Cardiac SMFM questions

Question 1

What increase left to right shunting during labor with a VSD

Answer 1

Increased stroke volume due to increased volume from contractions
Increased SVR due to catecholamine release
Can cause increased right ventricular/pulmonary artery pressures

Question 2

Vasodilation with an epidural can cuase what complication with a VSD

Answer 2

Reversal of the flow across the VSD

Question 3

What is the increase in cardiac output during labor

Answer 3

45%

Question 4

What is the increase in cardiac output after delivery

Answer 4

80%

Question 5

Definition of peripartum cardiomyopathy

Answer 5

1 month prior to delivery or 5 months after delivery

Echocardiograph findings demonstrate an ejection fraction <45% or a shortening fraction <30%

Question 6

Treatment of peripartum cardiomyopathy

Answer 6

diuretics ( decrease preload)
Vasodilators (decrease afterload)
Dig for any arrythmias
Consider anticoagulation

Question 7

Outcomes of peripartum cardiomyopathy

Answer 7

20% requrie heart transplant
30-50% continued dysfunction
30-50% recover normal function
- EF <25% 50% will need a transplant

Question 8

Risk for next pregnancy after peripartum cardiomyopathy and recovery

Answer 8

20% risk for peripartum cardiomyopathy

low mortality

Question 9

Risk for thrombosis of mechanical valve during pregnancy with warfarin vs. heparin

Answer 9

2-4% risk with warfarin
25% risk with heparin ( only used in 1st trimester 9.2% risk)
12% with LMWH titrated to anti-10a

Question 10

Fetal embryopathy risk with warfarin

Answer 10

in the 1st trimester 4-10 %

lower when warfarin dose is <5 mg