The majority of women with cardiomyopathy have no problems during pregnancy and childbirth. However, in addition to genetic counseling, necessary for women in whom a genetic abnormality has been documented as a cause of cardiomyopathy, pregnancy imposes greater demands on the heart and the risk should be assessed by the treating cardiologist possibly in advance, and in any case at the beginning. of pregnancy.
It is important that the cardiologist and the obstetrician collaborate closely in the evaluation of the symptoms and the clinical status, i.e. the symptoms (NYHA class), and associated pathologies (e.g. anemia, iron deficiency, diabetes, arterial hypertension, etc.) patient. Based on this and the results of the instrumental tests (e.g. evaluation of the gradient in obstructive hypertrophic cardiomyopathy and / or mitral regurgitation) it is necessary to evaluate the possibility that the symptoms may worsen and therefore the risk of heart failure, in addition to the risk of possible onset. of arrhythmias. The risk depends on the type of cardiomyopathy and the clinical status of the patient and based on this, monitoring in pregnancy should be established (eg every month, 2 or 3 months).
Pharmacological therapy must take into account both the well-known relative or absolute contraindications for some drugs in pregnancy, and its necessity based on the clinical status of the patient. For example, it is not usually necessary to discontinue beta-blocker drugs, but fetal growth should be evaluated periodically. Amiodarone should be suspended, as well as Disopyramide, Verapamil, Diltiazem, unless they are deemed indispensable.
If anticoagulation is necessary, it is preferable to use Vit K antagonist anticoagulants, (eg Coumadin, Sintrom) only after the first trimester and up to 36 weeks, with their replacement with low molecular weight heparin near birth.
Electrical cardioversion can be practiced, possibly in the presence of an obstetrician.
Delivery can be spontaneous if the patient is asymptomatic or with mild symptoms (Class I and II), but it is preferable that it is planned even if vaginally.
A caesarean section is indicated in all patients with cardiomyopathy with severe moderate symptoms and poor compensation (Class III), with obstructive hypertrophic cardiomyopathy, on anticoagulant therapy, and with a high risk of decompensation or arrhythmias during spontaneous delivery.
During delivery, spinal anesthesia should be avoided, and oxytocin given only as a slow infusion if really needed.
The patient's heart rhythm should be monitored constantly during delivery.
In patients with ICD, this should not be turned off.
The patient should be kept in the hospital for 24-48 hours after delivery.