Cardiovascular disease and pregnancy make for a high risk setting. Fortunately heart disease problems are not that common in the younger age group that is planning a pregnancy. But in the U.S. there are about 1% of pregnancies where pre-existing coronary heart disease is present and they result in 10% of all maternal deaths.
An assessment of these women with a significant heart disease risk should therefore be done by a cardiologist. It is from week 28 onwards that the cardiovascular strains of late pregnancy put extra stress onto the pregnant woman’s heart.
Women who had heart valve disease (thanks to www.drugs.com for this image; mitral valve disease shown here) in the past from a strep throat or if they were born with it, are at a higher risk for blood clots. Women with a tendency for blood clots in the deep veins of the lower legs or pulmonary emboli in the past should be carefully monitored with serial Doppler ultrasonography (thanks to www.nlm.nih.gov for this link) studies to check for clots. If found, heparin injections given by herself subcutaneously every 12 hours is the treatment of choice. Heparin is a large molecule that will not enter the fetal circulation (it cannot penetrate the placenta; see Ref. 19, p.2038).
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