الفهرس 
THE SYSTEMATIC REVIEWOnly 14 pages are availabe for public view
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Abstract
Heart disease during pregnancy encompasses a wide spectrum of disorders and is the leading indirect cause of maternal death al! over the world. Clear guidelines and policies for management of cardiac patients built on clear evidence is lacking in the explosive era of medical literature. Systematic reviews to understand and develop guidelines for the cardiac pregnant woman during pregnancy, labor and delivery is greatly needed. An understanding of systematic reviews and how to implement them in practice is becoming mandatory for all professionals involved in the delivery of health care to pregnant cardiac patients (Grobier et al., 2008).
The marked hemodynamic changes associated with pregnancy explain the characteristic signs and symptoms that occur in the pregnant patient. Normal pregnancy is often associated with fatigue, dyspnea, and decreased exercise capacity (Peterson et al., 2009)
Pregnant women usually have peripheral edema and jugular venous distension. Most pregnant women have audible physiologic systolic murmurs, created by augmented blood i flow. A physiologic third heart sound (S3), reflecting (he volume overloaded state, can often be appreciated (Maroo and Raymond 2004).
The hemodynamic changes during the post-partum stale are mainly due to relief of vena caval compression after delivery. The resultant increase in venous return augments cardiac output and causes a brisk diuresis. The hemodynamic changes return to the pre-pregnant baseline within 3 to 4 weeks following delivery (Peterson et al., 2009).
Basic concepts to bear in mind include the following:
Blood volume and cardiac output rise during normal pregnancy, reaching a peak during the late second trimester (Robson et al., 1987).
Preexisting cardiac lesions should be evaluated with respect lo the risk they impart during the stress of pregnancy (Peterson ef al., 2009).
Contraindications to pregnancy include severe pulmonary hypertension or Eisenmenger’s syndrome, cardiomyopathy with NYHA Class III or IV symptoms, history of periparfum cardiomyopathy, severe uncorrected valvular stenosis, unrepaired cyanotic congenital heart disease, and Marfan syndrome with an abnormal aorta (Hameed et al., 2008).
Awareness of major cardiac drug classes that are contraindicafed during pregnancy is important for the treatment of hypertension and heart failure during pregnancy (Born et al., 2006)
Anticoagulation during pregnancy presents unique challenges because of the maternal and fetal side effects of warfarin, unfractionated heparin, and LMWH (Elkayam 2006).
The mode of delivery whether cesarean or vaginal, the use of instrumental delivery to shorten the second stage, the proper anesthesia and analgesia and the use of oxytocin are all dependant upon the condition of the cardiac case and the obstetric variables that operate during delivery of the pregnant cardiac patient (Swan 2008).