Maternal Cardiac Disease

Question 1

Features of ToF

Answer 1

Large VSD
Overriding aorta
Pulmonary stenosis
Right ventricular hypertrophy

Question 2

Management of maternal pulmonary hypertension

Answer 2

TOP as 7% mortality risk
Most women who die do so usually soon after delivery

Question 3

Antenatal management of pulmonary hypertension

Answer 3

Continue sildenafil- safe in pregnancy
Consider CCB to improve cardiac output
Admit for bed rest, oxygen therapy, escalation of therapy if needed

Question 4

Peripartum mx of PAH

Answer 4

MDT discussion and planning of elective delivery
If vaginal birth- shorten second stage
Avoid hypovolaemia to maintain preload
Avoid systemic vasodilation- caution with regional and oxy
Avoid VTE
Avoid pulmonary artery catheters- thrombosis!

Question 5

Definition peripartum cardiomyopathy

Answer 5

Development of heart failure between 35 weeks of pregnancy and 5 months following delivery, where no other cause is found.

Dx criteria from echo:
- LVEF <45%
- fractional shortening <30%
- LV end- diastolic diameter >2.7cm/m2

Question 6

Differentiate between lupus nephritis and PET

Answer 6

Only definitive investigation is renal biopsy.
If pre- viability- biopsy to commence immunosuppressive therapy
If after viability- deliver then perform biopsy