**7. Mitral valve prolapsus and pregnancy**

The features of the course of pregnancy and childbirth in women with DST are not sufficiently studied. Pathology of pregnancy is much more common in women with MVP and CTD than in healthy women—85.5 versus 53.3%.The threat of spontaneous abortion and miscarriage occurs in 50% of women with MVP, and the threat of premature birth is observed six times more often than in healthy pregnant women [13]. The main reason for the habitual miscarriage of pregnancy in this group of patients is cervical insufficiency [16]. In women with MVP and CTD, the threat of interruption of pregnancy up to 20 weeks is in almost onethird of cases, the threat of premature birth—in 17.2%, pregnancy ended in premature births of 4.6% [40]. The threat of spontaneous termination of pregnancy in the first trimester was noted in every third patient with MVP, in the II trimester—in 25.9% of patients with MVP; in the third trimester—in 15.5% [33]. The 9.6% of women with habitual miscarriage have MVP [41, 42].

The pregnancy in patients with MVP and undifferentiated connective tissue dysplasia is accompanied by an increase in the frequency of the threat of interruption in the first trimester of pregnancy—OR 1.7, hyperemesis gravidarum—OR 1.8, the threat of interruption in the second trimester of pregnancy—2.5%, premature births—OR 3.2, and polyhydramnios—OR 2.7. The course of labor is complicated by cervical rupture—OR 1.8 and weakness of labor activity—OR 3.7 [7].

The most common complication of the second half of pregnancy in women with MVP is preeclampsia—51.7% [16, 43], and the course of labor in these patients is characterized by frequent complications [16, 40, 43]. It is known that preeclampsia ranks two to three in the structure of causes of maternal mortality [33, 44–47] and is one of the main causes of premature birth and perinatal fetal death. Every fifth child born to a mother with preeclampsia, to some extent, deviations in physical and psycho-emotional development are observed [7].

Another complication, no less important for obstetrics—preterm rupture of placental membranes and outflow of amniotic fluid—in women with MVP is observed in 40.0–51.6% of cases [7, 29, 43, 48]. The frequency of premature and early outflow of amniotic fluid in pregnant women with MVP is 38.1%.

Among the characteristics of the course of labor associated with MVP, the relationship with the rapid course of labor is described, and with a severe degree of MVP, the rate of fast and rapid delivery in primiparas reaches 50%, and for weakly expressed symptoms of MVP is about 12%.

In women older than 30 years, WLA occurs two times more often than in women at the age of 20–25. WLA leads to a prolonged course or complete stopping of labor, the appearance of signs of distress syndrome of the fetus, which causes operative delivery. In the structure of an emergency cesarean section, the WLA occupies the second to third place, reaching 37%.

cardiac death in MVP is ventricular tachyarrhythmias, which are especially common in family MVP forms [3, 10]. In a number of cases in the presence of pain in the left half of the chest, in women, there is an inversion of the T-wave on the ECG, especially in the II and III thoracic leads, even in the presence of normal coronary angiography. When conducting a treadmill test, it is also possible to detect the depression of the ST segment, indistinguishable from that

The features of the course of pregnancy and childbirth in women with DST are not sufficiently studied. Pathology of pregnancy is much more common in women with MVP and CTD than in healthy women—85.5 versus 53.3%.The threat of spontaneous abortion and miscarriage occurs in 50% of women with MVP, and the threat of premature birth is observed six times more often than in healthy pregnant women [13]. The main reason for the habitual miscarriage of pregnancy in this group of patients is cervical insufficiency [16]. In women with MVP and CTD, the threat of interruption of pregnancy up to 20 weeks is in almost onethird of cases, the threat of premature birth—in 17.2%, pregnancy ended in premature births of 4.6% [40]. The threat of spontaneous termination of pregnancy in the first trimester was noted in every third patient with MVP, in the II trimester—in 25.9% of patients with MVP; in the third trimester—in 15.5% [33]. The 9.6% of women with habitual miscarriage have MVP

The pregnancy in patients with MVP and undifferentiated connective tissue dysplasia is accompanied by an increase in the frequency of the threat of interruption in the first trimester of pregnancy—OR 1.7, hyperemesis gravidarum—OR 1.8, the threat of interruption in the second trimester of pregnancy—2.5%, premature births—OR 3.2, and polyhydramnios—OR 2.7. The course of labor is complicated by cervical rupture—OR 1.8 and weakness of labor

The most common complication of the second half of pregnancy in women with MVP is preeclampsia—51.7% [16, 43], and the course of labor in these patients is characterized by frequent complications [16, 40, 43]. It is known that preeclampsia ranks two to three in the structure of causes of maternal mortality [33, 44–47] and is one of the main causes of premature birth and perinatal fetal death. Every fifth child born to a mother with preeclampsia, to some extent, deviations in physical and psycho-emotional development are observed [7].

