1. Indication for Termination of Pregnancy due to Mother Cardiac Diseases
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Indication for Termination of Pregnancy due to Mother Cardiac Diseases
Anahita Tavoosi, MD
Assistant Professor
of Cardiology
© 2007 Microsoft Corporation. All rights reserved. Microsoft, Windows, Windows Vista and other product names are or may be registered trademarks and/or trademarks in the U.S. and/or other countries.
The information herein is for informational purposes only and represents the current view of Microsoft Corporation as of the date of this presentation. Because Microsoft must respond to changing market conditions, it should not be interpreted to be a commitment on the part of Microsoft, and Microsoft cannot guarantee the accuracy of any information provided after the date of this presentation. MICROSOFT MAKES NO WARRANTIES, EXPRESS, IMPLIED OR STATUTORY, AS TO THE INFORMATION IN THIS PRESENTATION.

2. Serious disease not symptomatic yet

3. WHO IV Pregnancy is contraindicated!
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WHO IV
Severe systemic ventricular dysfunction (LVEF <30%, NYHA III–IV
Previous peripartum cardiomyopathy with any residual impairment of left ventricular function
Pulmonary arterial hypertension
Pregnancy is contraindicated!
Native severe Coarctation
Severe mitral stenosis, severe symptomatic aortic stenosis
-Marfan syndrome with aorta dilated >45 mm
-Aortic dilatation >50 mm in aortic disease associated with bicuspid aortic valve
© 2007 Microsoft Corporation. All rights reserved. Microsoft, Windows, Windows Vista and other product names are or may be registered trademarks and/or trademarks in the U.S. and/or other countries.
The information herein is for informational purposes only and represents the current view of Microsoft Corporation as of the date of this presentation. Because Microsoft must respond to changing market conditions, it should not be interpreted to be a commitment on the part of Microsoft, and Microsoft cannot guarantee the accuracy of any information provided after the date of this presentation. MICROSOFT MAKES NO WARRANTIES, EXPRESS, IMPLIED OR STATUTORY, AS TO THE INFORMATION IN THIS PRESENTATION.

4. پزشکی قانونی: سقط هر بیماری دریچه ای که به ‌نارسایی ‌منجر‌به
4 و 3 Function Classرسیده باشد و غیر قابل برگشت به 2 باشد
هر نوع مسایل حاد قلبی غیر‌از‌كرونر‌كه به‌4 و‌3 Function Classرسیده باشد‌؛‌از قبیل‌میوكاردیك و پریكاردیك .
سابقه بیماری كاردیومایو پاتی دیلاته در حاملگی های قبلی
سندرم مارفان در صورتی كه قطر آئورت صعودی بیش از 5 سانتی متر باشد
سندرم ایزن منگر
 فشارخون غیرقابل كنترل با داروهای مجاز در دوران حاملگی
هر بیماری ریوی به شرط ایجاد افزایش فشارخون ریوی حتی از نوع خفیف
توانایی‌انعقادی افزون یافته‌كه‌تجویز هپارین منجر‌به تشدید بیماری دیگری شود كه جان مادر را تهدید نماید

5. Termination should be discussed before 19th weeks

6. AA aneurysm A 31 year old woman
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AA aneurysm
A 31 year old woman
Attended the Imam Hospital cardiology clinic at 8 weeks gestation
Was referred due to a heart murmur
After doing echocardiography she was found to have a
BAV
Moderate Aortic Regurgitation
AA was dilated(5.1cm)
© 2007 Microsoft Corporation. All rights reserved. Microsoft, Windows, Windows Vista and other product names are or may be registered trademarks and/or trademarks in the U.S. and/or other countries.
The information herein is for informational purposes only and represents the current view of Microsoft Corporation as of the date of this presentation. Because Microsoft must respond to changing market conditions, it should not be interpreted to be a commitment on the part of Microsoft, and Microsoft cannot guarantee the accuracy of any information provided after the date of this presentation. MICROSOFT MAKES NO WARRANTIES, EXPRESS, IMPLIED OR STATUTORY, AS TO THE INFORMATION IN THIS PRESENTATION.

