Pregnancy and your heart

As medical care improves, more and more heart patients are going through pregnancies successfully. Unfortunately, there have been cases where women have lost their lives on the delivery beds, because they had serious un-diagnosed heart problems that only manifested during the delivery process.

What do I need to know before conceiving?
‘Getting to the point of delivery without discovery of an underlying heart problem is potentially dangerous,’ says Dr. Robert Mathenge, a Heart and Blood Vessel Specialist/ Cardiovascular Interventionist. ‘One of the reasons we are called to labour wards is to attend to women who seemingly underwent normal pregnancy only to become breathless suddenly during delivery due to heart complications. There is accumulation of water in the lungs which makes breathing difficult. Some of these patients end up in Intensive Care Units for management. We usually advice women, especially those planning to start families, to go for ante natal clinics to ensure the body’s readiness for pregnancy.’

Dr. Robert Mathenge and Dr. Blasio Omuga an Obstetrician/Gynaecologist give more insight. Heart diseases can be congenital (born with) for example, a hole in the heart; and this type should be identified at birth. They can also be acquired conditions, which happen later in life, for example, heart failure, severe high blood pressure or, the very common, rheumatic heart disease.

Can I still conceive if I have a heart condition?

Having a heart condition should not be reason for a woman not to raise a family; even though more special care is needed in such a case. For other women who feel they are generally healthy, there is still need to consider heart tests.

Any abnormal heart condition should be identified through careful heart examination preferably in the first ante natal visit. A care provider should be able to tell when there is a problem and then refer you to a specialist. Precautionary measures will then be taken depending on the nature of the heart problem. Avoid getting pregnant or going into delivery without medically establishing the condition of your heart.

Whenever a heart problem is detected, a doctor will take a -e-, closer follow up from when you conceive so as to control it. With modern technology, the heart can be assessed. For whichever condition detected, medicine is provided and professional counseling given.

Pregnant women need to be aware that they should be careful about the medicine they take particularly in the first trimester as this is when the baby’s organs are forming. Always read the inserts placed in medicine packages, for indication whether the medicine is appropriate in pregnancy or not. Better still, confirm with your doctor.

Wouldn’t pregnancy pose more risks?
Deterioration may occur in pregnancy thence the need for careful assessment in early pregnancy and continuous care throughout pregnancy until six weeks or more after birth-which is mandatory. The mother should be evaluated even before pregnancy. Care should be undertaken by both an obstetrician and cardiologist throughout the period. This Is even more so because normal cardiovascular changes in pregnancy cause additional strain to a compromised heart.

How about my baby?
The chances of a baby being affected with a congenital heart disease from the mother are there but the probability is very low. A baby can be studied as it grows in its mother’s womb and all its developing organs monitored and required care given.

What is the recommended mode of delivery?
While in labour, a pregnant mother with a heart condition needs adequate pain killers to prevent rapid heart-beat and should be given intravenous fluids. However, if intravenous treatment must be administered, it should be done sparingly so as not to overload the heart.

The mode of delivery that the patient can withstand should be undertaken.
There are conditions that are so severe that a patient cannot undergo general anaesthesia. If anaesthesia has to be given, a specialist anaesthetic must be sought. The C-section should not be considered unless indicated. Vaginal delivery is recommended and the expulsion time of the baby must be short and assisted by vacuum or forceps. Ensure proper ventilation in the process.

Drugs called ergometrine should not be used to contract the uterus after delivery as they can lead to or worsen heart failure.

Usually, during delivery, the genital tract and uterus are ‘wounded.’ As a result, some bacteria are likely to get into the blood circulation. In a completely normal person, these bacteria are cleared by the body’s mechanisms but when one has a bad valve or a hole in the heart, the bacteria can lodge in the bad valve or in the hole or at the margins of the hole. In this circumstance, one can have an infection called infective endorcarditis, where you find someone has delivered normally and discharged, but a few days later, she starts getting high fevers, shortness of breath and even heart failure because of the infection.

Therefore, antibiotics are usually given to such patients to protect against likely bacterial complications.

Can I breastfeed my baby as I take heart medication?
In very few cases, breast-feeding can be limited to decrease demand on the mother’s heart. Otherwise, breast-feeding is encouraged even for women who have heart conditions including those on medication. Not all medicine will stop a mother from breastfeeding as breast milk is very essential for the baby’s growth and development.

There is need to discuss any treatment adjustments you need to make with your health care provider ahead of time and if need be, you can be advised on alternative medication.

Grading of heart diseases
This indicates the functional capacity of heart muscles and is closely related to the likely outcome of a pregnancy.

Grade 1: Normal activity. No respiratory difficulty.
Grade 2: Respiratory difficulty with slight limitations of activity.
Grade 3: Severe respiratory difficulty, one cannot do ordinary activity, comfort at rest.
Grade 4: Difficulty in breathing even at rest.

Contact your doctor if you have any signs that may concern you. They may include but not limited to: Difficulty in breathing, rapid weight gain, heart palpitations, rapid heart rate or irregular pulse, dizziness, chest pain and unusual fatigue.

Further assessment can be done by tests like echocardiography and electrocardiography.

Management
o Termination in early pregnancy is rarely necessary and may even be more dangerous than carrying the pregnancy.

o Ensure that you only take medication as prescribed by your health care provider and do not stop taking the medication or adjust the dose on your own.
o Long term care of the baby once born must be considered.
o If cardiac surgery is needed in early pregnancy it may be performed. The simplest procedures are preferred.
o Remember to keep your prenatal appointments. Visit your health care provider regularly throughout your pregnancy.
o Get plenty of rest and avoid strenuous physical activities. In most cases the doctor may recommend bed rest.
o Monitor your weight. Gaining the right amount of weight supports your baby’s growth and development, but gaining too much weight places additional stress on your heart.
o Reduce anxiety by asking your doctor about your progress. Build support systems from your family and colleagues. Find out from the doctor what to expect during labour and delivery. Knowing what is happening may help you feel more at ease.
o Know what is off-limits. For example if you are not supposed to carry heavy weights, do not, if you are supposed to avoid smoky places, do it.
o Cardiac patients should limit children to one or two to avoid physical and mental strain. There is need to avoid contraceptives and pills to reduce the risk of thromboembolism (clots in the blood system). Sterilization is best.

END: PG20/46-47