and Paula Briggs2
(1)
Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
(2)
Sexual and Reproductive Health, Southport and Ormskirk Hospital, Southport, UK
Cardiac Disease
Definition
This includes congenital cardiac abnormalities, rheumatic valvular heart disease, ischaemic heart disease, cardiomyopathy and pulmonary hypertension.
Incidence
Congenital heart disease in pregnancy affects less than 1 % of women.
Pregnancy increases the risk of myocardial infarction (MI) three to four fold. The risk of MI in women over 40 years of age is 30 times that of younger women.
The risk of death from ischemic heart disease in pregnancy in the UK is 1 in 130,000.
Aetilogy and Pathogenesis
The normal physiological changes of pregnancy result in additional demands on the heart. These include an increase in blood volume (plasma volume increasing more than red cell mass), peripheral vasodilatation and an increase in cardiac output (up to 40–50 % by 20–28 weeks). These demands increase even further during labour and immediately following delivery.
Patients with pre-existing risk factors include those with hypertension, pre-eclampsia, diabetes, smoking, obesity and hyperlipidaemia.
Clinical Assessment
History
Chest pain in pregnancy needs to be investigated (consider aortic dissection if severe)
Shortness of breath (especially postural), should raise suspicion regarding cardiomyopathy
Examination
Regular assessment of pulse rate and rhythm and blood pressure
Cardiac auscultation to detect murmurs suggestive of valvular heart disease
Investigations
ECG
Chest X ray
Echocardiogram
CT scan of chest (to exclude aortic dissection)
Oxygen saturation in women who are cyanosed
Treatment
Medical
Joint responsibility (cardiologists and obstetricians)
Mode and timing of delivery should be planned at the 32–34 week visit
Surgical
Minor – Minimise cardiovascular stress by eliminating pushing during the second stage with elective assisted vaginal delivery
Major – Caesarian Section is usually only required for obstetric indications
Complications
Cardiac failure, death
Prognosis
One in thirteen women who have a MI in pregnancy will die
Rhesus Disease
Definition
Rhesus immunisation of a woman who is Rhesus negative in response to blood from a Rhesus positive foetus entering her circulation.
There are also many other antigens on the surface of red blood cells, not as well known as Rhesus, such as Kell, MNS, and Kidd which may also cause iso-immunisation, but Rhesus is the most common and therefore the most relevant clinically.
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