Heart disease is one of the most dangerous, and when it comes to children, the prognosis can be extremely disappointing. It is not always possible to detect such an ailment at an early stage of development, therefore the pathological process proceeds as severe and causes serious consequences. Carrying a child is often accompanied by certain difficulties, problems with the main organ in a baby are often encountered. Heart disease during pregnancy in the fetus is considered a deadly disease, but medicine can help these children.
The structure of the heart is unique, the organ is made up of muscle tissue that constantly contracts to pump blood through the arteries of the body. Normal blood circulation creates all the conditions for the full activity of all body systems. If a failure occurs in this process, the delivery of oxygen and other nutrients to the organs is disrupted, causing various pathologies. The heart is divided by chambers, of which there are four. The upper two compartments are called the atria, and the lower compartments are called the ventricles. The blood first flows into the atria, and then into the cavity of the ventricles, and only from there it enters the heart valves, which are also four, then into the main arteries.
Any congenital malformation of the main organ is a serious problem resulting from intrauterine fetal development disorders. The disease can manifest itself in children immediately after their birth, and sometimes symptoms are completely absent until a certain age of the child. The disease itself is an anatomical defect that occurs in the region of the main organ, its vessels, and also the valve apparatus. Statistics show that a fetal heart defect during pregnancy is found in 7-8 cases out of a thousand births. As sad as it may sound, but it is this pathology that is the most common cause of death in babies.
Such ailments are very diverse, the prognosis of the disease and the method of treatment depend on their variety.
Currently, medicine knows more than a thousand varieties of heart defects in a child and a fetus in the womb. Depending on the form of such a disease, a change in the shade of the skin of children at birth is distinguished. If the baby has a tatrada of Fallot, clogging of the openings of the artery of the lungs, the wrong position of the trunk of the pulmonary artery or the aortic organ, then the color of the child's skin, especially in the area of the mouth, ears and body, will be bluish at birth. In addition, such manifestations can be observed and intensified when the baby is breastfeeding or severe crying.
White heart disease of the embryo indicates that this baby will be pale at birth. Further, in an older period, the tips of the fingers and toes in these patients may become cold. If pregnancy is accompanied by such a serious pathology as defects in the heart area, then this is usually detected on a planned ultrasound scan - the doctor hears noises in the work of the main organ of the fetus. This ailment can proceed without the presence of symptoms, but when the child turns 10 years old, the disease will declare itself, preventing the little person from living normally.
Reasons for development
The formation of the heart of the embryo occurs at 5-8 weeks of gestation, therefore it is important during this period to protect the expectant mother from various negative influences. If at this time of pregnancy there was some slightest malfunction in the body, this may affect the main organ of the child. Certain diseases that a woman has had throughout the entire period of expectation of the baby can provoke a heart defect in the fetus, which will be visible on the Uzi.
Dangerous diseases:
- scarlet fever;
- piggy;
- measles;
- rubella.
These diseases are very dangerous for any pregnant woman, and if, nevertheless, a similar ailment struck the expectant mother, more often doctors recommend interrupting the gestation. In addition, there are many more factors that can cause such abnormalities in the embryo.
Common reasons:
- Hereditary factor.
- Diseases of the chronic course.
- Infectious diseases.
- The influence of medications.
- Radiation is radioactive.
- Bad habits.
- Disorder of metabolic processes associated with hormones and other substances.
- Wrong diet.
All these factors are associated with the pregnant woman herself. In addition, fetal hypoxia also has a negative effect on the embryo. Scientists have put forward the theory that chromosome defects also lead to heart defects in babies, as well as the harmful effects of the environment. Medications taken by expectant mothers for a long period can affect the heart of the fetus.
What medications can affect:
- tranquilizers;
- antibacterial drugs;
- hormonal agents;
- antiviral medicines.
Many women are unable to conceive on their own and resort to in vitro fertilization. The process of preparing for this manipulation involves taking a large amount of drugs, hormonal or antiviral, which in the future negatively affects the health of the baby and can provoke violations in the field of the cardiovascular system.
The presence in future mothers of such infections as ureaplasmosis, cytomegalovirus, herpes virus, leukoplasmosis or Coxsackie virus affects the development of the fetus negatively, leading to a large number of pathologies. They are the most dangerous factors provoking heart defects in a baby. Diseases can be asymptomatic when patients are unaware of their existence in their body, which further aggravates the situation. Such viral infections can be detected only with the help of special tests, and they cannot be treated - there is only an opportunity to reduce their activity.
In addition to these diseases, there are many more varieties of conditions that are not fully understood, and their effect on the body of the expectant mother and the embryo is unknown. The Coxsackie virus is just such an ailment, it has a mass of species, and the symptoms are weak. The influence of such a disease often leads to termination of pregnancy and other deplorable facts.
Speaking specifically about vices, viruses provoke extremely serious disorders, this is due to the fact that such ailments affect the formation of the heart during an important period when the process of cell differentiation lasts. This leads to complex defective changes in the structure of the organ. Taking as an example 8 pregnant women who have not been treated for similar diseases, and 6 of them will have children with anatomical disorders in the left side of the heart, which in the future will have the greatest burden.
Diagnostics
The study of all aspects of pathology before the onset of childbirth is the main point in deciding on the methods of therapy. The baby's condition at birth depends entirely on the accuracy of diagnostic measures and the actions of doctors. Doctors decide what to do with a fetal heart defect during pregnancy.
Inspection methods:
- ultrasound method for studying the heartbeat and organ structure;
- echocardiography;
- genetic karyotyping (very rare).
The doctor can accurately make such a diagnosis immediately after a woman undergoes an ultrasound scan. Due to the fact that this method has improved, it is possible to identify such a fruit defect at an early gestation period, at 14-15 weeks. When the expectant mother skips this procedure at the due date, it is necessary to carry it out at a later stage, at 18-20 weeks. It is at this time that all cardiac disorders are available to physicians. It is important that the fetal heart defect on an ultrasound scan is studied by an experienced doctor who can make a targeted diagnosis by studying the details of the pathology.
If such deviations in the baby are confirmed, there is no need to panic, this will only worsen the health of the child. The main thing is to timely conduct an ultrasound examination at a later period of gestation, so that it becomes clear how the myocardium contracts, whether fluid accumulates in the pericardial region. Such deviations usually indicate an intrauterine infection, but they can be eliminated with the help of medication before the onset of labor.
When heart disorders are of organic origin, it will not be difficult to diagnose them either, but it is necessary to treat them in a hospital setting, under the supervision of a cardiologist. Echocardiography is prescribed for pregnant patients already in the third trimester of gestation, at 33-34 weeks. This procedure allows doctors at the time of delivery to understand what the anatomical features of the defect are.
Some types of pathologies arise due to chromosomal mutations, then genetic karyotyping must be carried out. This procedure is invasive, and the purpose of such a study is to study the cells of the fetus, but doctors resort to it only in extremely rare cases. More than 50% of all severe defects in babies in the womb occur together with Down's disease. This situation often ends with the termination of pregnancy, the doctor will advise the woman to have an abortion. These babies are born in a serious condition, they will not be able to undergo surgery, and it is also dangerous to administer anesthesia to them.
