Heart Diseases in Pregnancy and Preoperative Evaluation

Abstract

Increased prevalence of cardiovascular risk factors (diabetes mellitus, hypertension, obesity) and age at first gestation are the important factors that increase cardiovascular diseases incidence in pregnancy. Assessment of maternal and fetal risk is very important. In World Health Organization class 1, the risk is very low and it is recommended that the cardiologic evaluation be performed once or twice in pregnancy. World Health Organization class 2 patients have low to moderate risk and cardiology consultation is recommended at every trimester. World Health Organization class 3 patients have a high risk, so cardiology consultation is recommended monthly or bi-monthly. Pregnancy is not recommended for World Health Organization class 4 patients. In cases where surgery is necessary the general approach is the same as those who are not pregnant. However, a multidisciplinary approach is needed in pregnant patients. Surgery should be performed independently of the trimester in emergent cases. If an elective intervention is needed and there is no effect on fetus, the surgical procedure should be delayed after birth. If surgery is needed and semi-elective, the optimal time period is indicated as second trimester. The type of anesthesia to be applied is determined according to the type and timing of surgery,  maternal physiological changes and teratogenic effects.

Keywords: Heart disease, pregnancy, preoperative evaluation.