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Bradycardia in a pregnant woman at an early stage. Diagnosis and treatment of bradycardia during pregnancy. Deviations from the norm

The normal gestation period is 36-40 weeks. During fetal development, the heart begins to form at approximately 3 to 4 weeks. It is possible to listen to the heartbeat of the fetus using instrumental methods only from the 6th week. However, fetal bradycardia during pregnancy is better heard in the II or III trimesters. For a better understanding of the causes, principles of the course of the disease, we will analyze brief information on the intrauterine life of the unborn child.

Fetal development

From the first weeks of conception, the embryo feeds on maternal blood, which enters through the placenta, which is firmly woven into the structure of the uterus. From there, her vessels originate. Due to the presence of an amniotic sac with fluid in the uterine cavity, the fetus is protected from the influence of the external environment. This contributes to the normal and physiological development of all vital organs, especially the heart.

The heart has 4 chambers, each of which pushes blood into the vessels. In the first trimester, the formation of the organ and all its structures is carried out. It is this period that is considered critical, since any negative effect on the fetus can lead to the development of heart disease. Heart rate varies at different stages of pregnancy. The normal values ​​are:

  • I trimester - 80 - 170 beats per minute;
  • II trimester - 120 - 160 beats per minute;
  • III trimester - 120 - 150 beats per minute.

With early fetal bradycardia, the heart rate falls below 120 beats/minute. Tachycardia "gives" a similar indicator of more than 170 beats / minute. Stable values ​​of the fetal heart rate in the 2nd and 3rd trimester are the full development of the nervous system, which generates and regulates the flow of impulses to the heart.

Causes of pathology

So what are the causes of fetal bradycardia? At 18 - 20 weeks, a woman hears the baby moving. His heartbeat is detected by additional instruments. Many factors influence the intrauterine development of the fetus. The causes of bradycardia in the fetus are as follows:

  • the presence of bad habits, such as smoking, drinking alcohol and energy drinks;
  • taking contraceptives, especially during pregnancy;
  • injuries in the 1st trimester that disrupted the blood supply to the embryo;
  • surgical interventions: acute appendicitis, fractures of the extremities.

This is an incomplete list of the causes of pathologies in the development of pathology, but only the fundamental ones. In the first month of the development of the embryo, it is important to limit any influence on it. During this period, the most important systems of the body (cardiac, nervous, digestive, endocrine) are formed. Any negative impact on the embryo leads to a congenital malformation. Prolonged bradycardia subsequently causes insufficient saturation of the embryo with oxygen, which is unsafe and requires treatment.

Nature has formed a protective barrier for the baby in the form of a placenta and an amniotic fluid sac. They prevent the entry of harmful substances into the body of the fetus. But there are many reasons that affect the cardiovascular system, causing bradycardia. Among these factors are the following:

  • congenital malformations of the heart - the triad and tetrad of Fallot;
  • toxicosis of pregnant women is a pathological condition that occurs as a reaction to the vital activity of the fetus in the womb. It is characterized by nausea, constant vomiting, and sometimes abdominal pain in the mother. Disappear immediately after childbirth;
  • chronic diseases of a pregnant woman;
  • Rhesus conflict, which can even lead to termination of pregnancy;
  • low water or high water;
  • wrapping the umbilical cord around the neck of the fetus;
  • placental insufficiency, in which the child does not receive the full amount of nutrients and oxygen;
  • malnutrition of the mother, observance of church posts;
  • constant stress;

This period of pregnancy is important for the development of all systems of the future body and preparation for childbirth. Prolonged bradycardia contributes to cerebral hypoxia, which entails irreparable consequences, up to death or disability of the unborn child, which cannot be treated. Early terms are the time that can provoke spontaneous abortion.

