🤰🤱Labour Planning and Postpartum Monitoring 

in Women with Heart Disease

Pregnancy does not end at delivery.

In cardiac patients, the highest risk period may be during labour and especially the early postpartum phase.

Labour is a hemodynamic event.

🧨With each uterine contraction:

• Cardiac output increases further

• Blood is autotransfused back into circulation

• Heart rate and blood pressure fluctuate

For women with limited cardiac reserve, this may precipitate acute decompensation.

⛈That is why delivery must be planned not improvised.

👍Labour Planning Should Include:

• Multidisciplinary coordination (Obstetrician, Cardiologist, Anesthetist)

• Clear delivery plan (timing, mode of delivery)

• Hemodynamic monitoring strategy

• Pain control plan (epidural often preferred to reduce cardiac stress)

• Avoidance of fluid overload

• Thromboprophylaxis when indicated

🤔Vaginal delivery is preferred in most cardiac patients,

unless obstetric or specific cardiac indications require cesarean section.

🤱Postpartum: The Critical Window

The first 24–72 hours after delivery carry significant risk due to:

• Sudden increase in preload

• Fluid shifts

• Increased risk of heart failure

• Thromboembolic events

💥Close monitoring is essential:

• Strict fluid balance

• Vital signs surveillance

• Early detection of dyspnea or chest symptoms

• Medication re-adjustment when needed

Discharge planning must include:

• Clear follow-up schedule

• Contraceptive counseling

• Long-term cardiac care

Because protecting the mother’s heart

does not stop at delivery.

Dr Rabab Cares

#DrRababCares 

#CardioObstetrics 

#MaternalHealth

 #HeartDiseaseInPregnancy 

#SafeDelivery

 ❤If You Have Heart Disease and Want to Get Pregnant Read This First

Pregnancy in women with heart disease should be planned  not accidental.

Not every cardiac condition carries the same risk.

Some women can proceed safely with monitoring.

Others face significantly increased maternal morbidity and mortality.

Before conception, a structured cardiac evaluation is essential.

🔎 Ask These Questions Before Trying to Conceive:

1️⃣ What is my ventricular function (EF)?

2️⃣ Is my condition stable or progressive?

3️⃣ What is my NYHA functional class?

4️⃣ What is my WHO pregnancy risk category?

5️⃣ Do I need optimization before pregnancy?

Hemodynamic changes during pregnancy increase cardiac output by up to 50%.

If cardiac reserve is limited, decompensation may occur  especially in the second and third trimesters.

💊 Medication Review Is Critical

Some cardiac medications are contraindicated in pregnancy and must be stopped before conception:

⚠️ ACE inhibitors (e.g., enalapril, lisinopril)

⚠️ ARBs

⚠️ Sacubitril/valsartan

⚠️ Spironolactone

⚠️ Warfarin (especially in the first trimester)

⚠️ Certain statins

Others may be used with careful supervision:

✔️ Beta-blockers (labetalol, metoprolol preferred)

✔️ Low-dose aspirin when indicated

✔️ Low molecular weight heparin instead of warfarin

✔️ Selected diuretics in stable cases.

Medication adjustment should always occur before conception, not after a positive test.

🚨 Very High-Risk Conditions

Some conditions may carry extremely high maternal risk:

• Severe pulmonary hypertension

• Severe left ventricular dysfunction

• Advanced cardiomyopathy

• Severe symptomatic valvular stenosis.

In these cases, pregnancy may be strongly discouraged.

Pregnancy does not forgive poor planning.

Preconception counseling changes outcomes.

Risk stratification saves lives.

Because protecting the mother’s heart

means protecting two lives.

Dr Rabab Cares

Cardio-Obstetrics Awareness Series

#DrRababCares

 #PreconceptionCare 

#CardioObstetrics 

#MaternalHealth 

#HeartDiseaseInPregnancy

 ❤When Shortness of Breath Is NOT Normal 

And the Cardiac Conditions Behind It.

Shortness of breath is common in pregnancy.

But not all breathlessness is physiological.

💚Normal pregnancy-related dyspnea is usually:

• Mild

• Gradual in onset

• Worse with exertion

• Not associated with chest pain or syncope.

