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Y4R2 - Obstetrics I 🤰 > L15: Heart Disease in Pregnancy > Flashcards

L15: Heart Disease in Pregnancy Flashcards

1
Q

Incidence of Heart Disease in Pregnancy

A

1-3% of all pregnancies.

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2
Q

Types of Heart Disease in Pregnancy

A
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3
Q

Classifications of Heart Disease in Pregnancy

A
  • NEW YORK HEART ASSOCIATION (NYHA) CLASSIFICATION: CLINICAL CLASSIFICATION.
  • ACOG CLASSIFICATION: ACCORDING TO RISK OF MATERNAL MORTALITY.
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4
Q

Classifications of Heart Disease in Pregnancy

  • NHYA
A
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5
Q

Classifications of Heart Disease in Pregnancy

  • NHYA (Class I)
A
  • Asymptomatic (uncompromised) .
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6
Q

Classifications of Heart Disease in Pregnancy

  • NHYA (Class II)
A
  • Symptomatic with heavy exertion (slightly compromised)
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7
Q

Classifications of Heart Disease in Pregnancy

  • NHYA (Class III)
A
  • Symptomatic with light exertion (markedly com promised)
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8
Q

Classifications of Heart Disease in Pregnancy

  • NHYA (Class IV)
A
  • Symptomatic at rest (severely compromised).
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9
Q

Classifications of Heart Disease in Pregnancy

  • ACOG
A
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10
Q

Classifications of Heart Disease in Pregnancy

  • ACOG (Group I)
A
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11
Q

Classifications of Heart Disease in Pregnancy

  • ACOG (Group II)
A
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12
Q

Classifications of Heart Disease in Pregnancy

  • ACOG (Group III)
A
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13
Q

Effects of Pregnancy on Heart Disease

A
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14
Q

Effects of Pregnancy on Heart Disease

  • HF
A
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15
Q

Effects of Pregnancy on Heart Disease

  • Acute PE
A

Due to acute LSHF

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16
Q

Effects of Pregnancy on Heart Disease

  • Infective Endocarditis
A

More è puerperal sepsis.

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17
Q

Effects of Heart Disease on Pregnancy

A

Maternal & Fetal

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18
Q

Effects of Heart Disease on Pregnancy

  • Maternal
A
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19
Q

Effects of Heart Disease on Pregnancy

  • Fetal
A
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20
Q

Dx of Heart Disease on Pregnancy

A
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21
Q

Dx of Heart Disease on Pregnancy

  • Hx
A

Past or family history of rheumatic fever, past history of cardiac troubles or past history of cardiac surgery (valvotomy or valve replacement).