Diagnosis of bradycardia

A pregnant woman should be registered with a gynecologist before the 12th week of pregnancy. There are a number of surveys that should be carried out according to the schedule. Some types of diagnostics are carried out no more than 2 - 3 times for the entire period. If pathology is present or suspected, the range of examinations can be expanded. Fetal bradycardia is easy to detect using the following methods:

  1. Phonoelectrocardiography. A method that combines ECG, which records the electrical impulses of the heart, and phonocardiography, which records sound phenomena. This allows you to determine the frequency and rhythm of heart contractions, characterize heart sounds or identify additional pathological murmurs.
  2. Cardiotocography. This method allows you to make a synchronous recording of the fetal heartbeat and uterine contractions. Carried out using a cardiotocograph apparatus starting from the 32nd week of pregnancy. The device is attached to the belly of a pregnant woman or inserted into the vagina. This method makes it possible to assess the nature of the fetal cardiac activity, its motor abilities and the contractility of the uterus.
  3. Ultrasound study. During the period of pregnancy, a woman should perform this examination three times. The screening method allows you to determine the size of the fetus, carefully study the structure of its internal organs. During the examination, the heart with its own ventricles and valves, the head with the structural components of the brain, and bone tissue are clearly visible. You can also determine the heart rate.
  4. Auscultation. A simple, affordable method used by all obstetricians and gynecologists when examining a pregnant woman. A conventional phonendoscope or a special gynecological stethoscope determines the position of the fetus in the uterus. Then, in the most advantageous position, the child's heartbeat is heard. Sometimes it cannot be determined due to polyhydramnios, transverse presentation, missed pregnancy.

According to the classification, fetal bradycardia is of two types, depending on the heart rate. With basal bradycardia, a heartbeat of 110 beats per minute is noted. Timely detection and treatment does not lead to malformations. Decelerant bradycardia is accompanied by a significant decrease in heart rate to 90 per minute. Such a long-term condition leads to fetal hypoxia and irreversible consequences for the unborn child.

Treatment

Treatment of fetal bradycardia in the early stages should begin with conservative methods. Episodes of a prolonged decrease in the frequency of heart contractions in the first trimester can provoke an abortion. In this case, the woman should lie down for preservation in the maternity hospital, be examined. Drug therapy is reduced to the intravenous administration of drugs such as magnesium sulfate, papaverine, glucose. After that, it is imperative to monitor the cardiac activity of the fetus with the help of ultrasound, to take preventive measures.

Prolonged bradycardia in late pregnancy can cause premature birth, abortion, placental abruption, intrauterine fetal death. Treatment starts immediately. The woman is hospitalized in the department of pathology of pregnant women. Comprehensive treatment includes physical therapy, reflexology, medication. Are administered intravenously.


Bradycardia is a condition in which the heart rate (HR) drops to 60 beats per minute or less. The occurrence of bradycardia during pregnancy can lead to the development of fetal hypoxia and other serious complications. All women with bradycardia should be observed by a cardiologist from the moment of conception of the child until the very birth.

Causes

The normal heart rate of a healthy person is 60-80 beats per minute. It is in this rhythm that the heart muscle can fully function and provide the body of a woman and fetus with oxygen. A decrease or increase in heart rate disrupts the normal interaction of internal organs and can cause hypoxia.

Bradycardia is a condition in which the heart rate is less than 60 heart beats per minute. There are several reasons for this phenomenon:

  • heart disease;
  • vegetative-vascular dystonia - VSD (influence of the parasympathetic nervous system);
  • exposure to cold;
  • increased intracranial pressure (tumors, cerebral edema);
  • endocrine pathology (hypothyroidism);
  • infectious diseases;
  • prolonged fasting;
  • taking certain medications (diuretics, cardiac glycosides, etc.);
  • heavy metal poisoning.

During pregnancy, there is a physiological increase in heart rate due to increased stress on the heart. Decrease in heart rate in healthy women is quite rare. You can find out the exact cause of bradycardia during an examination by a cardiologist.

Sinus bradycardia

Sinus bradycardia is a condition that deserves special attention during pregnancy. With this phenomenon, the heart rate decreases to 60 beats per minute or less, but the heart rhythm remains correct. Physiological sinus bradycardia occurs in people involved in sports and leading an active lifestyle. A natural decrease in heart rate also occurs in the cold and during sleep.

