obsolete Congenital cardiovascular disorder complicating pregnancy, childbirth, or the puerperium

Obsolete Conditions Complicating Pregnancy

While many conditions have been identified as potential complications during pregnancy, childbirth, and the postpartum period (puerperium), some are considered obsolete due to advances in medical understanding and treatment.

• Congenital heart disease: Although still a significant concern for pregnant women with pre-existing congenital heart defects, this condition is no longer considered an "obsolete" complication. In fact, it's now recognized as the most common cardiovascular condition encountered during pregnancy (see [9] and [10]). However, with proper management and care, many women with CHD can have successful pregnancies.
• Cardiomyopathies: This group of heart muscle disorders was once considered a significant risk factor for pregnant women. While still a concern, advances in medical treatment and management have reduced the associated risks (see [1] and [5]). However, cardiomyopathy remains a potential complication that requires close monitoring during pregnancy.
• Arrhythmias: Abnormal heart rhythms were once thought to be a major concern during pregnancy. Although they can still occur, modern treatments and management strategies have minimized their impact on maternal health (see [7]).

Relevant Statistics

• Approximately 1% of neonates born in the United States annually are affected by congenital heart disease (CHD) (see [15]).
• The global prevalence of births with CHD has increased between 1970-2017, according to a meta-analysis (see [12]).

Current Understanding and Management

While these conditions were once considered significant complications during pregnancy, childbirth, or the puerperium, advances in medical understanding and treatment have minimized their impact. Pregnant women with pre-existing conditions can now receive proper care and management to ensure successful outcomes.

References:

[1] by WJ Franklin · 2011 [5] by MM Canobbio · 2017 [7] by LS Mehta · 2020 [9] by KJ Lindley · 2021 [10] Today, most female children born with congenital heart disease will reach childbearing age. [12] Introduction. Congenital heart disease (CHD) is the most common congenital malformation... [15] Congenital heart disease (CHD) is common and is estimated to affect approximately 1% of neonates born in the United States annually...

Common Signs and Symptoms

Pregnant women with a history of congenital heart disease may experience various symptoms that can complicate their pregnancy, childbirth, or the postpartum period. Some common signs and symptoms include:

• Dyspnea: Shortness of breath is a common symptom during pregnancy, especially for women with congenital heart disease (2).
• Palpitations: Irregular heartbeat or palpitations can occur due to changes in blood pressure and cardiac output during pregnancy (2).
• Edema: Swelling in the feet, ankles, and hands can be a sign of fluid retention and increased venous pressure (3).
• Fatigue: Feeling tired or exhausted is a common symptom during pregnancy, which can be exacerbated by underlying heart conditions (2).

Complications During Pregnancy

Women with congenital heart disease are at risk for various complications during pregnancy, including:

• Heart failure: The strain on the heart during pregnancy can lead to heart failure in some cases (3).
• Arrhythmias: Irregular heartbeat or arrhythmias can occur due to changes in blood pressure and cardiac output (7).
• Bleeding or thrombosis: Women with congenital heart disease are at risk for bleeding or thrombotic complications during pregnancy (3).

Other Signs and Symptoms

In addition to the above symptoms, women with congenital heart disease may also experience:

• Syncope: Fainting or dizziness can occur due to decreased blood flow to the brain (7).
• Tachycardia: A rapid heartbeat can be a sign of stress on the heart during pregnancy (8).
• Cyanosis: A bluish discoloration of the skin and mucous membranes can indicate poor oxygenation of the blood (14).

References

(1) No relevant information found in search results.

(2) Aug 25, 2020 — Dyspnea, palpitations, edema, and fatigue are common symptoms during pregnancy. For women with congenital heart disease (CHD), it may be ...

(3) by K Niwa · 2018 · Cited by 51 — Most frequent complications during pregnancy and delivery are heart failure, arrhythmias, bleeding or thrombosis, and rarely maternal death.

(4) No relevant information found in search results.

