title: Pericardial disease in pregnancy.
abstract: BACKGROUND
  There is no evidence that pregnancy affects susceptibility to pericardial disease. However, when such a condition occurs, its proper diagnosis and management may be crucial for the outcome of the pregnancy.
  Hydropericardium is the most frequent form of pericardial involvement in pregnancy. It is typically a small, clinically silent pericardial effusion present in the third trimester in approximately 40% of healthy pregnant women. Small amounts of fetal pericardial fluid (< 2 mm in echocardiography, in diastole) can be detected after 20 weeks of gestation. Larger effusions should raise clinical concern for hydrops fetalis, Rh disease, hypoalbuminemia, and infectious or autoimmune disorder. Wide varieties of etiologic forms of pericardial diseases occur sporadically in pregnant women. Significant symptoms, electrocardiographic changes, or physiologic impairment warrant hospitalization.
  
  
  METHODS
  Most pericardial disorders are managed during pregnancy as in nonpregnant patients (i.e., nonsteroidal antiinflammatory drugs for acute, antibiotics and drainage for purulent pericarditis, and corticosteroids for systemic autoimmune disorders). However, colchicine is contraindicated in pregnancy, and pericardiocentesis should be performed only for very large effusions causing clinical signs of cardiac tamponade or if presence of suppurative, tuberculous or neoplastic pericardial effusion is suspected. Echocardiographic guidance of pericardiocentesis is preferred to fluoroscopic guidance in order to avoid fetal X-ray exposure. Pericardiectomy should be reserved for significant pericardial constriction and resistant bacterial infections. Delivery of normal infants in term after pericardiocentesis or pericardiectomy is expected, whenever natural history of causative disease allows. Pericardiectomy itself is not a contraindication for subsequent successful pregnancies.
authors.affiliation: University Institute for Cardiovascular Disease, Clinical Center of Serbia, Belgrade, Serbia and Montenegro. arsenr@eunet.yu
authors.forename: Arsen D
authors.initials: AD
authors.lastname: Ristić
authors.forename: Petar M
authors.initials: PM
authors.lastname: Seferović
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Ljubić
authors.forename: Ida
authors.initials: I
authors.lastname: Jovanović
authors.forename: Gorica
authors.initials: G
authors.lastname: Ristić
authors.forename: Sabine
authors.initials: S
authors.lastname: Pankuweit
authors.forename: Miodrag
authors.initials: M
authors.lastname: Ostojić
authors.forename: Bernhard
authors.initials: B
authors.lastname: Maisch
mesh_terms: D003078:Colchicine; D000075202:Contraindications; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D010490:Pericardial Effusion / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D020519:Pericardiocentesis; D010493:Pericarditis / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D011379:Prognosis
chemical_list: D003078:Colchicine