Physiological sinus bradycardia does not bother a pregnant woman in any way and does not interfere with the normal development of the fetus. A similar condition is detected by chance during a routine examination in the early stages. Treatment is not required.

Pathological sinus bradycardia occurs in various diseases:

  • cardiac ischemia;
  • cardiomyopathy;
  • heart defects (congenital and acquired);
  • myocarditis (inflammation of the heart muscle);
  • endocrine pathology.

Such conditions are accompanied by a deterioration in the well-being of the expectant mother. With pathological bradycardia, the supply of oxygen to the tissues slows down, the functioning of the placenta and the development of the fetus are disrupted. Mandatory observation and treatment by a cardiologist is required.

Symptoms

At the heart of any bradycardia is the inability of the sinus node of the myocardium to produce impulses at the desired frequency (60-80 beats per minute). When the heart rate is low, the tissues do not get enough oxygen, and the following symptoms occur:

  • dizziness;
  • headache;
  • severe weakness;
  • noise in ears;
  • fainting;
  • labored breathing;
  • chest pain;
  • lowering blood pressure;
  • visual disturbances;
  • impaired memory and attention.

Similar symptoms are noted when the heart rate drops to 50-60 beats per minute. The less oxygen supplied to the tissues, the stronger the manifestations of bradycardia will be. In severe cases, Morgagni-Adams-Stokes attacks may develop, requiring immediate specialist help.

Complications of pregnancy and consequences for the fetus

During pregnancy, the load on the cardiovascular system of a woman increases significantly. The volume of BCC increases, blood viscosity increases, an additional fetoplacental circle of blood circulation appears. Normally, during this period, there is a physiological increase in heart rate and the development of tachycardia. The occurrence of bradycardia for the first time during pregnancy is an unfavorable symptom and indicates a serious malfunction in the body.

Against the background of bradycardia, chronic fetal hypoxia is formed - a condition in which the baby does not receive oxygen in the right amount. The development of the fetus slows down, the child lags behind in weight and growth. The fetal brain suffers - the structure most sensitive to lack of oxygen. Intrauterine hypoxia is considered one of the main causes of developmental delay in children in the first year of life.

Diagnostics

Throughout pregnancy, a woman regularly visits her gynecologist. At each appearance, the doctor necessarily measures blood pressure, and also determines the pulse rate. Modern blood pressure monitors do this automatically, after which they display the readings on the screen.

If bradycardia is detected, the expectant mother is sent for a consultation with a therapist. To determine the cause of this condition, an examination is carried out:

  • auscultation of heart sounds;
  • echocardiography (ultrasound of the heart) - according to indications;
  • blood test for thyroid hormones.

If an organic pathology of the heart is detected, a consultation with a cardiologist is indicated. A visit to an endocrinologist is recommended when thyroid hormone levels change. According to indications consultations of other narrow experts are carried out.

Morgagni-Adams-Stokes syndrome

This term is understood as a serious condition that develops when the heart rate slows down to less than 40 beats per minute. With this pathology, a sudden decrease in cardiac output occurs and acute cerebral ischemia develops. Morgagni-Adams-Stokes syndrome occurs not only with bradycardia, but also with other pathologies of the cardiovascular system.

Symptoms:

  • loss of consciousness;
  • sharp pallor of the skin (after the restoration of consciousness, pallor is replaced by hyperemia);
  • cyanosis of the nasolabial triangle;
  • respiratory failure;
  • drop in blood pressure;
  • involuntary urination;
  • convulsions.

The attack lasts no more than 2 minutes and does not lead to the development of neurological complications. Against the background of an attack, the condition of the fetus may worsen due to severe hypoxia. With frequent attacks, the likelihood of spontaneous miscarriage and premature birth increases.

With the development of an attack, you must immediately call an ambulance. Before the arrival of specialists, a pregnant woman should be laid on her side, pulse, blood pressure and breathing should be monitored. Indirect heart massage and artificial respiration are performed according to indications.

