gynecology and obstetrics
Heart Disease in Pregnancy
Valvular Stenosis and Insufficiency in Pregnancy
During pregnancy, valvular stenosis and regurgitation (insufficiency) most often affect the mitral and aortic valves. Mitral Stenosis is the most common valvular disorder during pregnancy. Pregnancy amplifies the murmurs of mitral stenosis and Aortic Stenosis but diminishes those of mitral and For mitral stenosis, prevention of tachycardia, treatment of pulmonary edema and atrial fibrillation, and sometimes valvotomy For aortic stenosis, surgical correction before pregnancy if possible Ideally, valvular disorders are diagnosed and treated medically before conception; surgical correction is often recommended for severe disorders. Prophylactic antibiotics are required in certain situations (eg, for Prevention ). Patients must be closely observed throughout pregnancy because mitral stenosis may rapidly become more severe. If required, valvotomy is relatively safe during pregnancy; however, open heart surgery increases fetal risk. Tachycardia should be prevented so that diastolic flow through the stenotic mitral valve can be maximized. If pulmonary edema occurs, loop diuretics can be used. (see Medications for Arrhythmias ). During labor, conduction anesthesia (eg, slow epidural infusion) is usually preferred. Treatment should be corrected before pregnancy if possible because surgical repair during pregnancy has more risks and catheter valvuloplasty is not very effective. During labor, local anesthesia is preferred, but if necessary, general anesthesia is used. Conduction anesthesia should be avoided because it decreases filling pressures (preload), which may already be decreased by aortic stenosis. Straining, which can suddenly reduce filling pressures and impair cardiac output, is discouraged during the 2nd stage of labor; operative vaginal delivery is preferred. Cesarean Delivery is done if indicated for obstetric reasons. 