However, shortness of breath becomes concerning when it is:

⚠️ Present at rest

⚠️ Worse when lying flat (Orthopnea)

⚠️ Associated with sudden nighttime awakening

⚠️ Accompanied by chest pain, palpitations, or fainting

⚠️ Progressive or rapidly worsening

These symptoms may signal underlying cardiac disease.

💥Common Cardiac Conditions in Pregnancy

 That May Present with Dyspnea:

• Peripartum cardiomyopathy

• Rheumatic valvular heart disease

• Congenital heart disease

• Pulmonary hypertension

• Arrhythmias

• Decompensated pre-existing cardiomyopathy.

Pregnancy increases blood volume and cardiac output by up to 50%.

In women with limited cardiac reserve, this hemodynamic burden may precipitate heart failure.

Many women are diagnosed with heart disease for the first time during pregnancy.

👁Early evaluation, echocardiography when indicated, and multidisciplinary care are essential.

Because protecting the mother’s heart

means protecting two lives.

Dr Rabab Cares

#DrRababCares 

#HeartDiseaseInPregnancy 

#CardioObstetrics 

#MaternalHealth 

#SafePregnancy

 Ramadan Kareem 🌙✨

Ramadan is more than a month of fasting.

It is a month of reflection… discipline… mercy… and quiet strength.

As an obstetrician, I witness new beginnings every day.

And Ramadan always reminds me that renewal is possible 

for the body, the heart, and the soul.

May this blessed month bring peace to your homes,

clarity to your decisions,

and barakah to your work and families.

Wishing you a meaningful and gentle Ramadan.

Dr Rabab Cares 

#DrRababCares 

#Ramadan

 #RamadanKareem

 ❤Physiological vs Pathological Cardiac Symptoms in Pregnancy

Pregnancy places significant demands on the cardiovascular system.

Many symptoms are expected.

Some are not.

Understanding the difference is essential.

✅ Physiological (Expected) Symptoms

These are usually related to increased blood volume and cardiac output:

• Mild shortness of breath on exertion

• Slight increase in resting heart rate

• Mild ankle edema (worse by evening)

• Occasional brief palpitations

• Soft systolic flow murmur.

These symptoms are generally well tolerated in a healthy heart.

⚠️ Pathological (Concerning) Symptoms

These require prompt medical evaluation:

• Shortness of breath at rest

• Orthopnea (difficulty breathing while lying flat)

• Paroxysmal nocturnal dyspnea

• Syncope or near-syncope

• Persistent chest pain

• Rapidly worsening or severe edema

• Cyanosis

• Sustained tachycardia

These are NOT normal pregnancy symptoms.

Pregnancy does not create heart disease.

It may unmask previously silent conditions.

Early recognition, risk stratification, and multidisciplinary management significantly reduce maternal morbidity.

Because protecting the mother’s heart

means protecting two lives.

Dr Rabab Cares

#DrRababCares 

#HeartDiseaseInPregnancy

 #MaternalHealth 

#SafePregnancy 

 #CardioObstetrics

 ❤Heart Disease in Pregnancy

Two Hearts. One Responsibility.

Pregnancy is a natural physiological process 

but it is also a cardiovascular stress test.

😥During pregnancy:

• Blood volume increases by up to 50%

• Cardiac output rises significantly

• Heart rate accelerates

• Systemic vascular resistance decreases.

For a healthy heart, these changes are well tolerated.

But for women with underlying or undiagnosed cardiac conditions, pregnancy may unmask serious risks.

💥Cardiovascular disease remains one of the leading causes of maternal morbidity worldwide.

👍And yet  with early assessment, proper monitoring, and multidisciplinary care  many cardiac conditions can be safely managed.

In this awareness series, we will explore:

✔ Physiological vs pathological symptoms

✔ When shortness of breath is not “normal”

✔ Common cardiac conditions in pregnancy

✔ Risk stratification before conception

✔ Labor planning and postpartum monitoring

Because protecting the mother’s heart

means protecting two lives.

Dr Rabab cares

#DrRababCares 

#HeartDiseaseInPregnancy 

#MaternalHealth 

#SafePregnancy

In Islam, your health and your baby’s safety come first.

Medically, some women may fast safely  others should not.

If you are pregnant this Ramadan, speak to your doctor before deciding. 

#DrRababCares