(5) by S Nanda · 2012 · Cited by 36 — Pregnant women may present with a preceding history of typical angina or atypical epigastric pain; nausea; dizziness; or pain in the chest, neck or left arm.

(6) No relevant information found in search results.

(7) Jun 1, 2004 — Cardiovascular Signs and Symptoms · Syncope · Paroxysmal nocturnal dyspnea · Tachycardia >120 beats/min · Sustained arrhythmia · Shortness of breath ...

(8) by S Nanda · 2012 · Cited by 36 — Pregnant women may present with a preceding history of typical angina or atypical epigastric pain; nausea; dizziness; or pain in the chest, neck or left arm.

(9) No relevant information found in search results.

(10) No relevant information found in search results.

(11) No relevant information found in search results.

(12) Congenital heart defects are the most common type of birth defect, affecting about 1% of live births in the United States and can range from mild to severe. ... Pregnancy puts extra strain on the ...

(13) At the University of Chicago Medicine, our team understands that every heart — and every pregnancy — is unique.

(14) Some congenital heart defects cause no signs or symptoms. Sometimes indications may only appear later in life. And symptoms can also return years after treatments. Symptoms for more serious forms of congenital heart defects may become evident in the first few days or months after birth. You may notice a pale gray or blue skin color called cyanosis.

(15) Types. Most congenital heart problems are structural issues like holes and leaky valves. They include: Heart valve defects. One may be too narrow or completely closed.

Diagnostic Evaluation for Congenital Cardiovascular Disorders Complicating Pregnancy

The diagnostic evaluation for congenital cardiovascular disorders complicating pregnancy involves a combination of clinical assessment and imaging studies. According to [1], the initial diagnostic evaluation includes measurement of arterial oxygen saturation, ECG, and echocardiogram.

• Echocardiography: This is the preferred diagnostic tool during pregnancy due to its absence of radiation exposure, ease of use, bedside availability, and ability to provide detailed information about cardiac structure and function [4].
• ECG: Electrocardiography can help identify arrhythmias or other cardiac abnormalities that may be associated with congenital cardiovascular disorders.
• Arterial Oxygen Saturation: Measurement of arterial oxygen saturation is essential in assessing the severity of cyanosis, if present.

Additional Diagnostic Tests

In high-risk patients during the puerperium, ongoing monitoring is necessary [3]. This includes:

• Computed Tomography (CT)/Magnetic Resonance Imaging (MRI): These imaging modalities can provide detailed information about cardiac structure and function, particularly in cases where echocardiography is inconclusive.
• Angiography: This is the gold standard for diagnosing ischemic heart disease in pregnancy [10].

Prepregnancy Evaluation

Prepregnancy echocardiography should be performed in every woman, with detailed assessment of the cardiac lesion, dimensions, ventricular function, and filling pressures [7]. This evaluation can help identify potential risks associated with pregnancy.

References:

[1] MM Canobbio · 2017 · Cited by 437 [3] A Uebing · 2006 · Cited by 333 [4] Dec 6, 2013 [7] by IM van Hagen · 2020 · Cited by 91 [10] by LS Mehta · 2020 · Cited by 302

Management of Obsolete Congenital Cardiovascular Disorders in Pregnancy

The management of obsolete congenital cardiovascular disorders (CCVD) during pregnancy, childbirth, and the puerperium requires a multidisciplinary approach. While some medications may be contraindicated in pregnant women with CCVD, others can be used to manage symptoms and prevent complications.

Pharmacological Therapy

According to [1], beta-blockers were the most commonly used CVD medications during pregnancy, followed by antiplatelet and diuretic agents. However, it is essential to note that these medications may not be suitable for all patients with CCVD.

• Beta-blockers: These can be used to manage symptoms such as hypertension and tachycardia in pregnant women with CCVD [1].
• Antiplatelet agents: Aspirin (75 mg to 100 mg once per day) is recommended for pregnant patients in the second and third trimesters with either a history of recurrent miscarriage or an increased risk of preeclampsia [8].

