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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
Q

Dx of Heart Disease on Pregnancy

  • Most Reliable Investigation
A

Echocardiography:

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26
Q

Managment of Heart Disease on Pregnancy

A
  • Preconceptional care
  • During Pregnancy
  • During Delivery
  • Neonatal Care
  • Post Natal Care
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27
Q

Managment of Heart Disease on Pregnancy

  • Preconceptional Care
A
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28
Q

Managment of Heart Disease on Pregnancy

  • During Pregnancy
A
  • ANC
  • Medical Care
  • Observation
  • Corrective Cardiac Suregry
  • TOP
    TTT of Complications
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29
Q

ANC for Heart Disease on Pregnancy

A
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30
Q

Frequency of Visits in Heart Disease on Pregnancy

A
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31
Q

Frequency of Visits in Heart Disease on Pregnancy

  • Class I & II
A

As any high risk pregnancy (every 2 weeks till 28 weeks then every week till 36 weeks)

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32
Q

Frequency of Visits in Heart Disease on Pregnancy

  • When to hospitalize Class I & II?
A
  1. () 28-32 weeks.
  2. At 36 weeks.
  3. At any time when complications occur.
33
Q

Frequency of Visits in Heart Disease on Pregnancy

  • Class III & IV
34
Q

Supervision for Heart Disease on Pregnancy

A

By team work of obstetrician, cardiologist & other specialists as needed.

35
Q

Medical Care in Heart Disease on Pregnancy

A
  • Antibiotics
  • Prevention of HF
  • Prevention of acute pulmonary edema
36
Q

Medical Care in Heart Disease on Pregnancy

  • Antibiotics
A

Long acting penicillin every 2 weeks.

37
Q

Medical Care in Heart Disease on Pregnancy

  • Prevention of HF
38
Q

Medical Care in Heart Disease on Pregnancy

  • Prevention of Acute PE
A
  1. Prevention of HF.
  2. Avoid administration of B -agonists (specially è corticosteroids).
39
Q

Observation of Heart Disease on Pregnancy

40
Q

Corrective Cardiac Surgery for Heart Disease on Pregnancy

41
Q

Corrective Cardiac Surgery for Heart Disease on Pregnancy

  • Indications
A
  • chronically ill patients not responding to medical treatment.
  • Although it is better to be done after pregnancy
42
Q

Corrective Cardiac Surgery for Heart Disease on Pregnancy

  • Time
A

When indicated, it is better to be done during 2nd trimester
(general rule of surgery during pregnancy).

43
Q

Corrective Cardiac Surgery for Heart Disease on Pregnancy

  • Types
A
  • Closed cardiac surgery (valvotomy): → Safer during pregnancy.
  • Opened cardiac surgery (valve replacement): → Not preferred
    during pregnancy.
44
Q

Indications of TOP in Heart Disease on Pregnancy (Induction of Therapeutic Abortion)

45
Q

Time of TOP in Heart Disease on Pregnancy (Induction of Therapeutic Abortion)

A
  • Done before 12 weeks (after 12 weeks, risk of TOP is > risk of continuation).
46
Q

Method of TOP in Heart Disease on Pregnancy (Induction of Therapeutic Abortion)

A

Suction evacuation under heavy sedation & prophylactic antibiotics.

47
Q

TTT of Complications in Heart Disease on Pregnancy (Induction of Therapeutic Abortion)

48
Q

TTT of Complications in Heart Disease on Pregnancy (Induction of Therapeutic Abortion)

  • TTT of HF
49
Q

TTT of Complications in Heart Disease on Pregnancy (Induction of Therapeutic Abortion)

  • TTT of Acute PE
50
Q

TTT of Complications in Heart Disease on Pregnancy (Induction of Therapeutic Abortion)

  • TTT of infective endocarditis
A

Antibiotics.

51
Q

TTT of Complications in Heart Disease on Pregnancy (Induction of Therapeutic Abortion)

  • TTT of Arrhythmias
A

Antiarrhythmic drugs.

