Medical Disease in Pregnancy

Question 1

What cardiac lesions are most affected by pregnancy (i.e. contribute most to maternal mortality?

Answer 1

• Cyanotic heart disease and pulmonary hypertension (R to L shunting increases)
• LV dysfunction
• Fixed-output disease (AS, MS)

Question 2

You’re called to a resuscitation. The patient is pregnant. What about a pregnant woman’s physiology will change the way the resuscitation is conducted?

Answer 2

• Left tilt to reduce aortocaval compression
• Blood volume is higher so volume of distribution of drugs is increased
• LOS is lax - early recourse to intubation
• Hypoxia develops rapidly (decreased FRC, increased BMR)
• Defibrillation is still safe

Question 3

Where do most DVTs of pregnancy occur?

Answer 3

• Left leg (85%)

Question 4

When is the most vulnerable time for a foetus to be exposed to radiation?

What doses are allowable after week 3?

Answer 4

• Days 0-9 - either the foetus will survive and completely repair or die and be resorbed completely
• < 5 rads (a CT is 250 millirad)