Pregnancy at women with heart diseases. Strategy of the minimum risk of
Impossibility to have children - the tragedy for the woman. However there are such situations when pregnancy is possible, but is accompanied by risk for health of a fruit, and sometimes - and for mother`s life. Quite so quite often happens at women to diseases warmly - vascular system. Recently increase in number of the pregnant women and women in labor having heart diseases that is explained by a variety of reasons is observed: early diagnosis of such diseases; a possibility of preservation of pregnancy in those cases in which earlier it was impossible; increase in number of the women who underwent a heart operation and numbers of seriously sick women who or with the permission of doctors, or decide to keep pregnancy, being confident in success of medical science and practice.
Conducting pregnancy and childbirth at women with heart diseases - the true art demanding the joint and coordinated efforts of the obstetrician - the gynecologist and the cardiologist or the therapist as this state imposes increased requirements to warmly - vascular system of future mother. It is caused by changes which are caused by coexistence of two organisms - mother and a fruit.Telling
about a combination of heart troubles and vessels to pregnancy it should be noted that pregnancy and changes of blood circulation, a metabolism, body weight caused by it (its increase by 10 - 12 kg by the end of pregnancy), vodno - a salt exchange (during pregnancy the general content of water in an organism increases by 5 - 6 l, and the content of sodium increases in an organism already to 10 - y to week of pregnancy twice) demand from heart of the strengthened work and quite often burden a current warmly - a vascular disease. All these changes are connected with the fact that the pregnant woman has an additional blood circulation - matochno - a placentary blood-groove. And respectively loads of heart change. These increased loadings depend on a type of defect and on how heart copes with the task assigned to it.Congenital heart diseases distinguish to
three groups From congenital heart diseases:
- of Defects with blood dumping from right to left. defects of a mezhpredserdny and interventricular partition - their nezarashcheniye (through openings at the same time and there is the wrong dumping of blood) and also open arterial protok* concern To them.
- Defects with blood dumping from left to right - a transposition (movement) of the main (main) vessels.
- Defects at which there is an obstacle to a blood-groove (narrowing of large vessels).
It is known that heart - the hollow muscular body responsible for pumping of blood in an organism. It consists of four departments. This right auricle and the right ventricle making the right heart, both the left auricle and the left ventricle making the left heart. The blood rich with oxygen arriving from lungs on pulmonary veins gets to the left auricle, from it - to the left ventricle and further to an aorta. The blue blood on top and lower hollow to veins gets to the right auricle, from there to the right ventricle and further on a pulmonary artery to lungs where it is enriched with oxygen and again comes to the left auricle.
Heart disease is called the permanent pathological change in a heart structure breaking its function. Heart diseases can be congenital and acquired. Congenital heart diseases meet much less often than acquired. They result from violation of normal development of heart and the main vessels in pre-natal development and make 1 - 2% of all diseases of heart.
Most often defects of the first group occur at pregnant women. If the disease is followed by insufficiency of blood circulation, i.e. heart, and so working at a limit ceases to cope with loading, then pregnancy interruption is necessary. Insufficiency of blood circulation is shown by fatigue, heartbeat, in more hard cases short wind, weight in a breast develops. Lack of medical care at fast development of heart failure can lead to serious consequences - to hypostasis of lungs (i.e. actually to their switching off from breath), a thrombembolia (obstruction by blood clots) to a pulmonary artery or thrombosis of other large vessels. But usually women with this disease well transfer pregnancy and childbirth.
Often after timely expeditious correction of heart disease (if the opening was narrow, it is expanded and vice versa) future mothers well cope with loading and pregnancy comes to an end safely. Recently even more often the women who underwent a heart operation before pregnancy and even during pregnancy meet.
Defects of the second group are the heaviest, and usually pregnancy should be interrupted as at these defects of violation of blood circulation are rather serious and heart of the pregnant woman often does not cope with the arising loading.
the Obstacle to a blood-groove at patients of the third group in the absence of insufficiency of blood circulation usually does not serve as the indication to pregnancy interruption, however often childbirth comes to an end with operation of Cesarean section that is connected with significant increase in load of heart at the time of delivery.the Acquired heart diseases
the Acquired heart diseases are connected by
with the postponed inflammation of an endokard (an internal cover of heart) and a myocardium - a cardiac muscle. These inflammations can arise at rheumatism - a disease of heart and connecting fabric, sepsis - generalized infectious defeat, atherosclerosis, syphilis. Under the influence of inflammatory process in the valve cicatricial fabric which causes deformation and shortening of shutters of valves or narrowing of an opening develops. As a result the valve cannot close completely an opening and there is an insufficiency of valves. At insufficiency of valves during a systole (reduction of ventricles) there is the return unnatural current of blood from ventricles in auricles. At a stenosis (narrowing) of the left atrioventricular opening during a diastola (relaxation of ventricles) blood does not manage to pass from an auricle into a ventricle. There is a pathological overflow of the left auricle, and load of it increases. Thus, heart diseases lead to blood circulation violation.
