Cardiac Disease

in
Pregnancy
Cheryl Larry-Osman, CNS
Cardiovascular Changes
During Pregnancy
During pregnancy, the heart changes
Position
Appearance
Function
Elevation of the diaphragm from the
expanding uterus creates
Heart becomes raised
Heart rotated slightly to the left side
Cardiovascular Changes
During pregnancy
Maternal HR increases & peaks in the 3
rd
TM

Singleton Pregnancy
~15% increase over the nonpregnant heart rate
Increase in rate by 15-20 bpm for singleton pregnancy.

Multiple gestation:
Maternal heart rate can increase as much as 40% over
nonpregnant.

HR returns to normal
6wks PP

Cardiovascular Changes
CO:
Heart rate x Stroke volume
Singleton:
Increases 30-50%
Multiples:
Increases additional 15-20%
CO in Pregnancy:
Increase continues to 25-30
weeks, then plateaus.


Cardiovascular Changes
Cardiac output also affected during
intrapartum and postpartum.
Latent phase of labor = 15% increase
First stage of labor = 12-30% increase
Each contraction = 15% increase
Second stage of labor = 45-50% increase
Pain
Anesthesia
Postpartum = 65% increase !!!
Cardiovascular Changes
Blood Pressure
1
st
Trimester
Begins to fall
2
nd
Trimester
Reaches lowest point between
24-32 weeks gestation
3
rd
Trimester
Gradually returns to nonpregnant
levels by term
Cardiac Disease in Pregnancy
Incidence ranges between 1-4%
Maternal cardiac disease is a major cause of
non-obstetric maternal morbidity and mortality
Etiology
Rheumatic Fever
Valve Deformities
Congenital Heart Disease
Congestive Cardiomyopathies
Cardiac Dysrhythmias
Cardiac Disease in Pregnancy
Pathophysiology
Depends on the functional lesion present.

Signs/Symptoms of Cardiac Deterioration
Dyspnea severe enough to limit usual activity
Progressive orthopnea
Shortness of breath (dyspnea) occuring when lying flat
Paroxymal (sudden) nocturnal dyspnea
Syncope during or immediately following exertion
Chest pain associated with activity
Cardiac Disease in Pregnancy
Fetal & Neonatal Effects
Fetal effects are the result
of either:
Decreased systemic
circulation
Decreased oxygenation
Congenital cardiac defects
If either parent had a
congenital defect, the
fetus has an increased
risk for having a
congenital cardiac
defect

Cardiac Disease in Pregnancy
If maternal circulation is compromised due to
inadequate cardiac function, uterine blood
flow may be severely reducedleading to:
Early pregnancy outcome
Spontaneous abortion
Preterm Delivery
Late pregnancy outcome
Growth restriction (IUGR)
CNS hypoxia

Hx Maternal Congenital
Heart Disease
Children of a mother with congenital heart
disease are at increased risk of inheriting a
congenital heart defect.
Overall risk: 3-5% (general population 1% risk)
Certain medications can adversely affect
fetus:
ACE inhibitors (teratogenic effects in 1
st
TM
Warfarin
Statins (potential teratogens)
Predictors of Potential
Adverse Outcomes
NYHA class greater than II
Cyanosis
Maternal left ventricular obstruction
Maternal smoking
Maternal age under 20 years or over 35 years
Multiple gestation
Anticoagulation during pregnancy