The Heart of Pregnancy By Elvie Victonette Razon-Gonzalez, M.D.

There is nothing more consuming than the joy and anticipation of the coming of a baby. It is nothing short of a miracle. It is proof that the body is a tower of strength, a fortress of Gods greatest gift, life itself. Not all women, however, are able to hurdle the nine months of pregnancy with ease. And unfortunately, pregnancy is even contraindicated in some women, for it plays a serious risk on their health, putting their lives on the line. During pregnancy, blood volume increases by 40 to 50 per cent while cardiac output increases by 30 to 50 per cent, peaking at 28 to 34 weeks of gestation. As such, there is increased workload to the heart. Furthermore, the stresses that labor and childbirth bring add to the extra work of the heart. Cardiac output increases by 20% with each uterine contraction during labor. Heart disease occurs in one per cent of pregnancy and it accounts for approximately ten per cent of deaths in pregnancy. Heart disease was the leading cause of indirect maternal mortality and the fourth cause of all maternal mortalities in a report by the Philippine Obstetrics and Gynecology Society in 1991. Common examples of heart diseases encountered in pregnancy include valvular heart diseases, peripartal cardiopathy, congenital heart diseases (aortic coarctation and Marfans syndrome) and peripartum cardiomyopathy. The most detrimental condition associated with mortality is pulmonary vascular disease and pulmonary hypertension (ex. Mitral stenosis and Eisenmengers physiology) or left ventricular outflow obstruction. Peripartum cardiomyopathy usually involves cardiac dilatation and congestive heart failure of unexplained cause during the last trimester of pregnancy or within six months within the puerperal period. Mortality rate is estimated at ten to twenty per cent. Among pregnant women especially those who have congenital heart disease, it is very prudent that close monitoring through regular prenatal consults be done to avoid both fetal and maternal complications. In a study published by Habana and Esteban in 1992, a higher rate of complications was noted among those with congenital heart disease, emphasizing the need for prenatal and even post-delivery cardiac monitoring. The need for concomitant obstetric and cardiovascular care among patients who are at high risk for developing frank heart failure, acute coronary event or sudden death cannot be underscored. For this is the only way that the safe delivery of a healthy baby by a healthy mother, the primary goal of obstetrics can be achieved.

References: Harrisons Principles of Internal Medicine 16th ed http://www.merck.com/mmpe/sec18/ch261/ch261g.html http://www.healthsystem.virginia.edu/uvahealth/peds_hrpregnant/cardiac.cfm http://www.mayoclinic.com/health/pregnancy/PR00124