Ukrainian Journal of Perinatology and Pediatrics. 2019.3(79):32-39; doi 10.15574/PP.2019.79.32

S.O. Siromakha, S.S. Arvanytakvy, S.A. Rudenko, V.V. Lazorishenetc
SI «Amosov National Institute of Cardiovascular Surgery of NAMS of Ukraine», Kyiv

For citation: Siromakha SO, Arvanytakvy SS, Rudenko SA, Lazorishenetc VV. (2019). Coronary insufficiency during pregnancy. Epidemiology, methods of diagnosis and treatment. Ukrainian Journal of Perinatology and Pediatrics. 3(79): 32-39. doi 10.15574/PP.2019.79.32
Article received: Apr 18, 2019. Accepted for publication: Sep 09, 2019.

The article presents a literature review on coronary insufficiency (CI) in pregnant women. Epidemiology of CI is outlined. The causes of this pathology in pregnant women and its symptoms are described. Main methods of diagnosis and treatment of CI are determined. Coronary insufficiency refers to acute and chronic diseases characterized by a mismatch between myocardial oxygen demand and coronary blood supply. The incidence of CN depends on a family history of atherosclerotic diseases, dyslipidemia, activation, nutrition, stress, blood sugar, smoking, and use of oral contraceptives in the past. The major reasons for CI development are atherosclerotic disorders of the coronary arteries, due to common risk factors for CI, as well as hemodynamic, hemostatic and hormonal changes during pregnancy. Coronary insufficiency poses a threat to the health and life of the pregnant woman and her baby. Diagnosis of CI during pregnancy is difficult and may include risks to the fetus. First of all, non-invasive methods are used, as they do not pose such risks. The introduction of percutaneous coronary intervention (PCI) as a treatment method reduces maternal mortality by 15%. To reduce the teratogenic effects of ionizing radiation, PCI is recommended after 15 weeks of gestation with the end of the embryonic organogenesis. However, in acute coronary syndrome, PCI is performed on an emergency basis at any time during pregnancy. Coronary artery bypass grafting is also a possible option for emergency myocardial revascularization. Coronary artery bypass grafting on a «working» heart is an operation of choice when endovascular methods cannot be used. According to the literature, postoperative mortality of pregnant women during surgery does not differ from mortality in the «not pregnant» group of patients, but fetal mortality reaches up to 20%, especially with the use of cardiopulmonary bypass. Before prescribing drugs for the cardiovascular system, their effect on uterine blood flow and the fetus should be considered. Pregnant women with CI need to be hospitalized in highly specialized healthcare institutions, on the basis of which there is a pregnancy heart team and where there is the possibility of emergency aid to both the pregnant, and the newborn.
No conflict of interest were declared by the authors.
Key words: pregnancy, coronary insufficiency, acute coronary syndrome.

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