Treatment
Despite the severity of the defect, the child needs to undergo surgery. This is the only way to correct the defect. If the baby was born with extremely serious heart disorders, then surgical intervention is performed in the first hours of his life or days. Since the main organ is constantly growing, along with the whole body, some violations of the structure of the heart can be eliminated only after the little patient reaches puberty. If it is not possible to postpone the operation, then it is carried out immediately, and after several years, another one is done. Sometimes, if a defect in a defect is diagnosed as a violation of the interventricular septum, then after a certain period the septum will close on its own.
After surgery, antibacterial agents are usually prescribed to the child, which is necessary for prevention. Such events are associated with the fact that infectious pathologies can affect the heart, the inner layer of the organ, valves and the endocardium. Until the treatment is completely completed, active games are contraindicated for babies so that increased loads do not have a negative effect on the heart valves.
Prevention
Pregnancy planning is one of the most reliable prevention methods. Today, few people are preparing for this crucial step, usually a child turns out by accident. Many parents hope for their health and believe that if they feel good, then there will be no problems with bearing a baby.
Due to the fact that the formation of the heart occurs in the first trimester of pregnancy, namely at 5-8 weeks, special attention should be paid to this particular period.
Often, women do not yet know that they are expecting a baby. The fifth week of the term is especially important, since during this period the processes of separation of all parts of the organ take place. Any, even the slightest violation of this program can lead to defects in the formation of the heart. Even one pill or a glass of alcohol can work in this way.
If a pregnancy is planned, then certain recommendations should be followed.
Prevention methods:
- Nutrition should be healthy and correct, include fruits, vegetables, lean meat, dairy products. It is necessary to remove fatty and fried foods, as well as smoked meats and fast food from the diet.
- Daily walks along the street, the duration of which is at least 3 hours.
- Regular visits to medical institutions for routine examinations.
- Eliminate excessive physical and emotional stress.
- Complete rejection of bad habits in the form of alcohol consumption, smoking.
A woman who wants to give birth to a healthy baby is simply obliged to monitor her lifestyle and protect herself from any harmful effects.
Fetal heart disease during pregnancy is often detected, but there are techniques to eliminate this defect. However, do not forget that deaths are also observed, even after timely surgical intervention. If, when carrying a child, a similar pathology was found, then you should seriously approach the solution of this issue and follow all the prescriptions and recommendations of the attending doctor. Treatment during pregnancy and the correct actions of doctors immediately after childbirth allow us to hope for a favorable outcome and full recovery of the baby. In most cases, these children grow up healthy, and are able to live a normal life, not limiting themselves in anything.
Congenital heart defects(CHD) are one of the most common developmental anomalies and, according to statistics, occur with a frequency of 7-12 cases per 1000 newborns. CHDs attract close attention of researchers around the world, not only due to their high frequency, but also because they are the main cause of death in children under one year of age. Among children born with CHD, 14-29% die in the first week of life, 19-42% - during the first month, and 40-87% of babies do not live to one year.
According to the state statistics congenital anomalies report in the Russian Federation, from 1997 to 2001, there has been a steady increase in the number of newly registered UPUs. According to this report, the infant mortality rate from malformations tends to decrease, while the losses from congenital heart disease remain practically unchanged, and in the structure of mortality from congenital malformations, almost 50% falls on congenital heart disease.
The whole story world prenatal echography proves that the basis for the diagnosis of any congenital malformation is a well-organized system of screening examination of pregnant women. The presence of a state screening program, a clear interaction of specialists at the I and II levels of examination, the introduction of national registers of congenital and hereditary pathology - all these factors significantly affect the quality of antenatal diagnostics, in particular, the detection of congenital heart disease in the fetus.
According to the data multicenter European study... the sensitivity of prenatal echography in the diagnosis of CHD at the I screening level in the late 90s. amounted to 25%. Since the conditions and organization of prenatal examination differ significantly in different countries, this indicator varied within a very wide range from 3 to 48%. It should be noted that with isolated CHDs, the accuracy of prenatal diagnosis was significantly lower in comparison with combined CHDs - 6 and 49%, respectively.
Held in our country multicenter prenatal detection test UPU in the late 90s. showed that in 28 constituent entities of the Russian Federation, the accuracy of prenatal diagnosis of congenital heart disease averaged 18.3%. The division of all respondents into two groups (level I of the examination and the centers of prenatal diagnosis (CPD)) made it possible to establish that the detection rate of CHD at level I averaged only 9.5%, and in regional CPD - 43.4%. According to the results of many foreign and domestic specialists, the sensitivity of prenatal echography in the diagnosis of CHD, provided that screening ultrasound examinations are carried out in the CPP, can reach 80-90%.
So, according to the CPD at the clinical maternity hospital No. 27 in Moscow, the accuracy of prenatal diagnosis of congenital heart disease in recent years was 85.7-92.3%. In two CPDs in Krasnoyarsk, the accuracy of prenatal diagnosis of congenital heart disease in 2002-2003. was 64.6%, and 88.1% of defects were diagnosed before the onset of fetal viability. According to the results obtained by N.N. Smirnov and I.T. Stremoukhova in the city of Orel, 90% of CHD were diagnosed prenatally. At the same time, it was noted that the use of a four-chamber slice made it possible to diagnose only 20% of all CHD and in another 40% of cases to suspect other cardiovascular anomalies.
According to the data center in the city of Orenburg, with the exclusion of clinically insignificant CHD from the analysis, the accuracy of prenatal diagnosis of cardiovascular anomalies in 2000-2001. amounted to 91-93%.
Thus, already in several regions it has been proven that an effective prenatal diagnosis of congenital heart disease can be achieved only with the implementation of screening "anatomical" ultrasound studies in the II trimester in conditions of CPP (II level of examination) by trained specialists and on expert or high-class devices. This scheme of screening ultrasound examination in the second trimester of pregnancy has already become dominant in many European countries, and in our country it is used so far only in a few regions. The most important thing in this scheme is the implementation of a mandatory comprehensive assessment of a four-chamber cut of the heart and a cut through three vessels.
Congenital heart defects and pregnancy
Currently, there is a lot of evidence of the possibility of anomalies in the development of the fetus when exposed to some harmful factors. Employees of the Department of Obstetrics and Gynecology of the I Moscow Medical Institute V.I.Bodyazhina, M.N. Kuznetsova, A.P. Kiryushchenkov and A. Yu. on animals, various developmental anomalies, including malformations of the cardiovascular system of the fetus. According to reports from Hiroshima, after the explosion of the atomic bomb, the number of various malformations and, in particular, anomalies of the cardiovascular system in the area increased. Barkani managed to cause various congenital anomalies in young animals by monotonous nutrition and exclusion of certain substances and vitamins from food.
MK Ventskovsky (1960), in experiments on pregnant female rabbits, showed that the complete exclusion of proteins, both organic and vegetable (protein-free diet) from the diet, leads to premature birth of fetuses with deformities.
