Acquired heart defects and pregnancy

Any heart defect interferes with blood circulation to one degree or another, but it can become especially dangerous during pregnancy, when the load on the heart of the expectant mother increases. The prevalence of heart disease among pregnant women is about 1–7%, the vast majority of which occur in the “operated heart.”

How acquired heart defects affect pregnancy will be discussed in this article.

Pregnancy: the dangers of heart disease

During pregnancy, even in a completely healthy woman, the load on the heart increases significantly from 3–4 months, reaching a maximum before childbirth and normalizing by the end of the second week after delivery. Even a healthy heart does not always withstand such loads and malfunctions, manifested by the appearance of isolated and.

An “operated heart” or a “heart with a defect” during pregnancy is less able to withstand the increased load on it, so the following complications are possible:

1. For a pregnant woman:

• fainting caused by low blood pressure;
• tachycardia, arrhythmias;
• increase in shortness of breath;
• thromboembolism.

1. In the fetus:

• increase in hypoxia;
• signs of delayed neuropsychic development due to hypoxia;
• threat of premature birth.

The nature of complications depends on the type of defect and its severity.

What to do before pregnancy

If a woman has an acquired defect or an operated heart and wants to get pregnant, she must first consult a gynecologist and cardiologist (rheumatologist). As a rule, a woman will be asked to undergo an in-depth medical examination, including a blood test for acute phase reactions (“rheumatic tests”), an echocardiogram (ultrasound of the heart with a Doppler attachment), and an ECG.

Usually the doctor is guided by the following classification of risk assessment:

1. I degree. The risk is not increased and pregnancy is permitted. There are no signs, the stage of rheumatism is inactive, the pressure in the pulmonary artery is normal. Chronic heart failure functional class (FC) I (ordinary physical activity is not limited, shortness of breath and discomfort only with increased exertion).
2. II degree. Pregnancy is allowed, but during pregnancy there may be complications and deterioration in the woman’s well-being. Cardiovascular failure stage I, activity of rheumatism 0-I, moderate increase in pressure in the pulmonary artery. Chronic heart failure FC II (habitual exercise may be accompanied by shortness of breath, fatigue, palpitations).
3. III degree. Due to the increased risk of developing cardiac and obstetric complications, pregnancy is contraindicated unless the nature of the disease allows surgical treatment of an acquired heart defect. Heart failure II A, activity of rheumatism II–III, Chronic heart failure FC III (at rest there are no signs of heart failure, shortness of breath appears with slight exertion).
4. IV degree. Pregnancy is completely contraindicated due to high mortality, although motherhood is possible (for example, surrogacy, adoption of a child, etc.). Cardiovascular failure IIB – III, FC IV (shortness of breath, weakness, tachycardia are observed at rest, aggravated by exercise).

If a heart defect can be corrected surgically, it is best to do this before pregnancy. Also, even before pregnancy, you need to ensure that rheumatism goes into an inactive phase and does not worsen throughout the year.

What obstetricians-gynecologists recommend for pregnant women with heart defects

1. Continue taking antirheumatic and cardiac medications. Rheumatism worsens during the first trimester of pregnancy and can complicate its course. For this reason, women continue to take antirheumatic medications during pregnancy. Cardiac medications are necessary to maintain adequate cardiac activity and prevent serious complications: pulmonary edema, thromboembolism. The doctor decides which medications and in what dosages to take individually in each specific case.
2. Heart surgery at 18–26 weeks of pregnancy. It is carried out in cases where there is a threat of complications associated with the progression of heart failure, and drug treatment is ineffective.
3. Planned hospitalization:

• The first time is before 12 weeks of pregnancy, in order to conduct a thorough rheumatological and cardiological examination and decide on the possibility of bearing a child.
• The second time is 28–32 weeks of pregnancy, during this period the load on the woman’s circulatory system increases significantly, so preventive treatment is necessary. It is during this period that the risk of pulmonary edema, thromboembolism in a pregnant woman, as well as fetal hypoxia increases.
• The third time - 2 weeks before the expected birth for re-examination and determination of delivery tactics.

1. Diet. .

What can you do at home?

Firstly, do not panic. Stress and negative emotions are unlikely to be able to save a pregnant woman from heart disease or rheumatism, but they can cause a worsening of the condition. Focus on the positive aspects of your life and try to remember that any difficulties experienced during pregnancy are temporary.

Secondly, be collected. Talk to your doctor about possible complications during pregnancy and ask questions about how to prepare for life's challenging times. For example, always carry with you doctor-recommended emergency medications that you should take if your condition worsens, as well as a phone number to call an emergency team.

Third, Teach your loved ones what to do with you if your condition worsens. Prepare a bag of personal belongings in advance in case of hospitalization. Tell what helps you cope with a worsening condition (for example, lie with your head elevated, turn on a fan, take a diuretic, etc.) and ask others to help you with this.

Fourth, ask your gynecologist about how you can determine by fetal movements whether the child is experiencing oxygen starvation or if everything is fine with him. Ask your doctor what to do if you notice your child is experiencing discomfort.

Fifthly, take medications prescribed by your doctor. Avoid products that are contraindicated during pregnancy, have side effects on the fetus, or have not yet been studied.

At sixth, watch your diet, because extra pounds are an additional burden on the heart.

Seventh, Lead a physically active lifestyle as much as your heart allows. Daily walking and light exercises help improve blood circulation in the fetus. However, if you have heart defects or after cardiac surgery, you should definitely discuss with your cardiologist what kind of physical activity is acceptable for you and will not harm you.

Childbirth with heart defects

Doctors decide on how to give birth individually in each case, taking into account the degree of compensation for the defect, its type, etc. The most commonly used are 2 delivery options:

1. Normal childbirth with shortening or switching off the pushing period. To shorten the period of pushing, they resort to dissection of the perineum (episiotomy, perineotomy), and to stop pushing, special obstetric forceps are applied to the baby’s head and removed from the birth canal.
2. C-section. It can be performed under general anesthesia, as well as with the help of epidural anesthesia (“injection in the back”).

After childbirth

After the birth of a child, the volume of circulating blood decreases, so the woman is given cardiotonics that will support the functioning of the heart. Blood circulation normalizes within 2 weeks after birth, and then discharge from the hospital occurs. Be prepared for the fact that rheumatism may worsen over the next year.

Breastfeeding with heart defects is allowed, except in cases where the mother needs to take medications that are contraindicated during lactation.

Which doctor should I contact?

A pregnant woman with a heart defect is observed by an obstetrician-gynecologist. A consultation with a cardiologist is required, and if necessary, a cardiac surgeon.