How is the ecg procedure in pregnant women, why is it needed. What is an ECG during pregnancy, how is the study carried out and why

An ECG during pregnancy differs from an ECG in a non-pregnant woman. This is due to developing changes in hemodynamics, electrolyte composition and hormonal changes. This must be taken into account when interpreting the result - what is normal outside of pregnancy can be a sign of pathology during it, and vice versa. This research method allows you to identify various abnormalities in the work of the heart, therefore it is widely used in obstetrics. But interpret ECG result should be a specialist who has the appropriate specialization.

Historical reference! An ECG during pregnancy was first performed in 1913. The electrocardiography method itself dates back to the middle of the 19th century, when it was noticed that the heart generates a certain amount of electricity.

Diagnostic value of the method

An ECG of pregnant women is performed to assess the work of the heart in conditions of increasing stress on the woman's body

A cardiogram during pregnancy allows you to obtain the following information:

heart rate;
the nature of this rhythm;
detection of ischemic myocardial damage;
determination of other damage to the heart, for example, inflammatory;
assess the effectiveness of appointed medicines, which are necessary for the normal functioning of the heart;
electrolyte disturbances.

Features of the ECG in pregnant women

The ECG norm during pregnancy includes certain changes that are not normal for non-pregnant women.

During pregnancy, single extrasystoles are allowed, that is, excitation occurs not in the sinus node, but in any other part of the heart

A change in the electrical axis when the heart takes a more horizontal position. This feature is revealed from about 25-26 weeks, when the enlarged uterus begins to deflect the diaphragmatic dome upward. On the ECG, this is manifested by the following signs:

in the first lead, the ventricular contraction wave (R) becomes higher;
in the third lead, the height of Q and S increases (initial and final ventricular contraction, respectively);
in all other leads, the height of the ventricular contraction complex becomes smaller;
the amplitude of ventricular relaxation also decreases (T wave);
the ST segment descends somewhat relative to the main level (isoline). In non-pregnant women, this would indicate ischemia.

Changes characteristic of hyperkinetic circulation, that is, for increased cardiac output. This increase occurs during pregnancy to ensure normal blood flow in the placenta and in the baby's body. ECG signs of this change will be:

the T wave consists of two phases in the third lead and in all chest leads on the right (it can also become not positive, but negative);
an increase in the depth of the Q wave in the same leads (in this case this does not indicate myocardial infarction, which is judged by the Q wave, this is a sign of the norm).

During pregnancy, the speed of propagation of an impulse through the heart increases. This reduced time is due to the effect of estrogens and corticosteroids on cardiac activity. Therefore, the heart rate increases to 90 per minute.

Detectable deviations

On the basis of the analyzes carried out, a conclusion is made about the possibility of prolonging the pregnancy or a plan for the management of childbirth is developed.

A bad ECG in a pregnant woman is most often manifested by the following disorders:

sinus tachycardia (more than 90 beats per minute in a pregnant woman), since the time of impulse conduction through the heart decreases;
sinus arrhythmia - the time between successive atrial contractions is different, but the impulse is generated in the right place;
ventricular extrasystole - during the registration, there is a contraction of the ventricles out of turn;
atrial extrasystole - atrial contraction out of turn;
change in the pacemaker (not from the sinoatrial node), which is reflected in the time of contraction of the ventricles and atria.

Other violations are very rare. Usually they are associated with heart disease that existed in a woman before pregnancy.

A bad electrocardiogram is a reason to contact a cardiologist. Together with an obstetrician-gynecologist, he will determine the optimal tactics for your management, and also select the best way delivery. For some heart conditions independent childbirth may not be allowed. In addition, based on the ECG, the anesthesiologist will be able to choose a gentle method of anesthesia for caesarean section.

Features of the procedure

For ECG interpretation great importance has the speed of the tape in the device. It is usually set to 50 mm/s. However, it can be more or less than 2 times. Electrodes are placed on the body of a pregnant woman in appropriate places - there are 6 standard leads, but in some cases additional leads can be used. The latter allow you to detail the previously received information.

