Valvular diseases in pregnancy

Abstract

Important cardiovascular changes occur during pregnancy, labor and the postpartum period. Blood volume and erythrocyte mass increase, physiological anemia occurs and blood pressure decreases. Cardiac flow rate and stroke volume increase. Although healthy pregnant women can tolerate these changes, pregnant women with cardiac disease may get worse and the changes may cause risk for both the women and their fetuses. A valve disease with a favorable outlook before pregnancy may get worse when pregnancy is superimposed and pregnancy may have to be terminated. In such cases pregnancy plays an important part in selection of the type of treatment. Diagnostic methods and treatment alternatives should be appropriate for individual patients. Health professionals should give priority to maternal health rather than fetal health, mothers should be informed about possible risks and treatment alternatives should be discussed with them. Any treatment given to mothers may affect their fetuses and treatment should be selected accordingly. Mothers with a valve disease should undergo a thorough examination, should be informed about the risks of pregnancy and should be referred to tertiary health care centers before pregnancy and thereby they can give birth without problems. Management of valve diseases in pregnancy involves replacement of contraindicated drugs with safe ones, controlling conditions likely to cause cardiac loading, close follow-up and aggressive treatment of conditions aggravating the disease. Echocardiography should be performed to determine pulmonary pressure and all cardiac hemodynamics including the valves and when there are changes in symptoms, the patients should be evaluated in each trimester. Even if pregnancy is tolerated well, infections, anemia, arrhythmia, pulmonary embolus, pain and anxiety may worsen the condition. In these cases aggressive treatment is required. Physicians should know the maternal cardiovascular physiology well, should be equipped with latest relevant knowledge and should adopt a multidisciplinary approach during follow-up and labor.