Bengaluru (Karnataka) [India], January 30: Pregnancy causes stress on the heart and circulatory system because the blood volume rises from 30% to 50%, which puts more strain on the heart valve. In India, congenital heart disease and rheumatic heart disease are the most prevalent forms of heart illness during pregnancy. Preeclampsia, anaemia, premature labour, and intrauterine foetal development restriction are among the obstetric problems that frequently affect pregnant women with heart disease.
“Mrs. Sohini (Name Changed), a 35-year-old woman who had been married for ten years, had a history of rheumatic heart disease. In 2006, she had to have a prosthetic valve placement because of blockage of a heart valve. Although this valve replacement saved her life, there were still concerns, such as the possibility of infection and clot development. She had to be on high-dose of blood thinners for that. She consulted Infertility specialist for pregnancy. While being evaluated for fertility concerns, she became pregnant naturally. Unfortunately, 10 weeks into her natural pregnancy, she miscarried. She underwent minor surgery for termination of pregnancy. Even after carefully following her cardiologist’s advice, she had valve obstruction, which required a second replacement procedure,” shared Dr. Varini N, Senior Consultant – Obstetrician and Gynaecologist, Milann Fertility Center, Bengaluru.
“Due to her cardiac disease and the usage of blood thinners, Mrs. Sohini’s current pregnancy was deemed high-risk. This presented two-fold challenges: managing the risk of bleeding that could endanger the baby while preventing clots to protect her heart. She was sent to the Milan Maternal-Fetal Medicine (MFM) department for specialized care at 10 weeks,” added Dr. Varini.
What is Rheumatic heart disease?
As a result of rheumatic fever, the heart valves become permanently damaged, leading to rheumatic heart disease. In the early stages of the disease, rheumatic heart disease usually shows no symptoms. Shortly after a childhood streptococcal infection that is either untreated or inadequately treated, heart valve damage may begin. Of greater significance, rheumatic heart disease continues to rank among the world’s most common causes of maternal cardiac problems during birth. Pregnant patients who have received inadequate or no treatment are at a greater risk of developing heart failure, and abortion is strongly advised.
Fever, lumps under the skin (nodules), a raised red rash, weakness, exhaustion, shortness of breath, chest pain, and swollen, tender, and painful joints—especially in the knees and ankles—are all typical indications and symptoms of rheumatic heart disease. Sudden cardiac death could result if treatment is not received for an extended length of time.
Rheumatic Heart Disease and Pregnancy Risks
During pregnancy, the blood volume increases which puts extra strain on heart valves. In women with rheumatic heart disease, this heightened pressure on damaged valves raises the risk of severe complications, including maternal and fetal death, preterm delivery, and heart failure around delivery.
Because she needed blood thinners and was at risk for pre-eclampsia, Mrs. Sohini’s pregnancy was high risk. The hazards associated with stopping or continuing the medicine were substantial, requiring careful monitoring of the fetal growth and the mother’s heart health. To control bleeding risks, an elective C-section was carefully arranged at 37 weeks. Blood components were ready, and twelve hours before surgery, her blood thinners were stopped. Six hours after the surgery, she resumed taking blood thinners, and the baby, weighing 2.8 kg, was born healthy. She spent 24 hours in the high-dependency unit before moving to the ward and was released on the fourth day. Mother and child had a full and trouble-free recovery.
Mrs. Sohini was extremely thankful to Dr. Varini, and shared, “She encouraged and explained the procedure, which helped me to relax and have trust on the procedure.”
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