BMJ 2007;335:1042-1045 (17 November), doi:10.1136/bmj.39365.655833.AE
Practice
Pregnancy Plus
Valvular heart disease
E Gelson, clinical research fellow1, M Gatzoulis, professor of cardiology2, M Johnson, reader in obstetrics and obstetric medicine1
1 Academic Department of Obstetrics and Gynaecology, Imperial College London, London SW10 9NH , 2 Adult Congenital Heart Centre, National Heart and Lung Institute, Royal Brompton Hospital, London SW3 6NP
Correspondence to: E Gelson egelson@imperial.ac.uk
Valvular disease may be unmasked in pregnancy when physiological changes increase demands on the heart. Women with valvular heart disease require close follow-up during pregnancy, delivery, and postpartum
| The first 150 words of the full text of this article appear below. |
Introduction
Valvular heart disease in pregnancy is rare, but it significantly increases maternal and fetal risk. Despite an overall decline in the incidence of rheumatic heart disease in Europe and North America,1 worldwide rheumatic mitral stenosis is the most common valvular lesion in pregnancy.w1 With changing patterns of immigration, rheumatic heart disease may well become a serious problem in the United Kingdom. Advances in cardiac medication and surgery mean that more women with congenital valvular disease survive into adulthood and reproductive maturity.
Valvular heart disease may present for the first time in pregnancy as the increasing demands on the heart lead to decompensation and cardiac failure. However, the diagnosis is not always easy as the symptoms of pregnancy (tiredness, shortness of breath, and palpitations) can mask those of deteriorating disease. Moreover, in the United Kingdom, a decline in rheumatic fever means that valvular heart disease is now rare, and doctors—particularly general
Does pregnancy affect valvular heart disease?
Mitral stenosisBox 1 New York Health Association classification
Aortic stenosis
Aortic and mitral regurgitation
Does valvular heart disease affect pregnancy?
Mitral stenosisAortic stenosis
How is pregnancy managed?
Before conceptionBox 2 Recommendations for the evaluation and management of women with valvular heart disease who are contemplating pregnancy
During pregnancy
Box 3 Cardiac findings in pregnancy for which further investigation is necessary
Symptoms
Signs
During delivery
Box 4 Recommended antibiotic prophylaxis during delivery for women with valvular heart disease
No allergy to penicillin
Allergy to penicillin
Follow-up
Conclusion
Scenario
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- Acute rheumatic fever and pregnancy
- A.D Singh Ahuja
bmj.com, 19 Nov 2007 [Full text] - Misleading advice on endocarditis prophylaxis in pregnancy
- Habib U Rehman
bmj.com, 21 Nov 2007 [Full text] - Some corrections are required in this article
- E.S Prakash
bmj.com, 23 Nov 2007 [Full text] - Inaccuracies and clarifications
- Kumar Satya
bmj.com, 29 Nov 2007 [Full text] - Antibiotic prophylaxis
- Emily Gelson
bmj.com, 1 Dec 2007 [Full text]
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