Pregnancy and labor in patients with heart disease

This lecture presents the management of pregnancy and labor in cardiovascular patients. Classification of congenital cardiovascular diseases is presented, the changes in cardiovascular system developing in pregnancy and labor are described. The authors emphasize that hospitalization is recommended for this patient population before 12 weeks, in order to diagnose the heart disease, rule out the rheumatic process, and decide whether pregnancy can be prolonged. Repeated hospitalization is recommended at weeks 28-32, for further examinations and treatment, and then 2-3 weeks before planned delivery, in order to prepare the patient to labor, determine the labor management plan and mode of delivery in an inpatient setting. Complex clinical and laboratory studies should be carried out in all pregnant patients with heart diseases. Women with congenital heart disease and their babies should be examined with the use of genetic methods. The management of pregnancy and labor in patients with mitral and aortic valvular diseases, with a history of cardiosurgery, with rheumatic heart disease is described. Differences in drug therapy of patients with various diseases are emphasized. The authors emphasize that the outcome of labor largely depends on proper preparation to labor, correct choice of the mode of delivery, timely therapy and anesthesiological care in labor, and qualification of the physician.