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    Heart Disease in Pregnancy Final

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    Bhawna Joshi
    1) Heart disease complicates less than 1% of pregnancies but remains a significant cause of maternal morbidity and mortality. The increased cardiac demands of pregnancy can precipitate complications in women with preexisting heart conditions. 2) Close monitoring is needed during pregnancy to prevent and treat cardiac failure and other complications. Management involves activity limitations, a low-sodium diet, infection prevention, and hospitalization as needed. 3) During labor and delivery, careful monitoring of vital signs and oxygen levels is crucial to detect issues promptly, and interventions like induction or cesarean section are only used if medically necessary to minimize strain on the heart. Close postpartum monitoring continues to watch for complications.

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    Heart Disease in Pregnancy Final

    Uploaded by

    Bhawna Joshi
    168 views24 pages
    1) Heart disease complicates less than 1% of pregnancies but remains a significant cause of maternal morbidity and mortality. The increased cardiac demands of pregnancy can precipitate complications in women with preexisting heart conditions. 2) Close monitoring is needed during pregnancy to prevent and treat cardiac failure and other complications. Management involves activity limitations, a low-sodium diet, infection prevention, and hospitalization as needed. 3) During labor and delivery, careful monitoring of vital signs and oxygen levels is crucial to detect issues promptly, and interventions like induction or cesarean section are only used if medically necessary to minimize strain on the heart. Close postpartum monitoring continues to watch for complications.

    Original Title

    HEART DISEASE IN PREGNANCY FINAL

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    1) Heart disease complicates less than 1% of pregnancies but remains a significant cause of maternal morbidity and mortality. The increased cardiac demands of pregnancy can precipitate complications in women with preexisting heart conditions. 2) Close monitoring is needed during pregnancy to prevent and treat cardiac failure and other complications. Management involves activity limitations, a low-sodium diet, infection prevention, and hospitalization as needed. 3) During labor and delivery, careful monitoring of vital signs and oxygen levels is crucial to detect issues promptly, and interventions like induction or cesarean section are only used if medically necessary to minimize strain on the heart. Close postpartum monitoring continues to watch for complications.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    168 views24 pages

    Heart Disease in Pregnancy Final

    Uploaded by

    Bhawna Joshi
    1) Heart disease complicates less than 1% of pregnancies but remains a significant cause of maternal morbidity and mortality. The increased cardiac demands of pregnancy can precipitate complications in women with preexisting heart conditions. 2) Close monitoring is needed during pregnancy to prevent and treat cardiac failure and other complications. Management involves activity limitations, a low-sodium diet, infection prevention, and hospitalization as needed. 3) During labor and delivery, careful monitoring of vital signs and oxygen levels is crucial to detect issues promptly, and interventions like induction or cesarean section are only used if medically necessary to minimize strain on the heart. Close postpartum monitoring continues to watch for complications.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
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    Heart disease can increase risks for both mother and baby during pregnancy, though it affects a small percentage of pregnancies. Management involves monitoring for complications and individualizing care based on the type and severity of heart condition.

    Heart disease can increase workload on the heart during pregnancy, potentially precipitating complications like cardiac failure. Factors like age, infections, anemia, and preeclampsia can further deteriorate a woman's condition.

    Symptoms are classified using the New York Heart Association grading system which ranks limitations from none to severe discomfort at rest.

    HEART DISEASE IN

    PREGNANCY
    Presented by:-
    Neha Barari
    Assistant professor
    SNSR
    Introduction
     In most pregnancies, heart disease is
    diagnosed before pregnancy. Although heart
    disease is an uncommon problem in
    pregnancy, complicating less than 1% of
    maternities, it continues to contribute
    significantly to maternal morbidity &
    mortality.
     Seen either as RHD or congenital heart

    diseases (ASD,VSD,PDA,Pulmonary stenosis,


    TOF, endocarditis,IHD)
    EFFECT OF CARDIOVASCULAR
    PHYSIOLOGY:

     In normal pregnancy the hemodynamic


    profile alters in order to meet the increasing
    demands of the feto-placental unit.
     Normal healthy women are able to adjust to

    these changes easily.


     In women with coexisting heart disease,

    added workload can precipitate


    complications.
     The cardiac failure occurs during pregnancy
    around 30 weeks, during labour & mostly
    soon following delivery.
     Additional factors responsible for
    deterioration are : advancing age, cardiac
    arrythmias, infection, anaemia, multiple
    pregnancy, pre- eclampsia.
    PROGNOSIS
     Maternal : depends upon
    1. Nature of lesion
    2. Functional capacity of the heart.
    3. Quality of medical supervision.
    4. Socio economic ,psychologic & family strain
    5. Appearance of other risk factors.( pulmonary
    edema, pulmonary embolism, active
    rheumatic carditis, endocarditis)
    Prognosis ( coun….)
    Fetal :
     In RHD fetal outcome is usually good .
     In cynotic group of heart lesion, there is

    increased risk of abortion, IUGR &


    prematurity.
     Fetal congenital malformation is increased by

    3 – 10 % if either of the parents have


    congenital lesions.
    SIGN & SYMPTOMS
     Recognition is difficult as many of the
    symptoms are similar to normal pregnancy.
     Fatigue, dyspnoea, orthopnea, palpitations,
    collapsing pulse, chest pain, development of
    peripheral odema, distended jugular vein,
    progressive limitation of physical activity.
    GRADING
    Symptoms are classified by degree of compromise.
    New York Heart Association Grading:
     Grade – I : uncompromised. Patient with cardiac

    disease but no limitation of physical activity.