Carrying out the ECG procedure for pregnant women practically does not differ from the usual procedure

To obtain the most accurate ECG, a special gel must be applied to the electrodes. It improves the conductivity of the electrical impulse from the heart to the device, since the air gap that is created between the body and the sensors is not conductive and dampens the signal.

Indications for electrocardiography

ECG during pregnancy is not performed for all women - this is not a screening examination. Therefore, there are certain indications when this diagnostic test is necessary. Such cases include:

violations blood pressure- How arterial hypertension, and hypotension;
feeling of pain in the heart;
feeling of pressure in this area;
loss of consciousness;
dizziness;
preeclampsia;
heart disease before pregnancy (in this case, the woman is registered with a cardiologist);
suspicion of heart disease during pregnancy.

ECG interpretation

The result of an ECG is a graphical recording of the electrical fields generated as a result of cardiac activity. This method of research allows you to obtain valuable information, while not spending large amounts of money on diagnostics.

It is important to distinguish between concepts! Electrocardiography is the process of recording heart impulses, and an electrocardiogram is the actual recording of these impulses (a film that is given to the patient in his hands). The doctor deciphers just this film, giving a conclusion.

When decoding an ECG, the doctor takes into account the following parameters:

heart rate (normal from 70 to 90 per minute);
the location of the electrical cardiac axis (the norm is from 30 to 70 degrees, that is, it coincides with the axis of the heart, drawn from the top to the middle of its base);
heart rhythm (the norm is sinus rhythm, that is, the impulses generated by the heart must come from the sinoatrial node);
determination of the time of atrial contraction (the norm is indicated in special tables);
determination of the time of contraction of the ventricles;
determination of the relaxation time of the atria and ventricles;
study of the nature of the main teeth and the intervals between them (there are their own norms of time and height).

Any abnormalities in the above parameters speak of a bad ECG. Based on them, a conclusion is issued, since certain signs are characteristic of a particular pathology.

Electrocardiography (ECG) is a method for determining the electrical activity of the heart and recording it on film. With the help of this study, you can determine how our heart works. A special device - an electrocardiograph - captures the total potential difference of all heart cells between two points, that is, in a certain lead, and writes it down on paper. The doctor, examining the electrocardiogram, evaluates the rhythm and heart rate, the location of the heart, the speed of the electrical impulse. That is, on the ECG, you can determine various arrhythmias, blockades and dysfunctions of the heart muscle.

During pregnancy, a woman's heart works with an increased load due to an increase in the volume of circulating blood. It also changes the level of hormones in the body that affect the work. of cardio-vascular system. Therefore, it is very important to find out at the beginning of pregnancy possible violations in the work of the heart, in time to spend necessary treatment and prevent the development of complications.

The procedure and its safety

Electrocardiogram recording procedure absolutely safe and painless, therefore, it can be carried out without fear even for pregnant women and young children. The study is carried out for all pregnant women without exception when registering, as well as for any complaints and changes in the indicators of the cardiovascular system.

During a conventional ECG study, 12 graphs are displayed on paper film, which display the direction of passage of an electrical impulse through the heart. In order to set these directions, special metal plates - electrodes - are superimposed on the skin of the wrists and legs, and electrodes are also attached to the chest in the projection zone of the heart.

Leads used in a conventional ECG study:

3 standard leads (I, II, III);

I - between the left and right hand;
II - between the left leg and right hand;
III - between the left leg and left hand.

3 augmented limb leads (aVR, aVL, aVF);

aVR - enhanced abduction from the right hand;
aVL - enhanced abduction from the left hand;
aVF - enhanced abduction from the left leg.

6 chest leads (V1, V2, V3, V4, V5, V6).

If necessary, the cardiologist may order an ECG recording using additional leads:

According to Nab (registration of the potential between points on the surface chest);
V7 - V9 (continuation of standard chest leads);
V3R - V6R ( mirror reflection chest leads V3 - V6 on the right half of the chest).

