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Management of pericardial effusion and acute pericarditis during pregnancy

Massimo Imazio, MD, FESC
Section Editors
Martin M LeWinter, MD
Jae K Oh, MD
Deputy Editor
Brian C Downey, MD, FACC


Although diseases of the pericardium may occur sporadically during pregnancy, there is no evidence that pregnancy increases the susceptibility to pericardial diseases [1]. 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".)


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'.)


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 [5]. 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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Literature review current through: Nov 2017. | This topic last updated: Jul 01, 2016.
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