp yetersizli\u011fi tehlikeleri vard\u0131r. Bu tehlike en s\u0131k 6.-8. aylarda ve bir de travay\u0131n \u0131k\u0131nt\u0131l\u0131 a\u011fr\u0131lar\u0131 s\u0131ras\u0131nda s\u0131k g\u00f6r\u00fcl\u00fcr. Bir K<\/strong>alpine diseases<\/strong> It needs to be closely monitored by a specialist.<\/p>\n

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.<\/p>\n

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.<\/p>\n

Aorta stenozu (%10): Gebelik ve do\u011fum ar\u0131zas\u0131z ge\u00e7er. Sol kalpte myokard lezyonu varsa prognoz k\u00f6t\u00fcd\u00fcr. Yetersizlik a\u011f\u0131r seyreder.<\/p>\n

Aortic insufficiency: Tolerance is good. However, in decompensated cases, pregnancy should be terminated on time.<\/p>\n

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
\nIt 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.<\/p>\n

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

\"pregnancyThey fall into groups I and II, g<\/strong>midwifery and birth<\/strong> 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.<\/p>\n

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.<\/p>\n

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.<\/p>\n

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).<\/p>\n

Rhythm disorders: In a normal pregnant woman, the pulse may be above 100. Differentiate from sinus tachycardia
\nzordur. Halbuki bu tip ta\u015fikardi yakla\u015fan bir kalp yetersizli\u011finin \u00f6n habercisi olabilir. Ta\u015fikardi ani ba\u015flam\u0131\u015fsa, emboli, infeksiyon, kanama gibi nedenler aranmalidir. Sinuzal bradikardi selimdir. K\u0131smi veya tam blok ciddidir. Esas hastal\u0131k prognozu tayin eder. %55 sonradan ortaya \u00e7\u0131kan pregnancy and heart diseases<\/strong> ile\u00a0 ba\u011fl\u0131d\u0131r. %19’a kadar varan mortaliteye neden olur. Konjenital olanlarda prognoz daha iyidir. T\u00fcm ritm bozukluklar\u0131nda tedavi esas hastal\u0131\u011fa y\u00f6nelmelidir. Yetersizlik ve emboll prognozu k\u00f6t\u00fcle\u015ftirir.<\/p>\n

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).<\/p>\n

TREATMENT OF PREGNANTS WITH HEART DISEASE<\/h3>\n

The following two complications are expected at any time during pregnancy, birth and puerperium.
\n1- Pulmoner \u00f6dem (Mitral stenoz %80-90): (Paroksismal dispne + \u00f6ks\u00fcr\u00fck + k\u00f6p\u00fckl\u00fc balgam + bazen hemoptizi) akci\u011ferlerde ya\u015f raller, bronkospazm ta\u015fikardi ile belli olur. Heyecanda, harekette, coitte, yatarken, uykuda ortaya \u00e7\u0131kar. \u00c7ok ciddi bir komplikasyondur.<\/p>\n

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.<\/p>\n

Pregnancy and Heart Diseases Treatment: It is the same as other heart diseases.<\/p>\n

    \n
  • After physical exertion, long rest is necessary.<\/li>\n
  • \u00a0It 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.<\/li>\n
  • \u00a0III. In this group of pregnant women, physical activity should be minimal and they should be checked in the clinic in the last two months.<\/li>\n
  • Starting from the 36th week, III. and IV. This group of patients must be admitted to the clinic. Pregnancy toxicosis<\/strong> varsa (%20) kaloriden fakir protein ve vitaminlerden zengin, tuzsuz rejim uygulan\u0131r (kilo, tansiyon).<\/li>\n
  • Kalp hastas\u0131 gebeleri bir kardiolog g\u00f6zlemeli ve tedavi etmelidir. Anemi varsa artan 0\u2082 gereksinmesini kalp, dakika volum\u00fcn\u00fc art\u0131rarak ve ta\u015fikardi ile kar\u015f\u0131la\u015f\u0131r. Hemoglobin %80 (100 ml.\/11\/7 gr.) alt\u0131na d\u00fc\u015fmemelidir. Lo\u011fusalarda y\u00fcksek antibiyotik bask\u0131s\u0131 ile romatizma infeksiyonunun alevlenmesi \u00f6nlenmelidir.<\/li>\n
  • In mitral stenosis, if there is an indication, the operation is carried out on the 4th-7th day. It is done in months.<\/li>\n<\/ul>\n

    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:
    \na) 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.<\/p>\n

    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.
    \n\u2013 The third period should not last more than 1 hour and should be assisted with forceps or vacuum.
    \n\u2013 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.<\/p>\n

    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, g<\/strong>midwifery and Heart Diseases<\/strong> depends on the situation.<\/p>\n

    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.<\/p>\n

    Today, to a pregnant woman with severe mitral stenosis:
    \n(1) The chance of pregnancy and birth can be given with heart surgery.
    \n(2) Or the pregnancy is terminated first. Then heart surgery is performed.
    \n(3) Or the pregnancy continues under strict control.
    \nThere 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.<\/p>","protected":false},"excerpt":{"rendered":"

    Kardiyovask\u00fcler sistem hastal\u0131klar\u0131 ve gebelik, anne ve \u00e7ocuk mortalitesi y\u00f6n\u00fcnden, \u00f6nemli bir yer i\u015fgal eder. Eskiye oranla daha etkin tedavi ve daha az gebeli\u011fe son verme zorunlulu\u011funa ra\u011fmen, anne mortalitesi h\u00e2l\u00e2 %3,9 ve \u00e7ocuk mortalitesi %10-50 aras\u0131nda de\u011fi\u015fmektedir. Normal gebelik de\u011fi\u015fmeleri (Kan volum\u00fcn\u00fcn artmas\u0131, vask\u00fcler yata\u011f\u0131n geni\u015flemesi, ekstraselluler \u00f6nemli su retansiyonu gibi), kalbi ge\u00e7ici de […]<\/p>\n","protected":false},"author":1,"featured_media":4703,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_themeisle_gutenberg_block_has_review":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-4701","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-genel"],"acf":[],"_links":{"self":[{"href":"https:\/\/burcaktok.com\/en\/wp-json\/wp\/v2\/posts\/4701","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/burcaktok.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/burcaktok.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/burcaktok.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/burcaktok.com\/en\/wp-json\/wp\/v2\/comments?post=4701"}],"version-history":[{"count":0,"href":"https:\/\/burcaktok.com\/en\/wp-json\/wp\/v2\/posts\/4701\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/burcaktok.com\/en\/wp-json\/wp\/v2\/media\/4703"}],"wp:attachment":[{"href":"https:\/\/burcaktok.com\/en\/wp-json\/wp\/v2\/media?parent=4701"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/burcaktok.com\/en\/wp-json\/wp\/v2\/categories?post=4701"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/burcaktok.com\/en\/wp-json\/wp\/v2\/tags?post=4701"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}