Cardiac Disease in pregnancy

Question 1

What is meant by cardiac disease in pregnancy? Pathophys and epidiemology

Answer 1

This is for the general management of people with cardiac issues during pregnancy, inculding cardiomyopathies and peripartum cardiomyopathy (new onset cardiomyopathy and HF after birth)

Pathopysh - 40% rise in blood volume during preg causes strain in women with cardiac disease - CO cant keep up leading to Uterine hypoperfusion and pulm oedema

Epidemology - increasing as people are getting pregnant older,

Question 2

Sx and Ix of Cardiac Disease in pregnancy?

Answer 2

Sx-
use NYHA classification of heart failure -Sx of normal HF
Class I- asympto
Class II -SOB, fatigue, palp, duspnea with physical activity
class II- more of that
IV- all that at rest

Most woman remain well and have NORMAL cardiac responses which are–
ESM, 3rd heart sound, forecful apex, peripheral oedema

ix - Echocardiogarm done at 28weeks

Question 3

what conditions are high risk for Cardiac Disease in pregnancy? what are the risk for baby?

Answer 3

High risk -
systemic ventricular dysf
cyanotic congenital, ischemic heart disease, Prosthetic heart vavlve, pulm HTN, Aeotic pathology (marfans), L obstruction, previous issues

Foetal risk - reccurence, maternal cyanosis-foetal hypoxia, iatrogenic prematurityy, FGR,
Risk of maternal drugs

Question 4

Mx of Cardiac Disease in pregnancy

Answer 4

Anticoagulation for any with congenital, pulm HTN, artifical valves, risk of AF- CANNOT use warfarin 1st trimester (teratogenic)–
LMWH can be used instead

Labour ward-
Aim to wait for spontaneous labour-
2nd stage short with ventouse/forceps
Active Mx of 3rd stage- avoid Ergometrine (causes vasoconstiction)- syntocinon alone (dilator so be slow)

Induction in very high risk to ensure predictable with personel present
Epidural recommended

Structural - give ABx
PP heamorhage dangerous

Question 5

Summary of things to consider in Cardiac Disease in pregnancy

Answer 5

Echocardiogram for all at 28w
Anticoag may be needed (no warfarin 1st trimester)
avoid induction of labour
Use prophylactic Abx
Ensure fluid balance
Avoid supine
Discuss epidural
2nd stage Short
Syntocinon alone