Conditions - Cardiac Disease IP

Question 1

What is the definition of cardiac disease in pregnancy?

Answer 1

Cardiac disease in the mother present before becoming pregnant. Can include congenital defects. Asymptomatic conditions can become symptomatic during pregnancy (and symptomatic conditions become worse) due to increased cardiac strain so goal of management during pregnancy is to keep cardiac strain low and thus minimise symptoms.

Question 2

What is the management plan for cardiac disease in pregnancy?

Answer 2

Pre-conception

• Adjust medications (advise to stop all teratogenic drugs)
• These include ACEi, ARBs, thiazide diuretics, statins, warfarin

Antenatal

• Arrange contact with joint cardiac and obstetric clinic (every 2-4 weeks until 20w, every 2 weeks until 24w, weekly thereafter)
• Monitoring - Maternal echocardiogram at booking + 28 weeks. Specialist foetal cardiac scan at 22 weeks
• Medical - VTE prophylaxis with LMWH SC

Intrapartum

• Aim for spontaneous labour + avoid induction where possible
• Advise epidural anaesthesia to reduce pain-related cardiac strain
• Use prophylactic antibiotics if structural heart defect present (reduce risk of bacterial endocarditis)
• Minimise length of 2nd stage of labour (using forceps or ventouse, aim to reduce maternal effort and cardiac output)
• Active management of 3rd stage of labour with syntocinon alone (introduce slowly, avoid ergometrine)

Postnatal
- Monitoring – transfer to HDU for close monitoring in first 12-48 hrs and arrange obstetric and cardiac follow-up