Such a large number of leads is necessary to clarify the localization pathological process in heart. So the first 6 leads (standard and reinforced from the limbs) show the electrical potential of the heart in the frontal plane and allow you to determine the electrical axis of the heart, that is, its position. At various diseases it changes, and the heart takes a horizontal or vertical position. The chest leads reflect the passage of an electrical impulse in the horizontal plane, with their help they specify the location of the affected area of the heart muscle.

Preparation for the procedure Before the study, you need to rest for 10 - 15 minutes so that the heart rate returns to its normal normal level. Also, it is desirable that at least two hours pass after eating, but it is not worth passing an ECG on an empty stomach, as this may affect the result of the analysis.

ECG recording is usually carried out in the supine position so that the subject can relax as much as possible. To attach the electrodes, it is necessary to undress from the top to the waist and expose the ankles (remove socks or tights). The skin areas on which the metal plates are fixed are wiped with alcohol to degrease the surface and improve the impulse conduction. A red electrode is attached to the right hand, on left hand- yellow, on the left leg - green and on the right leg - a black electrode (it is necessary to ground the current in case of a breakdown of the device). Recording heart activity takes only a few minutes. Then the resulting film is signed and sent to the doctor for decoding.

Indications for an ECG during pregnancy:

Pregnancy registration. An ECG is performed to clarify the condition of the woman's heart, determine the nature of the heart rhythm, possible conduction disturbances, and assess the ability to adapt to the increasing needs of the body.
Changes in blood pressure (increase and decrease);
Feeling of heaviness and pain in the region of the heart;
Dizziness, fainting;
Any complications of pregnancy severe toxicosis, preeclampsia, );

The procedure for taking an ECG is safe for a woman and her unborn child, so there are no contraindications to the procedure.

The main parameters determined on the ECG:

When evaluating an electrocardiogram, the nature of the heart rhythm and its frequency are first evaluated. Fine regular sinus rhythm, heart rate (HR) 60 - 80 beats per minute.

During pregnancy, single extrasystoles are allowed, that is, excitation does not occur in the sinus node, but in any other part of the heart. If an electrical impulse occurs constantly in the atrium or in the atrioventricular node of the ventricles, then rhythm called atrial or ventricular respectively. This condition requires further diagnosis and treatment.

Heart rate less than 60 bpm is called bradycardia, normally can be in athletes . Tachycardia- Heart rate more than 90 beats / min, in healthy people occurs during physical and emotional stress.

Electrical axis of the heart (EOS) coincides with the anatomical axis and characterizes the position of the heart in the chest. Normally, EOS is 30 0 - 70 0. During pregnancy, due to an increase in the volume of circulating blood, the heart can acquire a horizontal position, EOS = 70 0 - 90 0. This is not a pathology and after childbirth it returns to its previous values.

The location and size of the teeth and segments on the electrocardiogram determine the speed of the conduction of excitation, with blockades at various levels, the time of the conduction of the electrical impulse increases, and the heart cannot contract correctly. Depending on the level of violation, there are atrial, atrioventricular and bundle branch block.

Here is an example of a normal ECG report:

The rhythm is correct sinus, heart rate is 75 beats/min, EOS is normal.

Additionally With any changes found on the ECG, the woman is referred for a consultation with a cardiologist. The doctor prescribes additional examinations and, if necessary, hospitalizes the pregnant woman in a cardiological dispensary or department of a multidisciplinary hospital.

There, on the basis of the tests performed, they make a conclusion about the possibility of prolonging the pregnancy and give recommendations to the woman. For more later dates the pregnant woman is subjected to a second examination of the cardiovascular system and at this stage a plan for the conduct of childbirth is developed.

In this article, we will consider such a research method as an ECG - what it is, whether it can be done during pregnancy, what it is intended for.