Treatment

Bradycardia is not an independent disease, but only a symptom of problems in the cardiovascular system. The treatment regimen will depend on the identified cause of the disease, its severity and gestational age. Against the background of competent treatment of the underlying disease, the heart rate is restored to normal (60-80 beats per minute). Physiological bradycardia does not require treatment.

With a decrease in heart rate against the background of hypothyroidism, hormonal therapy is prescribed for the entire period of pregnancy. The dosage of hormonal drugs is selected individually for each woman. Hypothyroidism can cause miscarriage, fetal growth retardation, and other serious complications.

Surgical treatment is indicated for severe bradycardia against the background of organic heart disease. During the operation, a pacemaker is installed, which sets the heart to the desired rhythm and frequency. Surgical treatment during pregnancy is possible only for health reasons. In other cases, the operation is performed in a planned manner after the birth of the child.

Fedorov Leonid Grigorievich


Even in the case of small deviations from the norm, the expectant mother should always be under the supervision of a doctor. If the fetal heart rate is too low, it is important to follow all its instructions.

In most cases, hospitalization and treatment in a hospital is necessary.

If the problem arose at a later date, and the intrauterine development of the embryo proceeds without deviations, then a caesarean section is recommended as a method of delivery.

If the ultrasound showed a deterioration in the functioning of the heart in the fetus, slowing or stopping movement, the presence of sudden respiratory movements and convulsions, the woman should:

  1. Completely give up bad habits.
  2. Normalize lifestyle.
  3. Use vitamin and mineral complexes selected by the doctor.
  4. Drink teas and tinctures based on medicinal plants.
  5. Take prescribed medications.

In each case, separate methods for solving the problem are prescribed.

Prevention measures

In order to prevent any disturbances in the development of the embryo, more attention should be paid to:

  1. Planning for pregnancy.
  2. Treatment of chronic diseases before conception.
  3. Healthy lifestyle.
  4. Walks in the fresh air.
  5. The use of vitamins and minerals.
  6. Regular rest.
  7. Eliminate stress and physical activity.
  8. Passing preventive examinations.

It is much easier to try to avoid bradycardia than to eliminate it. Thanks to the observance of simple recommendations, you can successfully endure and give birth to a completely healthy child.

Preventive measures allow avoiding the development of bradycardia and eliminating the pathological process at the initial stages of formation. This can also help reduce the likelihood of abnormalities in the development of the fetus.

Bradycardia and pregnancy - as a rule, this combination is not dangerous and proceeds without any additional disturbances from the cardiovascular system. However, bradycardia can also be a sign of serious disorders, such as myocarditis. Therefore, a pregnant woman is examined and, if necessary, treated.

Bradycardia during pregnancy - types and causes

During pregnancy, a woman's cardiovascular system has a significant load, so her heart rate (HR) usually increases. But it also happens that during pregnancy, the heart rate decreases, that is, bradycardia develops. This is not always a sign of severe pathology and is most often not accompanied by unpleasant symptoms.

The heart muscle is able to contract automatically under the influence of impulses that arise in itself. Such automatism is provided by the conducting system of the heart - special muscles that run along the thickness of the entire heart, forming branches (bundles) and clusters of cells (nodes). The conduction system of the heart consists of nodes located in the atrium and on the border between the atria and ventricles, as well as bundles extending from them, which conduct excitation to the myocardium (heart muscle).

Bradycardia is divided into sinus (it can be a variant of the norm), when the main pacemaker (the place where impulses occur) is slowly working - the sinus node and bradycardia as a result of a violation (blockade) of the conduction of heart rhythms at various levels (between the sinus node and the atrium or between atria and ventricles).

Sinus bradycardia during pregnancy

If the sinus node has a congenital reduced automatism, then sinus bradycardia during pregnancy may be a variant of the norm. Such a woman from birth adapts precisely to such a rhythm without any damage to her health, and her pregnancy proceeds normally.

