Maternal antepartum complications Flashcards
Name the mortality group and rate for - Atrial Septal Defect
Group 1
<1%
Name the mortality group and rate for - Ventricular septal defect
Group 1
<1%
Name the mortality group and rate for patent ductus arteriosus
Group 1
<1%
Name the mortality group and rate for pulmonic/tricuspid disease
Group 1
<1%
Name the mortality group and rate for CORRECTED tetralogy of fallor
Group 1
<1%
Name the mortality group and rate for porcine valve
Group 1
<1%
Name the mortality group and rate for mitral stenosis, NYHA classes 1 and 2
Group 1
<1%
Name the mortality group and rate for mitral stenosis with atrial fibrillation
Group 2
5-15%
Name the mortality group and rate for artificial valve
Group 2
5-15%
Name the mortality group and rate for mitral stenosis (NYHA class 3 and 4)
Group 2
5-15%
Name the mortality group and rate for aortic stenosis
Group 2
5-15%
Name the mortality group and rate for coarctation of the aorta, uncomplicated
Group 2
5-15%
Name the mortality group and rate for uncorrected tetralogy of fallot
Group 2
5-15%
Name the mortality group and rate for previous myocardial infarction
Group 2
5-15%
Name the mortality group and rate for marfan syndrome w normal aorta
Group 2
5-15%
Name the mortality group and rate for pulmonary HTN
Group 3
25-50%
Name the mortality group and rate for Coarctation of the aorta, complicated
Group 3
25-50%
Name the mortality group and rate for Eisenmenger syndrome
Group 3
25-50%
Name the mortality group and rate for marfan syndrome w aortic involvement (>4cm)
Group 3
25-50%
Blood loss for postpartum hemorrhage
Greater than or equal to 1000cc in the first 24hrs following delivery
What time frame after delivery is a late (delayed) hemorrhage?
Greater than or equal to 1000cc
Causes of postpartum hemorrhage (birth to 24hrs)
Atony, retained POC, laceration, coagulopathy, uterine inversion, uterine rupture
Causes of late (delayed) hemorrhage
Retained products, infections (endometritis), subinvolution of placental site, inherited coagulopathies or abnormalities
Causes of maternal death w percentage
Cardiovascular (14.6%), infection (13.6%), cardiomyopathy (12%), hemorrhage (10%), preeclampsia (9.4%), thromboembolism (9.3%)
True or false - peripartum cardiomyopathy is a diagnosis of exclusion
True; there is no preexisting cardiac dz or other causes
What is the timing of peripartum cardiomyopathy?
In the last month of pregnancy or within 5 months of delivery
What is seen on echocardiogram in patients with peripartum cardiomyopathy?
Left ventricular systolic dysfunction
What is the most common cited cause of peripartum cardiomyopathy?
Myocarditis
What complications are related to peripartum cardiomyopathy>
Preeclampsia, acute anemia, multiple, short interim pregnancies
Buzz word for peripartum cardiomyopathy
Soluble FMS-like tyrosine kinase, oxidative stress, impaired VEGF signaling
Mortality rate for peripartum cardiomyopathy
10% within 2 years of diagnosis
What is the hallmark finding in peripartum cardiomyopathy?
Cardiomegaly
What is the ejection fraction in patients with peripartum cardiomyopathy?
<45%
What is the treatment for peripartum cardiomyopathy?
Diuretics to decrease preload (central cardiovascular)
Hydralazine to decrease afterload (peripheral vasculature)
Digoxin for inotropic effects (unless complex arrhythmia identified)
Heparin or anticoagulation strongly advised for increased risk of VTE
1/2 of all women diagnosed with peripartum cardiomyopathy will regain _____ within 6 months
Ventricular function
What factors are associated with a worse prognosis (increased deaths) for patients with peripartum cardiomyopathy?
Black race
>35-40yrs
LVEF <25%
What are diuretics for in the treatment of peripartum cardiomyopathy?
Decrease preload (central CV)
What is hydralazine for in the treatment of peripartum cardiomyopathy?
Decrease afterload (peripheral vasculature)
What is digoxin for in the treatment of peripartum cardiomyopathy?
Inotropic effects (unless complex arrhythmia identified)
