Pregnancy Flashcards
Pregnancy induced HTN/Gestational HTN
No HTN prior to 20 weeks, HTN during pregnancy and up to 6 weeks post delivery
Pre-eclampsia
HTN in 2nd half of pregnancy with >0.3gm protein (24 hour urine)
Proteinuria >2.0g 24 hrs
low plts
epigastric pain
Indication for delivery - HELLP, >38weeks, bad fetal testing, olgiohydraminos, fetal growth restriction
Aortic coarcation
Radial-femoral delay
HELLP
pre-eclampsia, elevated liver enzymes, hemolytic anemia and thrombocytopenia (platelets)
Symptomatic MS in pregnancy
FIRST - medical therapy - BB/Anticoag (inc’d HR in 3rd trimester increses MS gradient has diastolic filling time decreases)
then interventional options
Perc Balloon Mitral Valvuloplasy - increased need for CO via inc in HR and SV in 3rd trim - if HR increased, MS gradient worsens
Treatment of Pre-eclampsia
Urgent delivery - gestation HTN/proteinuria with associated pulmonary edema, coagulopathy, fetal distress
Pregnant chronic HTN patients
Goal <140/90\
Anti-HTN agents if >160/110 (methyldopa/BB ie labetolol)
Coronary artery dissection
CP/dypnea
ST elevations
JVP
tachycardia, HTN
Post partum CM
Mech support
Transplant eval
ACEi/BB once stable BP/euvolemic
A/C
MS in pregnancy
1st: Tx with BB increase diastolic filling time, maintain SR
2nd: Balloon valvuloplasty of MV
If afib - rate control with metoprolol or quinidine, digoxin, non-dihydropyridine CCB - need to consider A/C
3rd - surgery - bypass is 20-30% fetal risk so last resort…
Pregnancy with Structural Heart Disease
CO dec SV dec LV mass dec dec'd SVR inc'd plasma vol - inc'd preload - inc'd CO (not well tolerated in patients with Str Heart dz E/E' ratio increases - elevated PCWP
Regurgitant lesions in preg
well tolerated
Gestational HTN
2x r/o CAD - aggressive risk factor screening
Pregnancy and Marfans
ok if Ao<4.0cm
replace pre-preg if >4.0cm
Anticoagulation in pregnancy mechanical valve
-increased mortality or serious complications in pregnancy with mech valves
Warfarin not harmful to fetus at <=5mg daily
change to UFH just prior to delivery
Warfarin dose >5mg daily
1st trimester UFH (two fold control) or LMWH (anti Xa 0.8-1.2) - NOT WEIGHT BASED with inc’d vol of distribution during pregnancy
Warfarin 2nd and 3rd trimesters and UFH just prior to delivery