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22
Q

Dx of Heart Disease on Pregnancy

  • Symptoms
A
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23
Q

Dx of Heart Disease on Pregnancy

  • Signs
A
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24
Q

Dx of Heart Disease on Pregnancy

  • INVx
A
  1. ECG.
  2. Echocardiography: Most reliable investigation in pregnancy.
  3. Chest X-ray: For evaluation of size of heart.
  4. Cardiac catheterization: Not indicated during pregnancy.
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25
Dx of **Heart Disease on Pregnancy** - Most Reliable Investigation
Echocardiography:
26
Managment of **Heart Disease on Pregnancy**
- Preconceptional care - During Pregnancy - During Delivery - Neonatal Care - Post Natal Care
27
Managment of **Heart Disease on Pregnancy** - Preconceptional Care
28
Managment of **Heart Disease on Pregnancy** - During Pregnancy
- ANC - Medical Care - Observation - Corrective Cardiac Suregry - TOP TTT of Complications
29
ANC for **Heart Disease on Pregnancy**
30
Frequency of Visits in **Heart Disease on Pregnancy**
31
Frequency of Visits in **Heart Disease on Pregnancy** - Class I & II
As any high risk pregnancy (every 2 weeks till 28 weeks then every week till 36 weeks)
32
Frequency of Visits in **Heart Disease on Pregnancy** - When to hospitalize Class I & II?
1. () 28-32 weeks. 2. At 36 weeks. 3. At any time when complications occur.
33
Frequency of Visits in **Heart Disease on Pregnancy** - Class III & IV
34
Supervision for **Heart Disease on Pregnancy**
By team work of obstetrician, cardiologist & other specialists as needed.
35
Medical Care in **Heart Disease on Pregnancy**
- Antibiotics - Prevention of HF - Prevention of acute pulmonary edema
36
Medical Care in **Heart Disease on Pregnancy** - Antibiotics
Long acting penicillin every 2 weeks.
37
Medical Care in **Heart Disease on Pregnancy** - Prevention of HF
38
Medical Care in **Heart Disease on Pregnancy** - Prevention of Acute PE
1. Prevention of HF. 2. Avoid administration of B -agonists (specially è corticosteroids).
39
Observation of **Heart Disease on Pregnancy**
40
Corrective Cardiac Surgery for **Heart Disease on Pregnancy**
41
Corrective Cardiac Surgery for **Heart Disease on Pregnancy** - Indications
- chronically ill patients not responding to medical treatment. - Although it is better to be done after pregnancy
42
Corrective Cardiac Surgery for **Heart Disease on Pregnancy** - Time
When indicated, it is better to be done during 2nd trimester (general rule of surgery during pregnancy).
43
Corrective Cardiac Surgery for **Heart Disease on Pregnancy** - Types
- Closed cardiac surgery (valvotomy): → Safer during pregnancy. - Opened cardiac surgery (valve replacement): → Not preferred during pregnancy.
44
Indications of TOP in **Heart Disease on Pregnancy** (Induction of Therapeutic Abortion)
45
Time of TOP in **Heart Disease on Pregnancy** (Induction of Therapeutic Abortion)
- Done before 12 weeks (after 12 weeks, risk of TOP is > risk of continuation).
46
Method of TOP in **Heart Disease on Pregnancy** (Induction of Therapeutic Abortion)
Suction evacuation under heavy sedation & prophylactic antibiotics.
47
TTT of Complications in **Heart Disease on Pregnancy** (Induction of Therapeutic Abortion)
48
TTT of Complications in **Heart Disease on Pregnancy** (Induction of Therapeutic Abortion) - TTT of HF
49
TTT of Complications in **Heart Disease on Pregnancy** (Induction of Therapeutic Abortion) - TTT of Acute PE
50
TTT of Complications in **Heart Disease on Pregnancy** (Induction of Therapeutic Abortion) - TTT of infective endocarditis
Antibiotics.
51
TTT of Complications in **Heart Disease on Pregnancy** (Induction of Therapeutic Abortion) - TTT of Arrhythmias
Antiarrhythmic drugs.
52
Managment of **Heart Disease on Pregnancy** - Managment of **Delivery**
53
Managment of **Heart Disease on Pregnancy** during **Delivery** - Time of Delivery
Usually pregnancy is allowed to continue till term & elective preterm delivery is rarely indicated in cardiac cases.
54
Managment of **Heart Disease on Pregnancy** during **Delivery** - Methods of Delivery
Vaginal & CS
55
Managment of **Heart Disease on Pregnancy** during **Delivery** - Indications of Vaginal Delivery
The rule unless CS is indicated.
56
Managment of **Heart Disease on Pregnancy** during **Delivery** - % of Success of Vaginal Delivery
Vaginal delivery is usually easy due to: - Small sized fetus (IUGR). - Soft birth canal (due to congestion & edema).
57
Managment of **Heart Disease on Pregnancy** during **Delivery** - Team Work
Obstetrician + anesthesiologist + cardiologist (if needed) + neonatologist.
58
Managment of **Heart Disease on Pregnancy** during **Delivery** - Precautions of Vaginal Delivery
- During 1st stage - During 2nd stage - During 3rd stage
59
Precautions of vaginal Delivery in Managment of **Heart Disease on Pregnancy** - During 1st Stage
60
Precautions of vaginal Delivery in Managment of **Heart Disease on Pregnancy** - During 2nd Stage
- Avoid bearing down. - Shortening of 2nd stage by ventouse (better) or low forceps.
61
Precautions of vaginal Delivery in Managment of **Heart Disease on Pregnancy** - During 3rd Stage
62
Indications of CS Delivery in cases of **Heart Disease in Pregnancy**
63
Disadvantages of CS Delivery in cases of **Heart Disease in Pregnancy**
Risk of anesthesia & infection.
64
Managment of **Heart Disease in Pregnancy** - Neonatal Care
Proper examination to exclude congenital cardiac anomalies.
65
Managment of **Heart Disease in Pregnancy** - Postnatal Care
66
Postnatal Care in **Heart Disease in Pregnancy** - Prophylactic Antibiotic
To guard against infective endocarditis.
67
Postnatal Care in **Heart Disease in Pregnancy** - Rest
For first 2 weeks (but do leg massage to avoid DVT).
68
Postnatal Care in **Heart Disease in Pregnancy** - Breast Feeding
Allowed only for compensated cases.
69
Postnatal Care in **Heart Disease in Pregnancy** - Contraception
70
Contraception in **Heart Disease in Pregnancy** - Physiologicl Methods
Can be used safely but have high failure rate.
71
Contraception in **Heart Disease in Pregnancy** - Barrier Methods
Can be used safely but have high failure rate.
72
Contraception in **Heart Disease in Pregnancy** - Combined Pills
Contraindicated (due to salt & water retention & 1 1 incidence of thromboembolism).
73
Contraception in **Heart Disease in Pregnancy** - Progesterone only pills
Can be used (except in IHD).
74
Contraception in **Heart Disease in Pregnancy** - IUCD
75
Contraception in **Heart Disease in Pregnancy** - Female Sterialization
Excellent method for woman completed her family & women è contraindication to pregnancy.
76
Managment of **Surgically Corrected Heaty in pregnancy**
77
Managment of **Surgically Corrected Heaty in pregnancy** - Valvotomy (Commissurotomy)
General management (anticoagulation isn't needed).
78
Managment of **Surgically Corrected Heaty in pregnancy** - Cardiac Valve Replacment
79
Types of Valves

Y4R2 - Obstetrics I 🤰 (59 decks)

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