[Pregnancy management and spontaneous labor in heart diseases: present-day solution to the dilemma].
OBJECTIVE
to study cardiac rhythm variability (CRV), to optimize pregnancy management tactics and to choose a delivery procedure.


METHODS
Ninety-six 19-to-37 year-old (mean age 28.3 +/- 9.4 years) women at 35-39 weeks gestational age were examined. All the women were diagnosed as having congenital or acquired (rheumatic) heart disease. Their hemodynamics and CRV were analyzed according to the type of hemodynamic overload, for which purpose three patient groups were formed: 1) volume overload; 2) pressure overload; and 3) combined overload. A control group comprised 40 healthy pregnant women. Before and 2-3 days after delivery, all the women underwent 24-hour Holter cardiac rhythm monitoring with the estimation of the temporary and spectral parameters of CRV.


RESULTS
In antepartum heart diseases accompanied by volume overload, there was a tendency for total CRV (SDNN 95.4 +/- 15.8 msec versus 125.5 +/- 17.8 msec in the controls) to decrease and for sympathetic activity to significantly increase (SDANN 65.7 +/- 13.7 and 109.9 +/- 14.7 msec, respectively; p < 0.05). When pressure overload (a moderate gradient) developed, the temporary parameters of total CRV, sympathetic and parasympathetic activities did not differ from those in the control group. Heart diseases attended by pressure overload and a high gradient were characterized by a significant reduction in total CRV (100.5 +/- 24.6 msec; p < 0.05) as compared with those in patients having a moderate pressure gradient, with a declining trend for total spectrum power, Group 3 patients showed a reduction in all the indices reflecting the temporary and spectral characteristics, suggesting a considerable rise in sympathetic activity and a decrease in total autonomic spectrum power.


CONCLUSIONS
Based on SRV studies, indications for prolonged pregnancy and spontaneous or, in some cases, surgical delivery can be assessed in pregnant women with heart diseases.
Mravian
S R
SR
Petrukhin
V A
VA
Zaprudskiĭ
A A
AA
Pronina
V P
VP
D000328:Adult; D036861:Delivery, Obstetric; D004452:Echocardiography; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D005865:Gestational Age; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D006339:Heart Rate / Q000502:physiology; D006439:Hemodynamics; D006801:Humans; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D011256:Pregnancy Outcome; D012214:Rheumatic Heart Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D012307:Risk Factors