Most often () the acquired heart diseases develop in 75 - 90% of cases against rheumatism. (This disease is caused by a streptococcus - the same microbe which usually is the causative agent of quinsy and often strikes women of young age.) Defeats of valves of heart - mitralny, located between the left auricle and the left ventricle, - and the aortal, located between the left ventricle heart and an aorta prevail. These defeats lead to violation of normal operation of valves, an overload of a cardiac muscle and insufficiency of blood circulation.
Quite often the stenosis and insufficiency develop on one valve (the so-called combined defect). Besides, there are cases when defects mention two and more valves - it is accepted to call it the combined heart disease.
As there will take place pregnancy?
the Forecast of pregnancy depends on degree and a combination of defeat, and also on activity of rheumatic process (in other words, on whether there is its aggravation at present) and from expressiveness of violation of blood circulation.
the Question of preservation or interruption of pregnancy is solved jointly the cardiologist and the obstetrician - the gynecologist in each case individually. If pregnancy came after heart operation, consultation of the cardiosurgeon is necessary. It is necessary to know that not always corrective heart operations lead to elimination of organic changes in the valvate device or elimination of congenital anomalies of development. Quite often after surgical treatment recurrence of the main disease, for example, in the form of a restenoz (repeated narrowing) after some operations is observed. > It is extremely difficult to p to resolve by
an issue of admissibility of pregnancy at women with the fitted a prosthesis heart valves. At them danger of formation of blood clots therefore pregnant women with mechanical valves constantly receive antikoagulyantny (protivosvertyvayushy) therapy is high.
Of course, a question of preservation of pregnancy at women with warmly - vascular diseases it is better to solve beforehand, before its approach. A basis of the correct maintaining and treatment of such pregnant women is the exact diagnostics considering a cause of illness.
Defects with blood dumping to the right serve as contraindication to pregnancy, as well as any kind of defects with a decompensation at which insufficiency of blood circulation is already created.
of Feature of conducting pregnancy
Conducting pregnancy at women with heart diseases as it was already told above, is carried out with participation of several experts. It demands not only coordinate activity of experts of a maternity welfare unit, but also the disciplined behavior of the woman: early registration in a maternity welfare unit, timely visit of doctors and testing, full inspection, timely complex treatment.
If an opportunity is, then, of course, it is better to entrust the health to the large medical center specializing in this problem. It can be office for women with warmly - vascular pathology at institute or specialized office on the basis of large maternity hospital where the competent experts having experience of maintaining patients with such pathology will be able effectively to help.
the Course of pregnancy at women with heart diseases has the features. Often such complications as gestoza (the pregnancy complications which are shown emergence of hypostases, protein in urine, increase of arterial pressure) which are characterized by the hidden current meet and will badly respond to treatment. Pregnancy at such patients often is complicated by interruption threat - the number of spontaneous abortions and premature birth considerably exceeds average values. Besides, the course of pregnancy can be complicated by violation matochno - a placentary blood-groove that leads to a hypoxia (oxygen starvation) or a delay of pre-natal development of a fruit. Also the risk of an otsloyka of a placenta is high. Accumulation of blood clots in a placenta leads to switching off of part of a placenta from a blood-groove and to strengthening of oxygen starvation of a fruit.by
On all to the woman`s reasons given above with heart diseases and, other pathology warmly - vascular system during pregnancy not less than three times have to be hospitalized in a hospital:
the First hospitalization - on 8 - 10 - y to week of pregnancy for specification of the diagnosis and the solution of a question of a possibility of preservation of pregnancy. The issue of interruption of pregnancy till 12 weeks is resolved depending on expressiveness of defect, a functional condition of the blood circulatory system and degree of activity of rheumatic process.
the Second hospitalization - on 28 - 29 - y to week of pregnancy for supervision over a state it is warm - vascular system and, if necessary, for maintenance of function of heart in the period of the maximum physiological loads. It is caused by the fact that during this period normal load of heart (one of the periods of the maximum physiological load) considerably increases - almost so-called warm emission, generally due to increase in heart rate increases by a third.
the Third hospitalization - on 37 - 38 - y to week for preparation for childbirth and the choice of a method of a rodorazresheniye, scheduling of childbirth., a gestoz or the expressed anemia (decrease in amount of hemoglobin) and other complications hospitalization irrespective of pregnancy term is necessary for
At emergence of signs of insufficiency of blood circulation, an exacerbation of rheumatism, developing of vibrating arrhythmia (frequent spasmodic reduction of heart).
the Question of interruption of pregnancy on later terms is rather difficult. Quite often doctors should decide that it is less dangerous to the patient: to interrupt pregnancy or to allow it to develop further. In any cases at emergence of signs of insufficiency of blood circulation or any associated diseases the patient has to be hospitalized, subjected to careful inspection, treatment.
