Title Srčane bolesti i trudnoća Title (english) Heart diseases and pregnancy Author Ivona Šandrk Mentor Diana Delić-Brkljačić (mentor)Committee member Nikola Bulj (predsjednik povjerenstva)Committee member Jasenka Markeljević (član povjerenstva)Committee member Diana Delić-Brkljačić (član povjerenstva)Granter University of Zagreb Defense date and country 2018-07-13, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Srčane bolesti u trudnoći čine važan dio morbiditeta i mortaliteta majke i fetusa. Incidencija trudnica s kardiovaskularnim bolestima u porastu je, ponajprije zbog velikog broja žena s kongenitalnim srčanim greškama koje su, zahvaljujući napretku kardijalne kirurgije, dosegle reproduktivnu dob, s druge strane i zbog cjelokupne promjene populacije trudnica, koja je sve starija u razvijenim zemljama. Trudnoća sama po sebi uzrokuje značajne prilagodbe kardiovaskularnog sustava, kao što su povećanje intravaskularnog volumena i povećanje srčanog minutnog volumena za 50% te pad ukupnog perifernog otpora. Budući da ove promjene ponekad opterećuju i srca zdravih žena, tim je važnija evaluacija stanja, i predviđanje potencijalnih rizika i komplikacija koje trudnoća može donijeti kod žena sa srčanom bolesti u pozadini. Trudnice s otprije poznatim bolestima trebaju proći savjetovanje u sklopu planiranja trudnoće kako bi se procijenili rizici potencijalne trudnoće i razmotrile, ako je potrebno, druge mogućnosti. Za trudnice koje se prvi put prezentiraju s bolesti u trudnoći važna je rana procjena kardiovaskularnog statusa i monitoriranje trudnoće. Potrebno je revidirati primjenu konkomitantne farmakološke terapije i razmotriti mogućnosti vezano za porođaj i dovršenje trudnoće. Praćenje takvih trudnica zahtijeva interdisciplinarni pristup koji uključuje ginekologa, specijalistu opstetričara, kardiologa i anesteziologa. Pritom moraju misliti na dobrobit dvaju pacijenata istovremeno, majku i njeno nerođeno dijete. Najveći udio kardiovaskularnih poremećaja čine hipertenzivni entiteti, uključujući preeklampsiju, koji kompliciraju do 15% trudnoća. U zapadnim zemljama najveći udio strukturnih srčanih bolesti u trudnoći čine kongenitalne srčane bolesti. Ostale značajne srčane bolesti su aritmije, s jednim od najčešćih simptoma koji se javljaju u trudnoći - palpitacijama, kardiomiopatije i koronarna bolest.
Abstract (english) Heart diseases in pregnancy make up an important part in both maternal and fetal morbidity and mortality. The incidence of pregnant women with cardiovascular diseases is rising, primarily due to the increased number of women with congenital heart diseases reaching childbearing age and the changing demographics associated with advancing maternal age.
Pregnancy by itself causes substantital changes and adaptations in the cardiovascular system, such as an increase in intravascular volume, an increase in cardiac output by 50%, and a decrease in mean systemic arterial blood pressure. As those changes may overload even hearts of healthy women, it is very important to evaluate potential risks and predict plausible complications for women with underlying heart conditions and for their unborn babies. Pregnant women with known heart disease should undergo indivdual preconception counseling by an expert so that they are able to make informed pregnancy decisions. For women who have not had preconception counseling, a complete risk evaluation should occur at the first prenatal visit. For minimalizing the risks of adverse outcomes it is crucial to thouroughly estimate the present pathology, considerate concomitant pharmacology therapy if necessary, and considerate possibilites regarding the delivery. Keeping track of such women requires an interdsciplinary approach that includes gynecologist and obstetrician specialists, cardiologists and anesthesiologists who have to give special consideration to the fact that all measures concern not only the mother, but the fetus as well. The highest rate of heart problems in pregnancy make congenital heart diseases and hypertension, with preeclampsy included complicating up to 15% pregnancies, followed by cardiomyophaties, arrhythmias, and coronary artery disease.
Keywords
trudnoća
srčane bolesti
kardiovaskularne prilagodbe
planiranje trudnoće
interdisciplinarni pristup
Keywords (english)
heart diseases
pregnancy
cardiovascular adaptations
preconception counseling
interdiciplinary approach
Language croatian URN:NBN urn:nbn:hr:105:798439 Study programme Title: Medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2019-01-08 10:03:28
