Pregnancy and heart disease can be a dangerous combination. Heart disease causes around 10 percent of maternal deaths during pregnancy, the Merck Manuals Online Medical Library states. While women with heart conditions can have healthy babies, their pregnancies require expert care and close follow-up. Heart function will need careful monitoring and some medications may need to be stopped due to potential fetal damage. It's also possible to develop heart failure for the first time during pregnancy.
Risks
Women with known heart conditions should discuss pregnancy with their cardiologists before getting pregnant. In women with severe mitral valve stenosis, the risk of maternal or fetal complications approaches 80 percent, according to the Cleveland Clinic. Women with New York Heart Association class III or class IV heart disease should realize that their heart disease results in maternal death in 7 percent of cases, and causes serious problems in another 30 percent, the Cleveland Clinic stresses. Women with severe pulmonary hypertension or other class II or IV disease are advised against pregnancy.
Stresses
Pregnancy increases blood volume and cardiac output by 30 to 50 percent, which increases the workload on the heart, the Merck Manuals Online Medical library reports. Vascular changes reach their peak between the 28th and 34th week of pregnancy, MayoClinic.com reports.
Management
During pregnancy, heart monitoring such as electrocardiogram and echocardiogram helps diagnose increasing heart failure early enough to treat and prevent from worsening. Pregnant women with heart failure require more rest than most pregnant women, and may need bed rest after 20 weeks, especially if they have class II or class IV disease, Merck warns. Keeping weight gain under control also helps reduce the extra burden on the heart.
Delivery
Cardiac output increases about 20 percent during each labor contraction, making labor a particularly risky time for women with heart failure, according to Merck. Pushing during the second stage of pregnancy also places additional strain on the heart. Pain and anxiety require aggressive management during labor to prevent tachycardia, and increase in the heart rate. Epidural anesthesia and forceps or vacuum delivery to avoid prolonged pushing may also help reduce stress on the heart, MayoClinic.com reports. Cesarean delivery is not usually required. Specialized monitoring with catheters inserted into blood vessels to monitor heart function during labor may also be required.
Considerations
Management of heart failure during pregnancy depends on the disease process and when it occurs. Women with severe mitral valve regurgitation or severe aortic stenosis, for example, should have the defects repaired before getting pregnant. Peripartum cardiomyopathy occurs in the last few months of pregnancy or the first few months after delivery in women with no previous history of heart disease and can't be predicted. Women who developed this disease in one pregnancy should not attempt another pregnancy, the Women's Heart Foundation suggests.