The essence of the procedure

In general, this procedure is designed to track the rhythm of the heart by plotting on paper tape the form of a graph of the person's cardiac activity at the time of the study. An ECG allows you to quickly and accurately find out the basic information related to the central organ of the blood circulation of the mother and child. Analyzing the electric field of the heart, the method establishes the rhythm, the number of contractions of the organ, the rhythm of the heart, various disorders: cardiac, non-cardiac ailments, electrolyte metabolism disorders, etc.

Such a non-invasive (no injury skin any surgical instrument) method is painless and highly effective in cardiology. However, the ECG method also has its drawbacks.

IN traditional medicine it is believed that such a study is not able to directly detect tumors and heart defects and the presence of noise.

Did you know? Already in the 19th century, Gabriel Lippmann discovered electric fields generated during the work of the heart. He also recorded the first electrocardiogram.

Indications for use

ECG is one of the main research methods in modern cardiology, so it is often used to identify potential pathologies in a mother or child in the heart area. Indications for use can be both doctor's recommendations and the outgoing initiative of the patient herself.
An ECG is prescribed on the basis of such complaints:

severe dizziness, fainting, migraine;
general weakness of the body, shortness of breath, lethargy;
unreasonable rapid heartbeat (for example, not associated with physical activity);
the presence of heart disease in relatives in a straight line;
pain in the chest, difficulty breathing;
various diseases of the endocrine and central nervous system.

ECG is also recommended to be performed in without fail:

people over 45;
pregnant women or women planning;
with any complications during the course of pregnancy;
women who have had any infectious diseases;
with alcohol abuse and;
before any surgical intervention.

Is it possible for pregnant women

The time of pregnancy is a period of special restructuring of the body to a new rhythm, the development of certain and preparation for gestation. Such a procedure as an ECG is carried out without fail, when the patient contacts women's consultation.
The procedure should be performed at least 1 time, but basically the doctor prescribes such a study 2-3 times during interesting position women.

For a mother and her baby, an ECG must be performed in the first trimester of pregnancy in order to detect possible further early stage fetal development.

The mother's heart during pregnancy begins to work for two, pumping more blood and being subjected to increased stress.

These factors, along with changes in the hormonal composition in the body, provoke the emergence of certain risk factors associated with impaired rhythmic activity hearts.

Important! An ECG is performed for all women who are registered with the antenatal clinic. Additional studies are prescribed in the presence of dizziness, severe pain in the chest and severe shortness of breath.

Therefore, in order not to expose yourself and the baby to such danger, and, if necessary, to undergo treatment on time, it is necessary to undergo this procedure.

How is the procedure

Electrocardiography is a study of the heart muscle, displayed in the form of 12 graphs that show how electrical impulses pass through the heart organ. This method is always the beginning of the investigation and diagnosis of any cardiac abnormality.

Do you need preparation

In general, expectant mothers do not need any special preparation before the procedure. However, there are some recommendations that will improve the permeability of electrical impulses and display a more accurate result:

1 hour before the procedure, do not expose yourself to physical activity;
do not use energy drinks on the day of taking readings;
do not visit the sauna and bath immediately before the ECG;
do not smear the area fat cream. This impairs the conductivity of the skin.

Process description

This procedure can be carried out by both functional diagnostics specialists and nurses.

The order of the ECG:

The patient is located on a special couch or gynecological chair.
The area and attachment points of the devices are degreased with ethyl alcohol.
A special gel is applied to the skin, which enhances the conduction of electrical impulses.
Electrodes are attached to the chest, arms and hands. The wires are then pulled to the measuring device.
The cardiograph is turned on, the recording of the graph begins.
After the end of the study, a tape is obtained with a graph of the patient's cardiac activity printed on it.

In order for the results of electrocardiography to be displayed most accurately, the patient should not worry during its implementation.

The main thing is to relax and breathe evenly.

It is advisable not to eat food 2 hours before such a procedure, because the digestion of food slightly increases cardiac activity, which can distort the data obtained.

