Gebelikte Kalp Hastalıkları
Özet
Gebelik döneminde en sık %8 oranında hipertansif hastalıklar ve %2 oranında kalp hastalıkları gözlenmekte, bu durum dünya genelinde fetal ve maternal morbidite ile mortalitenin en önemli nedenleri arasında yer almaktadır. Hamilelik sürecinde plazma hacmi, kalp hızı ve kardiyak atım hacmi artarken sistemik vasküler direnç azalır. Pulmoner hipertansiyon ve Eisenmenger sendromu %16-40 arasında yüksek maternal mortalite riski taşır ve gebeliğin sonlandırılması düşünülebilir. Konjenital bozukluklardan ASD ve VSD'li hastalar genellikle düşük riskli olup vajinal doğumu tolere edebilirken, aort genişlemesi olan Marfan, Ehler-Danlos ve Turner sendromlu hastalarda diseksiyon riski nedeniyle gebelikten kaçınılmalıdır. Romatizmal kapak hastalıklarından mitral ve aort darlığı gebelikte akciğer ödemi ve kalp yetmezliğini tetikleyebilir; ciddi darlıklarda sezaryen doğum tercih edilir. Mekanik protez kapak kullanan gebelerde antikoagulan (VKA, UFH, DMAH) yönetimi fetal kanama ve embriyopati riskini önlemek için hayati önem taşır. Gebelikte koroner arter hastalıkları, peripartum kardiyomiyopati (PPKM) ve taşiaritmiler de yönetilmesi gereken diğer önemli klinik tablolardır. Sonuç olarak, DSÖ risk sınıflamasına göre yüksek riskli grupta yer alan kalp hastası kadınların multidisipliner yaklaşımla kardiyolog ve kadın doğum uzmanı tarafından takibi ve hastane ortamında doğum yapması gerekmektedir.
Hypertensive disorders are observed most frequently at a rate of 8% during pregnancy, and heart disease is seen in 2% of pregnancies, representing one of the most critical causes of fetal and maternal morbidity and mortality worldwide. During the gestation period, plasma volume, heart rate, and cardiac stroke volume increase, while systemic vascular resistance decreases. Pulmonary hypertension and Eisenmenger syndrome carry a high maternal mortality risk between 16% and 40%, and termination of pregnancy may be considered. While patients with congenital defects like ASD and VSD generally have low risk and can tolerate vaginal delivery, pregnancy should be avoided in patients with Marfan, Ehlers-Danlos, and Turner syndromes presenting with aortic dilation due to the risk of dissection. Among rheumatic valvular diseases, mitral and aortic stenosis can trigger pulmonary edema and heart failure during pregnancy; thus, cesarean delivery is preferred in severe stenoses. Anticoagulant management (VKA, UFH, LMWH) in pregnant women with mechanical prosthetic valves is vital to prevent fetal hemorrhage and embryopathy risks. Coronary artery diseases, peripartum cardiomyopathy (PPCM), and tachyarrhythmias are other substantial clinical manifestations that require careful management during pregnancy. Consequently, women with heart disease who are in the high-risk group according to the WHO risk classification must be monitored through a multidisciplinary approach by a cardiologist and an obstetrician, and delivery must absolutely be performed in a hospital setting.
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