Heart Disease

Question 1

Pregnancy on the heart

Answer 1

Cardiac output increases by 20% at 8 weeks
Increased oxygen consumption
Increased plasma volume
Increased Red Blood cells
ECG changes- inverted T waves
The delivery of the baby is the most pressure on the heart due to the relief of the uterus on the Inferior Vena Cava and the blood being released back to the heart.

Question 2

Conditions to be wary of

Answer 2

Pulmonary hypertension
Marfan’s syndrome
Aortic stenosis

Question 3

Antenatal care

Answer 3

Increased frequency of visits
Continuity of care
Multidiciplinary teams
Psych and social support

Question 4

Recognising compromise

Answer 4

Fatigue, breathlessness, palpitations.
Limitation of physical activity
Chest pain.

Question 5

Assessment of maternal condition

Answer 5

Cyanosis 
Pulmonary Hypertension 
NYHA classification 
ECG, Chest x ray, Echocardiogram USS
FBC and clotting studies

Question 6

Fetal well being

Answer 6

USS to check for CHD
USS for Amniotic fluid volume
Preterm labour risk

Question 7

Interventions

Answer 7

Depending on cardiac compromise
Admission for rest and oxygen therapy
Anticoagulants
Antibiotic prophylaxis

Question 8

Intrapartum

Answer 8

Mild: Spontaneous onset
Severe: Planned C/S with epidural
monitor maternal and fetal condition closely
Fluid balance and pain relief.
Limit the length of second stage- may need instrumental
Oxytocic drugs should be avoided as they cause vasoconstriction.

Question 9

Postnatal care

Answer 9

Monitor for 48 hours Regular observations 
Antibiotic prophylaxis 
Examine baby for CHD
Family spacing 
PN support groups