ECG Leads

There are several ways to record an ECG: from the region of the heart (during open operations), from the chest. Taking readings from the fetus, for example, is performed using a device that is attached to the belly of the expectant mother.
In every specific case, based on the location of the electrode, the ECG displays a graph obtained due to a certain lead (the electrical impulses of the heart organ are, as it were, retracted from parts of the body).

Lead - special way, which can register the potential difference using different electrodes.

Allocate standard and reinforced leads. Standard tapping occurs when devices are connected in pairs:

first position. Measurement of the potential difference between the right and left hand (-) and (+);
second position. Measuring the difference between the right arm and left leg (-) and (+);
third position. The potential difference of the left arm and left leg (-) and (+) is measured.

Did you know? Over an average lifespan, the heart pumps nearly one and a half million barrels of blood - enough to fill 200 train tanks.

Reinforced leads are characterized by an additional arrangement of active and passive electrodes at certain points of the limbs of the body. Thus, distinguish:

separation from the right hand (aVR) - the active electrode is located on right hand, and the left leg and arm are attached to the passive electrode;
separation from the left hand (aVL) - active electrode on the left hand, passive - on the right hand and left leg;
enhanced separation from the left leg (aVF) - in this case, the active electrode is located on the left leg, and the hands connected together are connected to the inactive electrode.

Results and their interpretation

The interpretation of ECG analyzes should be carried out only by a competent specialist. The analysis indicates the heart rate and the state of the fetal organ itself.

The conclusion will be represented by a large number of numbers, Latin names, letters, which is very difficult for an inexperienced patient to understand on their own. To understand whether the indicators correspond to the norm, the following decoding will help:

HR - heart rate. The norm for adults is from 62 to 90. In pregnant women, the figure rises to 120.

Intervals and teeth (in Latin letters):

PQ - (from 0.11 to 0.3) - time of atrial-ventricular blockade. Reduced time indicates ventricular overexcitation syndrome. As a result, a mother or unborn child may develop;
P - height in 0.2-0.5.5 mm displays atrial contraction. Indicators deviated from the norm may indicate hypertrophy;
QRS - (0.05-0.1 s). Index of the ventricular complex. Deviations may indicate the onset of myocardial disease;
QT - the norm is not more than 0.5 s. The indicator lengthens in the presence of oxygen starvation or a violation of the child's heart rhythm;
RR - shows the regularity of heart contractions, helps to calculate heart rate.

Description of heart rate:

the inscription that occurs most often on the analysis of the ECG is sinus rhythm. The norm in pregnant women from 70 to 160 shows that the heart muscle is in a positive state, its conducting system is also healthy;
bradycardia - decrease in contractions (less than 50). At healthy person this condition happens in a dream when naturally breathing slows down. If in a pregnant woman pauses in contractions reach 3-4 seconds, fainting appears. In this case, surgical intervention is required to return the heart rhythm to normal;
tachycardia - an excessive increase in contractions (more than 90). In a healthy person, tachycardia is short-term, it occurs with excessive physical activity, after drinking coffee, alcohol and tobacco. In pregnant women, the diagnosis is diagnosed at an indicator of 165 and above - this condition can cause a risk of a heart attack;
sinus extrasystole - uneven, "jumping", rapid heart rate. Often this condition leads to the development of heart defects;
paroxysm is an acute attack. Rapid rhythm lasting from several minutes to several days;
atrial flutter - atrial flutter. The ejection of blood by the heart muscle worsens, and as a result, there is oxygen starvation causing great harm to the fetus.

Features of the fetal ECG

The answer to the question of whether it is possible to do an ECG during pregnancy is definitely positive. This is a procedure that does not harm the unborn baby. Often such a study is called "cardiotocography".
For research, the patient is attached to the stomach sensors that record the number of uterine contractions and the baby's heartbeat. The recommended time for the study is in the morning or after 7 pm.

Also, to enhance fetal activity and successfully complete the procedure, doctors recommend eating a little. The procedure usually takes about an hour.

