PREGNANCY AND CARDIOVASCULAR DISEASES
Congenital heart diseases constitute 50% of maternal heart diseases. The most common diseases in this group are bicuspid aorta, ASD and VSD.
The second most common heart disease is rheumatism! are heart diseases and the most common disease of this group is mitral stenosis (1:- GOJ.
Mortality of Heart Diseases in Pregnancy
• Diseases without an increase in mortality compared to normal (WHO class I)
► Uncomplicated, mild or moderate; pulmonary stenosis, VSD, PDA, mitral valve prolapse
► Successfully repaired; secundum ASD, VSD, PDA, total pulmonary venous return anomaly
• Diseases that increase mild maternal mortality (WHO class province)
► Uncomplicated; non-operated ASD, repaired tetralogy of Fallot, most arrhythmias
• Individual situation dependent (WHO class II or III}
► Mild left ventricular dysfunction
► Hypertrophic cardiomyopathy
► Natural heart valve diseases
► Marfan syndrome without aortic dialatation
► Heart transplantation
• Diseases that significantly increase maternal mortality (WHO class III}
► Mechanical cover
► Cyanotic heart diseases
► Patients who have undergone Fontan surgery
► Repaired transposition
• Quite a lot of mortal heart diseases (WHO class IV}
► Pulmonary hypertension (highest}
► Severe systemic ventricular dysfunction
► Previous peripartum cardiomyopathy with sequelae of left ventricular failure
► Severe left heart obstruction
► Marfan syndrome with aortic dilatation
PREGNANCY AND THROMBOEMBOLIC DISEASES
• The risk of venous thrombosis and pulmonary embolism increases during pregnancy and puerperium. While deep vein thrombosis alone is more common antepartum, solitary pulmonary embolism is more common in the first 6 weeks postpartum.
• Obstetric risk factors that increase the risk of thromboembolism during pregnancy: Cesarean section (most common), diabetes, bleeding and anemia, hyperemesis, immobility - prolonged bed rest, multiple pregnancy, multiparity, preeclampsia, puerperal infection, stillbirth and operative vaginal delivery
thrombophilia
• Thrombophilias are responsible for 50% of thromboembolism encountered during pregnancy.
• The most common thrombophilia III• Activated protein C resistance (aPCR}
• The most common cause of aPCR III• Factor V Leiden mutation
• Most common hereditary thrombophilia III • Heterozygous Factor V Leiden mutation
• The most thrombogenic thrombophilia III • Antithrombin III deficiency
Protein S and homocysteine levels decrease in normal pregnancy.
• Empirical aspirin and/or low molecular weight heparin is recommended for hereditary thrombophilia prophylaxis.
Deep Vein Thrombosis (DVT)
• Most DVTs during pregnancy occur in the left leg, and the first-line test used in the diagnosis of DVT is compression ultrasonography of the lower extremities. Invasive contrast venography is the gold standard for excluding the diagnosis of lower extremity DVT.
• D-Dimer level; increases with gestational age in normal pregnancy, so its use in pregnancy is uncertain. However, a negative D-Dimer test excludes thromboembolism.
• Heparin is used in women with a previous history of DVT and in the treatment of acute thromboembolism. Heparin does not cross the placenta and is therefore not teratogenic. Treatment throughout pregnancy and postpartum 6-12. It should last up to a week.
Pulmonary Embolism PE)
• 70% of the patients have DVT in lower extremity Doppler ultrasonography, and in patients with leg DVT finding, Doppler ultrasonography should be performed first.
• Chest X-ray should be taken in patients without leg findings, and CT, which is the gold standard method for definitive diagnosis, should be performed in patients with abnormal findings on chest X-ray.
pulmonary angiography (CTPA} is performed J J. Ventilation perfusion scintigraphy (V/Q) should be performed in patients with normal chest X-ray.
• A therapeutic dose of heparin (25,000-40,000 U) is indicated in women with a previous history of PE. Unfractionated (normal) heparin is suitable for the treatment of acute thromboembolism. Treatment throughout pregnancy and postpartum 6-12. It should last up to a week. Oral anticoagulants are used after delivery. Alternative treatments (thrombolysis, embolectomy, vena cava filters) are not preferred because they are associated with high complications in pregnancy.