The clinical aspects and present developments in pregnancy in cardiac patients
Crépin, G.; Pauchant, M.; Delahousse, G.; Vennin, P.
Journal de Gynecologie Obstetrique et Biologie de la Reproduction 9(6): 675-685
1980
ISSN/ISBN: 0368-2315 PMID: 7462572 Document Number: 167538
An analysis of 58 cases observed between 1976 and 1979 of cardiac diseases of all types in association with pregnancy caused a revision of the conceptions and the classic opinions attached to this association, formerly so feared. From the cardiological point of view a diminution in the incidence of mitral valve diseases and a rise in the numbers of congenital cardiopathies, or those that were acquired and underwent surgical correction before pregnancy, were found. Pregnancy in a cardiac patient remains a high risk pregnancy. In 8 of 45 patients with congenital or valvular heart disease the disease progressed during the pregnancy. On each occasion the medical treatment was effective. The value of echography among the monitoring methods available to cardiologists is indicated. Every cardiac patient should be strictly supervised and treatment should be instituted during pregnancy if the patient is in functional class III or IV. The treatment includes rest, Na free diet, digitalis compounds, diuretics and anticoagulants in the form of s.c. heparin therapy. All of these treatments should be carried out in the hospital. In the postpartum period the treatment in all cardiac patients consists of systematic antibiotic therapy and prophylactic treatment of thrombo-embolic disease with heparin therapy. Prophylaxis is of the greatest possible importance, and this includes obeying the contraindications for pregnancy in a cardiac patient, surgical correction of operable cardiac pathology in infancy and adolescence, as demonstrated by the absence of complications due to the combination of heart disease and pregnancy in those patients who were operated beforehand for valvular disease or for congenital heart disease. From the obstetrical point of view the pregnancies in cardiac patients apparently can be handled as normal pregnancies as long as the progress of the pregnancies is watched very carefully by the cardiologist and the obstetrician from the early stages thoroughly and repeatedly. In those conditions the incidence of spontaneous abortions is the same as in the general population. Therapeutic termination of pregnancy has no place as long as the cardiac pathology was treated seriously beforehand. The incidence of prematurity, of gross retardation and of fetal death are at the same level as in other pregnancies. Threatened spontaneous premature labor is helped by beta-mimetic drugs which do have their place in cardiac cases except when there are disorders of rhythm, no matter how minor these are. Labor is helped greatly by epidural anesthesia. When the 2nd stage is helped by an instrumental delivery many more deliveries can take place through the vagina, the mother feeling comfortable and the cardiac condition and that of the fetus being satisfactory. Breast feeding can be recommended since it does not change cardiac pathology, except when drugs are used which could go through the milk and affect the infant.