Heart Diseases in Pregnancy Flashcards
Cardiac output _____ during preg
Inc
Overall max CO is seen during .?
Immediate postpartum - 70% > 2nd stage of labour > late 1st stage of labour > 28 - 32 weeks (40%)
Vascular resistance ____ during pregnancy
Dec.
BP _____ during pregnancy
Dec.
BP ____ in supine position.
Dec.
Supine hypotension syndrome.
in late 3rd trimester.
in supine position - Gravid uterus presses on IVC - Dec Venous return - dec CO - Hypotension in mother and Fetal distress .
Heart rate and pulse rate ___ in preg.
Inc.
Apex beat is heard at ___ ICS in pregnancy
4th instead of the normal 5th coz of diaphragm being pushed upward.
_____ is the ECG finding in Pregnancy
Left axis deviation.
S1 in preg.
Loud and wide +/- prominent split.
S2 in preg.
normal
S3 in preg.
Easily heard.
MC murmur in Preg.
ejection systolic murmur. (<3/6)
CXR finding in preg.
Mild cardiomegaly
Indications of HD in pregnancy.
Inc JVP. clubbing, cyanosis, PND, Orthopnea, Pul. Edema. Ejection systolic murmur >3/6 Marked cardiomegaly on CXR Any arrythmia.
MC heart dis in Pregnancy
Mitral stenosis
MCC of Heart dis in preg in developing countries.
RHD
MC HD in pregnancy in developing countries.
MS
MCC of HD in Pregnancy in developed countries
Congenital HD
ASD.
MC cyanotic HD in pregnancy
TOF
MC congenital valvular HD in pregnancy
Mitral valve prolapse.
MC HD associated with maternal mortality.
Mitral stenosis.
HD with highest risk of maternal mortality.
Eisenmenger syndrome
Clark’s Classification of HD
Class 1 - Maternal mortality < 1 % - all congenital HD
Class 2 - 15-25%
Class 3- 25-50%
Class 3 of clark’s classification .
25-50% risk of maternal mortality,
Pulmonary hypertension - primary and secondary including eisenmenger syndrome.
marfan syndrome with aortic involvement.
COA.
HD with best prognosis for pregnancy
Congenital HD
HD in which pregnancy is C/I
Clark’s class 3
EF <30%
Severe MS or AS.
NYHA class 3 or 4
When to do MTP in case of HD.
12 weeks
Method of MTP in case of HD
Suction evacuation.
Mx of HD in labour.
1) Left lateral or propped up position.
2) restrict vaginal examination.
3) fluids = max 75ml / hr.
4) best mode of delivery - vaginal
if second stage of labour is prolonged > 30 mins - Prophylactic use of vacuum or forceps.
Indications for CS in HD
Any aorta involvement.
Recent MI/CHF
Emergency valve replacement after delivery.
If pt has been on warfarin at labour or within 2 weeks of labour.
Inj Methylergometrine is _____ in 3 rd stage of labour in HD
C/I
laparoscopic sterilisation is _____ in pregnancy
C/I
Conditions for using GA in labour.
Intracardiac Shunt
HOCM
Pul HTN
Severe MS or AS
< 12 wks - Anticoagulant of choice
heparin.
12-36 wks - Anticoagulant of choice
Warfarin.
> 36 wks - Anticoagulant of choice
Heparin.
Why is Heparin C/I after 36 weeks.
No antidote available.
Warfarin can cause ____ to fetus
Condrodysplasia
Surgery of choice in case of MS in Pregnancy
Balloon valvuloplasty
Valve replacement is C/I
best time to do MS surgery in HD in pregnancy
2nd trimester - 14-18 wks.
If pt is on warfarin at time of labour
Do CS
