Summarized from European Society of Gynecology, 201a1; Nanna, 2014; Thorne, 2006; World Health Organization, 201a0.
attention is directed toward both prevention and early recogCigarette smoking is prohibited. Illicit drug use may be parnition of heart failure. Of speciic risks, infection with sepsis ticularly harmful, an example being the cardiovascular efects syndrome can precipitate this. Moreover, bacterial endocardiof cocaine or amphetamines. In addition, intravenous drug use tis is a deadly complication of valvular heart disease (p. 965). raises the risk of infective endocarditis. Each woman is instructed to avoid contact with persons who Fortunately, women in NA class III and IV are uncomhave respiratory infections, including the common cold, and to mon today. In the prior Canadian study, only 3 percent of the report at once any evidence for infection. Pneumococcal and approximately 600 pregnancies were complicated by NA inluenza vaccines are recommended (Chap. 9, p. 172). class III heart disease, and no women had class IV when irst
TABLE 49-4. Risks for Fetal Heart Lesions Related to Afected Family Members
Atrial septal defect 2.5 1.5 5-11
Patent ductus arteriosus 3 2.5 4
Coarctation of the aorta NS NS 14
Fallot tetralogy 2.5 1.5 2-3
NS = not stated.
Data from Lupton, 2002.
seen (Siu, 2001b). If a woman chooses pregnancy, she must understand the risks and is encouraged to be compliant with planned care. In some women, prolonged hospitalization or bed rest is often necessary.
In general, vaginal delivery is preferred, and labor induction is usually safe (Thurman, 2017). From the large Registry on
Pregnancy and Cardiac Disease, Ruys and coworkers (2015) planned cesarean delivery. Planned cesarean delivery conferred no advantage for maternal or neonatal outcome.
Cesarean delivery is usually limited to obstetrical indications, and considerations are given for the speciic cardiac lesion, overall maternal condition, and availability of experienced anesthesia personnel and hospital capabilities. Some of these women tolerate major surgical procedures poorly and are best delivered in a unit experienced with management of complicated cardiac disease. Occasionally, pulmonary artery catheterization may be needed for hemodynamic monitoring (Chap. 47, p. 916). In our experiences, however, invasive monitoring is rarely indicated.
Based on her review, Simpson (2012) recommends cesarean delivery for women with the following: (1) dilated aortic root >4 cm or aortic aneurysm; (2) acute severe congestive heart failure; (3) recent myocardial infarction; (4) severe symptomatic aortic stenosis; (5) warfarin administration within 2 weeks of delivery; and (6) need for emergency valve replacement immediately after delivery. Although we agree with most of these, we have some caveats. For example, we prefer aggressive medical stabilization of pulmonary edema followed by vaginal delivery if possible. Also, warfarin anticoagulation can be reversed with vitamin K, plasma, or prothrombin concentrates.