Wilson and Warkany (1949) in an experiment on female rats found that nutritional deficiency of vitamin A and complex B during pregnancy leads to the development of congenital heart defects in the offspring, in particular, ventricular septal defects and anomalies of the aortic arch.
A number of authors believe that fetal malformations can be caused by hormonal disorders in a pregnant woman. So, there are cases of congenital heart defects in children born to women with diabetes or hyperthyroidism. EP Romanova (1961) found congenital heart defects in 3 of 88 children born to women with diabetes (ventricular septal defect; significant atrial septal defect; narrowing of the aortic isthmus in combination with patent ductus arteriosus). Due to the fact that with congenital heart defects, intrauterine endocarditis is relatively often detected (VF Zelenin, 1952), some authors consider the cause of an anomaly in the development of the heart to be infection. Against this view, the absence of an inflammatory reaction to the introduction of infection from the fetus up to 7 months of intrauterine life speaks. Only in a later period does the fetus develop protective reactions against infection.
Many authors attach the greatest importance in the origin of anomalies to the development of the heart to viruses. Viruses receive a favorable nutrient medium in the tissues of the embryo; immature tissue elements of the fetus are the most vulnerable. Therefore, the danger to the fetus with a viral infection of the matter in the first months of pregnancy is very high. The development of tissue affected by a viral infection stops, as a result of which the growth of the septa of the heart may stop.
Greeg (1941) drew attention to the fact that rubella as a viral disease during the first 4 months of pregnancy is fraught with the risk of damaging the fetus. These observations were confirmed by E. M. Tareev and other authors. With a rubella disease of a pregnant woman in the early stages of pregnancy, the following triad is relatively often observed in the fetus: damage to the lens, inner ear and heart. Heart defects occur in 50% of cases.
Schick points out that the rubella and smallpox virus, even in the presence of immunity in the mother, can cross the placenta and cause impaired fetal development. However, according to the literature, covering 4951 cases of congenital heart disease, it turned out that rubella in the mother during pregnancy was only 0.8% of all cases (Yonash). Thus, the question of the risk of rubella in the mother to the fetus requires further study.
Clinical cases of congenital heart defects in the fetus were noted after the mother's illness during pregnancy with measles, mumps, chickenpox, poliomyelitis, infectious hepatitis.
Who needs fetal echocardiography?
Fetal echocardiography (ultrasound of the fetal heart) is recommended if there are certain indications from both the mother and the fetus. The presence of risk factors (see below) on the part of the mother is a direct indication for fetal echocardiography. As for the testimony from the fetus, they come to light only after ultrasound of the fetus at any stage of pregnancy and are determined by the specialist conducting the study.
Indications or risk factors for which a pregnant woman must undergo fetal echocardiography?
To date, there is no precise information indicating specifically any causes development of congenital heart disease in the fetus (the highest risk of developing heart disease in the fetus is up to 7 weeks of pregnancy).
However, there are factors (other than genetic factors) that, at some stage, can affect the embryological development of the fetal heart. Such factors are called risk factors and women in whom such factors are noted are referred to the "risk group" for the occurrence of congenital heart disease in the fetus. The presence of such risk factors in a pregnant woman is a direct indication for an expert-level fetal echocardiography.
Indications (from the mother's side) for expert echocardiography (ultrasound of the heart) of the fetus include:
- The presence of congenital heart disease (CHD) in the mother or father of the child
- Previous child or fetus with congenital heart disease or complete atrivoventricular (AV) block
- Maternal metabolic disorders:
- maternal diabetes (insulin-dependent, Type 1 or gestational, Type 2)
- maternal phenylketonuria
- Taking some medications (before and after the moment of conceiving a child):
- some antiepileptic drugs (risk is higher with polytherapy)
- lithium
- some antidepressants
- a group of drugs that lower blood pressure (angiotensin-converting enzyme inhibitors)
- Maternal therapy with nonspecific anti-inflammatory drugs (indomethacin and other NSAIDs) between 25 and 30 weeks of pregnancy
- The presence of viral and other infections such as rubella, cytomegalovirus, parvovirus B19, toxoplasmosis in the mother
- Diseases of the mother's connective tissue
- Increased maternal blood pressure (hypertension)
- Maternal thyrotoxicosis
- Abuse by the mother of alcohol, cocaine, mariuhana
- All fruits obtained by in-vitro fertilization, IVF method
If you took any medications before or after the moment of conceiving a child, you must definitely inform not only your obstetrician-gynecologist, but also the doctor who conducts an ultrasound of the fetal heart and be sure to indicate this in the questionnaire.
Indications for fetal echocardiography on the part of the fetus (fetal factor) include
- Suspected fetal congenital heart disease and arrhythmias during routine screening.
- Collar space thickness (TVP ≥3.5 mm)
- Fetal arrhythmias (bradi -< 100 в мин, тахи — ≥ 180-200 в мин, частые эктопические сокращения)
- Fetal conditions that can cause the failure of his heart:
- tricuspid regurgitation detected in the 1st trimester
- a-reverse wave in the ductus venosus detected in the 1st trimester
- TTTS (fetal fetal transfusion) syndrome
- monochorionic twins (MA and YES)
- venous agenesis
- fetal anemia
- arteriovenous fistula
- single umbilical artery
- persistent right umbilical vein
- Chromosomal abnormalities and microdeletions:
- Trisomy 21 (Down syndrome), trisomy 13 (Patau syndrome), trisomy 18 (Edward syndrome), XO anomaly (Turner syndrome), 22q11 microdeletion (De George syndrome) or
- genetic syndromes (CHARGE association, VACTERL association) and familial syndromes accompanied by cardiomyopathy (Noonan syndrome)
- Fetal edema, hydrothorax, polyhydramnios
- Other extracardiac defects:
- omphalocele, diaphragmatic hernia, duodenal atresia, esophageal atresia (VACTERL association), tracheoesophageal fistula, fetal cystic hygroma,
- kidney abnormalities (renal agenesis, renal dysplasia, horseshoe kidney)
At what time of pregnancy is fetal echocardiography performed and is it possible to diagnose congenital fetal heart defects?
At 11-14 weeks of gestation
In our center, during the screening for Down syndrome (11-14 weeks), the doctor always assesses not only the structures of the heart itself, but also ultrasound markers for the presence of congenital heart disease in the fetus, which include the assessment of blood flow through the tricuspid valve and in the venous duct.
The size of the heart at this stage of pregnancy is equal to a grain of rice. despite this, the chambers of the heart with a high-tech ultrasound machine and a good specialist can be seen. However, not all heart defects can be detected during examination in this period, defects can be diagnosed that change the anatomy of the 4-chamber heart section, such as hypoplasia of the left heart, tricuspid atresia and pulmonary atresia with an intact interventricular septum, AVK. These are usually severe forms of defects, often inoperable and incompatible with life. Therefore, it is very important to examine the heart early.