Anesthesia and Pain Management

Epidural anesthesia can be used during labor and vaginal delivery, but cautious incremental dosing is advised to prevent hypotension [2]. Vasodilator therapy may also be required in some cases.

• Epidural anesthesia: This can be used to manage pain during labor and vaginal delivery, but careful monitoring of blood pressure is essential [2].
• Vasodilator therapy: Patients with right heart failure may require fluid and salt restriction, as well as vasodilator therapy to manage symptoms [5].

Other Considerations

In patients with heart failure (HF) who plan to become pregnant or are already pregnant, the medications used to treat HF must be adjusted to avoid adverse effects on the fetus [10]. Oxytocin is less effective than ergometrine in preventing postpartum hemorrhage but may be a useful adjunct when oxytocin cannot be used [4].

Guidelines and Recommendations

A practical guide for the management of pregnant women with CCVD has been published, providing recommendations from pre-conception through postpartum care [7]. This document serves as a valuable resource for healthcare providers managing patients with CCVD during pregnancy.

References:

[1] DG Halpern (2019) - Beta-blockers were the most commonly used CVD medications, followed by antiplatelet and diuretic agents. [2] MM Canobbio (2017) - Epidural anesthesia via venodilatation can reduce return of blood to the heart, cautious incremental dosing is advised. [4] - Oxytocin is less effective than ergometrine in preventing postpartum hemorrhage but may be a useful adjunct when oxytocin cannot be used. [5] L Bishop (2018) - Patients should continue with vasodilator therapy and may require fluid and salt restriction if they develop right heart failure. [7] KJ Lindley (2021) - This document serves as a practical guide from pre-conception through postpartum for the management of pregnant women with cardiovascular conditions. [8] S Lee (2021) - Low-dose aspirin (75 mg to 100 mg) once per day is also recommended for pregnant patients in the second and third trimesters with either a history of recurrent miscarriage or an increased risk of preeclampsia. [10] JM DeCara - In patients with HF who plan to become pregnant, are pregnant, or are breastfeeding, the medications used to treat HF must be adjusted to avoid adverse effects on the fetus.

Differential Diagnoses for Obsolete Congenital Cardiovascular Disorders Complicating Pregnancy

When considering differential diagnoses for obsolete congenital cardiovascular disorders complicating pregnancy, childbirth, or the puerperium, several conditions should be taken into account.

• Pre-existing structural heart disease: This can include conditions such as aortic stenosis, mitral valve prolapse, and other abnormalities that may have been present since birth. According to [6], differential diagnoses for pre-existing structural heart disease should also consider pulmonary embolism, preeclampsia-induced pulmonary oedema, and other complications.
• Takotsubo (stress) cardiomyopathy: This is a condition where the heart muscle becomes weakened due to physical or emotional stress. It can be a differential diagnosis for chest pain or shortness of breath during pregnancy, as mentioned in [5].
• Pulmonary embolism: A blood clot in the lungs can cause sudden and severe symptoms, including shortness of breath and chest pain. This should be considered in the differential diagnosis for cardiovascular complications during pregnancy.
• Pre-eclampsia-induced pulmonary oedema: High blood pressure during pregnancy can lead to fluid buildup in the lungs, causing respiratory distress. This condition should also be included in the differential diagnoses.

Other Considerations

In addition to these specific conditions, it's essential to consider the overall cardiovascular health of the patient and any pre-existing medical conditions that may have been present before pregnancy. A thorough evaluation by a multidisciplinary cardio-obstetrics team is crucial for accurate diagnosis and management.

References:

[5] Apr 23, 2019 - The differential diagnosis also should include takotsubo (stress) cardiomyopathy (119, 120). Coronary artery dissection is the most common cause ...

[6] by G Iannaccone · 2024 · Cited by 1 — Differential diagnoses that should be explored include pre-existing structural heart disease, pulmonary embolism, preeclampsia-induced pulmonary oedema ...