Another complication, no less important for obstetrics—preterm rupture of placental membranes and outflow of amniotic fluid—in women with MVP is observed in 40.0–51.6% of cases [7, 29, 43, 48]. The frequency of premature and early outflow of amniotic fluid in pregnant

Among the characteristics of the course of labor associated with MVP, the relationship with the rapid course of labor is described, and with a severe degree of MVP, the rate of fast and rapid delivery in primiparas reaches 50%, and for weakly expressed symptoms of MVP is

of myocardial ischemia.

90 Structural Insufficiency Anomalies in Cardiac Valves

[41, 42].

activity—OR 3.7 [7].

women with MVP is 38.1%.

about 12%.

**7. Mitral valve prolapsus and pregnancy**

The investigation of the causes of WLA concerns mainly the issue of the state of the myometrium without sufficient attention to the general anamnestic and clinical signs inherent in the MVP, although the causative factors of the WLA may indicate the possible involvement of MVP in the pathogenesis of an abnormality of labor [16].

The study of the features of the course of pregnancy and childbirth of women with small and large signs of MVP and CTD made it possible to establish that anomalies of labor in the first stage of childbirth appeared in 85.2% of women giving birth, compared to 33.9% in the control group without CDT. Cesarean section in the main group was performed in 12% of pregnant women and only in 4% of patients in the control group. Hypotonic bleeding in the III stage of labor took place in 7.3% of mothers with MVP and CTD and were absent in the control group. The discrepancy of the pubic joint was diagnosed in 7.2% of women with MVP and CTD and was not detected in the control group.

The birth traumatism of newborns from mothers with MVP and CTD was diagnosed in 34.4% of cases compared with 3.4% in the control group. This study showed that patients with generalized manifestations (involvement of three or more organs in the connective tissue defect) of MVP and CTD even in the absence of severe forms of this pathology constitute a high-risk group for the formation of obstetric and neonatal pathology.

The frequent occurrence of MVP and CDT in pediatric practice, the pronounced clinical polymorphism, and multiple organ changes make the problem relevant from the point of view of differential diagnostics and complex therapy.

Hemodynamic changes that develop during pregnancy, during childbirth, and in the postpartum period (primarily changes in bcc and cardiac ejection) cannot but affect the current of the woman's cardiovascular diseases. As well as diseases of the heart and blood vessels can adversely affect the course of pregnancy. Changes in hemodynamics in the mother have a negative effect on uteroplacental blood circulation, which in some cases may lead to the development of placental insufficiency, fetal growth retardation (FGR), and premature birth [4, 7, 16]. The central hemodynamics in women with mitral valve prolapse in the III trimester is characterized by an increase in the overall peripheral resistance of the vessels against a background of a decrease in volume indices, which indicates the voltage of the compensatory-adaptive mechanisms of the cardiovascular system [33].

The features of hemodynamics (heart rate, peripheral resistance of blood vessels, changes in blood pressure) are due to changes in the activity of the sympathoadrenal system. The pregnant women with MVP showed a significant decrease in MI and BV, as well as CI and BI as compared to those in women without MVP with a physiological pregnancy. Perhaps, the reduction of these indicators is due to a decrease in the contractility of the myocardium and a decrease in the activity of the sympathoadrenal system. Formation in the first trimester of the hypokinetic type of central maternal hemodynamics with a reduced peripheral vascular resistance is one of the leading pathogenetic mechanisms of the development of preeclampsia and placental insufficiency (fetal hypoxia and IUGR) [4, 33].