If the situation does not demand such cardinal measures, the pregnant woman has to observe the maximum care. First of all it is necessary to take care of sufficient rest and long, 10 - 12 - an hour dream. It is useful day 1 - 2 - an hour dream. Rather effective remedies of treatment and prevention are physiotherapy exercises, morning exercises, walks in the fresh air. The complex of morning exercises has to be the simply, not leading to excessive retension, fatigue.Food needs to make
the most various, full, with the increased maintenance of proteinaceous products (to 1,5 g/kg of body weight). Reception of polyvitamins is necessary. Besides, the doctor can appoint sessions of hyperbaric oxygenation (sessions in a pressure chamber where under pressure air with the increased content of oxygen moves), the general ultra-violet radiation.
the Question of medical tactics in labor has special value. The best choice - early hospitalization in 36 - 37 weeks of pregnancy. The plan of a rodorazresheniye is formed is advisory with participation of the obstetrician, cardiologist or therapist and anesthesiologist. The choice of a method is strictly individual for each patient depending on a situation.
the Modern medicine has a sufficient arsenal of diagnostic means in time to prevent complications of pregnancy at women with heart diseases. The following techniques are usually applied:
- of of Elektrokardiografiya - registration of the electric phenomena arising in a cardiac muscle at its excitement. This research allows to register changes in a cardiac muscle on change of an electric impulsation.
- of Fonokardiografiya - a method of registration of the sounds (tones and noise) resulting from action of the heart. It is applied to evaluation of the work of heart and recognition of violations, including defects of the valve.
- Echocardiography (ultrasound of heart). It is applied to studying of blood circulation and cardiodynamics (work of heart), by determination of the sizes and volumes of cavities of heart, an assessment of a functional condition of a cardiac muscle. The method is harmless to mother and a fruit.
- of Test with loading is used for an assessment of a functional condition of a cardiac muscle. Tests with loading on the stationary bicycle apply and at inspection of pregnant women - during this test to the patient remove an electrocardiogram at various intensity of physical activities.
- Research of function of external breath and kislotno - an alkaline condition of blood assumes studying of capacity of lungs and saturation of blood oxygen at rest and at loading. Research allows to define, the blood saturation oxygen i.e. as far as heart copes with loading at the moment is how adequate.
- of the Blood test - usually rather standard analysis which is carried out at inspection of all pregnant women. However in this case the doctor pays special attention to a condition of the curtailing system of blood.
- of ultrasonography of a fruit, a kardiotokografiya which are regularly carried out after 28 weeks for an assessment of a condition of a placenta and a fruit. These researches help to find out whether the fruit suffers from a lack of oxygen and nutrients. Besides, ultrasonography of a fruit allows to reveal possible malformations of the child till his birth and to take the appropriate measures - from urgent operation after a rodorazresheniye before pregnancy interruption.
behind a natural method of a rodorazresheniye. At the compensated heart disease the therapy directed to prevention of heart failure and support of heart, prevention of hypostasis of lungs at a possibility of arrhythmia is carried out - an electrocardiogram - control. Adequate labor pain relief as the fear and pain lead to additional load of heart is carried out.
As a rule, the most difficult period of childbirth - attempts (the period of exile of a fruit) - try to shorten by means of an epiziotomiya - a crotch section. Switching off of attempts (imposing of obstetric nippers) is carried out at blood circulation violation.
Many doctors consider that the rodorazresheniye by means of Cesarean section reduces in time loading on warmly - vascular system and reduces mortality among the pregnant women having heart diseases.Cesarean section is carried out by
in the following cases:
- at active rheumatic process (temperature increase, emergence of pains in appropriate authorities, characteristic changes in analyses);
- at sharply expressed heart disease with the expressed insufficiency of the left ventricle and absence of effect of the carried-out medicamentous therapy;
- at a heart disease combination to the obstetric pathology demanding a surgical rodorazresheniye.
to the Successful rodorazresheniye of the patients having the heavy congenital and acquired heart diseases can be promoted by conducting childbirth in the conditions of hyperbaric oxygenation.by
After the birth of a fruit and an otkhozhdeniye of an afterbirth observes a rush of blood to internals (and first of all to abdominal organs) and reduction of blood circulation in the vessels of a brain and vessels feeding a cardiac muscle. Therefore for the warning of deterioration in a state right after the child`s birth to the woman enter the means ensuring normal functioning of heart.
the Postnatal period
Danger of developing of thromboses, bleedings and heart failure remains till 5 days after the delivery therefore during this period to the woman the bed rest is appointed. With 7 - 11 - go day at the rheumatic nature of defect to the woman research is appointed to activity of rheumatism; activity of rheumatism is controlled also within a year after the delivery.can be discharged by
of the Woman in childbirth with diseases of heart from maternity hospital not earlier than in 2 weeks after the delivery in a satisfactory condition under supervision of the cardiologist at the place of residence.
If the decompensation after the delivery did not occur and administration of drugs is not required, breastfeeding is preferable.
After the child`s birth experts surely examine him on existence of heart diseases as at children whose mothers had such problems the risk of their existence increases repeatedly.
Thus, timely diagnostics and the correct treatment allow many women to whom the child`s birth was inaccessible earlier, to feel this pleasure. And experts are always ready to help them with it.