     Grade –II : slightly compromised. Patients with

    cardiac disease with slight limitation of physical


    activity. Comfortable at rest.
     Grade – III : markedly compromised. Marked

    limitation of activity. Discomfort occurs with less


    than ordinary activity.
     Grade – IV : severely compromised. Discomfort

    even at rest.
    DIAGNOSIS
     Full Blood Count
     Electrocardiography.
     Chest X- Ray.
     Clotting studies.
     Echocardiography.
     Presence of diastolic murmur.
     Cardiac enlargement.
     Presence of arrhythmia.
    PRECONCEPTION COUNSELLING
     Treatment can be made optimal.
     A specific plan outlay can be prepared for
    pregnancy.
     General health advices with regard to diet,
    weight, exercise, rest , prevention of
    anaemia, avoidance of alcohol, drugs &
    tobacco.
    MANAGEMENT
     Principles:

     Early diagnosis & evaluation of the functional


    grading of the cases.
     To prevent, to detect & to institute effective
    therapy for cardiac failure.
     To prevent & to control the additional
    complications.
     Mandatory hospital delivery.
    THERAPEUTIC TERMINATION
     Primary pulmonary hypertension.
     Pulmonary veno-occlusive disease.
     Grade III & IV cardiac lesions.
     Grade I & II with previous history of cardiac
    failure in early months or in between pregnancy.
    Done with in 12 weeks with D&E or suction &
    evacuation.
    ANTENATAL CARE
     Initial assessment should be made in consultation
    with a cardiologist.
     More closer monitoring on frequent visits regarding :
    dyspnoea & cough, lung sounds for crepitations,
    pulse rate more than 100/min requires
    hospitalization, anaemia, weight, blood pressure,
    reevaluation of the functional grading, exclude fetal
    congenital abnormality by USG at 20 weeks in
    congenital heart lesions.
    Advices given:
     Advice patient to have adequate rest. 10 hrs in bed
    at night & 2 hrs rest at noon.
     Limit the activities that cause the shortness of
    breath. Avoid undue excitement & strain.
     Avoid caffeine, alcohol, high calorie or spicy diet.
    Diet should contain low salt, less caffeine,
    carbohydrate & fat but more protein.
     Avoid cold & infections. I/M injection of benzathine
    penicillin ( penidure LA 12) may be given at
    intervals of 4 weeks through out the pregnancy to
    prevent recurrence of rheumatic fever.
    Advices given:
     Adequate dental care & avoid dental caries
    & other such source of infection.
     On case of congenital heart disease patient
    having warfarin should discontinue as soon
    as pregnancy is diagnosed & should be
    replaced with heparin 5000 units.
    ADMISSION:
     Grade I : At least two weeks prior to the
    E.D.D
     Grade II : at 28th week specially in case of

    unfavorable social surroundings.


     Grade III & IV : as soon as the pregnancy is

    diagnosed. The patient should be kept in


    hospital through out the pregnancy.
     In case of emergency like deterioration of

    functional grading, appearance of dyspnoea


    or crepitations, anaemia, pre eclampsia or
    abnormal weight gain.
    MANAGEMENT DURING LABOUR:
     There is no place of induction for the heart lesion.

    FIRST STAGE :
     The patient should be confined to bed & be placed
    in lateral recombant position.
     Oxygen should be kept by the side & to be
    administered ( 5 – 6 L/min) as & when required.
     Quantity of infused fluid should not be more than
    75ml/hour to prevent pulmonary edema.
     Careful watch on pulse & respiration rate. If
    pulse exceeds 110/min between the
    contractions, rapid digitalisation is done by
    I/V Digoxin 0.5 mg.
     Cardic monitoring & pulse oxymetry can

    detect arrhythmias & hypoxaemia early.


     Prophylactic antibiotics during labour & 48

    hrs. after delivery can be given to prevent


    puerperal endocarditis. ( ampicillin &
    gentamicin)
    SECOND STAGE :

     Delay in second stage should not be there.


     Forceps or ventouse delivery is preferred.
     Ventouse is preferable as it can be applied

    without putting the mother in lithotomy


    position.
     I/V ergometrine with the delivery of anterior

    shoulder should be withheld to prevent


    sudden overloading of the heart by the
    additional blood.
    THIRD STAGE :
     Conventional management to be followed.
     If blood loss is more oxytocin can be given by

    infusion rather than ergometrine in all cases


    of heart diseases.

    CAESAREAN SECTION :
     Only to be done in case of any obstetric
    indication.
     In coarctation of aorta, elective caesarean

    section is indicated to prevent rupture of the


    aorta or any aneurysm.
    PUERPERIUM:
     The patient is to be observed closely
    for the first 24 hrs.
     She should be in absolute bed rest.
     Oxygen to be administered.
     Hourly pulse & respiration are to be

    recorded.
     She should be kept in hospital for at least
    two weeks. In the first week confined to bed
    & is allowed to move her limbs & to have
    breathing exercise.
     Puerperal fever of any origin should be dealt

    seriously by proper antibiotic therapy.


     Breast feeding is only contraindicated in

    case of cardiac failure. Anticoagulant


    therapy is not contraindication of breast
    feeding.
    CONTRACEPTION

     Steroidal contraception is contraindicated as it


    may precipitate thromboembolic phenomenon.
     Barrier method of contraceptives is the best.
     Permanent sterilisation should be considered
    after completion of family at the end of first
    week in the puerperium provided heart is well
    compensated.
    THANK YOU

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