Heart disease

A certain number of women who become pregnant suffer from heart disease. The figure is small, being around 1 per cent or less. Most have suffered from rheumatic disease in earlier life, and this is the cause of their cardiac problems.

Heart disease is a progressive disorder, and each pregnancy will throw an extra burden on this system.

Provided the patient is sensible, carries out her doctor’s instructions, and attends for adequate prenatal visits at intervals which will be more frequent than her healthy counterpart, a satisfactory outcome is usual.

Greater efforts to avoid abnormal weight increases, commonsense care in regard to eating habits, adequate periods of rest, and not performing activities in excess of her ability, all help to keep her fit throughout the term of pregnancy.

The key symptoms that all is not well are breathlessness with activity, and cough. These must be reported to the doctor, particularly if they tend to worsen at any time.

The doctor will want to see the patient every second week from the moment she conceives until the twenty-eighth week. After this, visits will be weekly, or even more often if the doctor has any question. Be guided entirely by his advice. It is most important.

Diabetes

Many diabetics are not diagnosed until adult life, often in the early forties. These are called maturity-onset diabetics; however, some people are born with the condition, or develop it in early life or adolescence. Another group, usually older people, is called “pre-diabetics.” They may develop into maturity-onset diabetics. But under certain circumstances, they swing over into the diabetic pattern.

A diabetic is a person with a disorder of the pancreas. This reduces his normal supply of insulin, so he is unable to adequately store circulating sugar. The doctor will check your urine regularly for sugar, for some pre-diabetics will suddenly reveal this in their urine.

Treatment of the pregnant diabetic is usually quite straightforward for the first twenty-eight weeks. But after this, she becomes progressively more difficult to care for. In practice, the best place for these patients is in centers equipped with facilities for caring both for diabetics as well as pregnancies. Many major units in larger cities are equipped along these lines.

The patient is admitted to hospital at about the thirty-second week. This is often essential to enable the sugar levels to be stabilized, to guarantee adequate rest, and to help check other complications which are more likely (mainly pre-eclampsia).

Many patients can be adequately controlled by diet alone. Others may require anti-diabetic medication, and still others may need insulin by injection on a regular basis. On some occasions if the mother’s well-being is in danger, termination of the pregnancy may become essential. But others will be allowed to go on until the thirty-eighth week, when induction of labour takes place. In some cases, delivery by Caesarean section is preferred by the obstetrician.

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