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Medical disorders associated with pregnancy. Care for women with pre-existing medical disorders (PEMD) should ideally take place before conception in.

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Presentation on theme: "Medical disorders associated with pregnancy. Care for women with pre-existing medical disorders (PEMD) should ideally take place before conception in."— Presentation transcript:

1 Medical disorders associated with pregnancy

2 Care for women with pre-existing medical disorders (PEMD) should ideally take place before conception in multidisciplinary pre-pregnancy clinics. This process should begin during adolescence with discussions about family planning, contraception and pregnancy. A complete medical history and assessment of health at this time, including obtaining up-to-date investigations, enables a risk assessment for pregnancy to be made. These risks should be discussed with the woman and her family so that appropriate choices can be made.

3 - Women with PEMD have high-risk pregnancies and a collaborative multidisciplinary approach is recommended to ensure careful monitoring of both the woman and her fetus. - Equally midwives and doctors need to be aware and recognize the clinical signs and symptoms of deteriorating maternal health -Labour and birth in women with PEMD can be a time of additional challenges

4 Timing and mode of birth should be carefully planned and should take place in a hospital with neonatal facilities. -disease will put an effect on the physical, psychological, sexual and social aspects of women's lives. - Involvement of the woman and her family should participate in decisions regarding her care

5 . *Midwives have a role in supporting women and their families, ensuring that their needs are met and that the pregnancy is treated as normal, as possible

6 Cardiac disease In most pregnancies, heart disease is diagnosed before pregnancy. - There is, however, a small but significant group of women who will present at an antenatal clinic with an undiagnosed heart condition. -Although heart disease complicates <1% of maternities -it continues to contribute significantly to maternal morbidity and mortality and is the leading cause of maternal death

7 Heart disease can be broadly classified into ‘congenital’ and ‘acquired’.

8 Congenital heart disease The most common congenital heart diseases (CHD) -atrial septal defect (ASD) ventricular septal defect (VSD) patent ductus arteriosus (PDA), pulmonary stenosis, aortic stenosis tetralogy of Fallot (TOF).

9 All of them need surgical intervention. -Uncorrected lesions may cause : pulmonary hypertension, cyanosis and severe left ventricular failure and are therefore high risk for pregnancy. CHD is also associated with increased fetal complications :

10 These include fetal loss, intrauterine growth restriction, pre-term birth and an increased risk of fetal CHD -high risk cardiac conditions for pregnancy include:

11 Eisenmenger's syndrome VSD, ASD or PDA -fibrosis and the development of pulmonary hypertension and cyanosis - Women with this condition are advised against pregnancy as maternal mortality 30– 50%. The greatest risk to the fetus is prematurity which contributes to the high perinatal mortality rate

12 Marfan's syndrome: -an autosomal dominant - defect on chromosome 15. - It is a connective tissue disease that affects the musculoskeletal system, the cardiovascular system and the eyes. -The cardiovascular abnormalities are the most life-threatening condition. -there is a 50% chance of a child inheriting Marfan's syndrome if one parent is affected.

13 -Women and their partners should be counseled carefully - Careful monitoring is required throughout pregnancy including the use of serial echocardiography to identify progressive aortic root dilatation. -Prophylactic antihypertensive therapy using beta-blockers is recommended

14 Acquired heart disease: -Rheumatic heart disease -the most common cardiac problem. - RHD causes inflammation and scarring of the heart valves and results in valve stenosis, plus or minus regurgitation. The mitral valve is most often affected with stenosis, c\p: -severe breathlessness and tiredness for the first time during pregnancy -Most women with valvular heart disease can be managed medically which aims to reduce the work rate of the heart.

15 During pregnancy, this involves bed rest, oxygen therapy and the use of cardiac drugs e.g. diuretics, digoxin and heparin (reduces risk of thromboembolic disease). Women with more severe symptomatic disease may require surgical intervention such as balloon valvoplasty or valve replacement Antibiotic prophylaxis is recommended for all women with valvular lesions during labour.

16 Myocardial infarction and ischemic heart disease Myocardial infarction (MI) and ischaemic heart disease (IHD) -uncommon cardiac complications -May lead to maternal death. - risk factors include : increasing maternal age obesity diabetes pre-existing hypertension smoking family history inequalities in health

17 A myocardial infarction is most likely to occur in the third trimester and periperium period due to the hypercoagulability induced by hormonal changes. - women present with ischemic chest pain in the presence of an abnormal ECG and elevated cardiac enzymes although these signs and symptoms may be masked during labour and birth as

18 abdominal or epigastric pain and vomiting. - Primary percutaneous transluminal coronary angioplasty (PTCA) which improves the patency of blocked arteries is first line therapy for this condition

19 Aortic dissection (acute) -may occur in pregnancy in association with severe hypertension (systolic >160 mmHg) due to: 1- pre-eclampsia 2- coarctation of the aorta 3-connective tissue disease such as Marfan's syndrome. The woman presents with severe chest intrascapular pain. Early diagnosis using computed tomography chest scan or MRI or as maternal mortality is high.

20 Endocarditis -Endocarditis is an inflammation of the heart involving the heart valves. -Although rare in pregnancy, it is one of the most serious complications of heart disease. Risk group: Women with valvular heart disease prosthetic valves a previous history of endocarditis periodontal disease and intravenous substance misusers

21 - Streptococcal organisms are the most common cause -Acute endocarditis is due to a Staphylococcus aurous, Streptococcus pneumonia and Neisseria gonorrhea. -Primary prevention includes recognition of risk factors and -e.g. good dental hygiene - avoidance of drug misuse -early treatment of sepsis - administration of antibiotic prophylaxis to women with high risk cardiac conditions

22 Peripartum cardiomyopathy: rare but fatal disease. - mortality rates range from 25% to 50%. - occurring between the last month of pregnancy and the first 5 months postpartum - women have no previous history of heart disease. Risk group: -older and - multiparous women, hypertension, pre-eclampsia,

23 obesity diabetes. myocarditis viral infection long-term oral tocolytic therapy and cocaine misuse.

24 Pathology : Inflammation and enlargement of the myocardium (cardiomegaly) left ventricular heart failure and thromboembolic complications

25 Treatment : -use of medication (oxygen, diuretics, vasodilators) to decrease pulmonary congestion and fluid overload, - inotropic agents to improve myometrial contractility - and anticoagulation therapy.

26 As the cardiomegaly resolves may take up to 6 months and there is a risk of recurrence in a subsequent pregnancy. -a heart transplant is performed mortality will be high

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