Cardiac disease in pregnancy

Abstract

Congenital heart disease in pregnancy is increasingly common because of the advances in surgery and medical therapy which have taken place over the last 30 years, which means that more affected women are surviving into the reproductive age. Antenatal counselling needs to be tailored to the specific lesion, with pulmonary hypertension and cyanotic disease presenting a risk of maternal mortality of up to 50%. The use of anticoagulants in women with artificial valves presents a particular challenge, heparin being safer for the baby and warfarin for the mother. Peripartum cardiomyopathy and Marfan's syndrome may be less dangerous than once thought. The risk of congenital heart disease in the fetus is increased, from twice to 20-fold, depending on the nature of the mother's lesion. Care throughout pregnancy and in the puerperium should be multidisciplinary and include cardiologists, obstetricians and midwives with experience of such cases, preferably in a tertiary centre.

Tetralogy of Fallot Complicated With Preeclampsia After Three Cardiac Operations

“…The American Heart Association guidelines do not recommend antibiotic prophylaxis in vaginal or caesarean delivery [11], but in practice most centres give prophylaxis, as we did in our patient. Oxytocin and ergometrine have unpredictable effects on the haemodynamic status and should be avoided [12] bu we did in our case. Close observation and continuous haemodynamic monitoring are mandatory during the delivery and up to one week postpartum.…”

Thalassemia and its Management during Pregnancy

“…An echocardiogram, electrocardiogram, and T2 star (T2*) cardiac magnetic resonance imaging (MRI) must be done. 37 …”

Asymptomatic hypoxia in a young pregnant lady — Unusual presentation of atrial septal defect

“…Pregnancy with ASD is associated with a risk of miscarriages (10%), preterm delivery (6%), small for gestational age (10th percentile, 2%), fetal and perinatal mortality (2-3%) [3]. Pregnancy is contraindicated in patients with severe pulmonary hypertension due to high maternal mortality (N50%) and foetal mortality (N60%) [5]. Favourable outcome in pregnancy is seen in patients with baseline low NYHA class symptoms of dyspnoea and preserved good LV systolic function.…”