Should I be worried about the exertion of labor?

[molly2647]

I am 37 years old, 35 wks, 2 days pregnant, with one baby, my 4th child. I have been having SOB for more than 2 mos, extreme fatigue for 5 mos and in the past 3 wks, it has been accompanied by chest pain (a tightening feeling, just to the left of my breastbone, at it's worst, the pain is about a 6 on a scale of 1 - 10). In the last 2 wks., I also tend to get light-headed when I have the pain and that feeling is usually followed by a headache. All of these symptoms are on mild exertion, climbing the stairs, taking a shower, etc. When I sit or lay down, I have few, if any, of these symptoms. I don't know if it's related, but I've also had a mild, intermittent cough. I've never had these problems in any of my other pregnancies, not even SOB. I had an outpatient 12-lead EKG 2 wks. ago that was normal. Symptoms continued to worsen, so in L&D,  they did another EKG (not a continuous monitoring), a CBC and cardiac enzymes and a chest x-ray, all of which were normal. They put me on a pulse oximeter for about a minute which showed my pulse to be 122 bpm. and my O2 sat to be 96. They took BP's x2, first was 132/90, which they didn't like, so the second was 128/87, which was what they put in my chart. My BP this pregnancy has been as low as 102/68 and as high as 138/93, with no protein showing in my urine. They didn't monitor the baby at all and sent me home after about 6 hours. They referred me to a family practitioner and wanted me seen within a day or so. Are there other tests I should be pushing for?  Should I be worried about the exertion of labor?  Thank you for your help!

[CCF-M.D.-RCJ]

Molly,

Thanks for the post.

I'm not an obstetrician, and I've not had the benefit of seeing you in person, but one explanation for your symptoms would be heart failure caused by the pregnancy.  This syndrome can start as early as the 30th week.  The shortness of breath, cough, and chest discomfort are all consistent with this syndrome -- but other things could be as well.  Other possibilities could include bronchitis, preeclampsia, deconditioning, and others.

I would recommend that you see a good internist, or perhaps cardiologist, to help sort through your symptoms.

Good luck.

[Dr. Erik]

You should have an Echocardiogram done of your heart. I'm not sure if you are two far along with your pregnancy to have a exercise stress test. I'm also not sure if being pregnant, you can have a chemical stress test. Somehow you need to see how your heart will perform under stress prior to giving birth or you will just have to be closely monitored. Best of luck.

[Carolina03]

Molly,

I'm 36 yrs old, 33 wks pregnant with my third child, a boy. I'm ALSO experiencing such symptoms with the SAME triggers and have had the SAME battery of tests and results, except that my cardiologist ran an echo. The echo revealed mild valvular insufficiency in the mitral, tricuspid and aortic valves. My cardio initially thought I had Mitral Valve Prolapse, but the echo overruled this. I had none of the symptoms you described during my first and second pregnancies either!

My cardio thinks the increased valvular "insufficiency" is transient, i.e., due to the pregnancy but wants to run another echo 8 wks after delivery. I've been reassured by my cardio; brother, a neurosurgeon; PCP; and OB that some valvular insufficiency at my age is absolutely NORMAL. (OK, so I had to ask more than one doctor before I accepted this!) Perhaps mild anxiety, (which is understanderable with the number of children we have and as our due date approaches) also contributes to such symptoms. I've started practicing Yoga breathing techniques 3x daily to compensate for this possibility, and it actually helps!

I've also learned to be an advocate for my health concerns. I found a compassionate cardio who is a great communicator (after experiencing the opposite). Please INSIST on an echo. The sonogram can rule out structural abnormalities in your heart and bring you the peace of mind you deserve. Please keep us updated.  

Best,
Kim