But sometimes during pregnancy, pathological sinus bradycardia develops. It is most often caused by irritation or compression of the vagus nerve (the vagus nerve is a cranial nerve that runs through the entire chest and abdominal cavity) by the growing uterus. Some chemicals, drugs, as well as inflammatory or metabolic diseases of the heart muscle (myocarditis, myocardial dystrophy, coronary heart disease) can also have a depressing effect on the sinus node.

The pulse with sinus bradycardia in pregnant women is rare (up to 60-70 beats per minute), but rhythmic. Sinus arrhythmia almost never causes severe disturbances in the work of the heart and discomfort in this area. Sinus bradycardia during pregnancy does not worsen the condition of patients and is not an indication for its interruption.

Bradycardia in pregnant women due to heart block

The conduction of impulses in the heart muscle can be disturbed when they pass to the atria or ventricles. Violation of the conduction between the sinus node and the atrium is called sinoauricular blockade, while not all impulses reach the heart muscle of the atria and ventricles. The cause of such a blockade can be any disease of the heart muscle. If a pregnant woman feels an attack of dizziness or weakness, then it can be removed by drinking a cup of freshly brewed tea.

With bradycardia in pregnant women, which develops against the background of conduction disturbances between the atria and ventricles (atrioventricular blockade), the pulse will be even more rare, rhythm disturbances appear (the atria and ventricles contract in different modes). A woman may be disturbed by weakness, dizziness, fainting and fainting.

With significant bradycardia in pregnant women, the brain primarily suffers due to insufficient supply of oxygen and nutrients. This condition is called the Morgagni-Adams-Stokes syndrome and is manifested first by dizziness (everything is spinning, it gets dark in the eyes), and then by loss of consciousness, temporary cardiac and respiratory arrest, convulsions and involuntary urination. After some time, the work of the heart is restored and the woman regains consciousness (she does not remember what happened to her).


The fetal heart rate should always be within certain numerical limits, depending on the timing of pregnancy. Bradycardia is a slow heartbeat. This condition can lead to irreversible consequences for the development of the fetus and the course of pregnancy in general. It is important to understand what led to such changes in the work of the heart, how you can help an unborn baby and how to prevent such a violation.

When the heart is normal:

As early as 3 weeks after conception, myocardial contractions in the fetus are noted. On ultrasound, a clear heartbeat is noted only by 5-6 weeks of pregnancy. From this point on, the heart rate (HR) begins to be controlled.

5(6)-14 weeks of pregnancy: Heart rate starts from 80-86 bpm, which roughly coincides with the mother's heartbeat. Further, almost daily, the frequency increases by 2-3 strokes daily. By the end of week 14, the normal rate is fixed at an average level of 156 bpm.

15-40 (42) weeks - the second half of pregnancy is characterized by indicators in the range of 140-160 bpm. At this time, the slowing of the heartbeat is of diagnostic value. Contractions up to 120 bpm already indicate an acute lack of oxygen, and below this indicator, bradycardia is recorded.

The moment of birth is characterized by two different rates of heart rate: up to 155 beats / min if the fetus is not full-term and 140 beats / min if the baby is born on time.

It should be noted that the diagnostic value is the heart rate from the 20th week of pregnancy. Until this moment, no calculation is carried out, but simply the presence of a heartbeat is determined, i.e. the fetus is alive or dead. And only from the 20th week, numerical indicators are considered an important diagnostic sign.

Types of bradycardia:

Bradycardia in the fetus can occur absolutely at any time during pregnancy, but the most common cases occur in the third trimester.

There are two main types:

Basal: is recorded when the heart rate drops to 110 bpm. Usually does not give irreversible changes if compensatory therapy is applied in a timely manner. Most often occurs due to low pressure in a pregnant woman or due to compression of a child's head;

Decelerant: Heart rate does not rise above 90 bpm. In addition to the reasons that provoke the condition, hypoxia is added - a clear lack of oxygen to the unborn baby. The condition requires immediate help, because. can threaten with irreversible consequences in the life of the fetus. Treatment is carried out strictly in stationary conditions.

