Cardiac disease in pregnancy

Question 1

How does pregnancy affect the cardiovascular system?

Answer 1

40% increase in blood volume during pregnancy, hence cardiac strain
If cardiac disease: unable to increase cardiac output, can lead to uterine hypoperfusion + increase risk of pulmonary oedema

Question 2

What are the risk factors for cardiac disease in pregnancy?

Answer 2

FHx
Obesity
Age
HTN
Smoking

Question 3

Summarise the epidemiology of cardiac disease in pregnancy.

Answer 3

Increasing prevalence with higer maternal age and CVD risk in population.

Question 4

Recognise 6 presenting symptoms of cardiac disease in pregnancy.

Answer 4

SOB

Palpitations

Orthopnoea

Paroxysmal nocturnal dyspnea (PND)

Low exercise tolerance

Chest pain.

Question 5

What advice should be given to women with cardiac disease preconception?

Answer 5

Stop all teratogenic drugs:
ACEi
ARBs
Thiazide diuretics
Statins
Warfarin

Swap to Labetelol/ Nifedipine, LMWH

Question 6

What is the antenatal management of women with cardiac disease?

Answer 6

Arrange contact with joint cardiac + obstetric clinic every 2-4w until 20, every 2w till 24w + weekly thereafter

Maternal echocardiogram at booking + 28w

Special foetal cardiac scan at 22w

Question 7

What is the intrapartum management of women with cardiac disease?

Answer 7

Aim for spontaneous labour + avoid IOL where poss.

Advise epidural to reduce pain related cardiac strain

Prophylactic Abx if structural defect present

Minimise length of 2nd stage of labour- use forceps/ ventouse to reduce maternal effort

Syntocinon for active Mx of 3rd stage

Question 8

What is the postpartum management of women with cardiac disease?

Answer 8

Transfer to HDU for monitoring 12-48h
Arrange obstetric + cardiac FU