Management of pericardial effusion and acute pericarditis during pregnancy
- Massimo Imazio, MD, FESC
Massimo Imazio, MD, FESC
- Professor of Physiology
- University Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza di Torino.
- Department of Public Health and Pediatrics, University of Torino.
- Section Editors
- Martin M LeWinter, MD
Martin M LeWinter, MD
- Section Editor — Myopericardial Disease
- Professor of Medicine and Molecular Physiology and Biophysics
- University of Vermont
- Jae K Oh, MD
Jae K Oh, MD
- Section Editor — Myopericardial Disease
- Professor of Medicine
- Mayo Clinic College of Medicine
Although diseases of the pericardium may occur sporadically during pregnancy, there is no evidence that pregnancy increases the susceptibility to pericardial diseases . The outcomes of pregnancies in women with pericardial disease are similar to those expected in the general population with pericardial disease. More difficult cases may require a multidisciplinary approach involving different subspecialties (eg, cardiology, internal medicine, maternal-fetal medicine, and neonatology).
Relatively few data are available to guide the management of pericardial disease during pregnancy. However, as with pregnancy in general, the major tenet of avoiding all medications and interventions that are not absolutely necessary should be followed.
This topic will discuss the clinical features, diagnosis, and management of pericardial effusion and acute (or recurrent) pericarditis during pregnancy. A broader discussion of pericardial disease in the general population is presented separately. (See "Acute pericarditis: Clinical presentation and diagnostic evaluation" and "Acute pericarditis: Treatment and prognosis" and "Recurrent pericarditis" and "Diagnosis and treatment of pericardial effusion".)
FETAL PERICARDIAL FLUID
After 20 weeks of gestation, a small amount of pericardial fluid (<3 mm) can be detected in the normal fetus [1,2]. Larger fetal pericardial effusions should raise suspicion of disease conditions, such as nonimmune hydrops fetalis, fetal hemolytic disease due maternal antibodies to Rhesus or other red cell antigens, structural anomaly (eg, heart or diaphragm, teratoma), chromosomal abnormality, infection, or an immunopathy [3,4]. Because of the limited distensibility of the fetal pericardial sac, pathologic pericardial effusion may be the first sign of hydrops, detectable before the appearance of ascites, pleural effusion, and soft tissue edema. (See "Nonimmune hydrops fetalis", section on 'Fetal findings'.)
MATERNAL PERICARDIAL EFFUSION
Epidemiology and clinical features — Pericardial effusion has been reported in the first and second trimester in 15 to 20 percent of pregnancies, and in about 40 percent of pregnant women during the third trimester . In general, these effusions are asymptomatic, benign, transient, and resolve spontaneously without therapy. In the absence of signs or symptoms of acute pericarditis or cardiac tamponade, neither diagnostic testing (generally with echocardiography) nor specific treatment is required.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Spodick DH. Pericardial disorders during pregnancy. In: The pericardium: a comprehensive textbook, Dekker, New York 1997. p.89.
- Dizon-Townson DS, Dildy GA, Clark SL. A prospective evaluation of fetal pericardial fluid in 506 second-trimester low-risk pregnancies. Obstet Gynecol 1997; 90:958.
- Mohan MS, Patole SK. Isolated fetal pericardial effusion: case report and review of the literature. Aust N Z J Obstet Gynaecol 2002; 42:216.
- Kyeong KS, Won HS, Lee MY, et al. Clinical outcomes of prenatally diagnosed cases of isolated and nonisolated pericardial effusion. Fetal Diagn Ther 2014; 36:320.
- Abduljabbar HS, Marzouki KM, Zawawi TH, Khan AS. Pericardial effusion in normal pregnant women. Acta Obstet Gynecol Scand 1991; 70:291.
- Halphen C, Haiat R, Clément F, Michelon B. [Silent pericardial effusion in late pregnancy: echocardiographic detection in the third trimester of pregnancy (author's transl)]. J Gynecol Obstet Biol Reprod (Paris) 1982; 11:245.
- Haiat R, Halphen C. Silent pericardial effusion in late pregnancy: a new entity. Cardiovasc Intervent Radiol 1984; 7:267.
- Enein M, Zina AA, Kassem M, el-Tabbakh G. Echocardiography of the pericardium in pregnancy. Obstet Gynecol 1987; 69:851.
