Congenital heart disease adversely affect growth, development and fetal viability by reducing oxygen (in the form cyanogen) by reducing the flow to the uterus. Fetal hypotrophy to prematurity are relatively common. Miscarriage may occur more frequently in women with heart disease cyanogen.
Surgery, performed before pregnancy, improves the abilities of these cases fertile. The risk of fetal, maternal disease from birth, must be considered and the following respects:- Transmission of cardiac defect;- The risk of using drugs during pregnancy (known embryo produced by warfarin).
Fetal ultrasound is an important diagnostic test (can detect ventricular hypoplasia, valvular atresia, septal defects, abnormalities of large vessels).
Prognosis
Excess labor cardiac tolerated by a healthy heart may be the origin of decompensation on heart disease. The influence of circulatory changes is even more redoubtable by the more severe as coronary or less well-controlled therapeutic. Breast prognosis is much appreciated, depending on the seriousness of heart disease, according to the classification in four stages proposed by New York Heart Association (the first two with good prgnostic)- Stage I - no limitations of physical activity;- Stage II - slightly diminished physical activity, functional amnifestari occur when large efforts;- Stage III - limited physical activity, functional events in light work;- Stage IV - sign manifest function at rest.
Breast prognosis depends on four factors:1. history: the age at which the disease was diagnosed, the etiology, evolution before pregnancy, current pregnancy history, obstetric history significant.2. nature of injury: most injuries are severe mitral valve lesions acquired, with more complex lesions are even more severe, the association of myocardial damage worse prognosis;3. assessment of cardio-circulatory state compensation: general decompensation is manifested by signs, arrhythmias are the most important (blood pressure and urine output does not change significantly) and functional (exercise or supine dyspnea, hemoptysis), clinical examination must be completed by exploration radiological, ECG, ultrasound;4. therapeutic trial is the quite important factor determining the prognosis.
Treatment
In collaboration with the cardiologist, will be established modlitatea prognosis and treatment. Indication of therapeutic abortion is declining. There are conditions that contraindicate pregnancy: primary pulmonary hypertension, congenital heart syndrome, tetralogy of Fallot, coarctation of the aorta complicated atrial septal defect complicated.Besides these situations, in general, therapeutic abortion is indicated in cases included in stages III and IV. Cases classified in the classes I and II will be scrutinized carefully in terms of obstetric and cardiac. Medical treatment is reserved for cases of grades III and IV.
Medical Treatment
- Rest, relative or absolute, it is very important for effective treatment and should be in the first quarter;- Compensated in the forms is given sedatives (barbiturates);- The appearance of functional signs (dyspnea, cough, tachycardia) requires: desodat regime, diuretics, tonicardiace digitalis;- Acute pulmonary edema occurred in pregnancy tonicardiace treat major medical only, administered slowly, in small doses, sedatives, morphine;- The rhythm disorders are prescribed: digital lidocaine, quinidine, heparin (do not cross the placenta);- In cases of twins or those who do not meet hygienic-dietary instructions can be recommended hospitalization at 32 weeks (in other cases at 36 weeks).
Surgery
- Comisurotomia can practice until months V and VI is indicated tight stenosis, medical treatment or rebel;- Treatment ductus arteriosus and aortic stenosis is practiced only in forms accompanied by heart failure.Hormonal contraception is contraindicated (except microprogestativele). Sterilization can be done during caesarean section.
Obstetrical treatment
- In imminent premature delivery will be made with indocid tocolysis (given year until the 36th week to avoid the risk of patent ductus arteriosus);- Birth of the natural way is possible in most cases;- During the second practice of birth is episiotomy, forceps or vacuum extractor application (protection against expulsion efforts);- Blood loss should be compensated with much attention, especially in cases with pulmonary hypertension or hypotension worse conditions for cyanogen right-left shunt;- Caesarean section shall be exercised only for obstetric indications;- Antibiotics (penicillin, ampicillin, gentamicin) will be sitematica to prevent endocarditis occurred in lehuzie;- Prevention of thrombo-embolic risk is you do by active mobilization, dextran, anticoagulants (calciparina) from day 4th or 5th of the puerperium;- The smallest signs of decompensation contraindicate breastfeeding.
Assistance cases with heart association - the task is performed in conditions of a team composed of obstetrician ultrasonografist, anesthesiologist, neonatologist.
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