Already from the 29th week of pregnancy, the fetus occurs correct formation cycles of rest and activity, therefore, it is from this period that his ECG begins to be carried out.

If any pathologies and disturbances in the activity of the baby's heart muscle are detected, special treatment is prescribed, and an ECG is performed every 10 days. In the presence of hypoxia, the study will be done every day.

Important! The rate of heart rate indicators during pregnancy should be 110-160 beats per minute. In case of deviations from the norm, appropriate therapy is prescribed.

The result of the analysis during pregnancy is provided in the form of a 10-point system:

8-10 points - the child is in absolutely healthy condition, nothing threatens its further development and formation;
6-7 points - an additional study will be assigned to identify the cause of the deviations;
5 points and below - urgent hospitalization and medical care.

Are there any contraindications

ECG is one of those methods for which there are no contraindications. Moreover, doctors strongly recommend undergoing this procedure during pregnancy, since it is with its help that you can observe the work of the fetal heart and, in case of deviations, take urgent measures.

Such a study can be carried out even several times a day - it is absolutely safe and does not harm the body.

So, we found out that such a study as an ECG can, and even needs to be done during pregnancy. Treat your health and the health of your unborn child responsibly - this will help to avoid many problems in the future.

Echocardiography (ECG) old method study of the work of the heart, which allows timely detection of diseases of the cardiovascular system. It is based on the determination of the electrical activity of the heart muscle itself, which is recorded on a special film (paper). The device records the total potential difference of absolutely all heart cells located between two points (leads).

Quite often, expectant mothers think about whether it is possible to do an ECG during pregnancy, and whether this kind of manipulation is dangerous for the fetus. Let's try to answer this question, and tell how often an ECG is done during pregnancy and what are the indications for such a study.

Why is an EKG done?

Before considering the features of such a procedure in pregnant women, let's talk about why an ECG is generally prescribed during pregnancy.

To begin with, it should be noted that when carrying a fetus, the heart future mother works in an enhanced mode, in view of the fact that there is an increase in the volume of circulating blood. In addition, a direct effect on the work of the heart muscle has and hormonal background, which changes almost immediately after conception. That is why it is especially important to establish possible violations even before the onset of pregnancy. Given this fact, most family planning medical centers include mandatory examinations and ECG.

With the help of such a study, the doctor can set such parameters as the rhythm and frequency of the heartbeat, the speed of the electrical impulse, which allows diagnosing such disorders as disorders of the functioning of the heart muscle, etc.

Is an ECG safe for pregnant women?

Among women, one can often hear the assertion that an ECG during pregnancy is harmful. Such a statement is unfounded and is refuted by doctors.

The thing is that during the procedure for taking an ECG, there is no effect on the human body, unlike radiography, nuclear magnetic resonance (NMR), which are strictly prohibited during gestation.

With an ECG, special sensors only record the electrical impulses emitted by the heart itself and record them on paper. Therefore, such a procedure is absolutely safe and is carried out by all expectant mothers, without exception, when registering in a antenatal clinic.

Features of the ECG in pregnant women

When evaluating the results obtained from the ECG, doctors take into account some features of the physiology of a pregnant woman. So, in particular, when carrying a fetus, the number of heartbeats is usually higher than normal, which indicates an increase in the load on the heart muscle, which needs to pump more blood. At the same time, normally it should not exceed 80 contractions per minute.

It is also worth noting that during pregnancy, the presence of separate extrasystoles (additional contraction of the heart muscle) is allowed, because. sometimes excitement can occur in any part of the heart, and not in the sinus node, as usual. In cases where the electrical impulse constantly occurs in the atrium or atrioventricular node of the ventricle, the rhythm is called atrial or ventricular, respectively. This kind of phenomenon requires additional examination of the pregnant woman.

With a poor ECG during pregnancy, before establishing possible violations, the study is repeated after a while. If the results are similar to the first, an additional examination is prescribed, an ultrasound of the heart, which allows you to establish the presence of anatomical disorders, causing violation work of the heart.