Fetal heart at 12 weeks, aortic arch
Fetal heart at 13 weeks, 4-chambers of the heart: the atria and ventricles, and the blood flow that runs from the atria to the ventricles.
The fetal heart is at the level of the main vessels: the aorta and pulmonary trunk.
Heart defects that are associated with a violation of the anatomy of the great vessels can be missed in the early stages, since their visualization is significantly reduced during this period.
If a congenital heart defect is suspected, a repeated ultrasound examination of the fetal heart at 15-16 weeks of gestation may be recommended.
If a congenital heart defect is detected at 11-14 weeks and the pregnancy is prolonged, the next examination of the fetal heart should be carried out at 16 weeks of pregnancy and at 19-22 weeks of pregnancy, and this woman should be observed throughout the entire pregnancy.
At 19-22 weeks of gestation
- this is the most optimal time for echocardiography of the fetus and the diagnosis of congenital heart disease.
In some cases, when the fetus is not in the optimal position, the pregnant woman is overweight, and the amount of amniotic fluid is low, visualization of the fetal heart can be difficult. In such situations, a re-examination may be recommended either every other day or within a week.
When a congenital heart defect is detected, dynamic monitoring of the fetal heart condition should be carried out every 4 weeks of pregnancy, at 24, 28, 32 and 36 weeks.
If a fetal heart defect is suspected, fetal echocardiography can be performed at any time during pregnancy.
When is fetal echocardiography recommended in early pregnancy (13-16 weeks)?
- if one of the parents has a congenital heart defect (if the mother had a heart defect, then the risk that the child will develop a congenital heart defect is 6%, if the father has a lower risk and is equal to 2-3%)
- if you have a congenital heart defect in a previous child or fetus (if one of the previous children or fetuses had a congenital heart defect, then the risk that the unborn child will have a CHD is 3-5%; if two previous children or fetuses had a CHD, then the risk that the child will be born with a congenital heart defect) increases significantly and is equal to 10%
- suspicion of a heart anomaly during screening in the 1st trimester (at 11-14 weeks);
- an increase in the thickness of the collar space, more than 3.5 mm during screening at 11-14 weeks;
- the presence of a-reverse wave in the ductus venosus during screening at 11-14 weeks (it is one of the markers of chromosomal abnormalities in the fetus, in 5% of cases it is a marker of congenital heart disease)
- the presence of tricuspid regurgitation in the right heart (is one of the markers of chromosomal abnormalities in the fetus, in 5% of cases it is a marker of the presence of congenital heart disease in the fetus).
What should be done if an a-reversible wave in the ductus venosus is found in the fetus at screening at 11-14 weeks?
A - a reverse wave, is a wave of reverse blood flow in a small but very important vessel in the liver, which is called a venous duct. In 95% of cases, the a-reversal wave disappears over the next several weeks, usually by 16 weeks; however, in 5% of cases, it may indicate the presence of a congenital heart defect. In this connection, when detecting a-wave in the venous duct, it is recommended to undergo extended echocardiography of the fetus in the early stages of pregnancy, or at least at 20 weeks.
What if a fetus has tricuspid regurgitation at screening at 11-14 weeks?
Tricuspid regugitation is a wave of reverse blood flow in the right ventricle of the heart. In 95% of cases, tricuspid regugitation disappears over the next few weeks, usually by 16 weeks; however, in 5% of cases, it may indicate the presence of a congenital heart defect. Therefore, it is recommended to undergo extended fetal echocardiography early in pregnancy, or at least 20 weeks.
Can all congenital heart defects be diagnosed by echocardiography before the baby is born?
Unfortunately, not all congenital heart defects can be seen with ultrasound of the fetal heart, even with the most detailed examination and on the most advanced ultrasound machine. A number of congenital heart defects remain undiagnosed during the prenatal period either because of their lack of expression, or because they appear only after the child has established an adult type of blood circulation after birth. Such vices include:
- Patent ductus arteriosus
- Secondary atrial septal defect
- Adult type of coarctation of the aorta
- Small-sized ventricular septal defect
- Mild (hemodynamically insignificant) valve abnormalities
- Incomplete abnormal return of pulmonary veins
- Other rare malformations
What can happen if a congenital heart defect was missed by an ultrasound scan of the fetus, or what are the benefits of diagnosing heart defects before and not after the birth of the baby?
Some of the congenital heart defects are incompatible with life and cannot be surgically corrected, or can lead to intrauterine fetal death, especially if the fetus has other extracardiac developmental anomalies or leads to varying degrees of disability. In such situation timely diagnosis will allow you to make a decision to terminate a pregnancy in time (and early detection of a heart defect will allow you to terminate a pregnancy at an earlier date, which is much less traumatic for a woman both from a psychological point of view and from the point of view of the method of termination, that is “The earlier a heart defect was diagnosed, the better”).
Some fetal heart defects, such as transposition of the main vessels of the fetal heart, require surgical intervention immediately after the birth of the child, while the ductus arteriosus is open (the ductus arteriosus normally closes after the birth of the child), and if such a heart defect is missed, delivery cannot be ensured. specialized institution, and not to operate on the child in time, this can lead to complications or even death of the newborn. With the development of complications, the subsequent surgical intervention may not give such good results, while the timely correction of the defect provides a good life prognosis for the child. Some defects, such as coarctation of the aorta, require medication to keep the ductus arteriosus open and prepare the child for surgery. And prenatal diagnosis of just such heart defects that require both surgical correction soon after birth and supportive drug therapy is vital. This is especially true for remote areas that do not have a specialized medical service nearby; prenatal diagnosis of congenital heart disease allows you to organize childbirth in a specialized medical institution and the timely adoption of medical measures.
There is a number of significant studies devoted to this problem. Summing up their results, we can say that intrauterine diagnostics unambiguously provides a number of advantages, and the following can be attributed to them:
- Higher survival rate for newborn / child
- Better pre-operative condition of the newborn / child
- Lower frequency of recurrent (repeated) surgeries
- Shorter hospital stay
- Lower mortality in long-term periods
Why me? Why exactly my child?
When parents find out that their unborn child has been diagnosed with a congenital heart defect, they begin to blame themselves and ask themselves and the doctors if they did something wrong during pregnancy, and if so, what? Why did their child develop a heart defect? This is a normal condition for parents, but parents should be aware that yes, there are certain risk factors (see the website), possibly changing at some stage the usual course of development of heart structures in the embryonic period, however, the problem is that 80% of newborns with CHD are born to parents with an unknown risk factor. According to statistics, today congenital heart defects develop in 7 pregnancies out of 1000. In more than half of cases, these are minor heart defects that do not require treatment or can be successfully corrected after the birth of a child.
Atrial septal defect is a congenital anomaly of the heart (congenital defect). With an incomplete defect, there is a hole between the partitions, and with a complete defect, there is no partition at all. The disease is characterized by the presence of communication between the right and left atria.
Causes of development and risk factors
Atrial septal defect is a genetic disorder. If a child has close relatives suffering from a heart defect, more attention should be paid to his health.
