Labor and Delivery with Cardiac Disease

Labor and Delivery with Cardiac Disease

The Northwestern Medicine Heart Disease and Pregnancy Program uses a multidisciplinary plan formulated by maternal-fetal medicine (high-risk obstetrics), cardiology, and anesthesia to anticipate problems that may occur during delivery for women with known cardiac disease. The actual mode of delivery, vaginal or cesarean section, is usually determined by obstetric indications and not the underlying cardiac disease.

What to expect during labor and delivery

In general, women with cardiac disease who have done well during the pregnancy usually only require general management with clinical observation during labor and delivery. These women may receive pain control and require monitoring of their blood pressure. Women who have symptoms during pregnancy and have high risk factors such as high lung pressures or cardiac muscle disease often require oxygen and invasive hemodynamic monitoring during labor and delivery.

Women with cardiac disease may be asked to labor while lying on their left side. In this position, the uterus is not resting on the inferior vena cava (large blood vessel that returns blood to the heart), which may be compressed by an enlarged uterus decreasing blood flow back to the heart. With decreased blood flow to the heart, the heart rate often increases. A woman may require antibiotics during labor and delivery to prevent cardiac infection. She may require a shortened "pushing stage" depending upon the nature of her cardiac disease. Overall, changes in the labor and delivery plan will be dictated by the underlying cardiac disease.