Pregnancy and chronic disease. When and where to deliver a baby? 4
An important question is when to deliver a baby if a mother has a medical disease. It may be wise to deliver a baby a little bit earlier than nine months. For example, if there’s heart disease and the ventricular function is decreasing, then an earlier delivery date may be worthwhile. Dr. Anton Titov, MD. There’s a question of how we can perform delivery [in a woman with the medical disease]. This is an interesting question both for Obstetricians and anesthetists. For example, what will be the impact of performing epidural anesthesia on the hemodynamics of a pregnant woman? When a pregnant woman has a heart defect, that needs to be discussed by the cardiologist and the anesthetist. How will pushing be tolerated by the pregnant woman? What is going to happen if she has an acute blood loss? Is there a particular risk for her health in that case? These things need to be discussed. But in many instances, it is possible to have a vaginal delivery. It is possible to deliver vaginally without pushing, for example, if this is required. Dr. Marc Dommergues. We discussed when to deliver a baby, how to deliver a baby. Then the question is where to deliver a baby. This also relates to the type of disease a pregnant woman has. If she has diabetes Type 1 or types 2 diabetes before the pregnancy, it is best to have a delivery in a hospital where it is easy to find a diabetologist. If a pregnant woman is at risk of having a heart abnormality, it’s best to have a baby delivered in a hospital where it’s easy to get a good cardiologist 24 hours a day. Dr. Anton Titov, MD. So this is something one has to consider [when choosing labor and delivery options.] It’s important to consider the quality of pediatric care as well. Many newborn kids may have the medications in their blood that their mother was taking. These drugs may affect neonatal health. This may require special medical care. It’s important that the pediatricians in charge know about what’s happening, what drugs are being taken by the mother. Now we know how to manage the pregnancy, how to prepare for labor and delivery, and where to do it, and when to deliver a baby. Dr. Anton Titov, MD. There’s the last point. Is it desirable to have a pregnancy? This is a difficult point. Our choice in this hospital is to tell people about the risks and to let them make the decision. Sometimes we are a bit worried. For example, if we believe that there is a 10% risk of dying during pregnancy. Then we are going to tell the patient, and this may be very hard to manage for patients. It may require psychological help for a woman and her partner. It’s a big worry for a partner: “Am I going to kill my wife by letting her become pregnant?” This is really what men are asking, and this is also something that should be taken into account. Overall, it’s probably easier to plan things and make unrushed decisions before pregnancy. Dr. Marc Dommergues. Medical second opinion. And to know in advance what to do as soon as you are pregnant. This is what I’m hearing. Planning ahead is the most important thing. Talking to a disease domain specialist and to an obstetrician who has experience with that disease. Dr. Marc Dommergues. Medical second opinion. And preferably these specialists should be in the same hospital. They should be able to talk to each other. But if they are not in the same hospital, one has to make sure that their work is somehow coordinated. Dr. Marc Dommergues. Medical second opinion. And if a woman finds that she is pregnant without having those preconception meetings, she has to have a meeting as soon as possible with a disease specialist as well as the obstetricians and follow all health issues very closely and carefully.
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