When a woman is pregnant, the heart pumps 40 per cent more blood to all of the organs in the body, which means, it works much harder than normal. Gynaecologists say this is why pregnant women are protected from excessive bleeding during childbirth. It is because their blood vessels always dilate to accommodate the increased blood flow, which lowers the blood pressure, making the blood more likely to clot. Emmanuel Semwaga, a gynaecologist/obstetrician at Mediheal Diagnostic and Fertility Centre in Kigali, says for women with heart issues, apart from going for antenatal care, it’s essential to always have a cardiologist follow up throughout the pregnancy. He says if one happens to have a heart condition, they will definitely need special care during pregnancy. He explains that when pregnant, the pregnancy stresses the heart and circulatory system. However, he adds that many women who have heart conditions deliver healthy babies. RISKS AND COMPLICATIONS Since pregnancy stresses the heart and circulatory system, Semwaga explains that during pregnancy, the blood volume increases by 30 to 50 per cent in order to nourish the unborn child. He adds that because of this, the heart has to pump more blood each minute, thus increasing the heart rate. Iba Mayale, a gynaecologist at Galien Clinic in Remera, says labour and delivery also add to one’s heart workload as well. During labour, he explains, particularly with natural birth, there is an abrupt change in blood flow and pressure. “It takes some time after one has delivered for the stresses on the heart to return to the levels they were before one became pregnant,” Mayale says. When it comes to the risks, he says it depends on the nature and severity of one’s heart condition. For instance, he says, one of the risks include heart rhythm issues. He says minor abnormalities in heart rhythm are common during pregnancy, and that in most cases, they’re not usually a cause for concern. Dr Theodomir Sebazungu, a gynaecologist at University Teaching Hospital of Kigali (CHUK), says another risk that can lead to heart problems during pregnancy, is if one has heart valve issues. He says having an artificial heart valve or scarring or malformation of the heart or valves can increase the risk of complications during pregnancy. Sebazungu explains that in this case, if the valves aren’t working properly, one might have trouble tolerating the increased blood flow that occurs during pregnancy. In addition, he says that artificial or abnormal valves carry an increased risk of a potentially life-threatening infection of the lining of the heart and heart valves. “Mechanical artificial heart valves also pose serious risks during pregnancy due to the need to adjust the use of blood thinners, the potential for life-threatening clotting (thrombosis) of heart valves,” he adds. Taking blood thinners can also put the developing baby at risk, he adds. Semwaga says congestive heart failure is also another risk, noting that as blood volume increases, congestive heart failure can worsen. For women who were born with a heart problem such as congenital heart defect, their unborn child has a greater risk of developing some type of heart defect as well. He adds that the same people might also be at risk of heart problems occurring during pregnancy and premature birth. Semwaga, however, notes that certain heart conditions, especially narrowing of the mitral valve or aortic valve, can pose life-threatening risks for the mother or unborn child. HOW TO HANDLE THE PROBLEM Depending on the circumstances, Mayale says some heart conditions require major treatment, including heart surgery, before one tries to conceive. He warns that pregnancy is not recommended for women who have high blood pressure that affects the arteries in the lungs and the right side of the heart (pulmonary hypertension). However, he advises that before one tries to conceive, it’s important to seek help from a cardiologist and a healthcare specialist, especially an obstetrician who will be able to handle the pregnancy. These people, he says, should be in a position to evaluate how well the patient is managing their heart condition and consider treatment changes they might need before they become pregnant. Sebazungu says certain medications used to treat heart conditions are not used during pregnancy. However, he says depending on the circumstances, the healthcare provider might adjust the dosage or make a substitution, as well as be able to explain the risks involved to the patient. For the pregnant women who are at risk of developing heart issues, he says it’s essential for specialists to always check their weight and blood pressure. Also, he says such patients might need frequent blood and urine tests. “How often one sees a cardiologist during pregnancy always depends on the severity of their heart condition,” he says. Mayale says it’s also important to monitor the baby’s development throughout the pregnancy. And that routine ultrasound exam can be used to track the baby’s growth, as well as to detect foetal heart abnormalities. Additionally, he says the baby might need monitoring or treatment after delivery as well. OTHER PREVENTIONS Semwaga says it is important for pregnant women to take good care of themselves as that also helps the baby. It can also help prevent complications related to heart problems during pregnancy. Some of the things to do to ensure this, he says, are by keeping prenatal appointments, taking medication as prescribed, and getting plenty of rest, among others. Semwaga says it’s also important to monitor weight gain, if possible on a daily basis. He explains that gaining the right amount of weight supports the baby’s growth and development while gaining too much weight places additional stress on the heart. Mayale says difficulty in breathing, shortness of breath with exertion or at rest, heart palpitations, rapid heart rate or irregular pulse and chest pain, should immediately be checked. To develop and maintain a strong heart, he says, pregnant women need to avoid cigarettes and alcohol. They should as maintain a healthy and well-balanced diet and get regular exercise. editorial@newtimesrwanda.com