Also, this disease can develop due to external causes. During pregnancy, you should stop smoking and alcohol, take medication only under the supervision of your doctor. A congenital defect can appear if the mother of the child during pregnancy was sick with diabetes, phenylketonuria or rubella.
Forms
Defects are distinguished by the size and shape of the holes between the atria:
- Primary.
It is usually characterized by a large size (from three to five centimeters), localization in the lower part of the septum and the absence of a lower edge. The underdevelopment of the primary interatrial septum and the preservation of the primary message are attributed to this form of the defect. Most often, patients have an open antrioventicular canal and splitting of the tricuspid and bicuspid valves.
- Secondary.
It is characterized by an underdeveloped secondary septum. Usually this is a small lesion (from one to two centimeters), which is located in the area of the vena cava orifices or in the center of the septum.
- Complete absence of a partition.
This defect is called a three-chambered heart. This is due to the fact that due to the complete absence of the septum, a single common atrium is formed, which may be associated with abnormalities of the antrioventicular valves or with asplenia.
Complications and consequences
Small defects are quite difficult to detect - some people only learn about their illness in old age. With a large defect, life expectancy can be reduced to 35-40 years.
Over time, this problem leads to a depletion of the restorative resources of the heart, which can lead to the development of pulmonary diseases, heart failure, pulmonary hypertension, and also lead to frequent fainting or even stroke.
Symptoms
In childhood and adolescence, it is often quite difficult to recognize a small to medium defect, since it does not bring any obvious inconvenience. It is much easier to recognize a large defect, since rather pronounced symptoms appear with it:
- shortness of breath that occurs during physical exertion;
- susceptibility to respiratory tract infections;
- pallor or even cyanosis of the skin;
- weakness, fatigue;
- violation of the heart rhythm.
If the patient observes one of the above symptoms, or the parents pay attention to the child's capriciousness, tearfulness, lack of desire to play for a long time with other children, then you should consult a pediatrician or a therapist. Next, the doctor will conduct an initial examination and, if necessary, give a referral for further examination.
Diagnostics
Various methods are used to identify the disease. For further instructions, you should contact your pediatrician or therapist, who, based on the analysis of complaints from the patient or his parents, can refer you to a cardiologist.
First, a history of the patient's life is collected (whether his relatives have congenital heart defects, how the mother's pregnancy proceeded), and then they give a referral for the following tests: general urine analysis, biochemical and general blood tests. Based on the results obtained, it is possible to find out how other internal organs function, and whether this is related to the work of the heart.
A general examination, auscultation (listening to the heart), percussion (percussion of the heart) are also carried out. The last two methods make it possible to find out whether there are changes in the shape of the heart and whether there are noises characteristic of this defect. After the studies have been carried out, the pediatrician or therapist decides whether there is a reason for further diagnosis.
In the event that the doctor suspects the patient has a congenital heart defect, more complex research methods are used:
- X-rays of the chest organs show changes in the shape of the heart.
- Electrocardiography (ECG) makes it possible to observe abnormalities in the conduction and rhythm of the heart in a patient, as well as an increase in the right sections.
- Echocardiography (EchoCG), or ultrasound. When using a two-dimensional (Doppler) method, you can see where the septal defect is located and its size. In addition, this method allows you to see the direction of the discharge of blood through the hole.
- Probing (insertion of a catheter) helps to determine the pressure in the cavities of the heart and blood vessels.
- Angiography, ventculography and magnetic resonance imaging (MRI) are prescribed in cases where other research methods were not indicative.
Treatment methods
One of the methods of treating minor defects that do not complicate the patient's life is a conservative method of treatment. In addition, this type of treatment is also used in cases where an operation that was not performed on time was the result of the development of diseases such as myocardial ischemia and heart failure.
Surgical intervention is recommended for patients aged 1 to 12 years. This is due to the fact that at this age the body has already adapted to the changes that have occurred in the body due to an atrial septal defect, and there is no longer any possibility of self-closing of the defect. At the moment, there are two ways to close the defect.
Open operation
If the size of the hole is less than four centimeters, then open heart surgery can be performed. During the operation, a heart-lung machine is used, most often with cardiac arrest.
Depending on the size of the defect, the method of its elimination is also determined: suturing the defect (no more than 120 millimeters) or installing a patch from its own pericardium.
The recovery period lasts about a month. At this time, it is necessary to monitor nutrition and refrain from physical activity.
Endovascular occlusion (closed)
This method of surgical intervention consists in the fact that a catheter with an occluder (plate) is inserted through the femoral vein, which is then directed into the right atrium. Then the occluder closes the hole, "seals" it.
This method of performing the operation has a number of advantages over open surgery: there is no need for general anesthesia, there are few injuries, and a quick recovery period is only a few days.
Forecasts and preventive measures
In order to prevent the development of an atrial septal defect in children, the mother needs to register with the antenatal clinic on time during pregnancy.
You should exclude smoking, drinking alcohol, adhere to a proper diet and take medications only as directed by your doctor. It is also worth telling the gynecologist who is managing your pregnancy about the presence of relatives suffering from congenital heart disease.
Today, it is quite simple to identify an atrial septal defect in children, heart defect in newborns in most cases is detected during ultrasound examination. If the disease was not detected immediately after birth, but you have suspicions, you should consult your doctor.
How long does an ultrasound scan show how the fetal heart beats?
When is a fetal heartbeat heard on an ultrasound scan? It sounds trite and trite, but pregnancy is the most exciting and at the same time alarming time in the life of every woman. For 9 months she has to go through many procedures, in particular those that assess the development of the baby's cardiovascular system. Starting from what week after fertilization, can you first hear how his heart beats?
How does a child develop
According to experts, the time from 3 to 5 weeks (determined by the analysis of hCG) after conception or embryo transfer with IVF is the most important in its development. In appearance, it looks like an auricle, which allows doctors to see the back and limbs well.
At this stage, the spinal cord is released, from which the spinal cord and spine will subsequently develop. If the process proceeds without disturbances, the end of the neural tube is flattened.
And also the formation of the so-called somites begins, cells that are responsible for the formation of absolutely all tissues.
In this early period of development of the crumbs, the rudiments of the cardiovascular system are laid. Its elements develop so quickly that the largest vessels can already be seen on ultrasound. They are located in the center of the embryo, maintaining a close connection with the tissue clot that will become the heart in the future. It should be noted that this tissue takes part in the development of many organs and systems.
Among them:
- respiratory tract (trachea, larynx);
- pancreas;
- liver;
- sex cells.
It is interesting. Despite the appearance of the rudiments of the cardiovascular system, it is impossible to hear the heartbeat even with the help of the most powerful ultrasound machines.
The rudiments of the heart are located in the cervical region. During their formation, the size of the embryo hardly reaches 2 mm, so it is not possible to consider or control what is happening.
The whole process consists of several stages.
- Two separate tubes appear, called endocardial tubes.
- The tubes are joined together.
- From the fourth week after conception (obstetric time plus 2 weeks), the heart tube is divided into 2 parts: right and left. A primary septum is formed between them, which has an oval window. It will not overgrow until the moment of delivery. The hole will only close when the newborn inhales for the first time.