- Imazio M, Cecchi E, Demichelis B, et al. Indicators of poor prognosis of acute pericarditis. Circulation 2007; 115:2739.
- Imazio M, Trinchero R. Triage and management of acute pericarditis. Int J Cardiol 2007; 118:286.
- Mayosi BM. Contemporary trends in the epidemiology and management of cardiomyopathy and pericarditis in sub-Saharan Africa. Heart 2007; 93:1176.
- Troughton RW, Asher CR, Klein AL. Pericarditis. Lancet 2004; 363:717.
- Adler Y, Charron P, Imazio M, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2015; 36:2921.
- Tsang TS, Enriquez-Sarano M, Freeman WK, et al. Consecutive 1127 therapeutic echocardiographically guided pericardiocenteses: clinical profile, practice patterns, and outcomes spanning 21 years. Mayo Clin Proc 2002; 77:429.
- Imazio M, Demichelis B, Parrini I, et al. Day-hospital treatment of acute pericarditis: a management program for outpatient therapy. J Am Coll Cardiol 2004; 43:1042.
- Imazio M, Trinchero R. Clinical management of acute pericardial disease: a review of results and outcomes. Ital Heart J 2004; 5:803.
- Imazio M, Spodick DH, Brucato A, et al. Controversial issues in the management of pericardial diseases. Circulation 2010; 121:916.
- Imazio M, Brucato A, Derosa FG, et al. Aetiological diagnosis in acute and recurrent pericarditis: when and how. J Cardiovasc Med (Hagerstown) 2009; 10:217.
- Imazio M, Brucato A, Mayosi BM, et al. Medical therapy of pericardial diseases: part I: idiopathic and infectious pericarditis. J Cardiovasc Med (Hagerstown) 2010; 11:712.
- Imazio M, Brucato A, Mayosi BM, et al. Medical therapy of pericardial diseases: part II: Noninfectious pericarditis, pericardial effusion and constrictive pericarditis. J Cardiovasc Med (Hagerstown) 2010; 11:785.
- Imazio M, Gaita F, LeWinter M. Evaluation and Treatment of Pericarditis: A Systematic Review. JAMA 2015; 314:1498.
- Brucato A, Imazio M, Curri S, et al. Medical treatment of pericarditis during pregnancy. Int J Cardiol 2010; 144:413.
- Beitins IZ, Bayard F, Ances IG, et al. The transplacental passage of prednisone and prednisolone in pregnancy near term. J Pediatr 1972; 81:936.
- Park-Wyllie L, Mazzotta P, Pastuszak A, et al. Birth defects after maternal exposure to corticosteroids: prospective cohort study and meta-analysis of epidemiological studies. Teratology 2000; 62:385.
- Imazio M, Brucato A, Trinchero R, et al. Colchicine for pericarditis: hype or hope? Eur Heart J 2009; 30:532.
- Brucato A, Brambilla G, Moreo A, et al. Long-term outcomes in difficult-to-treat patients with recurrent pericarditis. Am J Cardiol 2006; 98:267.
- Imazio M, Trinchero R, Shabetai R. Pathogenesis, management, and prevention of recurrent pericarditis. J Cardiovasc Med (Hagerstown) 2007; 8:404.
- Maisch B, Seferović PM, Ristić AD, et al. Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. Eur Heart J 2004; 25:587.
- Richardson PM, Le Roux BT, Rogers NM, Gotsman MS. Pericardiectomy in pregnancy. Thorax 1970; 25:627.
- https://toxnet.nlm.nih.gov/newtoxnet/lactmed.htm (Accessed on July 01, 2016).
- Østensen M, Khamashta M, Lockshin M, et al. Anti-inflammatory and immunosuppressive drugs and reproduction. Arthritis Res Ther 2006; 8:209.
- FETAL PERICARDIAL FLUID
- MATERNAL PERICARDIAL EFFUSION
- Epidemiology and clinical features
- Management and follow-up
- ACUTE PERICARDITIS
- Epidemiology and etiology
- Clinical manifestations
- Determination of risk and need for hospitalization
- - Activity restriction
- - Initial treatment
- NSAID therapy
- Glucocorticoid therapy
- - Subsequent treatment of refractory symptoms
- - Breast feeding
- PLANNING FOR PREGNANCY
- SUMMARY AND RECOMMENDATIONS