52
Q

Managment of Heart Disease on Pregnancy

  • Managment of Delivery
53
Q

Managment of Heart Disease on Pregnancy during Delivery

  • Time of Delivery
A

Usually pregnancy is allowed to continue till term & elective preterm delivery is rarely indicated in cardiac cases.

54
Q

Managment of Heart Disease on Pregnancy during Delivery

  • Methods of Delivery
A

Vaginal & CS

55
Q

Managment of Heart Disease on Pregnancy during Delivery

  • Indications of Vaginal Delivery
A

The rule unless CS is indicated.

56
Q

Managment of Heart Disease on Pregnancy during Delivery

  • % of Success of Vaginal Delivery
A

Vaginal delivery is usually easy due to:

  • Small sized fetus (IUGR).
  • Soft birth canal (due to congestion & edema).
57
Q

Managment of Heart Disease on Pregnancy during Delivery

  • Team Work
A

Obstetrician + anesthesiologist + cardiologist (if needed) + neonatologist.

58
Q

Managment of Heart Disease on Pregnancy during Delivery

  • Precautions of Vaginal Delivery
A
  • During 1st stage
  • During 2nd stage
  • During 3rd stage
59
Q

Precautions of vaginal Delivery in Managment of Heart Disease on Pregnancy

  • During 1st Stage
60
Q

Precautions of vaginal Delivery in Managment of Heart Disease on Pregnancy

  • During 2nd Stage
A
  • Avoid bearing down.
  • Shortening of 2nd stage by ventouse (better) or low forceps.
61
Q

Precautions of vaginal Delivery in Managment of Heart Disease on Pregnancy

  • During 3rd Stage
62
Q

Indications of CS Delivery in cases of Heart Disease in Pregnancy

63
Q

Disadvantages of CS Delivery in cases of Heart Disease in Pregnancy

A

Risk of anesthesia & infection.

64
Q

Managment of Heart Disease in Pregnancy

  • Neonatal Care
A

Proper examination to exclude congenital cardiac anomalies.

65
Q

Managment of Heart Disease in Pregnancy

  • Postnatal Care
66
Q

Postnatal Care in Heart Disease in Pregnancy

  • Prophylactic Antibiotic
A

To guard against infective endocarditis.

67
Q

Postnatal Care in Heart Disease in Pregnancy

  • Rest
A

For first 2 weeks (but do leg massage to avoid DVT).

68
Q

Postnatal Care in Heart Disease in Pregnancy

  • Breast Feeding
A

Allowed only for compensated cases.

69
Q

Postnatal Care in Heart Disease in Pregnancy

  • Contraception
70
Q

Contraception in Heart Disease in Pregnancy

  • Physiologicl Methods
A

Can be used safely but have high failure rate.

71
Q

Contraception in Heart Disease in Pregnancy

  • Barrier Methods
A

Can be used safely but have high failure rate.

72
Q

Contraception in Heart Disease in Pregnancy

  • Combined Pills
A

Contraindicated (due to salt & water retention & 1 1 incidence of thromboembolism).

73
Q

Contraception in Heart Disease in Pregnancy

  • Progesterone only pills
A

Can be used (except in IHD).

74
Q

Contraception in Heart Disease in Pregnancy

  • IUCD
75
Q

Contraception in Heart Disease in Pregnancy

  • Female Sterialization
A

Excellent method for woman completed her family & women è contraindication to pregnancy.

76
Q

Managment of Surgically Corrected Heaty in pregnancy

77
Q

Managment of Surgically Corrected Heaty in pregnancy

  • Valvotomy (Commissurotomy)
A

General management (anticoagulation isn’t needed).

78
Q

Managment of Surgically Corrected Heaty in pregnancy

  • Cardiac Valve Replacment
79
Q

Types of Valves

Y4R2 - Obstetrics I 🤰 (59 decks)

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