8. WHO III Pregnancy is not Recommended!
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WHO III
Cyanotic heart disease (unrepaired)
Other complex congenital heart disease
Mechanical valve
Pregnancy is not
Recommended!
Systemic right ventricle
Fontan circulation
• Aortic dilatation
40–45 mm in Marfan syndrome
45–50 mm in aortic disease bicuspid aortic valve
© 2007 Microsoft Corporation. All rights reserved. Microsoft, Windows, Windows Vista and other product names are or may be registered trademarks and/or trademarks in the U.S. and/or other countries.
The information herein is for informational purposes only and represents the current view of Microsoft Corporation as of the date of this presentation. Because Microsoft must respond to changing market conditions, it should not be interpreted to be a commitment on the part of Microsoft, and Microsoft cannot guarantee the accuracy of any information provided after the date of this presentation. MICROSOFT MAKES NO WARRANTIES, EXPRESS, IMPLIED OR STATUTORY, AS TO THE INFORMATION IN THIS PRESENTATION.

9. Serious disease, but decision on pregnancy

10. Mitral Stenosis A 23 year old woman
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Mitral Stenosis
A 23 year old woman
Attended the Imam Hospital cardiology clinic at 11 weeks gestation
Was referred due to a heart murmur
After doing echocardiography she was found to have a severe mitral stenosis
© 2007 Microsoft Corporation. All rights reserved. Microsoft, Windows, Windows Vista and other product names are or may be registered trademarks and/or trademarks in the U.S. and/or other countries.
The information herein is for informational purposes only and represents the current view of Microsoft Corporation as of the date of this presentation. Because Microsoft must respond to changing market conditions, it should not be interpreted to be a commitment on the part of Microsoft, and Microsoft cannot guarantee the accuracy of any information provided after the date of this presentation. MICROSOFT MAKES NO WARRANTIES, EXPRESS, IMPLIED OR STATUTORY, AS TO THE INFORMATION IN THIS PRESENTATION.

11. Mean gradient of 9 mmHg
MVA:1.2cm2
Good left ventricular and RV function
Mild to moderate aortic regurgitation
PAP was 45mmHg

12. Pregnant women with moderate or severe mitral stenosis (area <1
Pregnant women with moderate or severe mitral stenosis (area <1.5 cm2)
Heart failure :
Occurs frequently in (area <1.5 cm2) in the second and third trimesters
The rates of prematurity are 20% to 30%,
Fetal growth restriction 5% to 20%
Stillbirth (1% to 3%)

13. Continue pregnancy till it is possible

14. The patient was monthly visited by cardiologist
Beta-blocker and diuretic was prescribed for her
She was okay till 28th weeks when her FC deteriorated to II-III
The echocardiography showed MeanPG:14mmHG, and PAP:55mmHg

15. Three Options
Although the medical therapy was initiated in CCU the patients FC became worst
PTMC
Surgery
Pregnancy Termination

16. PTMC was not successful
Surgery associates with 20-30% fetal loss

17. 9/11/ :55 AM
A 41 year old woman
Attended the Imam Hospital cardiology clinic at 32 weeks gestation
Referred due to a dyspnea FC II-III
After doing echocardiography she was found to have
Severe Mitral Regurgitation
Moderate MS(Mean PG:8mmHg,MVA:1.8cm2 and mean gradient of 8 mmHg)
Mild to moderate TR, TRG:47mmHg, PAP:52mmHg
Mild aortic regurgitation
Good left ventricular function
© 2007 Microsoft Corporation. All rights reserved. Microsoft, Windows, Windows Vista and other product names are or may be registered trademarks and/or trademarks in the U.S. and/or other countries.
The information herein is for informational purposes only and represents the current view of Microsoft Corporation as of the date of this presentation. Because Microsoft must respond to changing market conditions, it should not be interpreted to be a commitment on the part of Microsoft, and Microsoft cannot guarantee the accuracy of any information provided after the date of this presentation. MICROSOFT MAKES NO WARRANTIES, EXPRESS, IMPLIED OR STATUTORY, AS TO THE INFORMATION IN THIS PRESENTATION.

22. Decision for termination should be individualized

23. Timing of delivery
Induced labor
Spontaneous onset of labor

24. Timing is individualized
Gravida’s cardiac status
Bishop score
A score based upon the station of the presenting part and four characteristics of the cervix:
dilatation, effacement, consistency, and position
Fetal well-being
Lung maturity

25. Thank you for your attention!