- Starting from the fifth week, the formation of a septum occurs. The endocardium and myocardium are involved in this process. It takes about 3 weeks.
- A small opening appears between the ventricles and the atria, which, starting from week 7, will be closed by a valve.
- At the onset of 6 weeks, the first heartbeats occur. They can be seen and heard during ultrasound examinations.
The heart takes the same shape as in adults by 8 weeks. It is at this time that it becomes four-chambered.
The number of heartbeats depends on two factors:
- child's activity;
- gestational age.
For example, at 6-8 weeks, the heart rate is 110-130 beats per minute. Before 11 weeks, it often reaches 190 strokes, and after 11 it ranges from 140 to 160 and remains so until later.
Starting from the second trimester, you can listen to the heart beating with the help of a stethoscope. One side of it is applied to the woman's abdomen, and the other is leaned against the ear by the doctor.
What does ultrasound show?
Why is an ultrasound of the fetal heart prescribed at different stages of pregnancy?
With its help, the doctor can see several indicators:
- Heart rate. As mentioned above, it depends on the term and condition of the baby.
- Where is the heart. It should be located on the left side of the chest and occupy one third of it.
- How rhythmically the organ contracts.
If at the first ultrasound some indicators do not correspond to the norms, after about 7 days the specialist will prescribe another one.
All subsequent procedures carried out in the second and third trimester help to control the general condition of the child and notice overload in time. Sometimes, in addition to planned, it is necessary to do several additional studies of cardiac activity.
There are several such cases:
- the expectant mother suffers from diabetes mellitus;
- the woman is over 38 years old;
- there were infectious diseases;
- there are violations in the development of the fetus;
- the woman has a heart defect.
There are only four deviations from the norm:
- the heart beats at a frequency of less than 120 beats per minute;
- the frequency is higher than 170 beats;
- the heartbeat is not heard well;
- the heartbeat is completely absent.
What does each of them mean?
The heart rate below normal in the early stages is:
- erroneously set deadline;
- normal development of the fetus;
- the risk of miscarriage (cases when the heart rate is below 80).
After 12 weeks, this indicates a chronic form of hypoxia or compression of the umbilical cord. During childbirth, the heart rate decreases with acute hypoxia.
If the number of heartbeats is more than normal, in the early stages this may be evidence of abnormalities in the formation of the placenta. After 12 weeks, the baby may react this way to his movements or suffer from a lack of oxygen. During childbirth, a rapid heart rate also indicates hypoxia or fetal response to contractions.
There are several reasons why heart sounds are heard poorly in the early stages:
- incorrectly defined term;
- overweight in mom;
- a heart or blood vessel defect in a child.
And if the heartbeat does not listen well in a later period?
This may be the result of such conditions:
- obesity in a woman;
- insufficiency of the placenta;
- placenta previa;
- excess or lack of amniotic fluid;
- uncomfortable position of the crumbs;
- defect of the heart or blood vessels.
If the tones are practically not heard during childbirth, this is either a reaction to strong contractions or hypoxia.
The complete absence of heartbeat in the early stages threatens spontaneous abortion. This is usually a sign of a frozen pregnancy. Sometimes the heartbeats are not visible due to faulty equipment.
If the heartbeat is not heard in the other two trimesters, one can judge the antenatal death of the child. The same goes for childbirth. There are times when it becomes necessary to control the fetal heartbeat during childbirth, from the moment the contractions begin until its very birth.
There are several of them:
- epidural anesthesia was administered to relieve pain;
- the child is lagging behind in development;
- the woman is pregnant with two or more fetuses;
- labor started ahead of schedule;
- pregnancy is post-term (42 weeks or more);
- the baby suffers from hypoxia;
- generic activity had to be stimulated;
- the pregnant woman suffers from preeclampsia;
- there are chronic diseases.
Usually, to assess the heart rate, the doctor prescribes an ultrasound scan. The study helps to assess not only this parameter, but also to see the state of the placenta and the size of the fetus. Particular attention is paid to women whose older children were born with diseases of the heart and blood vessels, as well as those who have had infectious diseases.
Another diagnostic method is auscultation, which determines the heartbeat with a stethoscope. It can be used by a person without special education. It is enough to attach the device with one side to the stomach and the other to the ear.
It is very difficult to often listen to how the heart beats in this way.
And there are several reasons for this:
- overweight;
- the location of the placenta on the anterior wall;
- lack of water or polyhydramnios.
Heart rate can also be monitored using CTG or cardiotocography. According to reviews on the forums, this is a fairly informative method. It allows you to determine hypoxia even at an early date.
The recording device is a small ultrasonic sensor. It receives the signal from the child and displays it on tape. It also records the number of contractions of the uterus (contractions).
The newest CTG devices allow expectant mothers to control the movements of the crumbs for about an hour. How to do it correctly, you can see in the training videos.
The first procedure is carried out for a period of 32 weeks. From this period, there is a certain connection between the number of heartbeats and how the child moves.
The obstetrician-gynecologist compares the general results of CTG with the results of ultrasound and forms a common opinion.
In which case the results will be good:
- Heart rate ranges from 120 to 160 beats per minute.
- When the child moves, the heart rate increases.
- The heartbeat does not slow down or speed up (no tachycardia).
Indicators above or below the norm are the result of such conditions:
- acute lack of oxygen;
- pressing the umbilical cord to the body;
- improper fixing of sensors.
Attention! If the CTG results are poor, the doctor may decide to carry out an emergency delivery. In this case, the woman is given a caesarean section.
And the last way is echocardiography. It is performed for a period of 18 to 20 weeks if heart defects are suspected.
Other indications for this procedure are:
- the presence of older children with pathologies of the cardiovascular system;
- congenital defects in the mother herself;
- infections transferred in the first trimester;
- woman over 38 years old;
- the pregnant woman is sick with diabetes mellitus;
- the child has developmental disorders of other organs.
So, you can hear the heartbeat of a child on an ultrasound scan starting from a six-week period. It is during this period that the heart begins to contract for the first time. By the frequency of contractions, you can determine how correctly the baby is developing.
Pregnancy is a wonderful time, which is sometimes clouded by a variety of problems. Cardiac abnormalities are a major concern.
Heart disease in an unborn baby or expectant mother is a phenomenon that, unfortunately, is becoming more common.
However, don't despair! Doctors say that modern surgery and competent management of pregnancy will save the life of both the child and the mother.
Heart defect - what is it?
This is how the heart works: two atria on top and two ventricles on the bottom. Septa and valves separate the right and left sides of the heart. Valve arrangement:
- Left bivalve valve. Dividing the left atrium and ventricle, it prevents back blood flow from the lower chamber to the upper one.
- Tricuspid valve. Consists of three cusps and delimits the right atrium and ventricle, does not allow reverse blood flow.
- Aortic valve. Placed on the border of the largest arterial vessel and the left lower chamber, it is necessary to prevent back blood flow (back to the ventricle).
- Pulmonary valve. Separates the right ventricle from the pulmonary artery.
