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Management of Heart Disease in Pregnancy.  It is estimated that 1% to 3% of women either have cardiac disease entering pregnancy or are diagnosed with.

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Presentation on theme: "Management of Heart Disease in Pregnancy.  It is estimated that 1% to 3% of women either have cardiac disease entering pregnancy or are diagnosed with."— Presentation transcript:

1 Management of Heart Disease in Pregnancy

2  It is estimated that 1% to 3% of women either have cardiac disease entering pregnancy or are diagnosed with cardiac disease while they are pregnant.  Approximately 10% of all maternal deaths in the United States can be attributed to cardiac disease  75% of the women with various types of cardiac disease had no complications during pregnancy.  complication in 25% include :

3  Congestive heart failure, including pulmonary edema (12.3%)  Cardiac arrhythmias (6%)  Thromboembolism (1.9%)  Angina (1.4%)  Hypoxemia (0.7%)  Infective endocarditis (0.5%)  The overall maternal mortality rate in this group was 2.7%, and the stillbirth and spontaneous abortion rate was 7.7%.

4 -- High-Risk Pregnancies (not pregnant) Pulmonary hypertension Dilated cardiomyopathy, ejection fraction <40% Symptomatic obstructive lesions Aortic stenosis Mitral stenosis Pulmonary stenosis Coarctation of the aorta Marfan syndrome with aortic root >40 mm Cyanotic lesions Mechanical prosthetic valves

5 M Maternal cardiac risk: (1) (1) prior cardiac event (e.g., heart failure, transient ischemic attack, or stroke before pregnancy) or arrhythmia; (2) baseline New York Heart Association (NYHA) class higher than Class II or cyanosis; (3) left-sided heart obstruction (4) reduced systemic ventricular systolic function (ejection fraction less than 40%). -The estimated risk of a cardiac event in pregnancies with 0, 1, and more than 1 point was 5%, 27%, and 75%, respectively. - -It was concluded that those with a low cardiac risk of 0 could safely be delivered in a community hospital, -but those at intermediate or high cardiac risk (risk score of 1 or more) should be delivered at a regional center.

6 Mode of Delivery   For most patients with cardiac disease, a vaginal delivery is feasible and preferable   a cesarean section is indicated only for obstetric reasons.   Exceptions to this include the patient who is anticoagulated with warfarin because the baby is also anticoagulated, and vaginal delivery carries an increased risk to the fetus of intracranial hemorrhage

7   Cesarean section may also be considered in patients who have a dilated unstable aorta (e.g., Marfan syndrome),   severe pulmonary hypertension   a severe obstructive lesion such as aortic stenosis.   High-risk patients should be delivered in a center where expertise is available to monitor the hemodynamic changes of labor and delivery and to intervene when necessary

8   If vaginal delivery is elected, fetal and maternal electrocardiographic monitoring should be performed.  -  -Delivery can be accomplished with the mother in the left lateral position so that the fetus does not compress the inferior vena cava, thereby maintaining venous return.   The second stage should be assisted, if necessary (e.g., forceps or vacuum extraction), to avoid a long labor. Blood and volume loss should be replaced promptly

9 Thank you


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