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 "Clinical presentation and diagnostic evaluation of acute pericarditis" and "Treatment of acute pericarditis" 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.
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- 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