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High Risk Pregnancy

Anemia in Pregnancy
Diabetes in Pregnancy
Hypertension in pregnancy
Cardiac disease in pregnancy
Liver disease in pregnancy
Malaria in Pregnancy
HIV infection in pregnancy
Recurrent Abortion
Pregnancy and Renal Disease
Hematological Problems in Pregnancy
Hemoglobinopathies in Pregnancy
Thrombophilia in Pregnancy

Cardiac Disease in Pregnancy

Pregnant women with normal cardiac function can accommodate many alterations in the cardiovascular system that accompany pregnancy and labor without difficulty. However, in women with cardiac disease these changes may lead to heart failure, arrhythmias and stroke. Maternal heart disease complicates 0.2 to 4% of pregnancies and is responsible for 10-25% of maternal deaths. Uterine congestion, insufficient oxygenation, elevated carbon dioxide content of blood may compromise the fetus and may lead to growth restriction and premature labor and delivery. With advances in surgery and medical therapy more women with congenital heart disease (CHD) now reach their adult reproductive years and are becoming pregnant more often. The etiology of heart disease has changed from primarily rheumatic to predominately congenital.
Fetal Risks

When a pregnant patient or a first degree family member has a congenital heart disease, then the risk for these diseases increases in the fetus. The incidence is 0% to 10% depending on the specific lesion when the fetus is affected. Approximately 50% have the same anomaly as the mother. Rate of growth restriction and prematurity is increased in pregnant women with cardiac disease.

Cardiac Murmurs

Early to mid systolic and soft murmurs (grades I - II) are very common during pregnancy (> 90%). These murmurs are rarely associated with cardiac pathology. Systolic murmurs that are loud or long are frequently associated with cardiac pathology. Late systolic, pan systolic and diastolic murmurs are abnormal and require further evaluation by echocardiography.

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