heart_disease_flashcards
What risk assessments should be done pre-conception for heart disease?
Risk assess based on modified WHO classification and NYHA functional class.
What medications should be stopped pre-conception for heart disease?
All teratogenic drugs (ACEi, ARBs, thiazide diuretics, statins, and warfarin).
How often should joint cardiac and obstetric clinic appointments be arranged antenatally?
Every 2-4 weeks until 20 weeks gestation, every 2 weeks until 24 weeks gestation, and weekly thereafter.
What monitoring should be done antenatally for heart disease?
Maternal echocardiogram at booking and repeat at 28 weeks, specialist foetal cardiac scan at 22 weeks.
What medical prophylaxis is recommended antenatally for heart disease?
VTE prophylaxis with LWMH SC.
What is the goal for labour in women with heart disease?
Aim for spontaneous labour, and avoid induction of labour (IOL) where possible.
When should a planned C-section be considered for heart disease?
If high-risk aortic disease, pulmonary arterial hypertension, or New York Heart Association class III or IV heart disease.
What type of anaesthesia is recommended during labour for women with heart disease?
Epidural anaesthesia to reduce pain-related cardiac strain.
What should be used to reduce the length of the 2nd stage of labour in heart disease?
Forceps or ventouse to reduce maternal effort and the need for more cardiac output.
What should be used for the active management of the 3rd stage of labour in heart disease?
Syntocinon alone, introduced slowly. Avoid use of ergometrine.
What is the role of prophylactic antibiotics in labour for women with heart disease?
Use prophylactic antibiotics if structural heart defect is present to reduce the risk of bacterial endocarditis.
What postnatal monitoring is required for women with heart disease?
Transfer to HDU for close monitoring for the first 12-48 hours, arrange obstetric and cardiac follow-up.