Sinus bradycardia is considered a type of decelerant pathology - the baby's heart in the womb gives tremors no more than 70 beats per minute. The most dangerous condition in which you can not have time to help the fetus. The risk of pregnancy fading is high. Treatment is carried out in a hospital with full bed rest and often until the very very birth.

Causes of bradycardia in the fetus:

At its core, bradycardia is one of the many signs that something is wrong with the baby’s health, and that he is literally suffering. The main reasons may lie in the mother, or may be directly in the state of the fetus.

When causes in a pregnant woman:

Unhealthy lifestyle of the expectant mother (malnutrition, bad habits or a sedentary lifestyle);
the use of drugs that are prohibited for pregnant women or have a negative effect on the fetus;
anemia of a pregnant woman (not only those that were before conception, but also those that formed in the process of bearing a baby);
severe toxicosis;
prolonged stressful conditions;
blood flow disorders and convulsions;
Rhesus conflict that does not stop;
multiple pregnancy;
pathologies associated with placental abruption, its presentation, infarction;
severe infectious diseases of the expectant mother;
little or polyhydramnios.

Violations in the body of the fetus:

Congenital pathologies of the respiratory and cardiovascular systems;
torsion or squeezing of the umbilical cord;
violation of cerebral circulation;
anomalies of fetal development;
entanglement of the umbilical cord.

Symptoms of slowing down of the heart in the fetus:

It is obvious that outwardly from a pregnant woman it is impossible to determine that something is wrong with her baby's heart. Except for the assumptions when the mother herself has health problems.

On ultrasound, you can determine:

Deterioration of the fetal heart;
- slow movements up to the stop of the movements of the child;
- rare respiratory movements and even occasional pauses in breathing;
- convulsions;
- cardiac arrest with a critical decrease in contractions.

Help the fetus in detecting bradycardia:

The biggest danger that a slow heartbeat carries is the death of the fetus. If not death, then serious pathologies in development are guaranteed. The earlier the pathology is detected, the more effective the treatment will be. Fetal bradycardia in early pregnancy is often compensated and does not affect the further development of the baby and the general condition of the mother.

The purpose of diagnostics is to eliminate the identified cause completely or reduce its influence. To determine the malfunction of the heart, use:

ultrasound diagnostics;
- cardiotocography;
- Doppleroscopy;
- studies directly of the fetal myocardium;
- Carry out blood and urine tests.

All studies are carried out at certain intervals in time to see the dynamics of the state. The frequency and intervals between diagnostic studies are determined by the gynecologist observing the pregnancy. The minimum is two more ultrasound examinations with an interval of 3 or 7 days after the first suspicion. The diagnosis is considered confirmed if the fetal heart beats at a frequency of 110 beats per minute or less for 10 minutes or more.

Any treatment is prescribed exclusively by a doctor, regardless of whether it is medication or traditional medicine recipes! Bradycardia in the later stages is a good reason for giving birth by caesarean section.

The entire therapeutic course includes:

Normalization of nutrition;
- complete rejection of bad habits (if any);
- correction of motor activity of a pregnant woman;
- the appointment of iron-containing drugs for anemia in women;
- the most safe therapy for a pregnant woman in the presence of infectious or internal non-communicable diseases.

After a course of treatment for primary diagnosis, the following is prescribed:

With early fetal bradycardia: continuous follow-up monitoring of the heartbeat using a vaginal ultrasound probe;
- with fetal bradycardia in the later stages: monitoring the work of the heart with the help of CTG, transabdominal ultrasound or auscultation (listening to the heartbeat).

The main drugs that are always administered to a pregnant woman with fetal bradycardia are:

Carboxylase and sodium bicarbonate drip;
solutions of ascorbic acid and glucose intravenously;
calcium gluconate intravenously.

Prevention:

The best prevention is considered to be the prevention of the effects of the main probable causes. In addition, it insists on the complete exclusion of bad habits in a pregnant woman, proper nutrition, a rational balance of work and rest, as well as timely scheduled visits to a gynecologist. Those. a healthy lifestyle for a pregnant woman is the best prevention not only of bradycardia, but also of many other pathological conditions.