**3.** investigation of the magnesium content in biological fluids and the detection of its defi-

Mitral Valve Prolapse in Pregnancy: Modern Concept http://dx.doi.org/10.5772/intechopen.76692 93

**4.** in case of complications of pregnancy and (or) complaints from the cardiovascular

**5.** systematic control of the fetus with the use of Doppler, cardiotocography, ultrasound in

**6.** labor is preferred to lead through the natural birth canal with adequate analgesia, under cardiac monitoring of the fetus and contractive activity of the uterus, prevention of abnor-

**7.** examination of newborns with the help of echocardiography and consultation with a car-

**8.** control echocardiography of a woman to determine the degree of prolapse of the mitral

However, this algorithm is the opinion of only domestic obstetricians. According to data of some authors [3, 10], the complicated course of pregnancy and the increase in clinical symptoms in women with MVP are extremely rare. Women are primarily advised to avoid stressful situations, drinking coffee, strong tea, alcohol and tobacco, and using β-mimetics. Therapy is required only in the presence of arrhythmia (often tachycardia and extrasystoles). In this case, β-blockers are the drugs of choice. An interesting one is the recommendation of antibiotic prophylaxis in the presence of MVP and delivery with cesarean section in order to avoid infective endocarditis, but it is also controversial. The risk of serious complications in women

Thus, the data presented earlier indicate a number of conflicting views on the etiology, classification, pathogenetic features of the mitral valve prolapsed, and the significance of its presence in the formation of various obstetric and perinatal complications. At present, it is urgent to continue research into the complex effects of nondifferentiated connective tissue dysplasia (NCTD) and MVP on the course of pregnancy, postpartum and neonatal delivery, analysis of current classifications of NCTD and pathogenetic (including genetic factors) of MVP features, and the definition of their importance in the development of obstetric

First Moscow State Medical University, I. M. Sechenov (Sechenov University), Moscow,

malities of labor. Cesarean section—according to obstetric indications;

with uncomplicated MVP younger than 45 years old is 0.2% per year.

Ignatko Irina Vladimirovna\*, Strizhakov Leonid Alexandrovich, Rodionova Alexandra Mihailovna and Martirosova Alina Lorisovna

\*Address all correspondence to: iradocent@mail.ru

ciency in the appointment of magnesium preparations;

the detection of abnormalities timely correction;

system—hospitalization;

diologist and neurologist;

valve after delivery [33].

complications.

**Author details**

Russia

The main clinical manifestation of placental insufficiency in patients with MVP is chronic intrauterine fetal hypoxia (7.33), which is detected in 34.5% of pregnant women, which is significantly higher than in women without MVP (13.2%). Dopplerometric examination of blood flow velocities revealed a violation of both placental and uterine-placental blood flow. In 11.2% of pregnant women with MVP on the background of chronic intrauterine fetal hypoxia, the fetal growth retardation (FGR) syndrome was detected, and in 84.4%—on the background of preeclampsia. In the development of placental insufficiency, the main and often initial causes are hemodynamic microcirculatory disorders. The factors that are genetically determined, exist in the maternal organism initially, also play a role in the formation of placental insufficiency, while the process of collagen formation has a certain role [7].

In the presence of a syndrome of non-differentiated dysplasia of connective tissue, the mother has the prerequisites for the birth of children with small developmental anomalies and congenital heart defects (MVP, TVP, left ventricular abnormal chords, patent foramen ovale, open arterial duct, atrial and interventricular septal defect). In children born from mothers with MVP, minor heart anomalies were detected in 16.4% [49].

The more significant clinical manifestations and a higher incidence of obstetric and perinatal complications are noted when MVP is combined with other intracardiac anomalies. Thus, in pregnant women with mitral valve prolapse and in combination with abnormally located chord and congenital heart disease (atrial septal defect), there is a significant increase in cardiac clinical symptoms from the first to the third trimester of pregnancy [5].

The postpartum period is characterized by a significant "positive" dynamics of ultrasound indicators of the degree of prolapse of the mitral valve and the degree of mitral regurgitation: they decrease reliably, even in comparison with the data during echocardiography in the first trimester of pregnancy. Thus, according to literature data [3, 5, 7, 10, 16, 41, 49, 50], women with MVP and other connective tissue anomalies of heart development are considered to be at high risk for complications of pregnancy, childbirth, and perinatal morbidity.