Functioning of the heart valves
The most common pathology of the bicuspid valve (60 - 80%), aortic valve insufficiency occurs slightly less often (about 30%).
Tricuspid valve pathology is the rarest occurrence. Pathology of one valve (isolated defect), 2 or more (multiple) may occur.
Atrial and interventricular defects are very common, as well as pathologies that are characterized by the release of blood from the left to the right and vice versa (patent ductus arteriosus, "blue" defect). It can be valvular insufficiency and stenosis, which interfere with blood circulation.
Insufficiency of the aortic valve structure
Left valve prolapse is rare; in this condition, the walls of the valve protrude, which interferes with the flow of blood from the upper left chamber to the lower one.
All pathologies can be divided into congenital and acquired. Congenital heart disease is a pathology of the structure of the heart that is present from birth. Children with this diagnosis often die in the first year of life, if timely treatment is not carried out. Acquired heart defects are pathologies that occur against the background of serious ailments or injuries.
Why do such defects occur in the fetus?
The heart of the embryo is formed in the first trimester of pregnancy (5-8 weeks). It is during this period that the body is especially susceptible to the negative influence of infections, medicines, alcohol or drugs. The main causes of the onset of pathology:
- eat right;
- walk in the fresh air for at least 5 hours a day;
- eliminate emotional and physical overload;
- visit a doctor in a timely manner and do an ultrasound;
- give up bad habits (alcohol, cigarettes).
Genetic predisposition.
If one of the parents or close relatives has heart defects, then the child is at risk. Pathology is especially dangerous for pregnant women, since both the child and the mother are at risk.
Chronic ailments.
For example, type 1 diabetes in an expectant mother. This disease threatens pregnancy, more often it ends artificially at 32 weeks. A child is born very weak and can die.
Environmental factors.
Chemical poisoning, negative environmental conditions, X-rays. It is strictly forbidden to take an X-ray during the first trimester of pregnancy.
Bad habits.
The use of alcoholic beverages, drugs, smoking ruins the health of a woman and a baby.
Medicines.
Antibacterial, antiviral drugs, anxiolytics provoke congenital malformations of the fetus.
Infectious diseases.
Herpes, genital infections and others. Often, the disease is asymptomatic, it can only be detected after laboratory tests.
Diagnosis
Congenital malformations of the fetus can be detected using ultrasound. With its help, you can detect cardiac pathologies from the 17th week of pregnancy.
Much depends on high-quality intrauterine diagnostics, and therefore it should be carried out by a highly qualified doctor using modern equipment.
This is the only way to identify more than 85% of cardiac pathologies.
After assessing the condition of the embryo and the woman in labor, a decision is made to carry out artificial childbirth. Ultrasound examination in the first trimester is mandatory, only in this way the doctor will reveal the features of the pathology, for competent treatment after childbirth.
In the third trimester, an echocardiogram is performed to assess the anatomy of the disease. Some pathologies are accompanied by chromosomal aberrations (breakage in the chromosome set). In such cases, a karyotype analysis is assigned, which will allow examining the cells of the fetus.
Therapy
Modern cardiac surgery can work wonders, it can help save the lives of 90% of children with CHD (congenital heart disease). It all depends on the patient's condition, doctors can carry out from one operation or more.
Corrective surgery is performed with the connection of a heart-lung machine, which performs the functions of the heart while it is being operated on. Many doctors use the method of strong cooling, which temporarily stops the heart for the necessary manipulations.
Parents should not panic, the first thing to do is contact a good diagnostic center, whose specialists will help you find out the reasons, conduct an accurate diagnosis and prescribe a competent treatment. Almost all babies who have undergone surgery for CHD recover and lead a normal, fulfilling life.
Preventive measures
Rules of conduct for pregnant women diagnosed with CHD in the fetus:
The expectant mother is simply obliged to remain calm and strictly follow the doctor's recommendations in order to bring the baby to 37 weeks and give birth naturally.
Heart defects in a pregnant woman
Cardiac pathologies in pregnant women are also divided into congenital and acquired.
There are 3 groups of UPU:
Acquired defects arise from inflammation of the endocardium and the main heart muscle. The main reasons for the development of heart pathologies: acute rheumatic fever, generalized infections, atherosclerosis, syphilis.
Prognosis for a pregnant woman with heart disease
Many people ask the question: "Is it possible to give birth with such a diagnosis?" It all depends on the degree of heart damage, as well as on the form in which the disease proceeds and how much the blood flow is disturbed.
This issue needs to be resolved together with specialists: a cardiologist, obstetrician-gynecologist and cardiac surgeon, if the woman in labor has undergone heart surgery. It is important to remember that corrective surgery is not always able to correct structural changes in the heart. There is a risk of recurrence of the underlying ailment, for example, vascular re-stenosis.
As for pregnant women with an artificial valve, the decision is made individually. Such women are constantly treated with anticoagulants, as they have a risk of blood clots.
Is it possible to give birth to a woman with ailments of the heart and blood vessels or not? This issue must be resolved even before pregnancy. And this decision is made on the basis of an accurate diagnosis and the main cause of the disease.
Important! It is strictly forbidden to give birth with pathologies with blood flow from left to right.
Specificity of pregnancy and childbirth management
A woman who is aware of the seriousness of her condition should participate in the process and strictly follow the instructions of specialists. It is necessary to register with an obstetrician-gynecologist as early as possible, visit doctors in a timely manner, take tests, be fully examined and carry out complex treatment.
Pregnancy in such women proceeds with the following complications: edema, proteins in the urine, convulsions, hypertension. Gestosis is difficult to identify and treat.
There is a constant threat of miscarriage or early birth. Often, the uteroplacental blood flow is disturbed, due to which hypoxia and delayed growth, weight and development of the fetus occur. There is a danger of too early separation of the placenta from the wall of the uterus, due to which the fetus suffers from hypoxia.
That is why a woman with heart ailments must be hospitalized at least three times during pregnancy:
- 7-11 weeks. A pregnant woman is hospitalized in order to clarify the diagnosis, and on its basis, decide on the issue of pregnancy. You can terminate a pregnancy before this period - 2 months 4 weeks.
- 27-28 weeks. Doctors monitor the patient's health, maintain the functionality of the heart and blood vessels. This is due to the fact that at this moment the load on the heart increases.
- 36-37 weeks. Final preparation for childbirth, doctors choose the method of delivery (medication, instrumental), draw up a delivery plan.
Dangerous ailments that require immediate hospitalization: acute circulatory disorders, rheumatic fever, atrial fibrillation, late toxicosis, severe anemia.
In general, the patient during pregnancy should sleep at least 10 hours, it is desirable to rest during the day. To engage in physiotherapy exercises, naturally on the recommendation of a doctor, to take walks.
With regard to nutrition, it is necessary to focus on foods high in protein. You can take multivitamin complexes. Such women are often prescribed oxybarotherapy and ultraviolet therapy.
The most dangerous period after childbirth is the first week, which can manifest itself as thrombosis, bleeding, or heart failure. At this time, the patient must constantly be in bed.
