[7] Cardiac Disease in Pregnancy Flashcards
How commonly is cardiac disease in pregnancy a cause of maternal death?
It is the main cause of indirect maternal death
How is the prevalence of cardiac disease in pregnancy changing?
Increasing
What is thought to be causing the increase of cardiac disease in pregnancy?
- More people surviving congenital cardiac disease and having children
- More acquired heart disease
Why does pregnancy have an adverse effect on pre-existing cardiac disease?
It puts strain on the cardiovascular system
What is one change in pregnancy that can worsen pre-existing cardiac disease?
Rise in cardiac output
What are some symptoms of cardiac disease that are also symptoms of normal pregnancy?
- Breathlessness
- Palpitations
- Syncope
What are some cardiovascular signs that are mimicked in pregnancy?
- Bounding pulse
- Systolic murmur
What is the result of cardiac disease signs and symptoms being present in some normal pregnancies?
It can be hard to diagnose a new or deteriorating cardiac disease
What can women with pre-existing cardiac disease in pregnancy be at higher risk of?
- Congestive cardiac failure
- Worsening hypoxia
- Arrhythmias and sudden death
- Bacterial endocarditis
- VTE
- Angina and MI
- Aortic dissection
How can cardiac disease affect pregnancy?
- Pre-eclampsia
- IUGR
- Preterm birth
- Fetal loss
What are some examples of medications that are taken in cardiac disease that may need review in pregnancy?
- ACE inhibitors
- Warfarin
What is the risk of congenital heart disease being present in the baby of a woman with congenital heart disease?
Up to 5%
How should women with cardiac disease in pregnancy be managed?
In an MDT
Who should be involved in the MDT management of pregnant women with cardiac disease?
- Obstetricians
- Cardiologists
- Obstetric anaesthetists
When should the MDT management of pregnant women with cardiac disease begin?
Ideally in the preconception phase
When may pregnancy not be advisable in women with cardiac disease?
If they have poor cardiac functional status
Give an example of a cardiac condition with a poor prognosis in pregnancy?
Eisenmenger’s syndrome
What is the maternal death rate in Eisenmengers syndrome?
40-50%
What may antenatal care in women with cardiac disease involve?
- Minimisation of stressors
- Alteration of medications
- Anticoagulation if required
- Fetal surveillance
Give 2 examples of stressors that should be reduced in pregnant women with cardiac disease
- Anaemia
- Infection
What fetal surviellance is done in pregnant women with cardiac disease?
- Serial growth scans
- Doppler measurements
- Screening for cardiac defects
What measures should be taken in labour in cardiac disease?
- Minimise pain
- Ensure fluid balance is maintained
What is the most risky time for pregnant women with cardiac disease?
Post-partum period
What is the result of the post-partum period being the most risky time for women with cardiac disease?
Careful surveillance is required