The woman in labor is discharged no earlier than 14 days later, if her condition is satisfactory. She must be constantly monitored by a cardiologist. If there is no relapse, you can breastfeed your baby.
As for the baby, immediately after birth, he is examined for CHD. If necessary, carry out treatment.
Thanks to timely diagnosis and competent therapy, many women felt the joy of having a baby. And highly qualified specialists helped them with this.
In contact with
Ultrasound diagnostics is highly informative and relatively safe for detecting congenital heart defects. Moreover, it can be carried out even before the birth of the child to resolve the issue of continuing bearing or the need for early surgery.
However, the subjectivity of the survey and technical errors can lead to the wrong conclusion. In doubtful cases, it is necessary to repeat the ultrasound scan, conduct an in-depth study of the newborn's heart.
Read in this article
Causes of fetal heart defects
Heart defects are caused by chromosomal defects, they can also occur with gene mutations, exposure to the external environment, but in the overwhelming case (about 90%) there are several damaging factors at the same time. The proven reasons for the appearance of an abnormal structure of the heart and large vessels include:
- family- the birth of children with deviations in the structure of the heart, the presence of a defect in the father or mother, close blood relatives, hereditary diseases in the family;
- maternal- rheumatism, autoimmune diseases, viral infections (rubella, herpes, flu, cytomegalovirus, Epstein-Barr), chlamydia, toxoplasmosis, ureaplasmosis, syphilis, taking medications with a teratogenic effect in the first months of pregnancy, age over 40 or under 16, diabetes mellitus , phenylketonuria,;
- fetus- arrhythmia, chromosomal mutations, abnormalities of other organs, low weight, dropsy, multiple pregnancy, hypoxia.
Complicated pregnancy Environmental factors also have an adverse effect - air and soil pollution, ionizing radiation, occupational hazards (both for the mother and the father), alcoholism, drug addiction. Violation of the development of the heart can also be with a complicated course of pregnancy, the threat of miscarriage, and a severe degree of early toxicosis.
Lack of vitamins, especially folic acid, leads to an abnormal structure of internal organs, including the cardiovascular system.
Is the defect visible on ultrasound
You can see the heart of the fetus at 10-11 weeks of pregnancy, but in order to assess its structure, it takes at least 20 weeks. Heart defects with a qualified examination and modern equipment are visible with high reliability, but associated rhythm disturbances, or myocardium, weakness of the heart muscle appear only after birth.
For pregnant women, ultrasound of the fetal heart is mandatory in the list of examinations, some categories may require extended echocardiography with Doppler ultrasonography. In addition to the existing risk factors listed above, these include women with the following conditions:
- gestational diabetes mellitus (occurs only during pregnancy);
- or other types;
- taking non-steroidal anti-inflammatory drugs, retinoids, anticonvulsants, antineoplastic drugs;
- artificial insemination;
- multiple pregnancy;
- the thickness of the collar zone of the fetus is more than 3 mm on ultrasound in the 3rd month.
Fetal heart ultrasound, left ventricle, color mapping When conducting echocardiography, it is possible to identify such deviations in the development of the heart: openings of the septa, changes in the location of large vessels, narrowing of the valve opening, vessels, non-closure, fusion or abnormal attachment of the valve leaflets, underdevelopment of the ventricle, untimely closure of the openings and ducts, as well as their combinations.
Can there be errors in determining the state of the myocardium?
Difficulties and errors in diagnosing violations of the structure of the heart in the fetus are associated with the following features:
- small size;
- complex structure;
- change in structure as it develops;
- assessment of the state of the cardiovascular system without devices with a special cardiac regime;
- technical errors;
- insufficient qualifications or experience of the doctor.
Expert opinion
Alena Arico
Expert in Cardiology
Most errors are associated with incorrect detection of aortic and pulmonary artery defects. In general, for standard echocardiography, the detection rate of defects is 40 - 70%, and in cardiac research centers it is 97%. Therefore, if ultrasound detects violations of the structure of the heart of the fetus, a pregnant woman is recommended to undergo it again in specialized diagnostic departments that have trained doctors for congenital malformations.
Pregnancy and childbirth with suspected fetal heart disease
If the diagnosis of a congenital malformation of the heart is confirmed, a pregnant woman needs an examination:
- repeated ultrasound of the heart to monitor the dynamics of the defect;
- targeted ultrasound (expert class apparatus) for examining the brain and internal organs to exclude non-cardiac abnormalities;
- geneticist consultation;
- study of amniotic fluid.
If multiple abnormalities or defects are found, in which an extremely high mortality rate (absence of the left ventricle, and myocardial damage), the mother may be offered abortion. Childbirth with congenital heart development abnormalities should be carried out in cardiology centers, where the pregnant woman is under constant supervision at a later date.
After birth, the child undergoes an ultrasound scan, he is transferred to intensive care or cardiac surgery.
In the event that emergency assistance is not required, the newborn enters the pathology department or pediatric cardiology department for further examination. This is due to the fact that the symptomatology of a congenital defect is not always obvious, it can be masked by diseases of the lungs, brain, and the data while listening (and clicks of opening the valve) can also be with small anomalies in the development of the heart.
In addition to repeated ultrasound, newborns are prescribed:
- to detect arrhythmias, hypertrophy or overload of the heart;
- chest x-ray - detect stagnant processes in the lungs, enlargement of the heart,;
- , aortography with contrasting vessels and parts of the heart;
- probing to measure pressure, the presence of pathological messages between the parts of the heart.
Signs of congenital malformations in a child
The most common abnormalities in the development of the heart and the signs that can be found on echocardiography are described in the table.
| Congenital heart defects | Short description |
| turbulent movement of blood through the hole, signs of overload in the right half of the heart, expansion of the pulmonary trunk; | |
| left-right discharge, expansion and hypertrophy of the right ventricle, with the progression of hypertension in the lungs, the direction of movement changes. The hole can be located in the membranous zone, muscular or in the efferent region; | |
| message of the aorta and arteries of the lungs, indirect signs in the form of hypertrophy of the left parts of the heart. Doppler ultrasound helps to see turbulent blood movements above the pulmonary valve; | |
| narrowed segment, accelerated movement of blood from top to bottom from this site; | |
| defect of the septum of the ventricles, reduced lumen of the artery of the lungs, hypertrophy of the right ventricle, displacement of the aorta, reduced left atrium; | |
| Pulmonary artery stenosis | reduced patency, increased right ventricle. The constriction occurs in the area of the valve, above and below it. With Doppler ultrasound, you can calculate the blood pressure drop, the severity of the narrowing and the indications for surgery. |
Ultrasound for heart defects helps to identify developmental abnormalities even during pregnancy. For this, the fetal heart is examined at 20 weeks of gestation.
To exclude possible errors, it is recommended to undergo a second examination at a specialized center.
Children's congenital heart defects, the classification of which includes the division into blue, white and others, are not so rare. The reasons are different, the signs should be known to all future and present parents. What is the diagnosis of valvular and heart defects?
